m 'vrvyvyvvi *:yvw,w^; y^v;:^w'^v^ vKvv r <-\ • « ;V V, , V Y ' V ,v ,v.; >v,, At'"^ y W'\. i* j iiA a! hYVw '*4*4 twft- ,VV*VV Vy/VV ^^v^w^f *v ^r^ ,,.,*, ,»:'Y ^y^VVS?VVyi v'vvV"' \vy^ ivL \A/C K ClA /"tX*>r» ->^£), IOLf(f>2~ L-ht^y £ 2_ a U.Z- - pr^rO*^"- r~ \, *>-^V &• v J ^r: G^J.-: <;£&L<_) *^v '- csLIIiRA 6- Williamson on Zf^to^^tafc. 11 Hence it followed, that near the beginning of a storm, the ground not being saturated with moisture, part of a flash of lightning forsook the rod and shattered part of the adjoining fence, being solicited by the iron spikes that were on the top of the fence. As the attraction of those spikes must have been inconsiderable, for they did not communicate with the earth, except by dry wood, it is clear that the lightning would not have forsaken the rod, if it had terminated in moist clay. The house of Mr. Maurice, in Savannah, like most other houses in that city, is built upon a body of silicious earth or white sand, which becomes dry in a few hours af- ter a fall of rain. The iron rod, that was attached to his house, was inserted, as usual, a few inches into the sand. During a thunder gust, the sand being dry, the light- ning forsook the rod and injured part of the furniture in the parlour. If the rod had been made to penetrate six or eight feet into the earth, as it should do in all such dry sandy ground, the furniture would have been perfects ly safe. A gentleman, some years ago, in a warm climate, com- plained to me that he had been considerably affected, in his parlour, by a flash of lightning, though his house was armed with an iron rod. Wishing, if possible, to discover the cause, I examined the rod and observed that the cattle had been licking away the earth, at the end of the house, so that the rod did not touch the ground by six inches. Such are the cases in which people complain that light- ning rods do not discharge their duty. 12 Observations on the Spotted Fever. It is conceived that the above observations may claim some attention in this city, because many houses, on this island, are built upon a rocky foundation, or upon coarse sand that retains little moisture. In all such cases parti- cular care should be taken to have the rod inserted so deep into the earth, that it may terminate with certainty in moist ground. HUGH WILLIAMSON. II. Observations on the Spotted Fever, as it appeared in Orange County, State of New-York, in 1808 and 1809. Communicated in a Letter from Doctor David R. Arnell, of Goshen, to Dr. David Hosack, Pro- fessor of Botany and Materia Medica, in Columbia College, New-Tork. Dear Sir, In compliance with your request, I now give you a his- tory of the fever which prevailed in the town of Minisinck some time since, and which proved so mortal among those it attacked. In doing this I shall take up the queries of your letter in the order which you have given them. 1st. What were the symptoms of the disease in its different stages ? The patients affected were first taken with a cold chill or slight shivering, and almost at the same instant com- plained of pain in the limbs, back, and particularly in the Observations on the Spotted Fever. 13 abdominal region ; head-ache, vertigo and coryza. This state lasted from ten to twenty minutes', when it was succeeded by a slight sensation of warmth on the surface of the body, sickness of stomach, vomiting, delirium, great anxiety and restlessness ; tossing in the bed, invo- luntary motions of the head, which appeared frequently to be drawn to one side ; mouth and tongue moist and clammy; pulse a little sunk, sharp and quick. Blood drawn in this stage of the disease shewed no buffy coat nor any other morbid appearance: the matter vomited was saffron-coloured bile in large quantities, but without any diseased appearance. This state continued from twelve to fifteen hours, when petechias, about the size of split peas, but of irregular shape, appeared all over the sur- face of the body ; they looked like what are usually- termed blood blisters, only they were not raised from a level with the surface, but were of a dark, livid colour. Anxiety and restlessness increased ; the colour of the skin was not changed, except where those spots appeared ; the countenance for the most part sunk, and the eyes drawn up in the head; these symptoms continued to in- crease until a general comatose state was brought on, when death closed the scene. 2d. The general duration of the disease ; when the pa- tient recovers, and when it proves fatal ? Years. Hours. A child of Phineas Terry JEt. 6 taken May 13th, 1808, died in 28 Jesse M'Whorter 22 Nov. 27th, 24 Miss Quick 17 29th, 24 Howel Roberts 10 Dec. 12th, 15 John Steward 16 May 19th, 1809, 48 Jeremiah Overton 26 25th, 72 Mrs. Eldred 24 June 12th, convalesc. in 24 14 Observations on the Spotted Fever. 3d. The persons it attacked, if natives or foreigners J If in habits of temperance, or irregular in their manner of living ? The persons it attacked were all natives of this country, and regular in their habits and manner of living. 4th. The state of the country in which it occurred, the time, the season, if dry or moist, the temperature, &c. ? The town of Minisinck is bounded on the east by the great drowned lands, and the Wallkill, which circum- stance renders the inhabitants liable to intermittent, re- mittent, and bilious fevers in the fall of the year; but at the time these cases appeared it was remarkably healthy; it being too early in the spring for inflammatory, and too late in the fall for bilious diseases. The spring was moist, and the autumn dry: temperature various. 5. The mode of treatment. Did they bear the lancet well ? What were the effects of emetics f Did they throw up much bile ? What was the effect of mercury ? Did you employ the bark, and what were its general effects ? In some cases blood was taken in the early stage of the disease, but it did not produce that desired good ef- fect which was expected from it: the blood drawn ap- peared like that of a person in full health, no unusual buffy coat, neither was the crassamentum broken down or destroyed. A cathartic of jalap and calomel was next administered; after the operation of which, I endea- voured to procure a sweat : this was attempted by warm herb teas, with spirits, and the common antimonial mix- ture ; but the time was so short, there was but little oppor- Observations on the Spotted Fever. 15 tunity of doing any thing* Emetics were not tried. Much bile was thrown up during the short course of the disease. Mercury was used in the case of Mrs. Eldred with happy effect; but I believe it was not used to the same extent in any other case. Immediately after she was taken, she was bled by Dr. Nathaniel Elmer, her at- tending physician, who administered a dose of jalap and calomel: I saw her about three hours after she was taken, and advised the use of calomel very freely, which was persisted in, together with wine, for twelve hours. When the petechial spots made their appearance, which were of a bright red colour, the uneasy symptoms began to abate, and in about twenty-four hours she was entirely- free from complaint, but remarkably low and exhausted* Shewas supported by wine and other stimulants, and had a speedy recovery. 6th. What proportion of those attacked died ? By reverting to the second* query answered, you will find that six out of seven died. 7th. Did the disease commence with a chill, or shak ing? Were they better or worse on alternate days r Were there regular remissions and manifest exacerba- tions ? The disease uniformly commenced with a chill, and latterly so as to induce violent shaking. There v. ere no remissions or exacerbations. 8th. When it proved fatal, at what period did it takr place ? Was the skin yellow ? 16 Observations on the Spotted Fever. It generally proved fatal in about twenty-four hours, and the skin after death, for some distance around the spots, became dark coloured and livid, though on the other parts of the body it was not changed. 9th. Did patients manifest the same thirst and dryness of tongue as in other fevers ? The tongue and mouth were generally moist and clam- my ; the patients were so uniformly delirious a few hours after the attack, that we could learn nothing from them but by observation ; but they did not appear to drink much when it was offered to them. 10th. Was the stomach affected in the last stages of the disease ? Was the usual termination, when fatal, a black vomit resembling coffee grounds, or blood, or mere dirty water ? Although the stomach appeared to be affected through the first stages of the disease, yet it did not increase in the last. Most generally a stupid, comatose state appear- ed a few Hours before death; the vomiting ceased, the ex- tremities became*cold, and the patient sunk away under a load of disease—In no stage did the matter which they vomited appear like coffee grounds, or blood, or mere dirty water. ( 331 ) II. Observations on the Origin and Nature of the Yellow Fever, which prevailed in Providence, Rhode Island, in the summer of 1805. In a letter to James Hardie, Esq, Secretary to the Board of Health, 2V. Y. from Dr. Par- sen BOWEN.* Providence, August 28th, 180?. Sir, Tour letter of the 3d instant, written by the direction of the Board of Health of the city of New-York, requesting ia- formation of the origin and nature of the malignant fever, which then prevailed here, and a retrospective view of the fever in former years, came to hand while I was in the coun- try, in a state of convalescence, from a fever taken, I pre- sume, by constant attendance upon patients labouring under the fever, before their removal; and I have been compelled, since my return to town, by the pressure of business, and the time necessarily taken to procure correct information, to de- fer my answer till the present time, as most of the persons, from whom the information was to be derived, were scatter- ed about the country; and I hope the Board of Health will Dot impute the delay to neglect, or want of respect. I will now, without further preface, endeavour to give you as correct a statement of the fever, as the most careful in* * With uncommon satisfaction we insert in the present number of the Register, the above highly interesting communication, from Dr. Bowen, an eminent physi- cian of Rhode Island. Its appearance has been delayed until now, in order that we might gratify our readers with the perusal of the interesting document, on the same important subject, which follows the present article, and which, though (at seae time promised, has but lately been received. Ed. 382 Bowen on the Yellow Fever of Providence. vesligation will admit, and I hope, with the candour the im- portance of the subject demands. And first, with respect to the origin of the fever. In order to investigate this point, it will be necessary to take into consideration the following circumstances, viz. In the first place, the general state of the health of the town, and especially of that part where the fever prevailed. 2dly. The condition of the houses, wharves, docks, stores, &c. in the vicinity of the fever ; and, 3dly. The connection this district had with the shipping. With respect to the first circumstance, the health of the town, &c. At the time the fever made its appearance, and for a long time before, the town in general was remarkably healthy; and this was the case more especially, with that part of the town, which was the seat of the disorder, immediately pre- ceding its origin. For several years past, the town has been exempt from any remarkable epidemic catarrhal affection, angina, or other complaints, by many deemed the precursor! of yellow fever. 2dly. Respecting the condition of the houses, wharves, docks, stores, &c. comprising the seat of the fever. On the most careful scrutiny, it appeared that this dis- trict was remarkably clean and free from filth. There were no offensive gutters, nor accumulation of putrid animal or vegetable substances, to be found in or near it. The houses were detached from each other, generally ; and in the occu- pancy of families, who might vie with any equal number, in point of cleanliness, in any part of the town. The wharves and stores had nothing offensive about them, and the docks were as clean and free from any obvious putrid and noxious effluvia, or filth, as in the most cleanly part of the town • and much more so than in some other parts, where the docks, at times, have beea extremely offensive, from the noisome Bowen on the Yellow Fever of Providence. 333 stench issuing from them ; and which, at the same time, has been increased by the putrid effluvium arising from damaged beef and fish in the contiguous cellars and stores ; and yet, as far as my knowledge extends, no malignant or yellow fever has ever arisen therefrom, although these apparently formidable agents, with their combined powers, have existed in a number of cases, for several years past, that have fallen under my observation, and to such extent as to have excited very serious alarm for the consequences. 3dly. With respect to the connection of the sickly dis- trict with the shipping. It is to be understood that the fever was confined, except in three or four cases, to be mentioned hereafter, to both sides of Water-street, extending about one hundred and thir- teen yards parallel with the wharves. From the back part of the houses next the river, the distance may be about thirty-five or forty yards from the head of the wharves, and from the opposite side of the street, about eighty or ninety yards ; and it appears as a matter of fact, that all vessels from the West-Indies, and elsewhere, have been permitted, and have actually come up to the town, and unloaded their cargoes at the wharves, without cleansing or performing quarantine, until since the commencement of the fever. And it furthermore appears, that three vessels from dif- ferent parts of the West-Indies, have arrived and unloaded at the wharves within the infected district, a very little while before the fever broke out, viz. the brig Planter, from St. Croix, arrived on the 4th of July ; the brig Hiram, from Antigua, and the brig Juno, from Havanna, both arrived on the 12th of July, and the fever began in Captain Stephen Russet's family on the 19th following ; between which time and the 2,3Lh, nineteen persons more were attacked, seven- teen in this district, and two living at a distance from it. At this time, the town council ordered all that part of the town 334 Bowen on the Yellow Fever of Providence. to be evacuated, and the vessels removed; and the fever iflT- mediately ceased, except in two cases ; one of which, a son of Captain Trowbridge, occurred on the 7th, and Mr. Clif- ford, on the 12th of August; the latter of whom declared to my partner, Dr. Eddy, and myself, that he was two or three times on board the brig Hiram, which vessel had been removed from her former situation, where the fever began, to the wharf back of the shop where he was employed, in- stead of being sent down to the quarantine ground. She has since gone to sea, and there are the strongest grounds to be- lieve that Trowbridge bad been in the infected street ; and if not, the shop where he worked was not more than thirty or forty yards from where the fever first began. Of the two persons above mentioned, who were early at- tacked, and resided at a distance from the infected part, one was Captain John Warner, and the other Mr. Jos. Masury, jun. and it is perfectly well known, that both had ben em- ployed on these wharves, and had been on board the suspect- ed vessels ; and there is no doubt but that they had the same fever the others had. Warner was quite yellow, and Masury died on the fifth day with the genuine black vomit, and other concomitant symptoms of yellow fever. In addition to the above, I would beg leave to call the at- tention of the board of health to the following circumstances, viz. On the 25th of July, the order for the evacuation of the infected district, and removal of the shipping was issued, and immediately complied with, and the fever ceased, so that many families returned to their habitations about the middle of August, the very season when, in general, the yellow fever begins its ravages as an epidemic, and yet not the slightest case of fever or other sickness has appeared in this district, [August 28th,] and the town continues very healthy • and what renders the case still more remarkable, is, that this district was in so dean a state, that no kind of alteration of Bowen on the Yellow Fever of Providence* 335 its former condition has been made in it, except that six loads of sand have been carted into one dock, and that mere- ly because two privies were situated over it, but which were constantly washed by the ebbing and flowing of the tide, and, of course, no considerable accumulation could, or did take place. This dock was not offensive, and the house adjoining the wharf, and very near to the dock, was the only one, whose inhabitants were exempt from the fever. It further appears by the declaration of Captain Benjamin Dexter, who had three of his family taken with the fever, that when some of these vessels pumped out their bilge water, it was so extremely offensive, that the workmen on his store were made sick, and in some of them to vomiting. And Mr. GofF declares, that the bilge-water pumped from one of these vessels was so particularly offensive, that he Was obliged to shut up the doors and windows of his shop, notwithstanding his workmen [shoemakers] had been much accustomed to the smell of bilge-water. I would further state to the beard of health, that the per- sons attacked with the fever had been on board the suspect- ed vessels, as well as that they lived in the vicinity of them. With respect to the condition of the above-mentioned vessels, the following circumstances appear, viz. The brig Planter had two men taken sick with yellow fever on board, at St. Croix, early in the month of May, who were carried on shore, as soon as the disease was ascertained, and died; but I cannot learn that the clothing belonging to them was brought home, and the vessel underwent no cleansing, before or after her arrival. The Hiram arrived on the 12th, from Antigua, and on her arrival, Mr. Church, one of her owners, says that he threw overboard twenty dollars worth of sailors' clothes, and the reason he assigned for it was, that the countenances of the 3a6 Bowen on the Yelloiv Fever of Providence. people did not look well, and he thought the air of the vessel was not good, and that part of the infection came from her. The brig Juno also arrived 12th July, from Havanna, and had one or two people sick on the passage home. All these vessels, without performing quarantine or being cleansed, immediately on their arrival, unloaded at the seve- ral wharves of the sickly district, a little before the sickness began, as before stated. Having thus related the circumstances respecting the origin of the sickness, as far as they have come to my know- ledge, I am now to reply to that part of your request re- specting its nature. When the fever first made its appearance, considering the number attacked, and in so small a compass, in the vicinity of the wharves and vessels, and very near to where the yellow fever had twice before appeared in an epidemic form, it highly excited our fears ; and when, added to these circum- stances, we found them labouring under the following symp- toms, rigours, violent pains in the head and eyes, back and limbs, prostration of strength, sickness at stomach, with great distress, which was a constant and universal symptom with them all,' with fever, &c. we were almost confirmed in the belief of yelloiv fever ; but as their eyes had not that suffusion so common to that fever, and the more decided and unequivocal symptoms kept off for four or five days,; and considering the earliness of the season, we still hoped that we might be mistaken, and did not make a report to the council, officially, till the fifth day, when the symptoms as- sumed such an aspect, as left no doubt of its real nature ; for now one patient was attacked with the black or coffee-ground vomit; another had a livid countenance, with petechia? • a third turned yellow ; a fourth had black vomit, and was yel- low ; a fifth had black vomit and stools ; and a sixth black vomit and stools, and profuse hemorrhage from the mouth, Bowen on the Yellow Fever of Providence. 337 stomach, &c. and all of them great sickness at the sto- mach. Six persons died about the fifth and sixth day from the attack. These symptoms, connected with the suddenness of the deaths, &c. will clearly point out to any person com- petent to judge of the case, that it was unequivocally the yellow or malignant fever. I will now take a retrospective view of the foregoing state- ment, and draw the conclusion that appears to me naturally and fairly to result from it. It then appears that the town of Providence has enjoyed a great degree of health for several years past, and been ex- empt from those epidemics supposed the precursors of yel- low fever. That about the 20th of July, seventeen or eigh- teen persons were attacked wilh yellow fever, in a small dis- trict, till this time remarkably healthy. That this district was very clean and free from any obvious cause of sickness about the houses, stores, docks, or wharves ; but that three different vessels, from three different ports of the West In- dies, had arrived at, and unloaded on, the wharves of this district, without performing quarantine, or being cleansed ; that one had lost two men with yellow fever, at St. Croix ; another was suspected to be infected, by the owner ; and that the third had had sickness on the homeward bound passage : that the inhabitants of this district and the vessels were removed on the 26th of July, and that the fever ceased ; that about the middle of August, many of the inhabitants returned to their habitations in this district; that they have been there about a fortnight, and no sickness had recurred, notwithstanding no alteration has been made in the condition of this district, except six loads of sand put into one dock, merely because two privies were over it, but which were not, in any manner, remarkably filthy ; that many of the sick iiad been on board of the suspected vessels ; and, finally, vol. IV. t 2 338 Bowen on tJie Yelhw Fever of Providence that they i.ad been much affected by the extreme offensive- ness of the bilge water of these vessels. From the foregoing premises, I think we may fairly infer, that the fever was the yellow or malignant fever, and that it had its origin, or stood, somehow or other, connected with one or all three of the vessels above mentioned. This is, at least, my opinion, decidedly ; and not only of the fever of this year, but in eacii epidemic yellow fever in this town, I think I have the most unequivocal evidence of its impor- tation ; and even in almost every sporadic case, I have been able to trace a connection with a source of foreign origin, either at the time, or, perhaps, by knowledge of it obtained a long time after. Two such instances have come to my knowledge lately. Now, notwithstanding my belief that the contagion is im- ported, I think it proper to observe, that I also believe, that it requires some peculiar, appropriate, and to me, inexplica- ble condition in our atmosphere, to render it capable of pro- pagation, either as a medium, through which the contagion may be spread, or by combining with it, and thus rendering it active. It is like tinder fitted to receive a spark of fire, and as far as this appropriate state of air extends, when sa- turated or contaminated with the foreign or contagious prin- ciple, so far is it capable of communicating the disease to those who inhale it, and are predisposed to it: and I am led to thit conclusion from the following circumstances: The disease, I believe, generally appears first as an epidemic, or in its propagating state, near to, or about wharves and docks, and extends its influence gradually and progressively ; so that if a patient ever so bad, and even dies with it, is carried into the country, or, in the beginning of the epidemic, into a dis- tant part of the town or city, remote from the water, he does not convey the disorder, even to those in frequent con- Bowen on the Yellow Fever of Providence. 339 tact with him : at least, this has been the case with us, and I believe is generally admitted as fact in other places. Now, if this fever possessed the common character of other contagious diseases, it would, like them, in all situations, and in all seasons, be more or less capable of propagating its kind under these different circumstances. What this condition of the atmosphere is, that by assimi- lating with the contagion, or serving as a medium to it, which renders it so destructive to the human race, I cannot pretend to say, or even conjecture : but that it is not the object of our senses, I am fully convinced, from long and much obser- vation. The inference, however, from this hypothesis ki obvious, if we cannot comprehend the condition of our at- mosphere, which renders the disease capable of propagation, then we should be the more careful to prevent the foreign principle from being brought into contact with the domestic one. This, however, is a task truly peculiar, considering the thousand different ways by running articles from vessels, by clothes sent from them, by persons visiting them secretly, &c. &c. by which it may be conveyed. Before I quit this subject, I must beg leave to call the at- tention of the board of health to one circumstance attending yellow fever ; a. circumstance of the utmost importance in investigating its nature, and so obvious, that one would think, that the meanest capacity would comprehend it, and which, at the same time, is overlooked by many eminent and ingeni- ous men. It is this : that the first frost, or what is called black frost, destroys the real yellow fever radically, although it may, at this time, have extended its influence ever so far; whereas the bilious and other fevers of our country, which are said to be only grades of the yellow fever, are often ex- tended into, and through the winter and spring. Now, it ap- pears to me absurd to suppose, that a cause which is capable to destroy the highest grade of a fever, should be unable to 340 Boivai on the. Yellow Fever of Providence. produce the same effect upon the lower degrees of it : but as we every year see, that frost radically destroys the yel- low fever at once, while our other fevers continue through the winter, in many cases, the inference is plain and irresisti- ble, that there is a specific difference between them, although there may be some symptoms in common to them all. With respect to a retrospective view of former years, I must beg leave to refer the board of health to some docu- ments I am about to send on to Dr. Hosack upon this sub- ject, and which I shall request him to give them the perusal of, if they should deem them of sufficient consequence. You will please to lender my respects to the Board of Health. I have the honour to be, with much respect, Your obedient servant, Pardon Bowen. September 10th, 1805. S1K, 1 have been under the necessity to withhold my commu- nication until this time, as I was informed that one of the circumstances mentioned therein, was not correct, and the persons capable of giving correct information were absent. I have this moment seen one of them, and am now able to say, that instead of the brig Juno's having one or two per- sons sick on the homeward bound passage, she had only one man sick or unwell several days in the Havanna, but was able to do his duty home. This vessel was also at New- Providence during her voyage. No person is or has been sick in the district, where our fever prevailed, and the inhabitants are all returned, with but a few exceptions. Yours, with esteem, &c. Pardon Bowex. ( 341 ) III. Observations on the foreign origin and contagions Na- ture of the Yellow Fever, as it luis prevailed in Provi- dence, Rhode-Island, and other parts of the United Slates. In a letter to David Hosack, M. D. New-York, from Dr. Pardon Bowen, Physician, Rhode-Island. SIR, The origin and nature of diseases, with their modes of operation on animal bodies, have, from the earliest history of medi< ine, employed the researches, and exercised the in- genuity of physicians and philosophers, in every quarter of the globe ; and notwithstanding a great mass of what are called facts, have been produced to establish their origin, and an abundance of curious and ingenious theories, framed to elucidate their nature and modus operandi, yet, they still remain obscured with great doubts and ambiguity ; and it is probable they will remain so in a great degree, notwithstand- ing all the aids furnished by the recent, numerous, and won- derful discoveries, in chemistry, anatomy, and the collateral branches of medicine. It is true, that we often can trace a connected train or series of symptoms, and thus name a disease ; but to discover and elucidate the material or cause, or a complication and combination of causes, and their mode of operation on animal bodies, constituting a disease, is far, very far, beyond my comprehension ; and that it was also beyond that of all the theorists and system makers up to the present time, is prov- ed, by each in successon building his own system on the abolition of that of his predecessors. 342 Bowen on the Yellow Fever. It is as difficult to conceive how the cause of a disease, be it contagious or infectious, or of whatever class you may please to designate it, operates on the living animal system, so as to produce the peculiar morbid action or excitement constituting its , rticular nature, as it is to comprehend the manner in which the mind, by the power of volition, operates on the muscular fibres of particular parts, to excite them into action, and produce certain determinate movements, and this without the knowledge of the animal, of even.the mus- cles put in requisition. This fact is continually passing in review before us; and yet after a lapse of many thousand years, and the united re- searches of mankind, what do we know further respecting the mysterious manner in which the mind acts on matter ? What new thing, or new fact, has thrown a ray of light upon it, to irradiate the benighted understanding—to withdraw the impervious veil, and disclose this arcanum of nature 1 None! and, probably, mankind ever will remain in profound ignorance of it, while they retain their mortal form and nature: for only spirit, after death, can comprehend how spirit, or the vital principle, can operate on substantial forms. Although I have said, that I conceive it impossible to comprehend the nature and modus operandi of diseases be- yond the nosological classification of them, and that, in ge- neral, their source or origin, was involved in much obscurity ; yet I shall endeavour, by producing a series of facts, to prove the origin of one that has excited more interest, and produced more alarm, for some years past, than any that is recorded in the annals of medical science in America : I mean the yellow fever. And I wish to have it distinctly understood, that when I speak of yellow fever in the United States, it is that disorder described by Dr. Chisholm and other writers, which has prevailed in the West-Indies since the year 1793; and which I believe to be a different disease. Bowen on the Yellow Fever. 343 and more malignant than that which was called yellow fever before that period ; at least it appears so to me, and I have had an opportunity to view the disorder in both of the periods above alluded to ; having been surgeon of a ship in His- paniola in the year 1782, when the disease, then called yel- low fever, raged with as much violence as is usual in that climate, and seized many of the crew on ship-board, labour- ing under every disadvantage of foul air, and crowded so close in their hammocks, between decks, that it was difficult to get between them ; when, under these unfavourable cir- cumstances, only seven out of more than one hundred men died. It is now several years since the yellow fever, that terrible scourge of our maritime towns and cities, has visited the United States, at least the northern section of them ; and we can now contemplate it more calmly, and weigh the evi- dences respecting its origin with much more accuracy, and make up a judgment with more precision, than when our minds were agitated with the apprehension of its annual visits. It is generally well known, how much the question re- specting the origin of this fever has engaged the attention, and employed the pens of writers in medicine, and how much has been said and written on the subject by other people, without settling the point in dispute ; but as every one ought, without being biased by preconceived opinion?, to make up his judgment upon any point by the preponde- rance of the facts and evidences brought in support of it ; so, I suppose, different persons have formed different opinions about its origin, according as the weight of evidence has inclined to the one side or the other. There are many, I know, who are led by the opinions of others, without taking the pains of investigating facts fo; themselves ; and others influenced by the pride of opinion, 344 Bowen on the Yellow Fever. who, having once imbibed an erroneous idea, will never relin- quish it. For myself, I had early entertained the opinion, that the yellow fever was an imported disease; and it may appear singular to you, when I declare, that I was led to this belief by reading Dr. Rush's treatise upon the yellow fever of Philadelphia in the year 1793, to prove its domestic origin. But the history of that fever, as given by him, appears to me to warrant a belief of its foreign origin. I, however, held my mind open to conviction, to be either confirmed or changed in my opinion, as further and more conclusive evi* dence should appear. And I can most conscientiously declare, that the great mass of evidence produced since that period, has fully con- firmed me in the belief that the yellow fever, whenever it has appeared in this town in an epidemic form, has always been imported, as well as in every sporadic case. To support this opinion, I must go back to the first ap- pearance of the fever in this town, and adduce a series of facts upon which it is founded ; and in order more fully to support it, I shall submit a chain of reasoning growing out of these facts, and connected with the circumstances attending them. The first case that I saw in this country that I consider to have been the genuine yellow fever, was that of my nephew, the son of the late John I. Clark, who came through Phila- delphia during the early period of the fever there, in the year 1793; from whence he arrived in this town after a short passage, was taken immediately ill, and died in a few days w ith what appeared to us afterwards the real yellow fever. No other case, either in the family, or in the town, oc- curred, to my knowledge, in that season. In the year 1794, several cases occurred, attended with circumstances so peculiar and strongly marked, that they Bowen on the Yellow Fever. 34.) made a deep impression oa my mind, and proved beyond a doubt, that they, at least, were imported, and of foreign origin. In August of this year, (1794,) Captain Joseph Gould ar- rived in a schooner from North-Carolina, being himself and two more, out of three persons who comprised his crew on board, sick ; they were so ill when they arrived in the river, that they could not get the vessel to the wharf; and I visit- ed them on board, and found these three persons labouring under all the marked symptoms of yellow fever; such as great distress and sickness at stomach, yellow skin, and in one of them the black vomit; this man died and was buried in Rehoboth ; but as I had pronounced it the yellow fever, the alarm spread, and only two or three persons followed the hearse at a distance. It now became a question with me to determine how these people came by the fever: and to my repeated inquiries Capt. Gould replied, that they came from Wilmington, in North- Carolina, and that it was as healthy as usual there ; and that no yellow fever, or other epidemic, prevailed in the town or neighbourhood: and I then concluded, that these cases either originated on board the vessel, or in North-Carolina, and did not stand connected with the West-India yellow fever. It so happened, that in a few days after the arrival of the before-mentioned schooner, Capt. John Bullock arrived in another vessel, from another port in North-Carolina, very sick. I was called to him, and found him labouring under the most marked symptoms of yellow fever. He recovered ; and to my inquiries answered as Capt. Gould had done, viz. that no sickness had prevailed before or at hjs departure, either near the river, or at the port he sailed from ; and that no other person on board his vessel had been sick, or was taken with the fever afterwards. This more fully confirmed me in the opinion that this case of yellow fever also originated en VOL. IV. 2 X 346 Bowen on the Yellow Fever. board his vessel, unconnected with the West-Indies; and, probably, I should ever have remained in this belief, if Capt. Gould, who came home in the first vessel, had not survived. Some lime after his recovery, recollecting the earnestness of my inquiries respecting the circumstances of his vessel and voyage, he came to inform me of certain facts which have a material bearing on the point in dispute, and tended, as much as any thing I had become acquainted with, to establish my belief in the foreign origin of the yellow fever, and particulary its connexion with the West-Indies. He gave me the following circumstantial information, viz. That Capt. Slocum sailed in a vessel belonging to himself and his father-in-law, Capt. John Bullock, from an infected port in the West-Indies: that he lost three of his hands with yellow fever on the homeward voyage: that he arrived at this port with a cargo of West-India produce; and his crew being most of them dead, and he himself quite indisposed, Capt. Gould went on board with another set of hands, and proceeded di- rectly for Wilmington, in North-Carolina, where he arrived after a short passage, and discharged his cargo, and set out immediately on his return voyage ; during which, he and two of his men were seized with the fever, as before related. He further informed me, that the vessel had undergone no kind bf cleansing or purification, either at Providence, during the voyage, or at Wilmington. This information unfolded the source, in the most satisfac- tory manner, from whence he and his crew derived their fever; but ii threw no light upon the case of his father-in-law, Capt. Bullock, whose vessel had not been in the West-Indies, like the other; and the port in North-Carolina from whence she sailed was healthy, and nobody on board of her had been sick except himself; and yet his was as decided a case of yellow fever as those in the first vessel. Capt. Gould then proceeded to disclose another fact, which Bowen on the Yellow Fever. 34? resolved every doubt, and corroborated, in the most conclu- sive manner, the origin of the fever in both vessels. He stated, that Bullock and himself were joint owners of both vessels ; that they sailed about the same time from dif- ferent ports in North-Carolina; that they met at sea, and that Capt. Bullock went on board Capt. Gould's vessel, and staid one night; and it appeared that Capt. Bullock was at- tacked with yellow fever in about six days afterwards. The case, then, stands thus: Capt. Slocum arrived from a port in the West-Indies where the yellow fever prevailed ; three of his hands died with it on the homeward voyage, and he was himself sick. Capt. Gould, with a fresh set of hands, went on board, without any kind of cleansing of said vessel, pro- ceeded to Wilmington, and on his return was himself, and two of his people, seized with yellow fever. His father-in- law, Capt. Bullock, went on board his infected vessel at sea, staid on board one night, and came down with the same fever in about six days after. Thus affording the strongest possible evidence the case will admit of, of the foreign origin of this fever. How clear and connected are the series of facts, with- out any interruption in its links, all tending to prove this point! approaching as near to the certainty of mathematical demonstration as this kind of evidence will admit of. No- body took the disease from these patients. And I would ob- serve, that all the above staled facts can now be substantia- ted by living witnesses. In the year 1795, I attended a person from New-York, who died with yellow fever, near the market, in a largehouse crowd- ed with tenants, and under circumstances apparently favoura- ble to its propagation, and yet nobody took it from him. He had a yellow skin, petechias, hemorrhage, and black vomit. The yellow fever was in New-York when lie left it. Passing over these scattered and solitary cases, I come now to the year 1797, when our first epidemic yellow fever 348 Bowen on the Yellow Fever. appeared amongst us, carrying desolation through the district where it raged, and dismay and terror through the town and country. Here, too, the evidences of its foreign origin were so clear and conclusive, that it would appear impossible that an un- prejudiced mind could withhold its assent to it. I will relate its history: About the 4th of August, 1797, the schooner Betsy, be- longing to Messrs. Wardwell and Coxwell, of Bristol, and commanded by Capt. Burr, arrived at this port from the West-Indies, and came to at Capt. Joseph Tillinghast's wharf, in the south part of the town, where she lay for some time. In about six days, eight persons, in different and re- mote parts of the town, were all attacked with a fever of a similar character, which destroyed seven of them in five or six days, and excited a universal alarm ; and the more so, considering the patients resided so far apart, rendering it thus more difficult to assign any local cause for it, and thus also preventing the inhabitants from taking the usual precau- tionary steps to guard against it. At the same time these seven persons died in town, Mr. Cole, a custom-house officer belonging to Warren, twelve miles from this town, and Mr. Wimor of Rehoboth, about four miles distant, were both seized and died with the same fever in a few days after the attack, as appeared by correct information obtained from persons who witnessed their sick- ness. I was requested to visit both of them, but was unable to leave town on account of the sickness and alarm here. The eight persons above alluded to in this town, were William Tillinghast and Mrs. Arnold, the wife of our town treasurer, who lived near Joseph Tillighast's wharf, where the above-mentioned schooner Betsey lay, four women in John Brown's long house, in the south part of the town, some distance below this vessel, and Lemuel Pitcher, and_____ Bowen on the Yellow Fever. 349 Fuller, in George street, a very remote and elevated situa- tion. You will at once see, sir, that these persons lived at a considerable distance from each other ; some near the i iver, some, as Pitcher and Fuller, in one of the most ele- vated parts of the town, Wimor in the country, and Cole iu Warren. And the question will naturally arise in your mind, how it was possible, that all these people could be at- tacked with the same fever from one and the same source ? This, I hope, I shall prove, to your satisfaction, they did. I confess, however, on a first view, and a superficial obser- vation of the case, it appears to be impossible. But when we come to examine all the circumstances connected with these cases, we can find in all of them the most direct con- nection and communication, either with the schooner at Til- linghast's wharf, or with persons or clothes of sick persons, who came home in her, or, as in the case of Mrs. Arnold, residing so near her, as to be within the sphere of her con- tagious influence. In pursuing this investigation, I will first call your atten- tion to the cases of the four women in Mr. Brown's house, a considerable distance below the vessel, and who had not been near her, and must, if they took the fever from her, have taken it indirectly, and this I shall prove to you, was the fact. Obadiah Brown, one of her crew, came home sick at the time of his landing, and went directly to this iiouse, where his sister then lived, and carried his bedding with him. Bear in mind, sir, that this house contain- ed nine families, comprising thirty-five souls ; and it so happened, that on the next day, or the day following, while his sister was pounding the blankets on which he had lain during his sickness, in a barrel with hot water, these four, these very identical four women, came into the room from four other families in the house, and stood near, and partly .tfO Bowen on the Yellow Fever. over the barrel for about half an hour during the operation. and on the fourth day thereafter, were all taken with the fever, and three of them died in four days from this period. These facts I had from the survivor, who was a member of Dr. Gano's church, and was informed, at the time, of the im- portance that the information she would give should be cor- rect. And it is a powerful corroborating proof of its foreign origin, that no other persons of the numerous tenants of this house took the disease, which almost certainly would have happened, considering its crowded situation, if it had origina- ted in, or near it. It is true, this inference has been objected to, because the woman pounding the clothes escaped the complaint. But this is by no means a conclusive argument; for it is well known, that some are not predisposed to take the fever. And, besides, I conceive it very possible, that the powerful state of excitement she was under by so hard labour, and the perspiration she was in, might have prevented its action upon her system, or have carried it off if inhaled. Look now at Fuller and Pitcher's cases, in George street: These, also, will tend to prove, most powerfully, that they received their fever from this same vessel, living at a great distance from the general scene of the ensuing sickness, in an elevated and airy situation : no one can suppose, or will venture to say, that causes, usually assigned to produce the disease, existed near their habitations. When a cause is sometimes known to produce a given effect, even if this ef- fect does not seem to follow regularly the apparent cause, it is much more philosophical to explain the effect from this cause, than from an imaginary one, or from no cause at all, as was the case with these two men ; but here we have a cause fully sufficient to explain the effect in the most satis- factory manner, and remove every difficulty resting upon it. Bowen on the Yellow Fever. &[> \ These two men, Pitcher and Fuller, worked in their shops on the head of Gifford's wharf, within seventy-four feet of the infected vessel at Tillinghast's wharf; and it is also known, that Fuller not only did work for, but was on board of her. Wimor and Cole's cases, were, if possible, more abso- lute and conclusive proofs of the foreign origin of this fever, than either of the foregoing ; and also, that they both de- rived their fever from the same source ; for it can be proved, that both had been on board the infected schooner while on her passage up the river. And it would be a most extraor- dinary circumstance, that only one person should die in Re- hoboth, and one in Warren, this season, with yellow fever, and that each of these had been on board this vessel; un- less you admit the supposition that they took the fever from her. Tillinghast not only lived near the vessel, but had been on board of her ; and Mrs. Arnold resided very near, and directly opposite the wharf where she lay. The feVtr by this time excited the utmost alr.rm and ter- ror, both on account of its mortality, and the numbers seized with it; and it was now, after the foregoing eight cases, con- fined entirely to a small circle in Tillinghast, Gifford,and Arnold's houses, the three most contiguous to this vessel; and from it gradually extended, as from a central point, till its progress was finally stopped by frost ; forty-two persons falling victims to its fury. Of these, sixteen died in three houses most contiguous to the vessel. And from Mr. Ai uold's every soul was swept off. I presume that it will not be denied that this was the ge- nuine yellow fever. If, however, any doubts remain about it, I will describe the general course of its symptoms, which I think must remove them. I will take Mr. William Tilling- hast's case, a journal of which I have preserved. The most prominent of his symptoms were, a yellowish flush about his 352 Bowen on the Yellow Fever. breast and armpits ; his eyes in a state of inflammation, and blood-shotten, comprehending not only the conjunctive tunic investing the globe of the eye, but also that part reflected under the eye-lids, exhibiting the appearance of a bright red colour laid over a coat of orange ; his mouth and fauces par- taking of the same inflammatory symptoms with his eyes ; frequent retching, petechia;, black vomit, and death, to close the mournful scene. There were some circumstances connected with the question of the origin of this fever, of so singular a nature, and having so strong a bearing upon it, that I cannot forbeaw relating them, seeing they will assist us the better in making up a judgment about it. The fever, in its progress, extended as far north as Capt. Benjamin Dexter's, and south, as far as Mr. Brown's long house, before mentioned, the distance of about one hundred and eighty paces. And it appears that a company followed seignii g menhaden through the summer, up to the time of the fever, averaging about ten barrels three times a week, which were brought to Ashton's wharf, four houses north of Dexter's, opened, and the guts and gills throwu into the dock, some of which would be necessarily exposed, at low water, to the influence of the sun in the day time. Again ; south of this district, and four or five houses beyond where the fever extended, were situated three distilleries: the middle one occupied as a gin distillery, with which was con- nected a long range of hog sties, containing two hundred and fifty hogs, where, consequently, there was a combination of animal and vegetable matters, constantly under tiie putre factive process in its highest state of activity, aided by heat and the crowded situation of the animals; and from whence issued such foetid and offensive exhalations, that all the neighbourhood weie incommoded, and the whole at- mosphere impregnated with them. These were sources as Bowen on the Yellow Fever. 353 prolific of infection and yellow fever as the most zealous ad. vocates of domestic origin could conjure up: but how stood the facts respecting them ? Why, the yellow fever, already existing in a central point between both, gradually extended itself toward them, till it arrived, at length, to within a few houses of them, at each extreme, and there stopt. No per- son employed in the fishery on the north boundary took it; and those engaged at the other extreme in the distilleries pursued their employment through the whole course of it, without the slightest attack. These, sir, are extraordinary circumstances, and ne- cessarily arrest the attention of every person disposed to scrutinize facts; and I will hazard the temerity to propound this query : Did the putrid exhalations, the mephitic gasses. and the septic acid, evolved, and continually issuing from these magazines of corruption, arrest, in any degree, the progress of the disease? Or was it some other powerful agent that interposed a barrier to the progress of this ter- rible malady ? I will not presume to answer in the affirma- tive to the first of these queries. I cannot believe a thing so totally repugnant to the universally received opinion of mankind; and yet I think more facts and further observa- tions are required, before we make up a final decision abont it. Of the yellow fever of the year 1800, I shall say but iittle, not having it in my power to relate many circum- stances from personal knowledge, as I was absent at its commencement, and during a great part of its continuance ; but I believe the foreign origin of this particular epidemic has been generally admitted, even by persons who believe in the domestic origin of almost all other cases of it. Nay, they even point out the identical chest of infected clothes brought into Carr's house, which were there opened and VOL. IV. * - 354 Bowen on the Yellow Fever. washed, and from whence the fever immediately spread in every direction. Passing over this, we come now to the fever of 1805, the t .ird epidemic yellow fever of this town, concerning which, I shall produce facts and evidences of its origin, that I should hope would carry conviction to every mind not rendered impenetrable by preconceived opinions ami prejudi.es. I beg first to premise, that before and at the time the fever made its appearance, the town was, in general, rema> kably healthy ; especially that part of it which was the seat of the disease immediately preceding its first ap- pearance . and that the town had enjoyed a great share of health ibr several years back; during which no epidemic, catarrh, angina, or other complaint, the supposed precur- sors of yellow fever, had occurred. Having stated these facts, I proceed to the history of this epidemic. On the 4th of July, 1805, the brig Planter arrived from St. Croix ; and on the 12th, following, the brig Hiram ar- rived from Antigua, and the brig Juno from the Havanna,' anJ came directly up to Capt. Godfrey and Dexter's wharves, within a few rods of each other, where they un- loaded without any cleansing or precautions of any kind ; and I beg leave to call your attention, in a particular man- ner, to the above dates when these vessels arrived ; and to bear in mind, also, that they came from infected parts; and that one of them, the Hiram, had had sickness on board : That they arrived at Godfrey and Dexter's wharves, while the town was in perfect security, and in the enjoyment of full health, on tl e 4th and 12th of July, and there unloaded ; and then mark, that on the 19th following, the fever first appeared in Captain Dexter's house ; between which time and the 25th in the short period of seven days, seventeen persons were seized with it, in a small district immediately surrounding Bowen on the Yellow Fever. 355 these vessels ; and, also, two others, whose cases will here after be mentioned. At this time, the 25th July, (six persons being now dead with the fever) the town council ordered the above-mention- ed vessels, and every inhabitant within certain limit* around them, removed, both sick and well; and the fever imme- diately ceased, except in two instances; those of Clifford and Trowbridge ; and Clifford declared to me, that he had heen on board the Hiram after her removal. And there is the strongest reason to believe, that Trowbridge had been in the infected street; and if not, it is known, that he worked within fifty or sixty yards of where the fever begun. Of the two persons attacked, who resided at a distance from the district, one was Captain John Warner, and the other, James Masury, jun. ; both of whom had been on board the suspected vessels. This fact is not denied ; and there is no doubt they had the same fever with the others. War- ner, in addition to the usual symptoms, was yellow; and Masury died on the fifth day with black vomit, and the other concomitant symptoms of the disease; which were in the first two or three days, rigours, violent pains in the head, eyes, back and limbs, prostration of the strength, suffused state of the eyes, sickness and distress at stomach; this was a constant symptom; and after three or four days, petechia?, hemorrhages, sublivid or yellow skin, and black vomit. A bare recital of these symptoms will convince you, that this disease was the real yellow fever. I before said, that the town council had ordered the sus- pected vessels, and all the inhabitants in the infected dis- trict removed, and that the fever immediately ceased; and so complete was its eradication, that except the cases of Trowbridge and Clifford, which have been accounted for, and I hope satisfactorily, no new case occurred, although ■naoy of the inhabitants returned to their houses by the mid- 1156 Bowen on the Yellow Fever. die of August, and the remainder by the twentieth; the very period when the yellow fever generally begins its career iu the United States. When we consider also, that no alteration was made in this district, except by casting six loads of sand under two privies, situated over the water, and constantly washed by the tides, and yet find no return of the fever; whereas iu every other instance, when it has assumed its epidemic form, it has continued its destructive ravages till subdued by frost, we are irresistibly led to seek some foreign and ex- traneous agent, armed with powers capable of producing so desolating a pestilence. If, too, we take into consideration the local situation and circumstances of this part of the town, and its inhabitants, their houses detached from each other, clean and well ven- tilated, their possessors easy in their circumstances, annoy- ed by no foul sewers or gutters near them or the wharves, and the docks as clean and free from filth as any in the town, and much more so than in many other parts, where the fever did not appear ; we are compelled to seek the cause in the vessels which had just before arrived at this very point, and unloaded without cleansing or ventilation. And when, added to this, we unite the facts of their coming from infected ports in the West-Indies, and that one of them had had sickness on board, we cannot avoid, from the clearest induc- tions of reason, concluding, that one, or all of them, were the cause or causes from whence the fever was derived ; for un- less we admit this inference, in vain shall we seek any other visible or assignable cause for it. Before quitting the history of this particular epidemic, I will relate a circumstance of some weight, as tending to prove the remarkable exemption of the whole district from any vi- sible cause of the disease. Bowen on the Yellow Fevei. '4 a 7 After the return of the fugitives to their homes-, about the middle of August, expecting, that if the fever were of lo- cal origin, it might reappear, they sat themselves to work to discover the cause, and in their investigation could find nothing in the district that could support such an opinion, except the two privies before named. These were situated on both sides of Christopher Arnold's dock ; from the dock an avenue leads to the street about twenty feet wide, and eighty in length ; at the end of this avenue are situated Cap- tain Christopher Arnold and Captain Christopher Shel- don's houses, and almost directly opposite, Captain Pardon Sheldon's house; and notwithstanding the contiguity of those buildings, to the only spot supposed capable of causing the fever, not a soul in them was attacked with it. This fact proves that these privies were not the source of the disease. I had the curiosity to visit them: they were situated at the sides of the wharves over the water, and daily washed by the tides ; and the most fastidious minds might have ven- tured to pay their devotion at those temples of Cloacina without seruple. Having thus stated the principal facts connected with th< appearance of the yellow fever in this town, that have come under my immediate observation, or been derived from un- questionable sources, and which can now be substantiated by living witnesses, I shall make some general observations, and draw such conclusions as are warranted by the facts and fair reasoning from them. And 1st. We will consider the general state of health of the town, prior to the appearance of the yellow fever that ap- peared in an epidemic form. 2dly. Something further of the situation of the town, re- specting its connections with docks, wharves, shipping, &• and, 358 Bowen on the Yellow Fever. 3dly. With other parts of the town, combining all the supposed causes of yellow fever, but where it has never ap- peared, at least in an epidemic form. With respect to the first consideration, the general state of health of the town, at, and preceding the several epide- mic yellow fevers, I would observe, that in the year 1792, we had a singular epidemic for our climate; many persons became yellow, with a high saffron colour, and sometimes almost black urine, costive bowels, &c. but with neither fever or thirst. This was undoubtedly the jaundice; but what constituted its peculiarity was, that it was accompani- ed in many cases with petechias, vibices and hemorrhages, and yet it was not mortal. In only one case did it prove fatal, that I know of. In 1794, an epidemic fever prevailed on the west side of the river, beginning, and being principally confined to the hill near Hayle's tavern, and from thence as far eastward as the high ground extended. In 1795, another, and more extensive epidemic fever be- gan on the west side of the river, appearing first near where the theatre now stands. These were undoubtedly the fevers of our country, having all the symptoms of our typhus fever, diversified by the peculiarity of constitution in many cases; but essentially different from the yellow fever ; and the mor- tality was comparatively small, considering the numbers at- tacked. During both these years the town was remarkably healthy on the east side of the river, as it was also in 1796, and till the yellow fever began in August, 1797 ; and no part of the town was more exempt from sickness during these years, than that which was the immediate seat of the yellow fever. With respect to the yellow fever of 1800, I do not know, that any remarkable disease preceded it. I have no notes respecting the subject; but as it is generally admitted, that Bowen on the Yellow Fever. 359 this fever wa3 not of local origin, it is less material to deter- mine this point. With respect to the yellow fever of 1805,1 have before remarked, that preceding it for several years, and till its commencement, the town had enjoyed a remarkable degree of health. With respect to the second consideration, as relating to the situation and connection of the districts where the fevers have prevailed, with shipping, docks, wharves, &c. I would observe: The seat of the first fever, that of 1797, was from Mr. Godfrey's to Mr. Brown's house, opposite Captain N. Power's, on both sides of the street. That of 1800, from Mr. William Thayer's to Thomas Sabin's ; and the last epidemic yellow fever of 1805, was very circumscribed, occupying only a small circle around Godfrey and Dexter's houses ; the three epidemics compri< ing a distance short of five hundred paces. These differenl seats of the fever, you will perceive, constitute but a small part of the town, bounding on the river: they pretty much comprise one district only, and stand more immediately con- nected with the shipping, than any other part of the place, and more exposed to any malignant or contagious diseases they may be infected with on their arrival. Any one who will visit this part of the town where these fevers prevailed, or who had visited it during those period-, will seek iu vain for those causes of its domestic origin which have been said to generate it. Let us examine, for instance. the seat of the yellow fever of the year 17117. View the ground gradually rising from the river up to the back street: examine the houses from Godfrey's to John Brown's house see them clean, well ventilated, and detached from each other: occupied by people in easy circumstances, and good livers; go down to the stores aud wharves, you find then 360 Bowen on the Yellow Fever. also clean and free from offensive smells; look into the docks, they penetrate but a little way in, and are thus the more easily washed by the tides ; you see nothing in them that appears to be the cause of the fever; with less dock effluvia than you find in many other parts of the town, where the fever has never appeared. In a more particular manner, look at, and into Mr. James Arnold's house directly oppo- site the infected vessel, enjoyidga large open space in front, of 120 feet breadth, and reaping all the benefits of the sea breezes ; the houses on both sides, detached on the south sixty feet, and on the north eighty feet distance, and con- nected backward with a beautiful small meadow, extending two hundred feet eastward, in full vegetation : consider all these circumstances, and then determine, whether this is the dwelling you would have selected for the fever to exert its most mortal and concentrated power upon; and yet here, in a most particular manner, it exhibited its utmost malig- nancy, leaving not a soul behind to mourn its ravages. If it is objected to the above description of this part of the town, that Mr. John Brown's long house was an exception to it, I grant it, for here, and here alone, in the whole range of the district, was there an accumulation and combination of the causes supposed capable of originating the disease: but I have, I hope, satisfactorily accounted for the appearance of it here before, and will only observe, that after the death of the three women who died in this house in the very be- ginning of the fever, no other person was attacked in it. The foregoing observations respecting the seat of the fevei of 1797, as connected with the shipping, docks and wharves. the cleanly condition of the houses, the comfortable circum- stances of their tenants, and the exemption of the district generally,from filth, stench, or any apparent cause of disease; will apply with equal force, to the seats of the fevers of 1800 and 1805; in fact, they comprise but one district of small Bowen on the Yellow Fever. 361 extent, of less than five hundred paces; the first of the fe- vers of each year, in part, running into that of the others, so that it is needless to detain you longer on this subject. I will only appeal to the knowledge and candour of those gentle- men present, who were here during the prevalence of the fevers; and ask them, whether at those periods, or since, while visiting in this district, they discovered, by their or- gans of sight or smell, or through any other channel, any of those causes assigned by the advocates of domestic origin, which appeared to them capable of generating yellow fever? And I will go further, and ask them) if they have not, in several other places in the town, seen these assigned causes existing in a high degree ? I come now to the third and last consideration, viz. that respecting other parts of the town, combining all the sup- posed materials and causes of the fever, and yet, where it has never appeared, at least, as an epidemic. And, 1st. I will mention the three distilleries in the south part of the town, with their two hundred and fifty hogs, wal- lowing in their accumulated filth ; contiguous to which, is the south dock, with its waters loaded with filth and putri- fying materials, brought down by the rivulet, and emptying into it the aggregated result from the whole range of the hill east of the town. So prolific was this source thought to be of yellow fever, that one of our most respectable citizens, in an essay on the subject, considered it a principal one. And when objections were made to this opinion, on the ground that the fevers did not appear in this neighbourhood, being at a considerable dis- tance north of it, he broached this curious hypothesis to support his doctrine, viz. that contiguous to this sink of im- purity, on its south side, rises Fox Point Hill, eighty or one hundred feet high; that the noxious exhalations ascending* vol. iv. 2 v 362 Bowen on the Yellow Fever. were kept condensed by this hill, till they gained the sum mit, when they were wafted, by the southern gales, over all the contiguous and neighbouring houses and hog pens, up to Tillinghast and Gifford's wharves, and over the infected schooner, and then descended, fraught with pestilence and desolation, upon this devoted spot. This opinion needs no refutation. Let us now turn our attention to other parts of the town, and see, if the above described situation could not originate the fever, whether we cannot conceive of one, so combining, in a super-eminent degree, all the assignable causes of domes- tic origin, that it shall absolutely compel our assent. I will attempt this description. We will first suppose the front, or head of a dock sixty feet wide, made by a street in a populous part of the town—let this dock extend, gradu- ally widening southeasterly, a quarter of a mile, to the chan- nel of the river; bounded on the one hand by marshes and stagnant pond holes, and on the other, hemmed in by wharves: next let us imagine the water of this dock to have no current, in consequence of its confined situation, and to be very shallow, merely rising and falling with the tides.__ Now let us again suppose the bed of this extensive dock to be a soft and miry mud, continually, during the heat of the day, discharging myriads of visible air bubbles, which, ari- sing through the water, discharge their gas into the atmos- phere ; or when the water is out, into it, without this medium. Here we have got all the requisite causes and conditions for the fever that can be obtained from the river. If, now, we can superadd equivalent causes from the land, we shall have obtained the whole groundwork and compli- cated machinery of domestic origin. We will again suppose, that by every rain is washed down all the accumulated vegetable and animal substances, of more than half a mile in length, of one of the principal P,:d. | IVrsons concerned in putrefactive processes, and living in the neigh- bourhood of shambles, church-yards, &c. are not peculiarly liable to fevers. Infection or contagion is rarely, if ever, received from bodies who died of contagious diseases; not even from dissecting them, unless by inocula- tion. (Stc Ferriar, Med. Hist, and Facts, vol. i.) " It must not, however, be concealed, that noxious effluvia do frequently arise from putrefying bodies in a certain state (perhaps from confinement); but the discuses produced thereby arc inflammatory, not pestilential." (See as above.) § It appears, from the testimony of many medical writers who have had great opponunities for observation, that they frequently act in con- junction, and that fevers are combined. Of this opinion are Chisholm, Lempriere, J.'.ckson, Lind, Clark, &c.—Putrid effluvia, generated on board of ship, may have the effect of changing the type and nature tif the original jever, by superseding the action of the marsh miasviata. || With what force the contagious matter generating fever will adhere to furniture, and the walls aiyl Moors of rooms, may be seen in many ex- traordinary cases, particularly in one related by Dr. Brockleiby, in hn Diseases cf the Armv. Six or seven persons died in succession of a ma- lignant liver, being put into an infected room, notwithstanding every pains was taken to purify it, each time it was vacant, by fumigation, ablution, &c. At last the walls were new plastered, and the fioor planed, and it then became safe. Was this contagion common putrid ma:.er' T See Inaugural Dissertation ty Mr. QuackC"^:.. 252 Contagiousness and Importation of Yellow Fever. such means be communicated, and become epidemical. Is not this an assertion without proof?* Besides, it would be very extraordinary that a disease should not be communicable through the same means by which it was received. It appears to me, therefore, however sufficient local causesf may be to generate a fever of this kind, that all the argu- ments which have been so industriously collected, and so stre- nuously urged against the contagious nature of it, are far from being conclusive. Like jail fever, Sec. being once generated, it is susceptible of being propagated in the same manner, viz. by effluvia from sick bodies, and from these adhering to clothes, &c. and it is not impossible or improbable that " the spark which first kindled up the epidemic in many places might have been imported."! Having thus stated, as briefly and explicitly as possible, my sentiments on the subject, I shall conclude by making refer- ence to the facts and circumstances on which my opinion is founded. In the first place I must refer to the facts stated by Dr. Chisholm, which, notwithstanding their being called in ques- tion, have not yet been invalidated, and remain, in my judg- ment, unanswerable. 2dly. Although Dr. Chisholm has been represented as being almost the only advocate for contagion in the West-Indies, the contrary of this is the truth. Most of the practitioners in the West-Indies concur with him, and various facts and cases have been brought in proof of what he has stated. * There are various instances quoted of the disease having been im- ported from the West-Indies in the clothes of those deceased. (See Lin- ing, Rush, &c.) f It is the opinion of many, that putrid effluvia may of themselves, in persons highly predisposed, generate the disease, and that from them it may be communicated, and become epidemic. (Med. Rep. Hex. I. vol. i. p. 321. See also Chisholm.) i. Seaman. Some persons, rather than allow of the existence and operation of con- tagion in any case whatever, refer epidemical diseases, 1st, to an unknown constitution of the air; 2dly, to a decomposition of the atmosphere by ca- loric—to the aspect and conjunction of the heavenly bodies—to earthquakes, volcanoes, &c. and, lastly, to the particular curse of God. If any such there are who still delight in mysteries, and in explaining things in the most far-fetched and improbable manner, let them talk of occult qualities, and let them believe, with Dr. Moseley, that carbuncles and buboes in the plague are owing to the gross food of the Turks. Is it not to be regretted that men really respectable for their talents should indulge in such whim- sies ; and, while arraigning others for their credulity, should exhibit such melancholy proofs of it in themselves, betraying a weakness bordering on puerility or dotageI Contagiousness and Importation of Yellow Fever. 253 Many similar instances of the contagious nature of yellow fever are related in the Medical Repository, which ought to have at least as much weight on the one hand as any staicd to the contrary should have on the other.* It is well known to the practitioners of this island, that the pestilential yellow fever pievails only on certain occasions— that it generally begins among seamen and soldiers lately ar- rived from Europe—that it has no apparent connection with local causes—that is to say, it makes its appearance during the most healthy seasons, and in the healthiest situations; while, on the other hand, it is never found to prevail in un- healthy or marshy spots. Lastly, it appears, contrary to what has been again and again asserted, to be directly communicable from one person to another, and from a single person to many. For example, one man only, going on board an infected ship, and contract-' ing the disease, shall communicate it to several others, who never had been otherwise exposed to the infection, f Many histories in proof of this might be adduced,% but I deem the following letter from my friend Mr. D. Brown, assistant sur- geon to the 6th battalion of the 60th regiment, quartered at Up-Park Camp, to be more than sufficient. • See Med. Rep. Hex. I. vol. vi. p. 160. Dr. Rush has mentioned a fact which he justly terms a very important one, viz. that if a person who had taken the yellow fever in town went to a family residing in a healthy inland situation, he did not communicate the fever; but, on the contrary, if he went to a family residing-near the river, that is to say, in a swampy or unhealthy situation, the family caught not a bilious remittent, but the yellovo Je%er. This might be deemed pru>f sufficient of the contagious nature of yellow lever. But Dr. Rush will not allow it. He says that the exhalations from persons in yellow fever act on others as a stimulus. This is what the contagionists will not cavil about; but they will not allow this stimulus to be similar to heat, intem- perance, or other exciting causes. It must be a stimulus sui generis, or it would not produce yellow fever. That yellow fever patients did varelj communicate yellow feverMor any other fever, to persons in healthy situa- tions, admits of an easy explanation. f This Dr. Rush has admitted, but has explained the matter differently. (See Med. Rep. Hex. I. vol. vi. p. 160.) i. Agreeable to the information I have received from several country practitioners, the crews of ships stationed at the out-ports are generally healthy till one or more persons fall sick; but as soon as a single in- stance of yellow fever occurs, the disease spreads from one to another till it goes through the whole ship, and afterwards from ship to ship. Th* disease has also been traced from estate to estate fifteen miles into the country. Vol. I. 2K 254 Contagiousness and Importation of Yellow Fevef. Copy of a Letter from Mr. David Brown, Assistant Sur-> geon to the 60th Regiment, Up-Park Camp, to Dr. Dancer. Military Hospital, Sept. 10, 1803. Dear Sir, In respect to thefever that has lately raged with such vio- lence in our hospital, it was without doubt contagious. The reasons I have for entertaining this opinion are shortly these: 1st. No local cause existed that could produce the disease.* 2dly. It went progressively through the battalion; the per- sons nearest the sick being always the first who were affected. 3dly. The medical gentlemen who attended (five in num- ber) were all taken ill; one of whom died, and the rest re- covered with difficulty. 4thly. The sergeants and orderly men were all affected, and many of them died. But, 5tbly. What was most singular, every man emplryci in shaving the sick fell a victim, to the disease. , -; These are a few plain facts, known to every officer and pri- vate in the regiment. I remain, dear Sir, Yours, &c. D. B. Not to extend this paper beyond the prescribed limits, 1 shall forbear any comment on the above. The conclusion is not to be withstood! Kingston (Jamaica), Sept. 18, 1803. * The situation of Up-Park Camp is as healthy a one as can be well imagined, being two miles from the sea, at a considerable elevation, and fully exposed to the strong sea breezes. There are no swamps or other sources of putrefaction in the vicinage. The barracks are not crowded nor filthy. The hospital, which is lately built, is a model for all others, being spacious, well ventilated, and clean, to almost an extreme of nicety. Yet, notwithstanding all these circumstances, upwards of ninety men have lately, in the space of a few weeks, and during a dry, healthv season, died of a malignant fever, having all the characteristics of yellow fever. Dr. Ferriar says, " I have known a pestilential fever produced in a new raised regiment, in a quarter where regular troops are always very healthy, and where there is a constant ventilation of the briskest kind." It would appear that there was some fomes of contagion which showed its effects only with persons who had a susceptibility to be ac.ted on. f «« ) ARTICLE VI. Additional Observations on the Nature of Fever, and on the Importance of Remedies applied to the Skin. In a Letter from Noah Webster, Esq. tu Dr. Miller, dated New-Haven, Oct. 3, 1803. Dear Sir, IN my letter* to you of the 30th ult. I offered to your con- sideration some ideas respecting the proximate cause of fe- ver. The following case, however trifling, may deserve to be recorded. Some time in September last I was stung upon the back of my hand, by a worm which is common upon the maize plant; a worm chiefly of a green colour, and covered with sharp, prickly hairs. These hairs, when applied to the skin, occasion a sensation like that of nettles. The part affected soon became of a florid colour, to the extent of more than half an inch in diameter. The sensation was, in no slight de- gree, inconvenient. Within a few minutes, perhaps fifteen or twenty, as I sat writing, I observed the red spot on my hand to be covered with moisture, equal to that of the most co- pious sweat; although my skin, in general, was perfectly dry. This excited my curiosity, and I wiped off the moisture with a handkerchief. Within a minute, or less, the moisture oc- curred a second time, and was removed. This was repeated, perhaps, ten times; and, at last, the efflorescence of the part gradually disappeared, the skin resumed its natural colour, the uneasy sensation abated, and no further perspiration appeared. —In this instance the whole process of disease, from poison to recovery, was carried on and completed in about half an hour. The morbid action of the poison probably destroyed, at least in part, the tone of the skin and cutaneous vessels; a slight fever succeeded, accompanied with an accumulation of blood, which disappeared in a few minutes, in consequence of a copious excretion of moisture, which carried off the preter- natural heat, while the parts were resuming their natural tone. There are many considerations which incline me to believe that, while the saliva, the gastric liquor, the bile, the chyle, the lymph, and other secretions, are destined to carry on the process of deglutition, digestion, nourishment, and the dis- • See page Hi 256 Observations on the Nature of Fever. charge of the fecal matter, the excretion by the skin is des- tined chiefly to carry off the superabundant heat. Indeed, no other means equal to this purpose seem provided by the constitution of animal bodies. The air undoubtedly receives a portion of heat from the skin with which it is in contact; but a dry air is an imperfect conductor, and by no means suf- ficient to answer the purpose. Aqueous particles seem by na- ture destined to this end; and hence the tendency of a moist atmosphere to occasion perspitation. The moisture relaxes the skin, and invites the discharge of heat, in an undue degree. This I presume to be the reason why a damp air occasions chilliness, or tends to occasion it, though sometimes counter- acted by extreme heat in the air; and hence the debility occa- sioned by such a moist air. The heat and juices escape with a preternatural rapidity, leaving the surface of the body cold, languid, and prone to disease. The proximate cause of fever, thus, is any obstruction of the natural discharge of heat; the primary or remote cause is any thing which induces debility in the system, and especially in the parts* which secrete the necessary aqueous or perspirable matter. Whatever destroys or impairs the action of the ex- cretory organs must occasion a. preternatural accumulation of heat or fever. Where this action is only impaired, or partially obstructed, a slight fever ensues: where the obstruction is more general and entire, a proportional degree of fever must follow. Many theories have been framed to account for the preter- natural heat of the body in fever. But why should we resort to spasm, excessive excitement, &c. to account for one of the plainest operations of nature ? All the heat of the body, which exceeds the temperature of the surrounding air, must be, and the most of it is, inhaled by the lungs; and why should we resort to any other cause for an unnatural degree of it, than to an obstruction which prevents its regular discharge? What is local inflammation but an accumulation of blood and heat in a part, the vessels of which are so impaired as to be unfit to separate the red from the serous part, and to carry off the heat which is constantly conveyed to the part by the circulation ? Is not topical inflammation cured by an abstrac- tion of blood, and by epispastics, or other vesicatories and fo- mentations, which occasion a discharge of the serous part of the blood; in short, by renewing the excretions? Why is fever attended with a dry skin, but because every particle of moisture which can find its way to the surface instantly flies Observations on the Nature of Fever. 257 off with a portion of heat? Philosophers are peifeCtly well acquainted with the capacity of vapour to contain heat; and the ordinary process of insensible perspiration seems to consist in the discharge of fluids in the form of vapour, charged with the heat imbibed by respiration. The heat of summer occasions an extreme stimulation of the surface of the body, and an undue discharge of perspirable matter, as long as the vessels continue to perform their func- tions. But the preternatural excirement often induces indirect debility, and disables the extreme vessels to perform their func- tions. At the same time, an excessive stimulation of the vis- cera, and especially of the liver, occasions an undue secretion of the bile, a part of which is forced into the system in va- rious directions, and urged to the surface through the perspi- ratory ducts, giving to the skin the yellow hue so common in summer and autumnal fevers. But it is probable that this fluid, being too viscid to pass freely through the capillary vessels of the skin, serves to clog those passages, and, finally, aid in producing fever in the system. '.This is bilious fever. I am led to these reflections, in part, by experiencing the good effects of applications to the skin, in cases of chronic debility. I have, for two or three years, ceased to look for a remedy for this species of indisposition in the shop of the apo- thecary. For indigestion and languid bowels, a more natural and easy remedy is found in friction applied to the region of the stomach, liver and intestines. A brush (not a flesh brush, for it is too soft), used at night, before retiring to rest, until the body is covered with a glow, never fails to restore tone to the stomach, and invigorate the alimentary canal, so as to procure a natural discharge the next morning; and it is obvious that a languid liver is thus stimulated to secrete its proper fluid to lubricate the intestinal canal. How much better is this practice than to run to the apothecary for pills ! In cases of more confirmed chronic debility, and hypochon- driacal affections, the brush may not be sufficient, and the warm bath mav be more effectual. To a debilitated frame, whose skin is dry, and whose extremities are cold—in which the peristaltic motion is languid, and the stomach weak or swelled with flatulence—what a luxury is the warm bath! It warms equally every part of the body ; relaxes and softens the skin, thereby restoring the excretions; gently stimulates the whole system ; renders the circulation equable, and pro- motes all the secretions. From my own observations, I am inclined to believe that chronic affections, being occasioned P58 Symptoms consequent on an injured Spine. by want of exercise, and a consequent muscular debility, are to be mitigated chiefly by external applications. Nothing will cure them but exercise—action being the natural business of man, and, of course, his natural prophylactic. But friction and the warm bath, by invigorating the muscles, and restor- ing the excretions, relieve the viscera, or rather excite them to perform their functions far better than cathartics, astringents, and chalybeates.—The orientals, from the highest antiquity, have made great use of the warm bath; and the ancients suf- fused the body with oil, evidently with a view to relax and soften the skin, and keep the excretions free. The modern Turkish practice of rubbing and pinching the skin, at the time of bathing, is intended for the same purpose. These consider- ations, and many others, lead me to believe that, in modern practice, physicians pay too much attention to the viscera, and too little to the skin and muscles. ARTICLE VII. Remarkable Symptoms consequent upon an Injury done to the Spine, with Remarks. In a Communication from Jonathan Dorr, Esq. of Cambridge (N. Y.J, dated May 23, 1803. ON the 22d of July, 1794, A— A—, aged 36 years, re- ceived a blow across the small of his back by the fall of a tree, which partially dislocated bis spine between the first and second lumbar vertebras, and which produced a considerable tu- mour, and an obtuse angle of the spine, with an entire aboli- tion of all sensation and muscular action in the lower limbs, beginning on a circular line passing around the ossa innominata exactly over the head of the femur, and two inches above the ossa pubis. This was the lowest line of the least sensation, which was determined by puncturing the parts. As low down as an- other line, three inches above, sensation and muscular action was entire. From the upper to the lower line there was a gradual diminution of sensation. In this situation I visited him five hours after the accident. By adopting the method Mr. Bell directs, the bones were replaced. Stimulants were directed and applied. I visited him the succeeding day, and found his bladder violently distended, and a retention of faeces, without any more pain than a slight uneasiness about the region of the THE Vol. VI. NEW SERIES. No. II. ORIGINAL ESSAYS. An Account of the Endemic Yellow Fever, as it occurred in the City of New-York, during the Summer and Autumn of 1819. By Charles Drake, M. D. Physician to tht Bellevue Establishment. THE public are already furnished with two able and cir- cumstantial relations of this endemic by Drs. Pascalis and Watts.* The design of their labours was to ascertain its origin, and the laws which regulate its propagation; with- out attempting to describe the disease, assign its type, or point out in what it differed from our autumnal endemics of former years. That they did not attempt to accomplish more, is probably to be ascribed to the fact that neither of those gentlemen attended a sufficient number of cases, to ena- ble them to detail the general concourse of symptoms with that degree of minuteness, which is desirable in such cases. Indeed, the same remark will apply to most of the physicians of the city, none of whom attended more than four or five cases, and very few even that num- ber. As physician of the Bellevue Establishment, the charge of the hospital opened for the reception of these * See A Statement of the occurrences during a malignant yellow fever in the oily of New-York, in the summer and autumnal months of 1819. By Felix I'ascalis, M. D. and Part 2 of Vol. I. Hospital Register, by Drs. Watts, Mott, and Stevens. Vol. C. _..«•«■* 1' 126 Drake on Yellow Fever. fevers at Fort Stevens, near Hellgate, gave'me a more am- ple opportunity of observing the disease, and noting its symptoms, than fell to the lot of any other practitioner ; but at the same time I must confess, it was not so extensive as, under other circumstances, would be required of one who attempts to write its history; which I had not undertaken but from the failure of others, and a persuasion that the deductions I have made, from the observation of sixteen cases, will be found to apply with sufficient correctness to the fever as it prevailed generally. The yellow fever had not made its appearance in the city of New-York since the year 1805. Nevertheless, th«? constituted authorities had not remitted the rigour of qua- rantine regulations, to guard against danger from abroad, nor relaxed the execution of those wholesome police ar- rangements which are calculated to obviate all sources of insalubrity at home. This long respite from an epi- demic calamity began to be viewed by many as a pledge of total exemption ; and measures, once deemed salutary, and submitted to with cheerfulness, were now felt to be preju- dicial to commerce, and burdensome to the city. Fortu- nately for the cause of medical investigation, as well as humanity, these feelings had not been suffered to influence those who were charged with the execution of the health laws; for, on the appearance of fever in the latter part of August and first days of September, such had been the rigid execution of the quarantine system, that the Board of Health were led, as if by intuitive discernment, to the cause and origin of the disease, and the consequent adoption of mea- sures, which, while they were successful in an unparalleled degree in securing the city from the ravages of pestilence, have presented in a clear, insulated, and conclusive manner, the causes which engender and propagate our autumnal endemics. The weather, for several weeks preceding the appear- ance of this endemic, was remarkable for its unusual and continued heat, the prevalence of southerly winds, and Drake on Yellow Fiver. 127 great drought. The same state of the air, and the same deficiency of rain, were felt, in a greater or less degree, throughout the Atlantic coast of the country, and appear to have had a very sensible influence on the diseases of the season : for besides the appearance of yellow fever in the cities of New-York, Philadelphia, Boston, Baltimore, Charleston, Savannah, and New-Orleans, the villages and many parts of the country, especially in the southern states, suffered considerably from obstinate remitting and intermitting fevers, dysenteries, &c. In the month of August, the thermometer in the city of New-York was never at noon below 80° Farh. and during several days of that month it ranged beyond 90°. The at- mosphere at the same time was uncommonly calm, and very little rain had fallen for several weeks, so that vegeta- tion in the surrounding country, and as far north as the Highlands, was seriously injured; the crops of all kinds were light, in many places they totally failed, and trees, even in the lowest forests, perished from the extreme drought. Such was the scarcity of culinary vegetables, that the city was supplied from distant districts of the country, and even from Albany ;* a circumstance that had never before occurred. The epidemics of 1798 and 1805 commenced at Old Slip, and the prevalence of 1819 was almost exclusively confined to a small district adjoining this commercial nui- sance. Every case officially acknowledged to have been yellow fever, was satisfactorily traced to this spot, ex- cept two, and some doubts respecting these induced many to believe that these persons also received the disease by visiting the infected district. What are the circumstances, of this locality, it may be asked, to originate these pesti- lential fevers? Is it that this slip is appropriated to the use of vessels arriving from West-India ports, and other places within the tropics, where yellow fever prevails? ' Distant from New-York 150 miles. 128 Drake on Yellow Fever. So far from it, that it is almost exclusively occupied by coasters, a very small number of which come from ports south of Baltimore; and we must look to the actual condition of the slip and its vicinage for an explication of their rise and progress. This slip is very shal- low, and one of the longest and most land-locked of any within the limits of the city, situated in the lowest and oldest part of the town, and further rendered liable to the ac- cumulation of filth from an extensive sewer which empties at the head of it. Its filthy condition, and that of its imme- diate neighbourhood, at the time, was such as to attract the notice of the Grand Jury, who represented it as containing much putrescent matter, exposed on the recession of tide water to the influence of a hot sun, giving occasion to the emission of noxious and offensive effluvia. The houses on the west side of the slip, where a great part of the victims of the fever resided, are for the most part old wooden buildings in a decayed state, without yards, ill ventilated, and crowded with inhabitants. The offensive condition of the slip and sewer, during the hot days of the latter part of August, was also remarked by many citizens whose business led them to that part of the city. A respectable practi- tioner informed me, that about this time he was employed in an obstetric case, in the house occupied by Mrs. Kave- naugh, where herself and four others sickened with yellow fever, and that the house was much crowded, almost every room being occupied by a family, very filthy and confined. The room in which he was engaged was so offensive, that he was induced to throw open the window; but the wind blowing in a direction from the slip, he was assailed by such a blast of putrid effluvia, that he was constrained to close the window, and patiently endure the unpleasant smell within. The best possible proof, that the fever originated from local causes, existing in and about this slip, the sewer, and the foul condition of many of the dwellings of the district, will be found by tracing the disease through its whole Drake on Yellow Fever. 129 course; for such were the active and efficient measures enforced by the Board of Health, that it was checked almost as soon as discovered to exist, and its entire history is destitute of all those adventitious and unimport- ant circumstances, which, in the accounts of similar en- demics, have only served to confuse and complicate con- tested questions. As soon as a malignant fever was known to prevail in the district, the Board directed all vessels to be ^removed from the slip and adjoining wharves; the in- habitants were persuaded to desert the infected neighbour- hood, which was estimated not to exceed thirty acres in extent, and was inclosed by a fence, to prevent use- less visits : persons were employed to remove nuisances when practicable, or neutralize their deleterious agency by lime and other antiseptics ; the poor were provided for at the public charge at Fort Richmond, on Staten Island ; and a temporary hospital was opened at Fort Stevens for such of them as were attacked by the disease. To these measures are to be attributed the very limited number of its victims, as well as our ability to trace them to their origin. Of 63 cases, the aggregate number reported to the Board of Health, 34 were persons residing in the small block of buildings on the west side of the slip, noticed by the Grand Jury, which does not contain more than thirty houses, chiefly of wood, old and decayed ; 9 in the block above, on the same side, and the remainder, except the two cases before mentioned, were persons who lived in different parts of the infected district, or whose occupa- tions required them to spend much of their time there. The two exceptions may with much reason be referred to the same cause, as they resorted to a narrow, ill ventilated, and filthy lane, near the Fly Market; and from the strictest examination, it could not be ascertained that they had been for weeks previous within the interdicted limits. The first case of the fever occurred in the latter part of August, in the building where four others sickened trmiw nated fatally. " On Sunday he was seized with long and con- tinued rigorsy succeeded by a short period of heat; pain im the eyes, loins and lower extremities: betty costive; these symptoms subsided altogether, and foe' remained wtett till the next day at three o'clock* when a similar attack recurred* and he was received at the Naval Hospital a* noon this day. The belly continuing bomrdl, purgatives we*e administered with such relief, that in the evening he again con- sidered himself well. The following day his eyes became of a dark fed ; he complained of a deep seated pain in his head, and accompanied by gresi increase of heat; blood was then drawn from the VOL. VIII. m 162 »K THE NATURE AND ORIGIN arm and temporal artery ; large doses of calomel were administered, also friction with mercurial ointment; a blister was applied to the head, and sinapisms to the feet. These symptoms continu- ed until Wednesday, when they became accom- panied with constant vomiting, the fluid exhibit- ed a coffee colour, and latterly much affected with spasm. " He died this day at two o'clock, P.M. Dissection. " The head and stomach exhibited great marks of inflammation; the vessels of the meninges were loaded with blood; the surface of the brain, espe- cially in the course of the longitudinal sinus, very turgid $ the outer coat of the stomach as though rubbed off by a blow, and the inside surface in several parts of a mottled appearance, and contain- ed about half a pint of fluid of a dirty brown hue; the gall-bladder was distended with fluid of the same appearance ; the liver was spotted in various parts; the other part of the viscera did not exhibit any marks of disease. The body was not in the least discoloured after death. " This man had been ill for some days previous to his being sent to the hospital, and by the man's ewa account, seems to have been brought on by 7 OF THE YELLOW FEVER. 163 sleeping on deck, and getting thoroughly wet, and remaining in that state without changing." Signed, P. Forbes, Deputy Inspector. APPENDIX IV. Report of Acting Staff Surgeon Ayton on a Case of Fever that terminated fatally, on Board the Regalia Transport, Basseterre Roads, Guada- loupe. Vaulters, Guadaloupe, February 27th, 1816. SIR, " In compliance with your request, I beg leave to state to you, that I visited the transport ship Regalia, on her arrival here from Barbadoes, I be- lieve early in the month of last November. I in- spected the ship's crew, and found them perfectly healthy with the exception of one man, who I was told had been ill three or four days: he was a stout young man, of a full habit: he complained of pain in the fore part of his head, with sickness of stomach; the eyes were suffused, the tongue loaded, and there was a dingy yellowness about the neck : the pulse was a little quickened, but not irregular or hard, and the skin moist with no very great de- gree of heat. I could not exactly ascertain what 164 ON THE NATURE AND ORIGIN medicine he had taken, but I directed the follow- ing to be given him immediately; R Hydr. Submur. gr. x. Pulv. Jalap, ^j M. ft. pulv. this was about three o'clock in the afternoon; the next morning as I was proceeding to the beach to go on board, I met the captain of her who in- formed me the man had just before died, having previously vomited a quantity of black matter." Signed, R. Ayton, Acting Staff Surgeon to the Forces. To Dr. Fergusson, Inspector of Hospitals, &c. &c. APPENDIX V. Extract of Inspection Report on the Island of Martinique, by Doctor Menzies, Deputy In- spector of Hospitals. " The Bomb-Proofs are excavations made in the rock below all the works, and near the level of the sea. On the right of the road, betwixt the first and third of these, the rock is of soft sandstone; the entrances are on a level with the road, and the square openings intended as windows somewhat higher. The height of the apartments is eight or nine feet, the breadth about twelve; they are nether paved nor floored, and there are no ham- OF THE YELLOW FEVER. 165 mock rails, nor the appearance of there ever ha- ving been any : indeed they have seldom been oc- cupied except during a siege. In rainy weather there is an oozing of water from the roof and sides anteriorly, which renders them damp. Some part of the rock above these Bomb-Proofs, has the ap- pearance of a concretion of sand and small stones. There are, at one end, interior rooms with arched passages leading to them, and air-holes cut perpen* dicularly for the admission of light, and which may create some ventilation. " The principal remarks that seem to offer re- garding the salubrity of these as a quarter for troops, are the uncommon lowness of them, there being a barrier gate at each end; a wall of fifteen feet directly to windward of them, and no thorough- fere, nor means of creating a draught of air, except the partial air-holes alluded to, as well as the neces- sary dampness, both from the nature of the rock, and from the non-admission of air to purify, and to correct humidity after rains; and these independ- ent of the general situation of Fort Edward, in re- gard to the surrounding country." Signed, Alexander Menzies, Deputy Inspector of Hospital. 166 on The nature and origin APPENDIX VI. Extract from the same Report. " In the third of these ravines, but by much the most considerable, is the village of Case Pilote, built on the beach. There is a church and endow- ment for a clergyman ; the soil seems good, and the sugar-cane grows on a small scale. There are two streams that run into the sea upon each flank of the village, and the wind observes the same course as at Case Navierre. The extreme breadth of the ravine did not appear to me to exceed three-fourths of a mile in the broadest part, and not more than one-fourth at the village; and the apparent extent towards the mountains, not more than a mile, at least, before the view terminates. I have not learnt that to the natives this place is unhealthy; what it might prove to new comers I have some doubt; from analogy drawn from other places similarly situated, I should not consider it as healthy. One of these streams takes a sweep and terminates in a serpentine pool of almost stagnant water, close upon the village. The ground adja- cent, to no great extent however, is low and swampy. The principal remarks that occur respecting the salu- brity of this place, are its being confined in its extent, surrounded with uncultivated grounds, having a par- tial swamp, not inconsiderable in comparison to the limits of the place; and its being exposed to the ob- lique rays of the descending sun, on the shore at OF THE YELLOW FEVER. 167 the foot of the immense steep mountains, and those bearing north-east almost directly to wind- ward." Signed, Alexander Menzies, Deputy Inspector of Hospitals. APPENDIX VII. Deputy Inspector Forbes's Statement of Admis- sions, Deaths, and Discharges, of the unattached African Recruits. Admitted. Died. Discharged. Periods. 1 •J i ■a © § V B a, 6 2 3 5 16 •0 O. o 1-Q 4 4 1 9 | 13 JO JB e. O 6 12 3 i V u 35 13 3 10 5 2 3 % U 14 12 a E 4 10 9 8 7 9 2 1 1 2 a. e u c 1 1 1 1 1 2 | 3 £ V > V From To c P* 2 3 2 2 P Aug. 24 27 Sept. 3 10 17 24 Oct. 1 % 15 22 Aug. 26 Sept. 5 9 16 23 30 Oct. 7 14 21 24 Total 7 1 1 9 49 18 15 8 6 4 4 3 4 111 1 1 1 » 218 21 73*49 53 1 V 9 1 1 2 218 ■ . ■ ■» W58 ON THE NATURE AND ORIGIN APPENDIX VIII. List of Persons who have lately died in Basse Terre, Guadaloupe, May 1st, to May 31st. Names. Age. Disease. Period in the Island. Period ill. Leading Symptoms of Disease. MM". Didier. Huges. Madue. Denault MM". Berville. Emar. Bernard. Blanche! Goudrie. Sandre. Madlle. Guenet. "23 an*. 2,5 ans. 1 if ans. 30 ans. Fievre Euro- peerme. idem. idem. idem. 4 mois. 4, idem. Creole. 4 mois. 5 jours mort. 6 idem mort. jours m/)rf, 7 idein idem. 6\ jours mort 7 jours mort. 7 jours mort. 2 jours mort. idem. Ill idem-14 jours mort. Vomisse- mentnoir, hemor- > rhagie na- zale et alvine. "| Vomisse- ment ooir, > hemor- rhagic na- J zale. ) idem et \ idem. idem. Vomiise- ment noir. Mr. Loriol died in June at the three Rivers; he was just arrived from Europe. Three days illness; black vomiting. One Provencal dead three days ago of the same illness. Seventeen days illness. 12 June. Signed, " Cheros." Of THE YELLOW FEVER. 169 APPENDIX IX. List of Persons who have died in July 1816, Basse Terre, Guadaloupe. Names. Age. Disease. Period in the Island. Period ill. Leading Symptoms of Disease. MM". Cadtournet. Nayent. Thoret. 30 ans. 23 ans. 27 ans. Fievre Euro-peenne. idem. idem. un an. 6 semaines. 6 semaines. 6 jours. 60 heures. 4 jours. ") Vomisse-1 ment noir, •' hemor-r rbagie na-| zale et J alvine. ) idem idem \ idem. ") Vomisse-2 ment nqir, 3 settlement. The above returns have been furnished by Mr. Cheros, a French surgeon, employed by the Brit- ish government, in the colonial duties of the Port at Basse Terre, Guadaloupe. His opportunities of information were limited, his practice not being extensive ; but his education is good, and he stated that he had himself seen all the cases detailed. He calls the fever that of the Europeans, the name commonly given to the yellow fever in Guada- loupe. His return for the month of June has been mislaid. Signed, W. Fergusson, Inspector of Hospitals. 170 ON THE NATURE AND ORIGIN APPENDIX X. Report from Assistant Surgeon Ralph, of the 2d, or Queen's Regiment, on the Difference of Health between the upper and lower Stories of the Barracks occupied by that Corps. " By a calculation made from the above Table, it appears that in the month of August, one case of fever presented itself in every twentieth man of those quartered on the ground floor, and in each thirtieth man of those on the upper floor. During that part of the month of September, which has elapsed, each twentyfourth man was attacked with fever of those stationed in the upper rooms, and %ach fourteenth among those in the lower." Signed, A. J. Ralph. OF THE YELLOW FEVER. 171 APPENDIX XL Comparative Sick Return of White Soldiers em- ployed as Orderlies, in the General Hospital at Barbadoes, from the 25th of June, to the 24th of October, 1816. Number of Orderlies employed during the period. Number taken ill of fever. Number who died of fever. Proportion taken with fever of the number employed. Proportion of deaths amongst the Orderlies. Proportion taken with fever from the total strength amongst the troops in garrison. 198 7 2 as 1 to 28 as 1 to 99 as 1 to 5 N. B. It is ascertained that of the Orderlies dis- charged by their own desire, or for misconduct, none came back as patients. One of those return- ed as having died from fever, was a very drunken character. Signed, tA. Menzies, Deputy Inspector of Hospitals. 172 ON THE NATURE AND ORIGIN, &C APPENDIX XII. Extracts from the Reports of Staff Surgeon Loins- worth, P. M. O. of Grenada, on the State of the 15th Regiment, on their arrival there from Martinique, dated 12th and 20th of September, 1816. " The 15th regiment have brought with them about seventy men as hospital patients, and nearly half the regiment as convalescents in barracks. I think I never saw a corps more dreadfully cut up from fever, I understand of the intermittent kind. " We still continue with a heavy sick list, and to judge from the appearances of the men of the 15th regiment, I apprehend it will be some time before they recover, or our numbers in hospital diminish. This day we have in hospital one hun- dred and forty-four of that number, ninety-eight are of the 15th regiment, independent of a nu- merous convalescent list in barracks; indeed so debilitated are the men, that the slightest exer- tion or fatigue brings on relapses of fever, and sends them into hospital. I have therefore thought it adviseable to make a requisition for wine, as the ex- penditure for some time will probably be great." Signed, F. A. Loinsworth. REMARKS ON THE SPOTTED FEVER, AS IT PREVAILED IN HARTFORD, CONNECTICUT, IN THE YEAR 1809. BY DR. HENRY FISH, Fellow of the Society. Read the 3d of September, 1815. The subject of the following remarks, is a pecu- liar disease, which has been denominated Spotted Fever. It is described as it appeared in Hartford, Connecticut, in the winter and spring of 1809. The treatment is that which was adopted and found successful by the physicians most conversant with it; a treatment which has been approved and ulti- mately resorted to wherever this formidable ma- lady has appeared. The facts related occurred to the writer's own observation, or were suggested by those, who were themselves eye witnesses. The name by which this disease has been known, is incorrect; because, strictly speaking, it is not a fever, and it is rarely attended with petechiae, or spots. I shall use it, however, knowing no other bv which to designate the complaint c 18 remarks on the It is a popular name, and as far as I know, the one most generally used. Before describing the Spotted Fever, it will be proper to notice the weather and diseases which immediately preceded it. I do not know that the former had any decided effect in exciting this epi- demic ; but there is a connexion between the wea- ther and diseases;, and it is only by long continued records of facts, relating to these points, that this connexion can be successfully and usefully unfold- ed. The winter of 1808-9 was unusually severe. The cold weather commenced earlier, and continued longer, than in the six or eight years preceding. The snow fell in December, in large quantities, and was not wholly removed until late in March. It was generally a foot or more in depth, and the air was intensely and uniformly cold. Snow storms were fre- quent and severe, without being succeeded by thaws. The diseases of the summer and autumn of 1808, had been noticed as uncommon in two particulars: first, for the slight evacuations whidh were neces- sary to remove them; and secondly, for the com- paratively large quantities of medicines necessary to produce these evacuations; whether they were to operate as emetics or cathartics. For two of three preceding years, it had been a common re- mark amongst the physicians of Hartford and its vicinity, that the diathesis of their diseases was changing; that instead of inflammatory diseases, which were almost universal, all, without exception, SPOTTED FEVER. 19 had assumed more or less of a typhoid character. Hence, many who had been accustomed to bleed at regular periods, and who suffered when it was neglected, had omitted this evacuation with safety; or if they persisted in it, had found it injurious. Hence, too, purely inflammatory affections, both general and local, had become rare: indeed, they were scarcely met with. From this cause, too, it was, that injuries of the body from blows, kc. which, for years before, had been invariably followed by active inflammation, requiring, for its removal, free evacuations and cold applications, were in danger of becoming gangrenous, from passive inflammation, or a want of sufficient action in the vessels of the affected part, and required, for their cure, a liberal use of local and general stimulants. Typhus fever, pneumonia typhodes and catarrh, preceded this epidemic, and were attended with the peculiarities already mentioned. The first of these prevailed more this season, and was attended with more debility, than is common. There were several cases of it immediately preceding the Spot- ted Fever; a number of which proved fatal in a shorter period than usual, under the ordinary treat- ment ; and in these cases there was less morbid matter in the alimentary canal, and fewer evacua- tions were required, than in typhus, as it usually appeals. Pneumonia was not so common as it had been in cold seasons ; and the cases of it, which occur- red, were not so inflammatory as in other winters, 20 REMARKS ON THE and under similar circumstances. Pneumonia ty- phodes was more common than usual, and attended with symptoms which showed extreme debility and proved the inflammation to be rather passive. In no instance was more than one bleeding required to remove it, and even that was generally unneces- sary. An emetic and cathartic, at the commence- ment, with a free use of calomel, opium, and wine, in the latter stages, were relied on for the cure, and found effectual. Catarrhs were not more prevalent than in former winters, and only deserve notice, as they were not so often attended with fever, and required only mild evacuations for their removal. With such precursors, this epidemic appeared: the first cases occurred the last week in January ; after which it spread rapidly in different parts of the town. In the first instance, it assumed such symptoms as une- quivocally marked the complaint to be Spotted Fever, and appeared totally unconnected with any other disease. These symptoms, as they appeared independent of the effect of medicine, will now be enumerated. Those which may be termed pathog- nomonic, as they serve to distinguish this from all other diseases, will be noticed hereafter. Although it was not difficult, in the first cases, to distinguish this from other diseases, yet it is not to be inferred, that the minor symptoms were in every case alike. On the contrary, they were very dissimilar; the characteristic marks of the disease, however, rarely varied. In the subsequent enumeration, I will ad- SPOTTED FEVER. su here, as closely as the subject allows, to the course they followed in the majority of cases; considera- ble deviations from this course will be noticed. The Spotted Fever, with a few exceptions, at- tacked with a chill. The cold sensations were fre- quently first perceived at the stomach; but in a few minutes they became general. They were often so intense, as to produce a shivering and chattering of the teeth, as in intermittent fever. In the cases where the chill was the most violent, the patients seldom complained of cold, even while they were shivering; but the skin was always cool to the hand of a person in health. The duration of the chill varied in different persons and under different cir- cumstances ; where no means were used to check it, it was rarely, if ever, followed by preternatujal heat in any part of the system. Whenever flashes of heat succeeded the chill, they were very slight and transitory; continuingbut for a short time, and leav- ing the patient in extreme debility. The tempe- rature of the body, during the chill, was always be low the healthy standard; the diminution of heat was perceptible in every part of the system; the ^kin was cool, sometimes shrivelled, and in many cases, drier than in health. The chill A\as, in most cases, accompanied with, or soon succeeded by, pungent and excruciating pain in some part of the body; as in one of the ex- Iremities, the back, stomach or head. Sometimes sharp and agonizing pains were the first warnings of disease, attacking the head or extremities. Ge- nordiir mU» w "-.-.c f;«.« f«i* ;« a limb, it proceed- 22 REMARKS ON THE ed along to the head. The spot complained of, as the seat of pain, was sometimes no larger than a cent; but it had no diseased appearance. These pains were scarcely ever described by the patients, as dull or heavy, but, sharp and lancinating ; and in most cases moving from one part of the body to another. The bowels were exempted from pain. I do not remember a single instance where this part was complained of. Pain was often complained of under the ensiform cartilage: on a closer examination, it was evident- ly not pain, but distress, having its seat in the sto- mach. This affection of the stomach is not easily described: patients themselves said they wanted words to express their feelings. Some called it a fajntness; some a coldness; others a deadly feel- ing, of which they could give no distinct account. All agreed in representing it as very distressing; and where it had been removed, dreaded its return. This affection varied, in its duration, in different cases: in some it did not return after being removed, but generally continued, in some degree, through the disease; sometimes recurring at regular pe- riods, or in paroxyms during the day, and bringing with it a countenance expressive of a degree of distress and horror that can scarcely be conceived. The stomach was otherwise severely affected; nausea and vomiting were general, and in most cases violent. Generally, if no application had been made to check-the chill, puking succeeded in a few hours ; and nearly every case, in some of SPOTTED FEVF.R. 23 its stages, was attended by vomiting. In a few in- stances, it was the first symptom that indicated dis- ease, and in these, it was generally followed by a chill. The matter discharged from the stomach, in either instance, had no morbid appearance; nor differing in quantity or quality, from the matter ejected from a healthy stomach. There was no bile or mucus discharged by vomiting, whether it was spontaneous, or excited by art. The respiration did not generally vary much from that in health; in some, during the chill, or when the pain Avas very severe, it was short and laborious; in others it was observed to be extreme- ly quiet and placid. The respiration, in the later stages of the disease, will be noticed in its proper place. The tongue varied much in its appearance, both on the attack and during the progress df the dis- ease. In some violent cases, it was smooth, dry, pallid, shrivelled, and almost of a livid hue. When the tongue had this appearance, where the circula- tion was very imperfect, and great danger was just- ly apprehended, it obtained the expressive epithet bloodless. In other cases, it hardly varied from a healthy state, except in being dry; in some it was moist, but soon became dry. It never had on it any fur or mucus, as in our common typhus fever; but during the progress of the disease, it was co- vered with a dark coloured slimy matter, in some dry, in others moist; having the appearance of molasses. \u some a black stripe ran longitudi- 24 REMARKS ON THE nally upon the tongue, but never entirely covered it. Frequently it became dry and shrivelled, de- noting a change for the worse. The bloodless tongue was almost always a fatal symptom. Pa- tients sometimes lost the power of moving this or- gan in a few hours from the attack: the muscles at- tached to it appearing to be paralytic. The pulse was always extremely weak, feeble and depressed: in most cases more frequent than in health; in others it was imperceptible on the at- tack, and for one or two hours, till it was restored by stimulants. There was not, before or after the chill, any increase of arterial action; on the con- trary, where the disease was left to its own course, the pulse grew more and more feeble until death took place. In some instances, though rarely, it was observed that the pulse, in fulness and frequen- cy, did not vary from a healthy state; but in all these it yielded to the slighest pressure. The pul- sation of the carotid artery was sometimes percepti- ble at some distance; and though frequent and full, yet like the radial, yielded on slight pressure. Two patients, the last winter, were bled: one fu- riously delirious, the other comatose : in neither of these did the blood present any uncommon appear- ance. There was no inflammatory buff, nor was it dissolved. In one case in 1807, where the eyes were suffused, it had a slight buffy appearance; in another, the following year, it was darker, and had a larger proportion of serum than usual. The two last mentioned cases proved fatal in a few hours af- SPOTTED FEVER. 25 lei the patients were bled. Haemorrhagies this winter were rare, although they were frequent in former epidemics. Epistaxes sometimes happened: in one case, there was a haemorrhage from the fau- ces ; the blood was discharged in small quantities, and during sleep. In another case, there was a haemorrhage from the stomach, and the patient evi- dently sunk under the discharge. The strength of the patient, from the moment of attack, was com- pletely prostrated. The debility of the muscles was astonishing, and formed a striking feature of the disease; for it took place without previous excite- ment, or debilitating evacuations. In some, a faint- ness and prostration were the first symptoms that excited the attention of the patient, who found himself unable to raise his hand, before he was sen- sible of being ill; in others, but very rarely, a las- situde or unwillingness to motion preceded the chill. In a few cases, where it commenced with a furious delirium, there was an apparent increase of strength in the muscles of voluntary motion; but this mor- bid excitement, in an hour or two, gave place to extreme weakness. In either case, the pulse was weak and feeble, and in some, where this morbid strength existed, it was fluttering. The eyes were sometimes natural: generally they had a wild and vacant stare, sometimes ac- companied with [i glassy appearance, at others with a dilatation of the pupils. In some, where the at- tack was violent, the eyes were very brilliant, and there was u rapid transition from a complete dila- 26 REMARKS ON THE tation to such a contraction, that the pupil was nearly obliterated. In some cases, this alternate contraction and dilatation continued for an hour or two, when it disappeared; being succeeded by a more natural state of the eye, or permanent dilata- tion, with coma.' In many instances, the eyes were suffused with blood, and had every appearance of excessive inflammation: they were never yellow. There were few, if any cases, where delirium, in some form or other, was not present in the course of the disease. It varied much in the time of its accession : in some, it commenced on the attack : in others, on the second, third or fourth day; gene- rally continuing until convalescence or death fol- lowed ; occasionally, however, intermitting for a day or two. When it ushered in the disease, the delirium was generally furious, or raving; the pa- tient being completely distracted, and complaining of excruciating pain passing through his head. Not unfrequently, such patients were without sleep for a week, and obstinately refused food, or medi- cine. When delirium began at a later period, as it did in most cases, it was more mild, sometimes of a playful kind; the patient being sociable and hu- morous. There was a great variation in the feel- ings or'spirits of many patients; sometimes being much elated, but more generally depressed. In females, above seventeen years of age, the spotted fever often disguised itself under the form of hysteria; attacking with such symptoms as glo- bus hystericus, crying or laughing, " without visi- SPOTTED FEVER. 27 ble occasion," sighing, or wringing of the hands ; generally, these symptoms were accompanied by others, from which a diagnosis was not difficult. But when this variety first appeared, there were cases, in which the patients were supposed to have nothing but hysteria, until they had sunk beyond the reach of medicine. These patients, when de- lirious, were talkative and jocose: from their ac- tions and expressions, they appeared to be com- pletely happy; and, though convinced that their cases were hopeless, showed no fear of death, nor any desire to recover; some seemed resolved on dying from the first, and became impatient when attempts were made to encourage them with hopes of recovery. There was much variation in the con- tinuance and degree of these symptoms; generally when they were present, they began with the dis- ease and continued through its progress. The state of the pulse did not vary from that in other cases, of equal violence. In many cases of this epidemic, there was a pe- culiar affection of the urinary bladder—a difficulty and pain in discharging urine; and it was seated in the neck of the bladder. There was a frequent dispo- sition to void urine, when there was none collected; or if the bladder was filled, emptying it gave ex- quisite pain. This might have been attributed to the operation of cantharides, had it not frequently occurred, where none had been used. In some cases, the secretion of urine was diminished, but without pain around the kidneys: in a few instances. 28 REMARKS ON THE in which there were symptoms of hysteria; the urine at first, was paler than usual; in all others, it had a natural colour. The appetite was always impaired, especially on the attack and during the violence of the complaint; but, as soon as the patient had passed these stages, it returned, and the stomach recovered its digestive powers. It is believed, it did this in a shorter time than in most other diseases; for it was uncommon to find a patient oppressed by a full meal of animal food, even while they were unable to sit up. That there was an irritable state of the stomach, and that the matter discharged had no morbid ap- pearance, has already been noticed. The intes- tines were not disordered, except from torpor. They were not loaded with vitiated secretions of bile, or mucus: the evacuations were always natural, whe- ther spontaneous or artificial. No morbid matter, whether bile, mucus, or indigested sordes, ever fol- lowed the operation of an emetic or cathartic, at the commencement or in the progress of any case of spotted fever. In a few cases, just before death, there was an involuntary evacuation of faeces. The catamenia, if present on the attack, imme- diately ceased. This cessation was not followed with any of the usual symptoms of suppressed men- struation. Some patients complained of a sore throat, which on examination, presented the same appearance as in cynanche maligna, except the swelling of tho tonsils. In some cases, the throat was ulcerated on SPOTTED FEVER. 29 the attack: this part also, was sometimes first com- plained of; and when in this situation, there were ulcerations, the disease was violent, if not fatal. In almost every case, the sense of feelingwas great- ly impaired, if not wholly lost. In some instances, a general numbness was the first symptom com- plained of; for, though the patient's skin was cool, yet he was insensible of a diminished temperature. The numbness was generally first felt in the ex- tremities, though sometimes in the face. When the arm or leg was first affected, the patients would ex- claim, " that they had none, or that they had lost it:" when the attack was in the face, they were constantly rubbing it: sometimes in the extremi- ties, it amounted to a complete paralysis. In the face it was so severe and distressing, that they ex- pressed their sensations by saying, " there was an iron mask drawn over it to the bone." The skin was often so insensible, that the most irritating ap- plications produced no effect; cantharides, nitrate of silver, and the actual cautery were repeatedly applied in one case, without raising a blister or giving pain ; in another, a pin ran under the nail of the great toe was not felt. It was always, as may readily be perceived from this statement, very dif- ficult to excite a sweat, or preserve a moist skin, after it had been procured. In a few instances, blindness was the first devia- tion from health, noticed by the patient or his friends, and this was generally followed by raving delirium. When the numbness was extreme, blind- 30 REMARKS ON THE ness, with dilated pupils, sometimes succeeded in a few hours. In some cases, vision was restored in a few hours ; in others, it was more or less impaired for several days; but it is not known that the sight was ever permanently injured by this disease. While the senses of feeling and seeing were thus totally lost or much impaired, that of taste was si- milarly affected; very hot liquids being always re- quired to make any impression on the tongue. In some, this obtained to such an extent, that brandy could not be distinguished from water. The hearing and smelling were natural. There have been instances, where patients when recover- ing, lost their hearing, without any perceptible in- jury about the ear. There was often a melancholy tone in the voice on the attack, and during the progress of the dis- ease. The breath on the attack, generally, was not foe- tid ; but to this, there were some exceptions: in many cases, at some stage of the complaint, the breath was offensive, particularly during the coma; but had the fcetor of ordinary fevers. Aphthae were general, they were dark and heavy, spreading over the gums and fauces; in mild cases, of a whitish or lighter colour than in those which were more violent. Deglutition was often much impaired; in the most violent cases, it was sometimes lost in a few hours: in some cases it appeared to be spasmodic, SPOTTED FEVER. 31 but in most, it arose from the loss of power in the muscles attached to the pharynx. In all fatal cases, the patients, before death, be- came comatose. Although the disease terminated in this manner, it is not to be understood, that co- ma was always a fatal symptom ; on the contrary, many have recovered from this state, when appa- rently the powers of life were nearly extinguished. It was common for patients to be lethargic, and fre- quently difficult to rouse them. Some became co- matose in a few hours from the attack; others not until the third, fourth, fifth or sixth day. The appear- ance of this symptom varied according to the vio- lence of the attack and the remedies that had been employed. Before it began, the vomiting was inces- sant : whatever drinks were taken, were very soon rejected; the stronger stimulants, however, remain- ing on the stomach longer than the weaker. To this succeeded a strong disposition to sleep, with a slight rattling in the breathing: the difficulty of rousing them now increased fast, and they soon be- came insensible to the loudest noises, and all ef- forts to awaken them. At this period, the eyes were closed, and of a glassy shining appearance. The pupil was often di- lated, and insensible to the strongest light. If there had been any suffusion of blood in the eyes on the attack, it had now disappeared. Sometimes the skin was of a natural temperature, but more generally, it was below it, and not more moist than in health: in some places, as on the forehead or breast, it was 32 REMARKS ON THfc cedematous. The mouth, with one exception, was always open, and the gums and fauces loaded with dark coloured aphthae, except in one case, and in that the tongue was moist, but pale and shrivelled. The respiration generally was short and laborious, with a rattling noise, or an apoplectic stertor : just before death, in a few cases, it did not vary mate- rially from health. Singultus was observed in some instances, but not generally. The pulse, at this stage, was always extremely weak and feeble, and sometimes quick: in some, it had the apparent fulness, that has been mentioned, but yielded on very slight pressure. In this state, the patient sometimes continued for six, eight, or twelve hours, when he expired without a struggle. Petechiae, or livid spots, from which the spotted fever has derived its name, did not occur in one case of this epidemic before death: after it, they were noticed in several. In 1807, when the spot- ted fever first appeared in Hartford, there were but few cases without them : in the following year, they were less common, and since then, they have not been seen in that place, before death. Their size, time of appearance and continuance, have been va- rious ; I have seen them as large as a dime, in twelve or fourteen hours from the attack, but gene- rally, they were smaller—about the size of a hall' pea, and of a livid or deep black colour. They con- sisted of extravasated blood. I have seen some cases with petechiae, and an eruption or efflores- SPOTTED FEVER. 33 cence, resembling that of scarlatina; the red spots forming the eruption, receded on pressure, while the livid would not: they have also been fre- quently opened, when extravasated blood was dis- charged. The petechiae appeared sometimes on the neck and breast, sometimes they were confined to the extremities, and in other cases, they were spread over the whole body. The lymphatic and glandular systems were not particularly affected. Carbuncles were observed in a few patients, but not until they were convales- cent : some were filled with a yellowish matter, while others disappeared without suppurating. In some of the towns around Hartford, where the spot- ted fever has prevailed, carbuncles and buboes in its first stages, have been frequent; and in Spring- field, Massachusetts, there were several cases, with an eruption in the latter stages, similar to that of variola. In some cases, where the attack was sudden and violent, the symptoms, at the expiration of twenty- four hours, were aggravated; and in one case, this exacerbation regularly returned till the patient was convalescent: it was then succeeded by a tickling sensation, which recurred at the same hour; begin- ning at the feet, and gradually extending to the head. One patient only had an inflammatory or painful affection of the joints, and that not till he had nearly recovered. One patient, while ill with the spotted fever, was delivered of a healthy child, after a natural labour: 34 REMARKS ON THE she recovered after a very severe affection, under the ordinary treatment. The progress of the spotted fever has generally been very rapid : the disease always arriving at its height in one or two days; and in some instances, in three hours. Such cases, however, were rare, patients generally surviving the attack from one to three days ; and there have been instances of their living ten or twelve days, and then sinking under the disease. In this epidemic, death took place, at different periods, between eighteen hours and seven days. There were no particular symptoms, which showed a crisis was about to take place, or which marked the period when convalescence began ; for some were evidently better in a few hours, and re- covered very rapidly ; while in others, there was no material alteration for three, four, or five days, and in such, convalescence was generally slow. DIAGNOSIS. From this description of the Spotted Fever, it is evi- dent, that there was some variety in its appearance, especially in some of the minor symptoms, and also in the manner of its attack. This has been the case wherever it has prevailed; but in all the epidem- ics of this disease, there were symptoms or combi- nations of them, by which it might without diffi- culty, be distinguished from all other diseases. These are, the intense cold, which was never suc- ceeded by any permanent increase of heat • the pungent and excruciating pain; the entire prostra- SPOTTED FEVER. 35 tion of strength, without previous excitement, or debilitating evacuations; the clean or dry, pallid and shrivelled tongue; the weak, feeble, and in some cases, imperceptible pulse, neither preceded nor followed by any increased action ; the raving, or mild and playful delirium ; the hysteria, inde- pendent of any usual cause; the impaired external senses; the exemption of the alimentary canal from disease ; the profound coma and apoplectic stertor, all agree to distinguish this from other dis- eases, and mark it as hitherto unknown. The cynanche maligna and typhus fever, are, I be- lieve, the diseases most liable to be taken for it. In the first, a mistake might not be of great conse- quence, but in the latter, it might prove fatal to the patient. The temperatureof the skin, the exemption of the tonsils from swelling, the absence of efflores- cence, the numbness, the appearances of the tongue, and the healthy state of the alimentary canal, point out the difference between spotted fever and cy- nanche maligna. There is little or no resemblance between spot- ted and typhus fevers, except in mild cases of the former ; and in these, the character of the disease may easily be discovered by the pulse, the tem- perature, the appearance of the tongue, the im- paired external senses, the excretions, the delirium, and the state of the skin. In typhus, we have an increase of arterial agtion, a foul tongue, bitter taste in the mouth, and loss of appetite, clearly indicating a disordered stomach. TKo intfV3tinpc* also nrp dpronged; the excretions $6 REMARKS ON THE are altered in quality, or quantity; the tempera- ture is increased and the skin hot and dry ; in short, between almost every symptom of the two diseases, when they are carefully compared, there will be found a material difference. CAUSES. So little is known respecting the causes of Spotted Fever, that in treating of them, it will be impossible to follow the division usually made of the causes of disease, any further than as it relates to the proximate and remote; and even on these, I have but little to offer that is satisfactory. It is ne- cessary, however, to speak of them, if it is only to acknowledge that the subject has hitherto eluded investigation: indeed, I do not know that any thing can be assigned as a proximate cause, which is adequate to the effect. Dissections have been made, but they have served only to point out the parts principally affected. When the Spotted Fever first appeared in Hart- ford, persons of all ages, from sixty and upwards, were seized by it; yet, as children from two to ten years, the young under and about the age of pu- berty, women, and enfeebled constitutions, were more frequently attacked than strong robust adults, and those in full health, it appears that the remote causes are such as induce debility. Ai»ong these, are fatigue, especially (rom watch- ing, anxiety, intemperance, and the debilitating passions. Fear, and profuse evacuations, some- times excited the Spotted Fever, and sometimes SPOTTED FEVER. 37 predisposed the body to receive it by infection; for there are facts which go to prove that it is in- fectious. It is not to be inferred, however, that all, or a greater part, of those who had this disease, received it by infection: on the contrary, many who were ill with it, were not, as is known, exposed to receive it in this manner. It is not known that the infection was ever preserved, or conveyed by bed- ding or clothes; and there are many facts which warrant us to believe, that it is not more infectious than the common typhus, or autumnal fevers of our country. Whenever it has prevailed in Hart- ford, it has appeared in the same, or near that part of the city, where it did at first, and thence spread in different directions. There are many houses, in which it has appeared twice, and in some three times, with an interval of a year or six months be- tween its visits. And while these families have been thus successively its subjects, neighbouring ones have been wholly exempt; although there is no- thing peculiar in the situation, habits of life, or diet, which can be supposed sufficient to produce this difference. Both in this, and in other places, a number of patients have recovered from a second attack. Negroes have not been exempted from this disease. The Spotted Fever has not confined it- self to towns of a particular size or situation, nor to those which are considered as unhealthy. It has raged with the same violence and malignity in small villages, as in populous towns. There is no- thing peculiar in Hartford and Litchfield counties, ivliorn it hn« PYtPn«ivolv "availed, which COllld be 38 REMARKS ON THE imagined sufficient to produce it. Hartford has been as healthy, if not more so, than other places con- taining an equal number of inhabitants. And many of the towns in Litchfield county, which have been visited by it, occupy bleak and elevated ridges, equally noted for being the most healthy, as well as the coldest places in the state. It has generally prevailed more in the winter and spring, than in other seasons ; yet it has appeared, with nearly the same violence, every month in the year. The last cases of the epidemic have uniformly been more mild than the first; and in very warm seasons, a few of them have been,slightly bilious. It has been suggested, and I think with much probability, that the Spotted Fever is seated in the brain and nerves. When the delirium, the coma, the state of the external senses, and the \ extreme prostration of strength, which constitute an essential part of this disease, are considered, this opinion is ren- dered probable; and it gains additional strength from the appearances of five dissections, as recorded in the Medical and Agricultural Register, for 1806. Unequal excitement of the brain, is said to be the cause of delirium; and coma, as appears from these dissections, arose from pressure upon the same or- gan. We call apoplexy and palsy, diseases of the brain and nervous system, from the effects produ- ced on the senses, particularly from the loss of vo- luntary motion, and the sense of feeling. There are the same, if not more forcible reasons, for SPOTTED FEVER. 39 placing this in the same class; which, though not conclusive, almost establish the opinion which has been mentioned. PROGNOSIS. The danger in Spotted Fever, arose principally from the loss of action in the arterial system, and the inability of the stomach to retain the necessary medicines. The greater, therefore, the depression of the pulse, and the more obstinate the vomiting, or, if it had not already occurred, the greater the disposition to it, the more dangerous was the case. But a prognosis should not be formed from these alone: the other symptoms deserve attention, to- gether with the probable effect, which medicine will have on the disease. If, therefore, the pulse be not much depressed; if the muscles of the tongue and deglutition obey the will; if the exter- nal senses be not much impaired; if neither de- lirium nor vomiting have come on; or, if the latter occur and be checked by stimuli, and the pulse and heat increase by their application; if the- throat be not sore, nor the tongue bloodless, it is probable, although the case be violent and obstinate, that the patient, with proper atten- dance, will recover. On the other hand, if the pulse be imperceptible, or appear full, and recede on the slightest pressure; if the muscles of the tongue and deglutition be palsied, or contract with difficul- ty ; if the throat be sore, with much redness, the tongue shrivelled and pallid; if the eyes be red and waterv, with a ciuick transition from a full, 40 REMARKS ON THE open, to a small, contracted pupil; if the patient ex- press but little concern for his situation, and the senses be nearly lost; if the stronger stimuli have not conquered the vomiting, and the patient be- come stupid, and his respiration laborious and rattling, the event is certainly fearful, for the case will probably prove mortal. But, notwithstand- ing, if the symptoms threaten coma, or if it has al- ready come on, our efforts should not be relaxed; they ought rather to be redoubled. While the lamp of life burns, although its flame be scarcely perceptible, no means, which can possibly prevent its extinction, ought to be neglected. By a constant and careful attention to the patient, by a vigorous perseverance in the use of medicine, by seizing every opportunity to introduce it, many have been raised almost from the grave, and restored to the world, their friends, and to health. " Dum spiral, sperabo," on such occasions, should be our motto! In no disease can its observance be more useful, nor its effects more pleasing, than in Spotted Fever. METHOD OF CURE. The indication of cure in Spotted Fever, consi- dering it as a disease of debility, is, to support the powers of life by diffusible and permanent stimuli. The prostration of the vital powers, is so extreme that there is danger of the patient's life before re- action can take place; and as long as this prostra- tion continues, he must be supported by stimuli, or life will be extinguished. If there be excess of action in the sanguiferous - SPOTTED FEVER. 41 dued by venesection, before any other curative mouns arcj employed; or, if the secretions of the alim^ntin canal be diseased, they should be re- moved by emelics and cathartics, before tonics, to brace the weakened fibre, are administered. But where ncilhcv of these objects are to be accom- plished, no jne will adopt the means for that end; for iheir eff^ts will always be injurious, and hurry the patient to his grave. Willi this indication, the physicians commenced the treatment of this dis- ease, and were confirmed in the truth of it, by the success which followed their practice. The means, used to effect this intention, the proper quantity of medicine, and the time for its application, will now be pointed out. " Unexceptionable rules cannot be introduced into the practice of physic;" and as the spotted fever existed, like the scarlatina, from the most dreadful form, through all the interme- diate grades, to one so mild, as to require but little assistance from art, it is impossible to give direc- tions suited to the exigency of every case. The necessary doses of medicine, therefore, cannot be specified ; it must be determined by the physician, from the violence of the symptoms, and the progress the disease has made; but the indication, already laid down, must, in a short time, be accomplished, or the patient will inevitably die. If mild stimuli will effect it, it is well; if not, the stronger must be resorted to: some cases will require no more than warm aromatic teas, with a generous diet; while in others, a very liberal use of the most diffusible F 42 REMARKS ON THE stimulants, will be indispensable to the recovery of the patient. 1 shall now state the practice that was found necessary in ordinary cases, and in adult pa- tients, and the treatment for some particular symp- toms. The agents, chosen according to the indication, already lai& down, to support the powers of life, and sustain the patient, until the violence of the disease had passed, were opium, arsenite of potash, ardent spirits, wine, hot teas, soup, epispastics, and the external application of heat. Heat was applied by fomentations, by billets of wood steeped in hot water, and by the other modes in common use* Its effects were found very useful, not only at the commencement, when these means were always used, but also, during the progress of the disease: they were renewed asoften'as the skin became cool, or they had given out their heat and lost their stimulating powers. It was always an object of much importance to produce a moist skin,or, if this could not be effected, to preserve a warm one, both of which, these applications assisted materially to procure. They could not, however, be fully ob- tained, without internal stimulants, given in large and frequent doses, and continuing them, until the heat and pulse were restored to a proper state. Of these, hot aromatic teas, opium and wine, or one of the ardent spirits, formed a part; the quantity of each being proportioned to the age of the patient, and the violence of the symptoms. It was only in the milder cases, that hot teas were allowed before more powerful stimuli had ' SPOTTED FEVER. 43 then, it was necessary to add to them spirits, as well as opium. In more serious cases, from fifteen to thirty drops of laudanum, repeated in two or three hours, with a glass of wine or spirits, every hour or two, was a common prescription. When vomiting had come on, wine, if adminis- tered, was generally rejected, and if persisted in, increased this dangerous symptom: in such cases, a more powerful stimulus was required, as brandy, clear or diluted, with or without spices, or, if more agreeable to the patient, gin or spirit. Sometimes hot liquors would remain on the stomach, when cold ones would have been rejected; and gene- rally, when spirits were diluted, they were much more palatable, as well as really better, for being hot: at other times, the same effect was produced by the addition of spices. If the puking continued very violent, a blister over the stomach, or on the back opposite to it, operated very favourably, and was generally applied at this stage. In other cases, blisters applied to different parts of the body, pro- duced very good effects, by increasing the excite- ment, and were freely used. Arsenite of potash, in doses of one or two drops, every hour or two, was administered especially, if the numbness was con- siderable,.andin some instances of vomiting, which had not been checked by other means: in some cases, it was not ordered until a day or two from the attack, and in others, its use was not necessary. The quantity of this medicine was regulated by the state of the external senses; eight or ten drops, pvpw semnd or third hour, being necessary for the 44 REMARKS ON THE first doses, where they were most impaired; but af- terwards, this quantity was reduced to two or three drops every hour. Soup also was ordered as soon as the patient could retain it; and in many cases, after the stimuli already mentioned, had been con- tinued a number of hours, they took it in consider- able quantities. If, under the operation of the above remedies, the pulse became stronger; if the tongue lost its dry and pallid appearance; the skin became warm and moist; if the patient had been delirious, but wis regaining his reason, he was then consi- dered in a state of comparative safety. But it was necessary for his complete recovery, that he should be kept in this state, until the appetite was so far restored, that animal food with tonics could be in- troduced, in sufficient quantities, to preserve a pro- per action. To effect this, a regular course of the stimulants was ordered, suited in Lind and quantity to the exigency of the case ; diminishing them as the appetite and strength increased, and substi- tuting in their place the more permanent, as the cinchona, Colombo, or any of the vegetable astrin- gents. Some time between the second and sixth day, if the medicines had produced the expected effect, by increasing the action of the system, it was necessary to open the bowels by a mild cathartic . or an enema. In most cases, small doses of calomel were given on the second or third day; not with a view to evacuate the bowels immediately, but to prepare them to be opened by an enema. It was not attempted to open th_.._......." SPOTTED FEVER. 45 relief; for, during the violence,of the disease, no- thing could be removed from them which had any agency in producing, or which assisted in keeping up the diseased action: and this relief was called for, at an earlier period, where clysters of laudanum and brandy had been frequently used, than where their use had not been required. To effect this, an enema was preferable to a cathartic, for it induced less debility, and its operation was more under con- troul. It was generally administered after the calomel had been continued twelve or fourteen hours: it was not intended to procure more than one evacuation; and in some capes, so great a pros- tration followed this, that the patient was with much difficulty recovered from it. When this took place, large injections of laudanum and brandy, or laudanum and soup were resorted to; as well to check the discharge from the bowels, as to increase the action of the system, for which additional sti- mulants became necessary. When the clysters were continued for a number of days, the intestines were evacuated once in twenty-four or forty-eight hours; but when stimuli, in sufficient quantities, could be introduced into the stomach, an evacuation, unless some particular reason required it, was not neces- sary more than once in three or four days. The diffusible stimuli were always cautiously and very gradually withdrawn, and only where the more per- manent could be substituted in their place. About the fourth or fifth day, or at an earlier period, if the stomach would retain it, cinchona was given in as Ipi-o-p doses as the natient could bear; and at this 4b' REMARKS ON THE period, wine was generally sufficient, with the to- nics, to preserve a proper action, and was continued until the debility, consequent to the disease, was removed, and the patient could resume his usual mode of life. If coma had come on, a fatal termi- nation was only prevented by increasing the quan- tity of stimuli, and by seizing every opportunity to introduce them. As during this state, no medicine could be given by the stomach, large and repeated injections of laudanum and brandy, or soup, some- times raised the patient from a comatose state, and enabled him to receive stimuli by the stomach, so as to prevent the return of this formidable symp- tom. The application of epispastics, and volatile medicines thrown in the nostrils, have had the same effect. There have been instances, where an emet- ic, which operated very quickly, produced the same result. Attempts have been made to rouse the patient by injections of turpentine and copaiva, and in a few instances, with success; but more generally the bowels were so torpid, that even six or eight ounces proved useless. Venesection gave no relief. Therefore, when called to a patient recently at- tacked with spotted fever, our object is to raise the excitement by the use of external and internal stimulants. If the attack be moderate, mild ones will answer at first, and probably through the course the disease; if it be violent, the more powerful must be used: at any rate, let enough of such as are proper be administered. To increase the ex- SPOTTED FEVER. 47 citement, and procure a warm, moist skin, let the patient be put in a warrh bed, let heat be applied and continued till the object is gained. At the same time, some internal stimulants must be given, con- joined with opium, which, in all cases, will be in- dispensable ; especially if there be great pain or ra- ving delirium, when it should be repeated at short intervals until the senses be restored. Let the stimu- lant that is used, be repeated at proper intervals, and increased if the symptoms do not soon yield. On this circumstance, in a great degree, depends the succeeding treatment: if they do yield; if a warm and moist skin be produced, and if the pulse increase in strength, it is probable the case will re- quire only mild treatment, and the weaker stimuli will be sufficient. But, if the symptoms do not yield; if the heat be not restored, nor the pulse increased in energy; if the medicines be ejected from the stomach, let the stronger stimuli be resorted to, or the mode of administering those already used, be changed. When laudanum does not agree with the stomach, from some peculiarity in the constitution, let it be given by injections, with brandy or soup. If wine sours on the stomach, and increases the vomiting, let one of the ardent spirits be used, or the acidity corrected by some alkali; apply an epispastic to the back or over the stomach; let the medicines be given in smaller and more frequent doses; let the arsenite of potash be administered in small quan- tities ; especially if the heat be not restored, or after 48 REMARKS ON THE SPOTTED FEVER. having been restored, it has again receded. In some cases, much benefit will be derived from changing the stimuli, although they be of equal strength ; let the patient have constant and careful attention; let all means, that afford a prospect of success to check the vomiting, be used ; for unless this be soon stop- ped, coma will succeed, when access to the sto- mach being cut off, there will be much less prospect of removing the disease. But, if coma has come on, we should not despair. Let the number of blisters be increased, as well as the external applications of heat; let there be large and frequent injections of laudanum and soup, or soup administered, and some of the methods of rousing a patient already mentioned be tried. But we will suppose, that the medicines have had their intended effect, and more favourable prospects present. The small doses of mercury should now be assisted by a laxative injec- tion and the patient supported under its operation; milder stimulants with tonics will enable us to hold the advantages gained; the former should be cautiously diminished and the latter gradually increased as convalescence progresses. Let these be assisted by generous diet and proper cordials until health be completely re-established. Under such a course, this end will probably soon be gained; for, to such treatment, and to such only, has this disease yielded. OBSERVATIONS ON THE REMITTENT FEVER, AND ON THE PLAGUE WHICH PREVAILED IN THE ISLAND OF CORFU DURING 1815 AND 1816. BY WILLIAM GOODISON, M. D. A^isTANT SURGEON, 75th REGIMENT. ADVERTISEMENT. THE following letters, although manifestly not written with 'a view to publication, appeared to the Editors to contain so much valuable matter, that they obtained the permission of Mr. Crampton, the Surgeon General, to whom they were addressed, to lay them before the profession. Original observations, illustrative of the nature of pestilential contagion, must always be possessed of considerable interest; but their value is mate- rially enhanced when, as in the present instance, they are made without a view to the support of any peculiar opinions. v2 192 DR. GOODISON Extract of a Letter, dated Corfu, December 26th, 1815. I have had a good deal to do since my arrival here, a severe fever having prevailed in the regiment during the whole of the hot weather, which I have had to encounter myself, with only the occasional assistance of an hospital mate : it was the bilious remit- tent, attended in many instances with a deep yellow- ness of the skin, and in a few severe cases, with great irritability of stomach, and, in my opinion, differing only in degree from the yellow fever. In most instances I found decided advantage from opening the temporal artery, more than the depletion, merely as such, would seem to afford; where the hcadach is severe, the eyes brilliant, and the countenance flushed, it cuts the disease short at once. An universal symptom, which the men des- cribed as a stunning and dizziness of the head, prevailed, which also derived generally decided ad- vantage from the same remedy. This affection, when amounting to fainting upon sitting or stand- ing up, was, as you may suppose, a very alarming symptom. I opened the bodies of eight out of twelve (I think) that died ; the number of cases of fever of all descriptions, during the summer, amounting to between 210 and 220. In all I found the gall bladder distended with bile, the quantity amounting in two cases to two ounces; and in the others, vary- ing from one ounce to 1^ ounces; it was black and ON REMITTENT FEVER. 193 ropy, but made a beautiful yellow when lowered down with water. No gall stones or other obstruction in the biliary ducts. The large intestines were in some places much contracted, in others considerably dilated, and some distended with air. There were always traces of inflammation to a greater or less extent in the brain ; in some, water in the ventricles ; in some, the vessels of the pia mater were turgid with red blood ; in most cases, in three at least, that I recollect, there was an effusion of coagulable lymph directly under the vertex of the skull to the extent of a Spanish dollar. There are no marshes sufficiently near to assign as the source of this complaint, and although we had softie bad cases, among such as had been on guard in the neighbourhood of ditches con- taining stagnating sea water, yet they were not altogether confined to sources where the causes were so evident and ascertainable ; in many cases, it must have originated in the heat of the weather (the thermometer standing generally at 84°.) merely or conjointly with a peculiarity of soil. When light rains occurred during the heat, we were sure to have bad cases immediately after. Since the cold weather it has changed gradually into the intermit- tent form, of which many cases have been very se- vere and obstinate. Bark, although it has been greatly decried in these countries, from its being found not to come up in infallibility to the expecta- tions of some enthusiasts is yet an excellent me- dicine in the purely intermittent form, and will cure two thirds of the cases to a certainty, but is never used in the remittents of these countries, 19i DR. GOODISON from the certain conviction of its doing harm ; in the latter, bleeding from the temporal artery, purgatives, and the James's powder, were active and useful re- medies, when employed with judgment and discri- mination. In cases of irritability of stomach, the effervescing mixture and tincture of opium, the latter was particularly useful, joined with the tepid ablu- tion at bed time, when the heat of the skin re- quired it, and the state of the stomach forbade the use of antimonials. I think calomel did mischief l>y encreasing the action of the liver, and, as I sus- pect, producing tympanites, for which I could assign no other cause. I fear I have dwelt too long upon this subject, without offering you any thing new or interesting ^however, since writing the above ac- count, I am sorry to inform you that there are grounds to suspect that the plague has made its ap- pearance in this island, and about fifteen miles from this town. We are all upon the alert, and have formed a cordon of light troops about the villages where it has been discovered, so that, if the fomites have not been already disseminated amongst us, we shall, please God, escape; and there is every reason to hope that we shall be able to circumscribe this hor- rible evil, and confine it to the source from which it is believed to have sprung. The first village where it appeared contained about 52 or 53 inhabitants (a colony of Albanians) of whom 30 were taken ill, and four only survived. The town has been burned with every thing in it, and the few remaining inha- bitants supplied with every necessary and comfort, but kept under strict quarantine. I do not like to ON THE PLAGUE. 19^ call it by so horrible a name, but certaiuly there are stong suspicions that it is the same. Extract of a Letter dated Leftimo, Island of Corfu, July 2d. 1816. If the following detail of facts, which came under my own observation, and that of my friends engaged in the same duty, afford you any satisfaction, I shall be content. I was ordered down here on the 12th of March, and took charge of one half the infected district, called Lower Leftimo, then under Deputy Inspector Tully, who superintended the whole ; I had only an opportunity of seeing about twenty cases, as in the scattered population of this district I was obliged to assign a great deal of the medical inspection to a native doctor; our duty was to separate the infected, and have them sent to the Lazaretto, and the sus- pected to a camp constructed for the purpose, and admirably arranged by General Phillips. The disease was at its height about the time of my arrival, but soon began to feel the effects of the order established upon this plan ; it declined rapidly afterwards, and the last accident occurred upon the 6th of May, ten days having intervened between jt and the one which preceded it, free from plague. As to the origin of the disease, the fact is not sa- 196 DR. GOODISON tisfactorily ascertained ; it existed about twenty days before the government got information, and about thirty persons had died ; they were supposed to have died of the stripes and strangulations inflicted by the spirit of a man who had been murdered in the village of Marathea, where first it appeared; under this impression the inhabitants collected all the priests of the neighbouring villages to aid in appeas- ing and laying the angry ghost; a convocation of Papas (as the Greeks call them) was accordingly held ; several ridiculous ceremonies used, amongst others the digging up of some of the bodies, putre- fying and in their infected cloths, (the custom of the country being to bury them so) and solemn mass was performed amid a crowded congregation. Another act of superstitious infatuation had nearly involved the city in the same calamity, a close narrow-laned dirty town containing about 18,000 inhabitants. They actually sent pieces of the clothing of the infected bodies to be nailed upon the coffin of the tutelar Saint, Spiridion, who among many other mira- cles, has preserved the city at least, from the conta- gion. The breaking up of the convocation was fol- lowed by the dissemination of the disease through the persons of the Papas in all the surrounding villages, to the number of ten or twelve, the population of which varies from 1 to 7 or 800 each, scattered over a district of about twelve or fourteen miles ; after this a cordon was formed against the infected district, which proved effectual in protecting the city, with the aid of St. Spiridion. Deputy In- spector Tully came down with an hospital assistant, OK THE PLAGUE. 197 and attacked the enemy at his first point, Marathea, but they soon found that he was too many for them, having had the start of them long before. Poor-----the hospital assistant, fell an early vic- tim to his own inexperience. Only nine of the people of Marathea, remain out of 45, its original number ; and it continued to break out in the other villages from time to time, till at last the number of deaths amounted to eleven of a day, no inconsider- able mortality for the small population. The gross amount of deaths, as well as could be collected, was stated, in the Gazette of the 11th May, at 414, and about 60 counted convalescent; but I have reason to believe that only one recovered out of every fifteen attacked with real plague. The character of the disease, when I saw it, was marked by the following symptoms, set down in their order of succession: previous costiveness and white- ness of the tongue; nausea ; a dirty sallow com- plexion ; slight irregular rigors, sometimes, but rarely amounting to severe shiverings ; vomiting, with un- common anxiety and irritability of stomach ; tongue permanently white, and loaded with white curdy matter at the root, generally a triangular patch in the middle, of a florid colour, the base of the triangle at the apex of the tongue, and two white stripes occupying the remainder of the upper surface ; the edges remarkably red; the countenance sallow, indicating fear and anxiety, with a horrible expres- sion of despair, particularly when the patient was aware of his awful situation ; staggering came on the first evening, if the patient was attacked in the 198 DR. G00DIS0K morning, and formed a decided feature of the disease upon the morning of the second day. This symp- tom, or total inability to keep the legs, was quite suf- ficient for the diagnosis, although the rest were wanting. This staggering is not like the effects of weaknes in remittent or other fevers, where the patient falls doubled up like a sack ; in plague he is capable of making an effort with his limbs to keep himself erect;—nor do I think in plague it is so often attended with syncope ; in fact it is the staggering of a drunken man ; and many were reported to be drunk, who were actually plagued. When brought to the full light at the door, he probably collects sufficient strength to strip himself, aided by one or two of the family ; he sinks under the exertion, the light too overpowers him, he rolls his glistening eyes and staggers off. Generally the bubo or carbuncle has been now discovered, or the purple petechia?, that evening (the second day), and he dies the fol- lowing morning, or before the next night. This was the usual progress. I am unacquainted wholly with the particular appearances after the second day, from personal observation, as our duty in the villages was to send the infected off to the La- zaretto instantly. They sometimes died delirious, sometimes comatose ; at the commencement, a frantic delirium generally terminated their life and their mi- series together, the bubo being attended with a dreadful succession of convulsive paroxysms : The buboes were sometimes large, and sometimes nu- merous. Upon one old woman I saw five, livid at the top and fiery at the base ; the carbuncle OX THE PLAGUE. 1&? was of the same character, and attended with rapid sloughing, or rather mortification. I have seen the petechia? just as if you had taken a pen full of ink, and filliped it against the body, so black and well defined were they. So far the diagnosis of the disease is easy, but the symptoms are not always thus clearly marked. I have seen two medi- cal men, and a third, a man of great experience, though not a professional man, pronounce upon one of the last cases, that it was not plague. The fol- lowing morning the man, who was an expurgator, had a bubo, and died upon the third day. He had been employed in the most dangerous offices from the beginning with impunity, in carrying the infect- ed and burying the dead. Th? anomalies were frequent and various. A man came to a friend of mine to have his tooth drawn, with toothach and swelled face. The swelling was a parotid, and he died the thiiu day. In another the first symptom was pain in the occi- put ; the disease, too, frequently set in with pains resembling rheumatism. One of the most extraor- dinary facts was the existence of bubo, although the constitution was but little disturbed : of two men who were so little indisposed as to converse with me long and freely, upon the cause of their complaint, and calmly to point out the persons with whom they had had any communication ; one had at the time an axil- lary, and the other an inguinal bubo : both were dead in forty-eight hours. Many similar cases occurred to other medical officers. Poor ----- was, I am 200 DR. GOODISON told, first attacked suddenly with pain in his grom, after resisting the contagion for a long time. These facts appear to me to argue strongly against the opinion, which savours so much of the humoral pathology, that bubo is an attempt at a salutary and critical discharge. That nature should take up the alarm so very quickly, (as it is expressed) before she feels the effects of the original impressions, is making her provident indeed, and to very little pur- pose, as the worst symptoms usually follow the com- plete formation of the bubo; it is in effect making her a perfect suicide, which our visionary theorists never stick at. Another extraordinary fact was the almost total suspension of all other acute diseases during the period, in a country where every change of season brings a train of diseases more or less fatal. Tully, who knew what was passing in the whole district, observed the same circumstance; and it is singu- lar, that the only exception to this, was three cases of gout occurring in Lower Leftimo, and two of the same at the camp, and this notwithstanding the hardship and privations to which all were exposed, being mostly under canvass at a season of such con- tinued rain between the equinoxes, that the occur- rence of two successive fair days might be deemed a phenomenon, yet in the city and beyond the cordon, inflammatory diseases occurred in the usual propor- tion. ON THE PLAGUE. 201 With respect to the contagion, the following facts may not be uninteresting. A woman was taken ill within a month of her time; she was delivered in two days, after which she only survived three. She had no symptoms or mark of plague upon her body ; however I judged it prudent to send the family, con- sisting of six persons, including the infant, to the camp, to be placed in observation ; after six days a thrifty old lady of the family, having got herself set- tled, took a handful of cotton to spin ; she" had no sooner set to, than she was taken ill with vomiting; a young man was also infected before night, and the whole six were exterminated in a week, with five other persons in an adjoining building, who had had communication with them. I traced the contagion in two instances to pack-saddles which were infect- ed. In one of these cases the father, who used the saddle, escaped; but his son, a boy about nine years of age, caught the infection, and died in three days. The mother, who carried the boy to the camp in her arms, a distance of six miles, left her house in per- fect health, was attacked the following day, and died in thirty hours with petechia?, carbuncle, and bubo. I think we are but ill acquainted with the limits of the operation of contagion and the laws of suscepti- bility. Most extraordinary and unaccountable in- stances occurred, where the greatest caution, excited by the greatest terror, could not shield the unfortu- nate victims of this horrible disease ; of course the infection was conveyed, in all these instances, by contact, which, in the ever multiplying sources of danger, unexpectedly took place; yet of 300 Alba- 202 ER. GOODJSON nese soldiers, employed in guarding the infected, following the track of contagion hourly, patrriling the streets at night, and, above all, guarding the expurgators in their various offices, we lost but two, a captain and his servant. Yet they could not take any precaution about their shoes and clothes. In many families in this quarter the mortality was deplorable, fifteen dying out of sixteen infected, at the lowest calculation: this was, however, owing in some measure to the remoteness of the Lazaretto, which was six miles off. With respect to the intro- duction of the disease, I am firmly persuaded that it was imported, although I know many believe it to be indigenous, and they have some strong rea- sons to support this opinion. First, they say we cannot trace out the fact of its introduction > notwithstanding the offer of a large reward. Se- condly, that the district has been always remark- ably unhealthy, and twice had medical officers been sent down two successive autumns, to ascertain the nature of a suspicious epidemic. Thirdly, the cha- racter of the disease varying so much ; at first it ap- peared in the form of cynanche maligna, nor did pa- rotids appear until some time after this period, and bubces much later, accompanied by convulsions and sudden deaths. The period of the disease also va- ried ; at first it extended to five and seven days, lat- terly three days was the mean duration. Most of the patients I saw died in forty-eight hours, and there is reason to believe that some were cut off in twelve hours. ON THE PLAGUE. 203 In answer to all these : First, the whole nearly of the village of Marathea, where it broke out, was de- stroyed, certainly all that could know any thing about it. Secondly, the exemption of all the other parts of the island outside the cordon, (although subject to all the circumstances assumed as the cause of the disease at Marathea, viz. bad air, the consequent generation of a contagious distemper, aggravated by poverty and every sort of privation). Add to this, that although the district had been always unhealthy, no disease, known there before, approximated to this in its pro- portion of mortality (ab initio) to convalescence. The ratio was nearly inverted, one death occurring in six- teen cases of the severest remittents, during a sum- mer ; whereas fifteen died of plague, for every one that recovered. Thirdly, I believe it always hap- pens that plague makes Its appearance in an ambigu- ous form, and shifts and changes about like a Proteus. I know not what apology to make for this long string of facts and opinions, all jumbled together, but that if I had had more leisure I should have been more attentive to order. I was determined, how- ever, to dispatch them even so, and just set them down as they occurred in my note-book. CHARLESTON MEDICAL JOUEML AND EEVIEW. Vol. XV.] CHARLESTON, S. C, JAN., 1860. [Xo. 1. Art. I.—The Yellow Fever of Charleston, considered in its rela- tions to the West India commerce. By William Hume, M.D., Professor of Experimental Science in the State Military Academy of South-Carolina. It must be obvious to every reader, who follows the argu- ments of the various writers on the origin of yellow fever in our city, that the object of one party is to protect the citi- zens at any pecuniary cost, from the ravages of pestilence, , while the other is interested in the protection of a particular commerce, which is believed to be more beneficial to the city, than the preservation of our sojourning foreign popula- tion. It seems to be conceded by one party, that the impor- tation of one thousand hogsheads of sugar and molasses advances the prosperity of the city more than the immigra- tion of one thousand Irish and German candidates for per- manent citizenship, while the opposition party believe that an increase of our population from any source, is a perma- nent increase in our means of fixing wealth, and that the income from an emigrant's labor, remains and accumulates, so long as he lives, and also survives in the labor of his chil- dren. Opinion is divided between the receipt of an annual income from commerce, and a permanent capital from popula- tion, for, in the present state of our knowledge, derived from the experience of the past, an increase of population is incompatible with the occasional prevalence of a mortal pestilence. It operates in two modes. It destroys those vol. xv.—no. 1. 1 <■') m 2 Original Communications. who settle, and deters others from settling. The ignorant, the destitute, or the desperate, alone will risk our climater while the more desirable and useful will settle other and safer regions. Thus Charleston suffers both in the quan- tity and quality of its emigrant population. Capitalists and foreign merchants avoid us, while petty German traders and Irish laborers supply their places. Onr pride and pre- judices are excited against them, and it is not uncommon for a native to rejoice at the advent of fever, because he knows that the evil is to be diminished by the funerals of many. These intemperate expressions are occasionally rebuked by the death of a favorite native, or presumed climatized citi- zen, when all parties unite in one general conviction of the extent of our calamity, propose the employment of energetic means for its future prevention, agree upon the necessity of the most complete sanitary measures to prevent its propaga- tion, and the most rigid quarantine to prohibit its introduc- tion. The winter returns, the disease is arrested, business is resumed, and the visitation of the last season is forgotten. The summer again returns, and finds the parties again divid- ed; one maintaining the domestic origin of the disease, and the sole propriety of cleaning, draining, ventilation, &c, as the only means required for its prevention, the other party concurring in the benefits of these precautionary measures, desires 'to add the rigid quarantine to make " assurance doubly sure." The claims of commerce are interposed. It is made to appear that the commercial wealth of the city is concentrated in the yellow fever ports; that all the cotton and rice on hand will remain unsold, and the cargoes re- quired for old Spain will remain on our hands. Spain and her colonies thus become magnified into the Avhole World, and we are urged to believe, that we must trade with Spain, under the contingency of importing a pestilential disease, or lose the trade of the world. We have no objection to trade with the Spanish colonies for nine months in each year, and do all that we have to do, but we cannot consent to trade with any country on such dangerous terms as the other three months necessitate; and if this principle was fully carried Hume on Yellow Fever. 3 out, we would avoid a danger which is believed by some, suspected by many, and denied and ignored by a few. The odious humbug of quarantine would be useless, the attempts to avoid its provisions would be unnecessary, the hopeless endeavors of the hygienists would cease to annoy the com- munity, and the citizens would then be convinced that our past misfortunes have proceeded from our own avarice, and not as a retribution for our other manifold sins. Cleanliness and adequate drainage are essential to the ame- lioration of our indigenous and local diseases; and in what- ever climate cities may be built, and in whatever locality, a large population may be collected, there must drainage, sewerage, and scavengers work be done, as a common preventive to every disease that moisture, and bad air produce or propagate, commencing with the fashionable cold, and ending with the prolonged typhus. It is obvious that the only true and certain mode of re- lieving our city from the occasional visitation of yellow fever, is to prohibit promiscuous and careless intercourse for three months with presumed infected cities. If a single case of such introduction and subsequent propagation is es- tablished beyond a doubt, we may have strong suspicions that it can be done again, and has been done before. If it can be shown that the eight epidemics which have appeared in Charleston since 1838, have been traced to Cuban commerce, introducing into our city persons already sick of the disease, or taken sick soon after arrival, it is clear that tue disease can be, and has been transported from an infected city to a sound city; or if it can be shown that during the healthy summers no such case has been introduced, and this particu- lar disease has not prevailed, then we are justified in our position that a subsequent propagation does not, and cannot occur, without a preceding importation. The effect is ab- sent, because the cause is absent. The native counterfeit, the so-called sporadic cases never assume an epidemic num- ber, are never traceable to a foreign influence, nor are they propagative. The proposition of a three months suspension of the West 4 Original Communications. India trade will fall harshly upon the commercial ear, and a greater clamor majT be expected than has ever fallen upon the ill-fated Quarantine. Nevertheless, desperate means must be opposed to avert imminent dangers. The facility of evading the most carefully prepared regulations, the unseen, and stealthy manner of introduction, the unknown escape of a dangerous subject, and the rather prolonged incubation of the disease in an individual who has undergone the detention demanded by the present law, possibly in an infected ship, are so many reasons to doubt the certainty and security of the present system. It is satisfactory to know that each year of Quarantine adds to our knowledge, and that an amount of positive information may be hereafter obtained adequate to remove all defects and secure a system capable of protecting our city. The last summer's observation devel- oped some important facts. Namely, that the cook Tynen could secrete himself on board the steamer plying between the city and the Catawba, escape the vigilance of the police for many days and remain well all the season. That Garcini and Scharwacter did remain on board of the Catawba for the allotted period of eight days, were lawfully discharged, took the fever three or four days after their entrance into the city and died. Thus want of vigilance was manifest in the escape of Tynen, and although we have no reason to apprehend that any injury was done to the health of the city by his entrance into it, yet another escape of a better subject for fever might not have been attended with the same happy result. The lawful discharge of Garcini, and his arrival into the city before his period of incubation had terminated, was a far greater mis- fortune than the escape of Tynen. In the latter ease, the framers of the law erred in the presumed time of incubation, and notwithstanding great efforts were made at the time to obtain twenty one days, the majority prevailed and eight days was voted to be sufficient. The case of Garcini and others show that the period of incubation exceeds eight days, yet the law remains unamended, and other Garciuis and Scharwactcrs may renew the calamities of 1858 in other vears. By a curious concurrence, Tynen and Garcini put up Hume on Yellow Fever. 5 at the same house, and in this house was reported the first case of yellow fever in 1858. Abbot and Tynen occupied the same room, and were together for twelve days before Abbot sickened. Garcini and Abbot were adjacentand visi- ted each other for two days before the illness of Abbot, and other two days before the illness of Garcini. On the evening of the 12th, Garcini was removed from the room of Abbot to bed from which he never arose, for he died on the 15th, 4 A. M. The discovery of yellow fever in a house in which two men recently from Havana where domiciled, was sufficient, to awaken the suspicions of the community, and to refer the origin to direct importation. The contagionists were elated, but the non-contagionists were equally sanguine on the dis- covery, that an old cellar had been deepened, and converted into a cistern, that the earth had been deposited under Gar- cini's window, and that a privy had been removed, and the old sink filled up with earth, and boards laid over the whole. Here was a local cause adequate, in their estima- tion, to produce the whole effect, and the illness of Abbot and Garcini was referred to this local cause rather than the infected city of Havana from whence Garcini had returned four days before. In the absence of positive proof each party must enjoy their own conclusions. Garcini had yellow fever, of which he died. Garcini had just arrived from an infected city, Garcini was exposed to the malaria of the excavated cellar and removed privy, hence Garcini was bound to die from one or the other cause, according to the opinions of the contending parties. But Tynen was equally exposed to both causes. He had also returned from Havana, and he had been exposed to the malaria of the cellar, &c. and was proof against both. He still lives. If we now trace out Scharwacter, the companion of both, we find him at his brothers, Xo. 18 King street, where no cellar had been excavated, and where no privy had been removed, yet Scharwacter proclaims himself to be unwell, on the 10th, returns to the Catawba, is sent to the Lazaretto, a case of yellow fever, and dies on the 16th. Now it is certain that no similar local cause had an action on Scharwacter, as that alleged against Garcini. Yet both died G Original Communications. of the same disease, and about the same time. It is evident that the only cau>e of yellow fever, that was common to both, was the visit to Havana, and if both were susceptible of the poisonous influence of that locality, there is nothing new, nor wonderful in the fact of the disease, and death. The febrile transactions in Tradd street became more com- plicated by the illness, and death of Abbot, who made no voyage to the Havana, yet suffered the evils of such a voyage. It is alleged that Abbot died of yellow fever, which is not denied, but is it proved that Abbot's disease commenced as yellow fever ? May it not have been a con- version of type, from an ordinary fever? under the influence of Garcini's presence. Similar conversions of type are com- mon, during the prevalence of yellow fever; a case of common remittent fever, becomes a case of yellow fever in a day or two, as has been often observed in our Hospitals. In fact the conversion is so complete, that it is impossible to dis- tinguish the convert from the original, except by reference to the previous history. Sailors from Georgetown, Savannah, and Wilmington, with the respective fevers of those locali- ties, have been admitted into the Marine Hospital, and have died of yellow fever within four days. Now it would have been a grave error to have attributed the origin of yellow fever to those localities. They are clearly conversions of type, under the influence of the more powerful disease, which is present in the building. Such conversions do not occur when the yellow fever is absent. Such fevers pursue their natural course, and end as they would have done in Georgetown, Savannah or at Wilmington, and in the same manner as if they had not been removed. The principles contained in these observations apply to Abbot, as correctly as they do to the sailors in the Marine Hospital. There is nothing wonderful in the fact, that a policeman should have a fever. Such things are common. There is nothing won- derful in the fact that the disease should assume the appear- ance of yellow fever. Such things are also common. There is nothing wonderful in the fact that he should die of yel- low fever three days after another man had died of the same Hume on Yellow Fever. 7 disease within ten feet of him. Such things have happened before. In 1856 Diola was brought to the Murine Hospital with yellow fever, on the 2nd of August, first case. Nelson was confined to his bed with a broken leg in the opposite room about 14 feet distant. On the 5th Nelson took the dis- ease and died on the 10th. That Diola was the cause of Nelson's disease, there can be no question, for Nelson had not been out of his bed for four months. The same influences were produced on the 2nd story shortly after. Pettighon, the 2nd case, infected Hansler, and Hansler infected his nurse. Now if these infections can occur in a public Hospital, and become parts of the history of the dis- ease, where is the impropriety of explaining similar occur- ences, when they happen in a private dwelling on the same principles? If Diola could infect Nelson, free from any feve'r as he was, and of course less susceptible of the disease, from an adjacent chamber, why could not Garcini have the same influence on Abbot, who was suffering under some kind of fever ? and of course more easily influenced. The identity of the two histories is so perfect that whatever may be true of one may be assumed for the other. The influence of the sick upon the well, in this particular disease, is so well estab- lished, that it does seem strange that many will resort to local causes to account for those results which are so much more rationally explained by the facts connected with per- sonal causes. Who can say that Abbot would have died of yellow fever, if Garcini had not brought the disease from Havana ? Would Nelson have died, if Diola had not been in the next room with the identical disease ? I have presumed that Abbot's disease was not primarily yellow fever, notwithstanding its resemblance to it, but be- came yellow fever under the plastic influence of the genuine disease in the person of Garcini, who had recently arrived in the Catawba from Havana. I found this presumption on the observation of many cases of fever which came under my notice, which were at first reported to be yellow fever and subsequently Droved not to have been. It is probable, that these fevers continued to occur during the whole summer, 8 Original Communications. and increased the extent of the epidemic by frequent con- versions of type in susceptible persons, under the influence of effluvia emanating from persons in the neighbourhood afflicted with the genuine disease. These mild, possibly malarial fevers attacked natives as well as foreigners, the acclimated as well as the unacclimated, the negroes and colored as well as whites, and presented various degrees of intensity, frequently passing into yellow fever and death, but oftener into recovery. Many persons who had yellow fever in former years declared that they had the fever again in 1858. And the cases were so numerous as to leave no doubt, that we had a malarial fever prevailing at the same time with yellow fever. Under these circumstances, it is not surprising that errors of diagnosis should have been commit- ted. At the onset of disease it was impossible to say which would terminate the case. If the patient was a stranger we apprehended the fatal yellow fever, if a long resident we might hope for a speedy recovery. Now if this uncertainty prevailed during the epidemic, how much more uncertain must our diagnoses have been before the epidemic was fully developed ? And how probable does it seem that Abbot's disease did commence as malarial fever, and subsequently assumed the type and fatality of the recently imported West Indian disease, and was but an unrecognized prototype of many cases which followed under similar conditions. The deaths of Garcini and Abbot on the 15th and 18th of July excited the medical mind to watch for the first signs of propagation of the disease, which from previous observa- tion was reasonably expected. The seed was planted, the soil and climate were propitious, and we had onlv to wait for the germination. On the 21st the alarm was sounded in the person of Cathcart, residing in Whim's Court, King street, a policeman from New York, and well suited to receive either disease; the result proved that he had the native malarial, and not the foreign introduction of Garcini; for he speedily recovered, and later in the season fell a victim to yellow fever. Another policeman of the name of Nevins, residing in Tradd street, at the Carolina Coffee House was the first to Hume on Yellow Fever. 9 sicken, and die of yellow fever. He was attacked on the 30th July and died the 5th of August. We have no positive information relative to his previous movements, except that he had visited Fort Johnston, and as a policeman may have visited the neighbourhood of Garcini's and Abbot's house. The infection of the neighbourhood is so well established by other testimony, that the proof that Nevins did duty in the neighbourhood, could add little to the force of conviction. If others, as will appear hereafter, did take the disease by passing the house of Abbot, it is probable that Nevins did also, and suffered the usual penalty. Coincident wTith Nevins, in attack and death, was a negro, residing in Broad street, between King and Meeting, who was recently from Orangeburg District and a stranger to the disease. Hij residence in Broad street was but nominal, for he slept in King, and twice each day passed the house of Abbot. The infection of Abbot's house is further shown in the case of E, Coffine, an Irish carter, residing No. 3 Lingard street, who was attacked August 6th and died on the 14th. This man was employed in carting materials to fill up Tradd street, he passed and repassed the house several times each day. and occasionally entered the premises to satisfy his thirst. The 5th is recorded as the last day of work in that region. Coin- cident with the carter who visited Tradd street, was Mirs, Bauer, who resided at the corner of King and Tradd street, and within a few feet of Abbot's house. She died on the 12th. On the 8th and 10th her daughters sickened, one recovered, the other died on the 13th. On the 10th a Ger- man girl immediately opposite Abbot's house sickened, and died on the 13th. Many other cases immediately succeeded each other in this neighbourhood, all tending to show that ger- mination had commenced, and that a fearful harvest was to be gathered. At this period much malarial fever prevailed in distant parts of the city, and some of them were reported as yellow fever which the subsequent history disproved; for they recovered and died afterwards of yellow fever in its un- mistakable form. The propagation of the fever from its primative location was observed to occur both by diffusion 10 Original Communications. and transportation. In process of time, the range of cases was enlarged from the corner of Tradd and King streets, among the fixed population, to all of the neighbouring streets) and soon became so wide and general as to defy correct record. Lingard street soon became another centre of pro- pagation. Receiving the disease by transportation, through the Irish carter Coffine, it was subsequently extentded both by transportation and diffusion. " In the room in which the first case ocurred were 4 other occupants, and in the same house wrere 4 others. None of these 8 men took the disease while the case was in progress, but as soon as its nature was ascertained, they scattered, and carrying the germs of disease with them, as many as 4 sickened in various localities to which they went, and spread the disease over Lingard street and neighbourhood. " It is not necessary to pursue the pro- pagation of the fever any further. If we have succeeded in pointing out its first location, the method by which it was there carried, and its subsequent spread to all parts of the city, we have accomplished our design. Perhaps there never was a summer when the facts were more clearly ob- served and the conclusions more positive, notwithstanding the complication introduced by Abbot, and the simultaneous prevalence of a native malarial fever, than the summer of 1858. If we reject Abbot altogether, and the various visitors to his neighbourhood, who received and developed the dis- ease in other places, and limit ourselves to the fixed popula- tion of Tradd street, we will find the facts equally conclusive. Garcini arrives from Havana, locates in this street, developes yellow fever and dies on the 15th of July. Ahrens is repair- ing the adjoining house, converts a cellar into a cistern, and removes a privy. During his illness a " fearful odor" of a cow yard, was perceived in the street; on further examina- tion into this " fearful odor, " it was found that aheap of filth, recently excavated from the cellar, was piled up in the angle of the two houses, six or seven feet high, and within two or three feet below the window of the room occupied by Gar- cini. I have been thus particular to give my readers a choice between two local facts, of an odor from a cow yard, and a Hume on Yelloiv Fever. 11 mass of earth from an excavated cellar, to account for the origin of yellow fever in Garcini, or the more commonly ob- served fact, that when a subject visits an infected city, he returns with the disease upon him. From annual observa- tions, I am inclined to think that i; fearful odors" and excavated earth, are not adequate to produce such fearful results, and if Garcini had stayed at home, we never would have known of the presence of a heap of cow manure in Tradd street, nor the improvement of these premises by placing a ristern where a cellar formerly was. Such things are perpe- tually being done, and are unnoticed because unavailable for a scientific purpose. It is injurious to commerce to admit the possibility, that a man can return from Havana and bring the yellow fever with him, notwithstanding the repeated observation of the fact, and its fatal consequences. An injury to the city by the destruction of one thousand inhabi- tants is a damage easily repaired, but commerce must not sutler by the suspicion of being accessory to this terrible calamity. It is for this reason that local causes are sought out. Cellars and sewers are occasionally condemned when in the vicinity of the sick, but harmless at all other periods. The time was, when the filthy docks bore the blame of local origin to yellow fever, but since the operation of Quarantine, and the detention of infected vessels at a distance, they have been found to be innocent and slander has ceased to assail them. If the interests of the city alone were consulted, and a particular trade detached from general commerce and deprived of its imperious sway, it would soon be discovered, that local causes play a subordinate part in the tragic scenes of our city, while at other times they are the foundation of that superior health which we are accustomed to boast of when yellow fever is absent. Garcini died on the 15th of July and left the city in the enjoyment of health. Reports were, however spread in the country that yellow fever was in the city, and prudent customers avoided us. A reverend gentleman who had returned from the interior, and found the city still free from an epidemic, proposed that I should pub- lish a card on the 3rd of August declaring the city healthy, 12 Original Communications. and assuring the country gentlemen that they might return with safety. I declined, on the ground " that b}7 the time the gentlemen arrived, they would discover that I had lead them into danger, for I never knew so palpable a case as that of Garcini, to be introduced into our city, without producing an epidemic, and that the most frequent date of develope- ment, was the 7th of August at which time I apprehended that the epidemic would be known. But if you will have patience, until the 14th, and no epidemic is then reported, I will assure the gentlemen that they may come." We now know that at the time of this conversation, Nevins and the Broad street negro, were suspected of having the disease, for they died two days after, on the 7th. Mrs. Bauer, living near Garcini's house, was declared to have yellow fever. Thus the epidemic was established about its usual period, and continued to extend to the end of the season. It is certain that at the time of Mrs. Bauer's attack there was no local cause for the disease on Ahrens' premises. All the alleged odors, and filth had been removed, the cistern was completed, and Garcini's house had been scoured, white washed and closed, its inmates having been sent to the Lazaretto. Yet strange to say, the disease of Garcini survived in the person of Mrs. Bauer, and shortly after in the persons of her two daughters, and finally ex- tended to more remote distances from the original source. The intervention of Abbot then becomes but an episode in the general tragedy of Tradd street. The same events would have occured whithout him, or without Ahrens' improve- ments, as did actually occur in Lingard street, where the Irish carter first transported the disease, and where it was extended without regard to any particular local causes, to which its origin could have been attributed. It is curious, and perhaps inexplicable, that the advocates of the domestic origin of yellow fever cease to investigate local causes after the first case. We have no observations of odors, filth or upturnings of the earth in Lingard street, yet the disease was as virulent and extensive there as in Tradd street. The general filth of the city seems to be sufficient to produce the disease anywhere after its first introduction, but for the first Hume on Yellow Fever. 13 case something extraordinary must be pointed out, anything* in fact, which will direct attention from the pernicious doc- trine that the disease may be imported, and that the West India commerce may suffer if such a belief becomes pre. valent. It is treason to the West Indian interest to charge it with the introduction of a pestilential disease, even if we see its entrance through Garcini, and observe its propagation from the position that he occupied. Is it not a crime of deeper dye to sacrifice the health and happiness of our whole community, to paralyze, for three months, all other commerce, and to expatriate our citizens, for the simple purpose of granting to a few a freedom of commerce, which is intrinsi- cally valueless to the city ? for the same articles may be im- ported from sound parts in sufficient quantities to supply the demand, at prices not exceeding the directly imported articles, whenever the received supply shall fall short of the demand. Could a portion of the mercantile community be induced to yield their rights to the general welfare of the city, it is acknowledged that the most certain, economical and efficient protection against the introduction and spread of yellow fever would be the suspension of the West India trade for three months. During the other nine, the whole work could be done, and a supply left in store to supply all necessities arising from the temporary suspension. It is a common argument advanced by the merchants, that yellow fever is not introduced by commerce, because com- merce has frequently failed to bring it. In other words, we have for a season, and for many seasons, been exempt from the disease, notwithstanding an active commerce has been carried on. This is certainly true, but cannot outweigh nor contradict the positive observation that commerce has brought it on many occasions. All the observations made since 1838, have concurred in this common truth; and the facts above detailed, relative to its importation in 1858, are beyond the powers of a reasonable contradiction. It is cer- tain that our predecessors never traced out the origin and spread of the disease, and were perfectly ignorant of its mode of entrance or origin. To assert that it was not intro- 14 Original Communications. duced by commerce, when it is apparent that they never made any inquiry, is to assume that to be true which has not been proved, and in regard to which no testimony can be ad- duced on either side. Recent researches have proved beyond a doubt many points that our forefathers never suspected nor investigated; and their negative testimony is but evidence of their carelessness and credulous reliance on the admitted doctrines of their day. The origin of yellow fever is not a medical question, it is a mercantile question. Any prudent physician would give the benefit of a doubt in favor of the inhabitants of a city, and decide that the liability to infec- tion is sufficient to suspend a particular commerce, provided that liability was established by the observation of any one season. But the merchant opposes this humane decision on the plea that it is an interruption of commerce, and an inter- ference with his private pecuniary interests. Public inter- est is but the sum total of private interest, and if you injure one of these "little ones," you injure the whole. The apple woman, at the corner of the street, has a right to garnish her tray with bananas and pineapples, and it is better that hundreds should die rather than that this privilege should be curtailed. Poor woman! how unconscious is she of the zeal and disinterestedness of her commercial protectors, when in her native benevolence she would give her whole capital and stock in trade to avert the disease from a single victim. The free trade principle may be precious to the merchant, but he should have the magnanimity to inquire into the fact maintained by others, that plague and pesti- lence follow in the footsteps of a continuous and indiscrimi- nate exercise of his alleged rights, and that the evils to the public far outweigh the private benefits. There is but a step between legitimate and licentious commerce; and any commere is licentious which becomes injurious to the pub- lic; and any commerce which is injurious to the public should be suppressed or suspended by those in authority, who are presumed to be empowered to take care that the common- wealth shall suffer no detriment. The frequent exemption of our city from the ravages of Hume on Yelloiv Fever. 15 yellow fever, when an uninterrupted commerce with the West Indies was maintained, is no proof that it is not brought to us at other seasons. The examination of the general fact may throw much light upon the particular facts, and lead to a principle of great practical value. It may be the means of correcting many popular errors which lie at the founda- tion of an honest prepossession, and enable us to distinguish established theories from assumed hypothesis. It is a com- mon assumption with some, that the air of an infected city may be brought by a vessel, and, when liberated, may infect the citizens; and that every vessel, thus arriving, is equally charged with the same poisonous material; and entertaining this view, many are of the opinion that simple ventilation is sufficient to expel it. This view may be perfectly correct, provided that no yellow fever case has been on beard; but if such a contingency has happened, no ordinary ventilation nor reasonable time for self purification will succeed in re- moving the infection. Thus, the presence of the disease on board materially alters the condition of the vessel, and what is true in one case becomes untrue in the other. The dan- ger of a vessel, then, consists in the fact of having had a case on board, and not that she has arrived from an infected port. Many vessels annually arrive in our harbor without having had a case during the voyage, and are perfectly harmless; a*nd many seasons of exemption are explicable on this fact. During the season of 1858, of one hundred ves- sels retained at Quarantine, only ten developed the fever; and possibly only those ten would have been detrimental to the cit}', while the ninety would have been harmless. Of the ninety we may allow ten as having had concealed cases; there still remain eighty that might have come up to the city without provoking an epidemic. During the season of 1857, seventy-eight vessels were retained at Quarantine, and but one developed the disease (the Ciscar), and only two others are known to have had the disease on board previous to ar- rival; thus sixty might have been admitted to the wharves without the production of an epidemic. During the present season of 1859, no vessel with the disease on board has ar- * 16 Original Communications. rived, and but one discovered which had the disease on board before sailing for this port. Hence, with the single exception just mentioned, we might have escaped an epi- demic this season without the exercise of any quarantine. That similar exemptions may have proceeded from similar failures to bring the disease into port, on other occasions, is very possible; and the failure of our records to show a case at the Lazaretto during the years of exemption, proves in- contestably that no vessel arrived with it on board, and we may infer that no vessel arrived in our port which had had it previous to sailing. If only six, out of one hundred ves- sels which arrived in our harbor in one season, were infected, it is not wonderful that thirty, forty, or even fifty, might ar- rive without infection during another season. Or the case may be stronger, when only one out of sixty-eight arrivals is observed to be infected. Hence if this one had taken an- other direction, sixty-seven vessels wTould have arrived with- out the means of doing mischief, and the friends of the West Indian commerce would exultingly have pointed to this par- ticular season to prove that the disease is not imported, be- cause so large a commerce was carried on and no fever pre- vailed. But the history of 1857 tells another tale; for among the sixty-seven there was one that had had the disease on board, and that one infected two others, and was the means of introducing the disease into one portion of the city; while the vessel which brought the disease, at the time of arrival, succeeded in infecting another vessel, which, when liberated, infected the village of Mt. Pleasant. It is thus apparent that seasons may and do occur, when no infected vessel enters our harbor, and those seasons are marked by a continuation of normal health. There are other seasons, when only a few infected vessels arrive, and with proper care the disease may be limited to the Lazaretto; but it has most commonly escaped and invaded the city. Thus a care- ful examination of the facts disprove the general impression, derived from the occasional exemption ot the city, that the yellow fever is never imported. It proves satisfactorily that when it is not in the city, that it has not been imported; Hume on YeUow Fever. 17 and also, that when it is in the city, that it has been imported —a conclusion which the particular history of each year, in recent times, satisfactorily establishes. There is nothing in the local affairs of the city, nor in the meteorological condi- tion of the atmosphere, which can account for the exemp- tion of 1859. Had the disease appeared, our opponents would have attributed its local origin to the intense heat, excessive rain, general filth, cleaning out of old drains and distributing the contents on the surface of low streets, and particularly to the extensive excavation in Meeting-street, for the construction of the tidal drain. But the disease is not here; therefore these causes, so satisfactorily and con- clusively advanced on other occasions, to account for the presence of the disease, cannot account for its absence, and have certainly failed to produce it. Local and climatic causes which were adequate to produce the disease in 1858, should do the same in 1859, or confidence in their powers may be diminished. "Fearful odors" of cow manure have been produced, cellars have been excavated, premises have been generally filthy, and back buildings have been occupied by colored persons, yet no fever has been engendered. These four causes, which were relied on to produce a fever in 1858 in a man recently from an infected city, have totally failed in 1859 to produce a similar fever in any person who has re- mained at home. It may, then, be doubted whether they were the true cause of fever in 1858; and as Scharwacter took fever without the concurring agency of these causes, and some others arrived from the Havana with the disease upon them, we may fairly infer that Garcini brought the germs of the disease from the Havana, which were naturally developed in process of time, and would have done the same, irrespective of any local cause existing in the city at that time. From the statistics of the three last years we observe that the per centage of infected vessels is 10, 2 and 0; and although from the nature of the disease the 2 may be as dangerous as the ten, no evil whatsoever has arisen from the 0 per cent. During the whole period of Mr. Creutzburg's o 18 Original Communications. administration as keeper of the Lazaretto, no yellow fever case was landed in any one healthy year. What it may have been with his predecessor, we have no means now of learn- ing, as the books are lost. The imperfect laws, which were then imperfectly executed, can teach us little which is posi- tive; for the vessels were liberated, and the first intimation that we had of the fever was its prevalence among the ship- ping at the wharves, or in the Marine Hospital. From these points it spread over the city, and deceived the people into a belief of its domestic origin, which policy induced many to encourage. If the proportion of infected vessels is as small as our statistics show, there can be nothing extraordi- nary in the observation that many summers pass without the arrival of a single one, and as a sequence, those summers are free from the prevalence of the disease. While in other summers a single infected vessel arriving at the wharf has infected the whole city, and produced as much injury as if the whole number had been infected. The alleged biennial visitation of fever to our city, is by no means a fixed fact; nor is it a character of the disease. The time has been when it was annual. From 1792 to 1804, it appeared ten summers out of twelve. It has occasionally been absent ten years; once upwards of twenty, and at another time upwards of forty years. It is certain that neither changes of climate, nor local causes, can account for this irregularity; but it is by no means certain that the revolutions of commerce, or the especial modes in which it was conducted at different times, may not have had an efficient agency in producing this irre- gularity. We have noticed the comparative paucity of in- fected vessels which visit our port during our most fatal epi- demics. If we now turn our attention to the crews arriving in all the vessels, we will be astonished at the wonderful paucity of cases which arrive. We are erroneously led to suppose that every one who arrives from Havana, during its epidemic period, is doomed to take the disease. The records show a very different result. Of 1261 passengers who ar- rived in 1858, not one had the disease; and of 1328 officers and sailors arriving at the same time, only 16 had the dis- Hume on Yellow Fever. 19 ease. In 1857, 280 passengers arrived in health; and 516 officers and sailors, of whom 7 had yellow fever, and all be- longed to one vessel (Ciscar), which had a crew of 11. We do not expose these records to prove the folly and cruelty of detaining so many sailors at the quarantine station, when so few are really capable of injury, but to show how possi- ble it may be that successive season may pass without a single arrival of a diseased sailor; and these are the seasons which are characterized by the continuance of perfect health; and these seasons may be multiplied at will by a judicious regulation of this particular commerce, or more certainly by its suspension for certain months in each year. Our people have vast faith in the potency of money, when expended by the city or State, and they are induced to believe that the expenditure of $50,000 by the State in the erection of a Laz- aretto and stores, at a distance from the city, will eventually protect it from the epidemic. There may be some safety in distance; but if a constant communication is to be kept up by steamers, distance will prove of no security; and if con- stant importations and exportations are to be carried on, we will soon discover that a six hours voyage is as dangerous as a one hour's voyage, and that all the alleged objections to the present station will apply to another at a greater dis- tance. If non-intercourse shall become popular, the present station will be necessary for the reception of distressed ves- sels, a certain number of which we have a right to expect each year—especially after the annual gales—and some pro- vision should be made for their assistance and accommoda- tion, as well as for the protection of the city from the con- tingencies of their infection. The frequent failure of the West India vessels to bring cases of yellow fever to our city, not only accounts for its occasional absence, but is interesting as opening a field of research by which we may be enabled to ascertain the con- ditions, and, perhaps, succeed in applying the principles to the accomplishment of a safe trade. Independent of the danger, there can certainly be no other objection to a West India commerce; but until means are discovered by which 20 Original Communications. this danger may be removed, the safer way is decidedly to limit the trade to certain months which are known to be in- capable of propagating the disease if accidentally intro- duced. With no other object in view than the welfare of the city, I would receive with delight any plan by which the benefits and evils of this particular commerce may be sepa- rated. I would rejoice with the merchants that a safe, fair and free trade could be established. I would also rejoice with the citizens to be relieved from the annual apprehen- sion of disease and death. Improbable and uncertain as such a result may be, it is worthy of investigation; and some hope is derived from the fact that accident has occasionally accomplished that which art may always effect, provided we know the exact conditions which constituted what we have called accident, and invariably take care that those condi- tions and no other shall exist. It is well known that yellow fever has been a denizen of the West Indies since the set- tlement of Charlestown, and possessed the same properties then that it now does, yet its introduction into Charleston was, in its infancy, comparatively rare. From 1700 to 1792 it was rare; from 1792 to the present period it is compara- tively frequent. Thus 1792 becomes the dividing period be- tween the two series of Dr. Ramsay; or in other words, the division between rarity and frequency. If we could estab- lish the fact that there was no commerce prior to 1792, and a large commerce afterwards, the question would be easily settled. But such is not the fact. By reference to the ma- rine list of 1783 in the State Gazette, we find vessels arriv- ing from the following ports, viz : St. Thomas, St. Eustacia, St. Kitts, Port au Prince, St. Christophers, Havana, St. Lucia, Hispaniola, Barbadoes, Jamaica, Capo Francois, Dominica, Curacoa, St. Croix, Martinico, Granada and Guadaloupe. By turning over to 1793, we find a similar list, viz : St. Eusta- cia, Jamaica, St. Thomas, Hispaniola, New Providence, Cape Francois, Aux Cayes, Martinique, Nassau, Port au Prince, St. Bartholomews, Barbadoes, St. Johns Antigua, Dominica, and Havana. Without attempting to show which was tho larger commerce in these two equally healthy years, the fact Hume on Yellow Fever. 21 is evident that an extensive trade was carried on at these and intermediate times. By reference to 1803, we find the following list, viz: St. Vincent, Porto Rico, Trinidad, Cape Francois, Nassau, St. Thomas, Havana, St. Domingo, Kings- ton and Antigua. In 1813 the trade was limited to Havana and Matanzas. showing clearly that the absence of fever from our city was not produced by an absence of West India commerce, but proceeded from causes which we uow propose to investigate. The existence of yellow fever in the West India Islands is known to have preceded the year 1700, but it was only occasional. In 1793 there commenced a new era; a fresh importation was alleged to have been received in the island of Granada, and the ship Hankey and the African island of Bullam became celebrated. Be this as it may, it is admitted that the disease became more frequent, and covered a larger space than it did before. Islands that never before witness- ed the presence of the disease, were now involved, and it is certain that its appearance in the United States became more common. The New York fever of 1791, and the Charleston fever of 1792, must have belonged to the old series; but the fevers of Philadelphia in 1793, and subse- quent years in most of the northern and southern cities, may have appertained to the new series. Suffice it to say, that from 1791 to 1807 the yellow fever prevailed annually in some of our ports, without much respect to latitude, local causes, or meteorological conditions; for New Orleans, Charleston, Norfolk, Baltimore, Philadelphia and New York suffered alternately or simultaneously. Every summer of this period of years was marked by the appearance of the disease in one or more cities of the United States; and it is almost incredible now to notice that it occurred in Philadel- phia precisely the same number of times that it did in Charleston as an epidemic, and if we include the sporadic years, it was twice oftener in Philadelphia than in Charles- ton, to wit: Charleston 10, Philadelphia 12. That an in- crease of extension and frequency in the West Indies should have been attended by a similar increase and frequency in 22 Original Communications. the United States, is reasonable; but still it will not explain satisfactorily, why, after an exemption of forty years, it should have occurred annually, visiting with equal regulari- ty northern and southern cities. No natural cause of origin, dependent upon climate or locality, could have produced so extraordinary an effect in so short a period, and persevere in it for so long a time, and then return to an exemption of ten years, i. e. from 1807 to 1817, without leaving some record on the meteorological tables of such a climatic change. We must here look to art, and we find it coincident with the pas- sage and operation of the American Navigation Acts of 1789' and 1792, which, while securing a monopoly of the coasting trade, gave encouragement to foreign trade also, especially to the West Indies aud other ports on the American conti- nent. Prior to this period, the West Indian trade of Charles- ton was carried on by Charlestonians and by West Indians. Schooners and sloops were exclusively used, and manned by sailors habituated to both climates. South Carolina regu- lated her own commerce, and directed it according to her own interests. Experience had demonstrated that a vessel could not become infected simply by visiting an infected port, return and expand the disease throughout the city. Experience also proved that West Indians were incapable of bringing the disease with them, forasmuch as they were in- capable of taking it themselves. This immunity of the West Indians was observed to appertain.to the Charlestonians, after having had the disease themselves. Hence crews made up of men habituated to the disease, were enabled to make voyages between Charleston and the tropical islands, with- out danger to themselves or their fellow citizens. Small vessels, owned and manned in Charleston, in conjunction with other small vessels owned and manned in the West In- dies, carried on the whole West Indian commerce for up- wards of one hundred years, with the slight accident of seven epidemics, occuring at the earlier period, viz : 1699, 1703, 1728, 1732, 1739,1745 and 1748. Bad the Assembly of South Carolina understood the foundation on which this compara- tive security rested, it would have been simple, easy and ef- Hume on Ydloio Ftver. 23 fectual to have introduced a regulation by which the trade could have then been made absolutely safe, and no merchant would have been injured or aggrieved. Had it been clearly set before them that the danger of importation consisted in the liability of a sailor to take the disease in consequence of non-habitude to that particular disease, to return with it upon him, or to infect the vessel during his illness, which infection remains on board of the vessel as long as she con- tinues in a quasi-tropical climate, and ready for diffusion whenever an opportunity should occur, ic is certain that some restraint would have been placed upon the indiscrimi- nate enlistment of sailors, or the equally unguarded accept- ance of apprentices. It is not possible, at this distant pe- riod, to determine to which of these indiscretions the excep- tions of safety are to be referred, and it is possible that we may add non-habituated passengers to the list of dangerous subjects. After 1789, this comparatively safe interchange of pro- ductions, until then carried on by habituated officers and sailors, was divided with northern vessels, manned by northern and unacclimated crews, ready for any enterprise and indifferent to any danger. Wherever a barrel of rice, a hogshead of sugar, or a bag of coffee was to be found and made into freight, there these vessels were to be found, ready to carry it to any part of the United States. They also car- ried supercargos, prepared to buy or to sell anything at any place. Free trade was carried on to perfection. Although money was made, a sad sacrifice of human life was also made. To replenish a crew was a quick and frequent operation, but to eradicate the evils that the}7 brought to the different sea- ports, was not easily done. The introduction of the West India }Tellow fever into almost every seaport from Georgia to Massachusetts, was the fruit of these voyages; yet the citi- zens, so interested in the profits of this pernicious trade, as then conducted, were unwilling to attribute it to any other than a natural cause, unconnected with any change in their commercial arrangements. The importation of molasses gave rise to the manufacture of rum, a large article for ex- 24 Original Communications. port, which, in addition to what are now called Yankee no- tions, constituted their exports. Thus the local inhabitants became interested in the advantages of this trade, and were advocates for its continuance, piously trusting in the Al- mighty for a reversal of his desolating decree, and endeavor- ing to hasten his decision by humiliation and prayer. To give some idea of the effect of this trade, it is only necessary to enumerate the following cities and towns as having been in- vaded by this fleet of coasters and made to suffer the fatal consequences of the first attempt of Congress to establish free trade by the memorable Navigation Act of 1789, and its amendment in 1793. Yellow Fever appeared : In 1790. New York, sporadic. " 1791. New York, epidemic and violent. " 1792. Charleston, epidemic. " 1793. Philadelphia, epidemic. <; 1794. New York, New Haven, Baltimore and Charleston. " 1795. New York, Bristol, R. I., Providence, R. I., Norfolk and Charleston. " 1796. Bristol, Providence, Boston, Newburyport, New York, Philadelphia, Norfolk, Charleston and New Orleans. " 1797. Bristol, Providence, Boston, Philadelphia, Baltimore, Norfolk and Charleston. " 1798. New London, Conn., Westerly, R. I., Stonington, Conn., Boston, New York, Portsmouth, Philadel- phia, Wilmington, Del., Baltimore, Norfolk, Alex- andria and Petersburg. " 1799. New York, Boston, Philadelphia, Baltimore, and Charleston. " 1800. New York, Providence, Philadelphia, Baltimore, Norfolk and Charleston. Spain. " 1801. New York, Philadelphia, Baltimore, Norfolk and Charleston, (sporadic only). Spain. " 1802. New York, Philadelphia, Wilmington and Charles- ton. Spain. " 1803. New York, Philadelphia and Charleston. Spain. " 1804. Charleston. Spain. " 1805. Philadelphia and Providence. " 1807. New York and Charleston. " 1809. Brooklyn, (New York.) " 1811. Spain/ Hume on YeUow Fever. 25 In the year 1808, the prayers of the people of these United States were answered, according to their desires, and the plague was stayed. The troubles with England and France now commenced. Embargoes and non-intercourse were the order of the day. The northern coasters were kept at home, and health was restored to the United States. The war soon followed, extending our term of health, and continuing it to 1816, when peace was proclaimed, and the coasters were again on the ocean. In J817, disease returned, and has continued to prevail, more or less, ever since. It is worthy of remark, that during the war, the Charleston and West India trade returned to Cuban vessels, and, notwith- standing an active trade with Havana and Matanzas. no epi- demic appeared, yet it is recorded that a few sporadic cases occurred in 1812. The amity between England and Spain warranted our commerce with Cuba, but limited the carriage to Cuban vessels. Neither Old Spain, nor New England, with their non-acclimated crews participated therein; hence the security from disease wThich was so manifest throughout the United States from 1807 to 1817. I am fully aware that previous attempts have been made to connect the occurreuce of our epidemic yellow fever with the political necessities of commerce, but it has been limited to the increase or diminution of commerce at certain periods, and has had no reference to the peculiarities incident to vessels and crews continually passing between infected and uninfected cities. On the common doctrine of chances, a less commerce should insure less danger, but our dangers have not been commensurate with the quantity of commerce, but with the quality. One vessel with a northern or Euro- pean crew is seen to be more dangerous to the health of cities, than one hundred vessels with crews habituated to the climate and diseases of Havana. It seems to be through persons alone, primarily, that the disease can be transported from one place to another, and that person must have the disease, or he is innoxious to his non-habituated neighbor, and also incapable of infecting the vessel on which he sails. No one will question the fact, that a vessel may be manned 26 Original Communications. by any number of sailors, who have already had yellow fever, that they may be sent to Havana during the epidemic there, that they will not again take the disease, nor will they bring it back to Charleston. The men will return Avell and sound, and the vessel will be uninfected, and, of course, inca- pable of infecting any person who may go on board. Voyages of this kind would accomplish the legitimate ob- ject of the merchant, and not react upon the legitimate interests of other people. We will now repeat the voyage with the introduction of one rubicund, jolly Jack-tar from Ireland into our ship's company, and observe the result. The outward voyage may be enlivened by his wit, and assisted by his strength and activity. The company may have a gallant spree in the charming Havana. The ship is dis- charged, re-loaded, and returns to our port, say at the end of July. Our jolly Pat is no longer the life of the crew. He is desperately ill, and must be sent to the Marine Hospital. On arrival, the dreaded yellow fever is developed, recognized and proclaimed. His death astonishes no one, but his dis- ease must be concealed for a while> or an alarm may be created among a timid people. One week after the arrival, a sailor in an adjacent ship is suddenly seized with fever, no known cause can be assigned, but the filthy mud in the dock, and yellow fever is again recognized. About this time a sailor in the hospital may be taken, and a stranger living in a filthy portion of the city is reported as suspicious. Soon, however, the cases multiply, and we have an epidemic con- dition of the atmosphere, as it is termed, by which any non- habituated person may be seized with this especial disease, and fall a victim to what is called acclimation. So especial and peculiar is this acclimation to our city at this particular time, that a man who has resisted the violent fevers of the country, which are death to the inhabitant of the cit}T, dares not visit the city; for acclimated though he may be, to the climatic fevers of the swamps and rice fields of South Caro- lina, he cannot resist the epidemic condition of the atmos- phere, which our generous Pat has produced by his thought- less visit to Havana, and his return, with the disease there Hume on Yelloiv Fever. 27 acquired. He has sowed the seeds, as it were, broadcast; ho has eliminated from his person a matter which seems to have dissolved in the air, and imparted to it a faculty for diffusion and destruction, which none but those accustomed to its action—that is, those who have previously experienced its influence, like the ancient kings who habituated themselves to poison, by its daily use, in order to resist its action whe n criminally administered—have been able to escape. Habitude to the poison is the only safeguard against its deadly influence. Acclimation to the latitude is no protection; hence persons who live within ten miles cannot with safety visit the city during the epidemic. Children born between epidemics, or who have been absent during epidemics, are as strangers, and frequently fall a sacrifice to the erroneous belief that nativity and general residence produce acclimation, and that acclimation is habitude to the disease. A country negro is acclimated, but he is not habituated to yellow fever; as is proved by frequent cases among negroes from the adjacent islands and main-land. The distinction between acclimation and habitude, seems to be clear and well founded in observa- tion. Acclimation does enable us to enjoy general health in Charleston, notwithstanding extremes of heat and cold, wet- ness aud dryness, and the other vicissitudes of weather to which we are subjected; but habitude alone, as produced by frequent and early exposure to the poison of yellow fever alone can defend us from it, when re-introduced by importa- tion from another infected city. The dreadful calamity and universal spread of the disease at Norfolk in 1855 was pro- duced by want of habitude to the disease; acclimation natu- rally existed among the inhabitants, but an absence of the disease for so many years had destroyed the habitude. The habituated generation had died out, and a non-habituated population had taken their places. All were subjects for the disease, and faithful indeed was the fever to detect its old acquaintances, and spare them; few, indeed, but unerr- ingly correct. A return of yellow* fever to Charleston after an absence of thirty years would find us as illy prepared to receive it. Acclimation would be perfect, a new aud non- 28 Original Communications. habituated generation would be in existence. The physi- cians would not know how to treat the unaccustomed dread- ful disorder. The fall of a few would create a panic, and we would have repeated the dreadful scenes enacted in Phila- delphia in 1793. The thirty years accumulation of a popula- tion would be decimated in one summer; nativity, residence and alleged consequent acclimation, to the contrary notwith- standing. In anticipation of such a scene, some have advised that we import the disease every summer, thus to habituate annually all the children that may be born, and other new comers, in the wise hope that by distributing an evil through a series of consecutive years, we will ultimately mitigate its magnitude. An extreme pietist may deem it safer to die in infancy, than in the wickedness of maturity; but the majority of mankind prefer the evening of life, when we can bid the world a cordial farewell, after having fulfilled our respective destinies, and done those things which we should have done, even, if we have left undone many things which should have been done. It does seem incredible, that, in an enlightened age of moral and religious light and liberty, a minority should plead in vain for the preservation of their lives; that a monied majority, under the plea of commercial freedom, should be accessory to the introduction of a pestilence an- nually among our citizens, in order to obtain from them an increase of wealth, or that a foreign merchant should have the privilege at any season to send us his produce, irrespect- ive of any danger that may accrue to the citizens, totally heedless of those hygienic laws which have been observed to regulate the prevention or introduction of disease. A conservative adherance to the practices of our forefathers may be meritorious, so long as we remain in their ignorance; but when a new and true light bursts upon our view, and dis- pels our ignorance, conservatism is no longer a virtue. Con- sciousness of ignorance is the first step to wisdom, as the turning from wickedness is the first fruit of repentance. Reforms arising from the conviction of error, are salutary and permanent; but reforms are never effected without a sacrifice of pride, of feeling or of interest. The pecuniary Hume on Yettoio Fever. 29 benefits arising from the West Indian trade, induce many to desire its continuance. The pride of opinion in maintaining early impressions, the humiliation of any recantation expres- sive of change of belief, and the uncertainty connected with any modification of action, relative to success, are so many reasons against the unanimity of any creed or course of duty. Habit has reconciled us to the misfortunes of others. It | was appointed once for all to die, and we seem to be indif- 1 ferent whether we see others die of fever or of age; whether ) they die in the morning, in the noon, or the evening of man's I allotted period; whether we drag down to the grave the f young, the stranger, or the sojourner. One fact is para- mount, habitude has fortified the native and the initiated, v and he can play the good Samaritan without fear and with- out favor, and still pursue his ordinary avocations, regardless f of the afflictions which encompass others. The time was when Charleston was famed for its hospitality and kind at- tentions to strangers. Public hotels were not in existence, nor were they necessary. Each inhabitant entertained his acquaintance as one of his family, and when the fever made \ its appearance, the stranger was transferred to another, who enjoyed the happiness of living in a presumed healthy local- ity, and who immediately accepted the charge, and esteemed it a privilege and a pleasure to offer an asylum to a stranger and protection to a fellow being. , Such was the benevolence of Charleston before it as- pired to become the commercial Queen city of the South, when the yellow fever was universally believed to be a direct and inevitable visitation, belonging to our climate, and proceeding from it, as did the endemic fever of the country with which it was deemed identical. This belief in the identity of the two diseases was common among | the people and the medical profession, and all attempts to establish its truth or falsity were considered to be a work of supererogation. In the year 1839, Dr. Strobel, then I physician to the Marine Hospital, was startled by some | curious ocurrences, relative to the arrival of vessels from the West Indies bringing cases of yellow-fever, and tho apparent 30 Original Communications. dissemination of the disease from these vessels to others from healthy ports. He traced its introduction and diffusion both in the hospital and in other parts of the city, and as in duty bound he published the result of his careful observations. He was condemned by the profession, and voted to be inaccurate in observations and in references. In 1852, the fever reappear- ed, and similar observations were made, and, to abbreviate the matter, each successive year has tended to confirm the observations of Dr. Strobel, as a reference to the detailed histories published in this journal of each epidemic will clearly show. The effect of a public discussion was to strengthen the old quarantine laws, but still to leave them imperfect, and in such a degree of looseness as to be viola- ted by force or fraud, as parties desired. Discretionary power could be exercised for the protection of commerce, or for the protection of the city, it being well known that any action for the benefit of commerce was dangerous to the city, while any action for the safety of the city was detri- mental, or at least inconvenient to commerce. The exact line of duty which would injure neither commerce nor the city could not be defined. It is an attempt to reconcile antago- nistic interests, and like all such attempts, Avill fail to accom- plish the desired end. West Indian commerce, and continued health in Charleston are incompatible. We must abandon the one to preserve the other, or we must exchange the health and lives of many, for the benefit of a few. The mer- chants or the people must yield; the minority must consent to give up their privileges to secure health, happiness and life to the majority, and whether the merchants interested in this particular trade are a majority, is a point yet to be de- termined. Allusion has been made to the possibility of carrying on a safe trade with the West Indies, by habituated crews, in vessels owned in Charleston or in the West Indies. Such voyages seem to have been successfully made in former times, but occasioually they have failed, and the city has been unexpectedly overwhelmed by the disease. The diffi- culty of determining accurately those who are and those Hume on Yellow Fever. 31 • who are not habituated, will ever prevail, and the uncertain- ty will increase the longer we are exempt from the prevalence of fever. It is manifest that when the present habituated sailors shall have died out, that Charleston could not supply the deficiency, for her whole population will have lost the habitude, and if we persist in this trade on this principle, it is certain that the seamen must be supplied by the West Indies, and the trade will fall into their hands. If this West India trade was of vital importance to the city of Charleston, and we had determined to pursue it, with minds fully pre- pared to undergo the fever occasionally, then we might hazard the plan of habituated crews, hired by the life-time. But the true policy of the city would be to incur no risks; to secure the health of the people, and to accomplish that de- sirable object, we must sacrifice the profits and comforts of the West India trade for four months in each year, begin- ning in June and ending in September. It may be a ques- tion whether the city has the power, but there is no question relative to the power of the State; and if the Legislature will pass a bill prohibiting all intercourse with the West Indies, and all other ports known to be liable or that actually have the disease, Charleston will be exempt from the great cause that prostrates her energies, and may yet realize the golden dreams which have stimulated her to compete with more favored cities in attaining both population and wealth. Sad experience has taught us that yellow fever is fatal to all trade in our city. Country customers, on whom all mercan- tile hope depends, are prevented from using the facilities that the city has provided for the convenience of travel, and fail to appear. Thus a double loss is effected; loss of sales and loss of transportation of passengers and return goods. Under such a series and multitude of small losses as may be enumerated, it is impossible for any city to increase; and Charleston, with her natural advantages, must yield, and con- tinue to be a small town, so long as she mixes the commerce of the fatal West Indies with the commerce of the rest of the world, and thereby introduces into herself the seeds of her Vvn destruction. f ! 32 Original Communications. * The absence of yellow fever during the summer of 1859, may prove as instructive as its presence in 1858, if the de- tails are properly studied. The history is shori. but com- plete, and is resolved into the simple fact that nc* vessel arrived in our harbor with the disease on board. Its appear- ance in Cuba was later than usual; the ill-fated Isabel ceased to perform her accustomed voyages after the 28th of June, and very few other vessels arriv4d4ifter the disease became epidemic in Cuba. During the months of July, August and September/but six arrivals from Ciibau -ports are reported by the Port Physician, and these were retained at Quaran- tine. We have no reason to know that they were infected; the probability is that they were not. They were not, how- ever, allowed to come up to the city wharves. No case of fever came to the city, and hence no case was reported to have taken its origin in the city; tio introduction, hence no propagation; no importation, hence no prevalence. Exclusion of the disease is, then, the sole sure method of preserving health, and non-intercourse is the cheapest, surest and most certain mode" of teelu&km. We have seen that a protective embargo need affect a certain commerce only, and that for but a brief specified time. During the, rest of the year the sugar trade might be carried on with sufficient activity to richly repay its agents and satisfy all the wants of the consumer. In pointing out the dangers of the intercourse, we have simply performed a duty to science and the community; it remains *: for the latter to provide those measures of public,.safety which the.,yearly peril of our lives and fortunes so^urgently demands. To "the sober second thought of the people " we commend the serious con- sideration and impartial decision of this question. X Jackson's Reply. 3Q9 author's views of the operation of mercury, and an attempt to deduce some general principles which may direct its ex- hibition in those diseases which are accompanied by fever. A Reply to " Remarks on Certain Parts of an account of the Yellow, or Malignant Fever, as it occurred in the city of Philadelphia in 1820 ;" and some observations on "A Reply to the Remarks of J. on the Review of the Papers relating to the Fever in New-York in 1820," which were published in the 4th vol. American Medical Recorder, October, 1821. By Samuel Jackson, M. D. Philadelphia^ The American Medical Recorder, for last October, con- tains two papers, in which 1 am assailed with a degree of rancour, that must appear strange, and be wholly unaccoun- table to those unacquainted with the feuds which have here- tofore distracted the Medical Profession the city of New- York. The observations that excited these bursts of passion, and that seem to have touched more deeply than was conceived possible, or even contemplated, were not intended to abet the designs of a party, or injure any individual. Their aim was much higher. Truth was their object; and in its pur- suit, authorities wrongly quoted, and statements erroneous and unfounded, were unhesitatingly exposed, perfectly inde- pendent of any sentiment of personal animosity, or purpose to inflict a personal annoyance. If individual feelings have suffered, the circumstance should be imputed to its proper cause. Every medical disquisition should be conducted in that sober and unbiassed temper, that can alone render it of utility, or calculated to accomplish its only legitimate purpose —the establishment of truth. When it assumes a different character, and, more especially, when, from levity, rashness, prepossession, or other motives, a departure from the most 310 tfackson's Reply. rigid observance of accuracy and correctness, in assertions and positions, is hazarded, it becomes a solemn public duty, that the delinquency should be pointed out, and animadvert- ed on by some one. Preparing to submit my remarks on the malignant fever of 1820 to the public, although not as well qualified as many others to the task, yet it was not irre- levant to notice the inaccuracies of the " Discourse on Me- dical Police." This is the offence, that has awakened so much ire ; and procured for my humble productions the distinction of having given rise to such passionate criticisms. From a note, attached to one of the papers, to which I have alluded, Dr. Eberle, one of editors of the Recorder ap- pears to have been conscious, that the personal allusions contained in that paper, are calculated to disgrace its author. To remove from himself every suspicion, that he could be guilty of the improprieties it contains, he disavows any par- ticipation in them ; and indicates Dr. Ducachet, his co-edi- tor, as the writer, to whom belonged, this evomition of venomed spleen. The indecent personalities of this writer, are to be treated with contempt. Reputation for abusive writing, is cheaply obtained, by those, to whom it is an object of ambition. I have no desire to detract a particle from that, which Dr. Du- cachet and his co-adjutant writer, have laboured so earnest- ly to merit, and of which they have shown themselves so worthy;—Let them enjoy it in the fullest fruition. I disclaim the slighest disposition to lessen the just repu- tation of Dr. Hosack, or any other individual; 'but I have to learn, and cannot imagine, what are the circumstances that so elevate him above common mortals, that to question his infallibility, or examine bis literary productions, re to be ac- counted a presumption, deserving to be overwhelmed with contumely and reproach. Dr. Ducachet should have re- flected, that it was possible, the u distinguished man," who filled, in his imagination, so vast a space, might bold but Jackson's Reply. 311 a moderate standing in the estimation of others. The beetle that circles with drowsy hum around the evening taper, daz- zled with its glare, may imagine it a glorious luminary in the little world in which it exists. Though the declaration may appear inordinately arrogant to Dr. Ducachet, I can assure him, I have no apprehensions of being esteemed egregious- ly vain, should I engage in any contest with this " god of his idolatry." " Victorque virum volitare per ora." My thanks are due for the quotation, and find in the triumph, but little to satisfy the cravings of a very moderate ambition. Dr. Ducachet has taken the liberty to imagine my motives for the heinous crime of questioning Dr. Hosack's profession- al accuracy. He can take no offence, should I imitate his example. Honest old Burton, with no little indignation, describes the company of parasites and flatterers, who, with immode- rate praise, bombastic epithets, glossing titles, and false eulo- gium, so bedaub, applaud, and gild over, many an undeserv- ing man, that they clap him quite out of his wits. Their hero is never in his proper character, but always appears in masquerade. " If he be a big man," says our quaint author, -" then he is a Sampson, a Hercules; if he pronounce a speech, another Tully, a Demosthenes ; if he can make verse* a Homer, a Virgil;" and should any one laugh at these ob- streperous claims, he is immediately, " a Zoilus carping at Homer's genius." We are here presented with a picture, for which a prototype might be found. But having some- what more charity than the wrathful doctor, no use will be made of it; and his example and his motives, be permitted to rest with himself. Dr. Hosack, I feel assured, has too much good sense to countenance these ridiculous pretensions that are made for him, or to quarrel with those who reject them. It might, 312 Jackson*s Reply. otherwise, be suspected, he had been " clapt out of his wits," and had adopted the vain boast of Ennius— " Volito docta per ora virum." The papers to which I have alluded, would have been earlier noticed, but for the engagements in which I had en- tangled myself at the period of their publication, and which occupied almost exclusively, my attention and time. During the winter 1 was employed in delivering a first course of lectures in the college of Apothecaries, which was prepared from day to day; and, consequently, enjoyed but few mo- ments of leisure—I felt, besides, probably too indifferent on the subject. The inconsistencies, the sophistry, the unfair deductions of those writers are so glaring, that it appeared to me, they must strike the most casual reader. But I may be in error : few examine with attention, the matters con- tained in essays of the character of those published in the Recorder of last October, to which 1 have reference. Their allegations are too often admitted, especially if urged with boldness. It is therefore a duty, that I should substantiate all that I before advanced, and which these writers have de- nied ; and repel the personal attacks, in which they have so freely indulged. At my first leisure, I accordingly prepared an answer, in- tending to publish it in the Recorder. A suspicion never entered my mind, that I could possibly be denied the exer- cise of the same latitude of remark, and freedom of observa- tion, provided 1 thought proper to use it, that had been em- ployed towards myself, especially by one of its editors. It is obvious, that it is nearly impossible to rebuff arguments and allegations, intimately woven with rudeness and incivi- lity, without the " retort courteous." Considering the pro- vocation that had been given, my right, I conceive, was used with moderation. It is unpleasant, it must be admitted for an editor to give publicity to his own scandal; but he should Jackson?s Reply. 313 take care not to place himself in the situation to deserve the exposure, or, by a refusal, to act with injustice. Doctor Eberle, the editor of the Recorder, residing in this city, received my communication, intended for the April number, and put it to press. The proof was sent to his co- editor, Dr. Ducachet in New-York, the writer of the essay to which it was an answer. The proof was returned by him, with several erasures. The rejoinders to Dr. Ducachet'9 personal remarks, appeared to have been peculiarly offen- sive, as none escaped his censorial excision. As my com- munication was placed under editorial interdict, unless I submitted to this bare-faced injustice, it was withdrawn, rather than have it published in a mutilated condition. The editors of the New-York Medical Repository, immediately granted my request, for the admission of my replication on the pages of their valuable journal, and I am thus enabled, by their politeness, to defeat the littleness of the policy, that has dictated this unmanly conduct. The reasons that Dr. Ducachet may have assigned, for rejecting the passages on which he exercised his censorship, have not been made known to me. They could not have been, most certainly, an objection to the publication of personal allusions. The Recorder has not been remarked for its purity in this res- pect ; and they would come with too ill a grace from so no- torious an offender as the New-York editor of the Recorder, to be tolerated. A plain relation of the circumstances connected with this controversy, will more strongly picture the conduct of Dr. Ducachet, and elucidate its character, than any commenta- ries I can offer on it. In the Recorder for April 1821, a review was published of the report of the New-York Medical Society, on the Bancker- street fever, to which was attached the initial letter B. The committee of the Medical Society, some of the most intelli- gent and distinguished of the profession in New-York, was 314 Jackson's Reply. treated in this paper, with little ceremony and less delicacy* The subsequent number for July, contained a paper signed J. devoted to the discussion of a single point which had been made in the report of the Medical Society, was contested by the reviewer B, the correct determination of which, is of considerable interest and importance in a pathological view. The writer of B, was well known; but, as he chose not to declare himself openly, although under his disguise he did not spare others, his wish for privacy was respected. No personal allusion was made to him by J, whose remarks were confined to the subject-matter under examination and grow- ing out of the review of B. This paper called forth a reply, filled with petulant and angry invectives directed to me, as the author of the re- marks of J. Dr. Eberle, as was mentioned before, seemed to feel so sensibly the indecency- of this unprovoked attack, that he thought it necessary to disavow a participation in the personal allusions, and designated Dr. Ducachet, his brother editor, as the writer of the anonymoua paper that contained them. Dr. Ducachet has, thus, in this first place, infringed that comity which every writer who respects himself in the opinions of others, will observe in a discussion of a scientific topic, by mingling with it personal reflections on an opposing writer; this offence becomes peculiarly flagrant when the discussion is anonymous. In the second place, he has vio- lated the confidence reposed in him as an editor, by a cor- respondent, without the slightest provocation to justify the outrage. To point the climax that marks his conduct, he takes advantage of his editorial privilege to close his jour- nal to the replication to his own attacks. I wish it to be understood, that it is not intended to object to, or to com- plain of the personal reflections contained in the papers the subject of these observations ; of the editors of the Recorder, favours were neither expected nor asked : simple justice alone was looked for—that my right to reply through the Jackson's Reply. 315 same medium to the aggression I had received, should not be opposed ; but in this reasonable expectation I have been deceived. The object of this short narrative, is merely to display the principle of Dr. Ducachet, and to explain the cause of my answer appearing in another journal, than the Recorder. These prefatory observations have occupied a greater ex- tent than was intended. I shall now, without further pre- lude, proceed to the consideration of the papers in question, examine into their character, expose the means both of de- fence and attack, that are employed in them ; and exhibit the just value of their pretensions to correctness, research, and information. The first paper purports to be " Remarks on certain parts of an account of the Yellow or Malignant fever, &c." Its object is to defend the accuracy of Dr. Hosack's references and quotations, in his " Discourse on Medical Police," which I had impeached ; and to retort on myself, the allega- tions I had made against the late " Resident Physician for the city of New-York, Professor, &c." As it regards the character and kind of defence, attempt- ed in this paper, it is to be remarked, that the inconsistencies I pointed out in the " Discourse, &c." are unnoticed, and, consequently, are admitted to be accurate. Of the instances of " deceptious references, to authors for opinions, on sub- jects they do not treat, and for facts they do not mention," that were indicated ; while an effort is made to contest some of my charges, others are not controverted, and are of course also admitted to be true. Thus it results, that it is allowed, by the champion of the " Discourse on Medical Police," that Dr. Hosack has been inconsistent with his principles; and has made some deceptious references. His defence then amounts simply to this: some of the references are net deceptions. Vol. 7, 41 31G Jackson''s Reply. Had this writer confined himself to the proof of this posi- tion, so far as it could be yielded to him, by a candid exami- nation of the authorities disputed, and a correct report of the passages in controversy; I should not have felt myself called upon to write another line on the subject. But he has acted otherwise; he has charged me with being guilty " of the very practices against which I inveighed." He has made it obligatory on me to establish the truth of my alle- gations, the perfect correctness of my quotations, the can- dour and justness of my deductions. If, in doing this, the defence that has been attempted of the poor remnant of the " Discourse on Medical Police," and the puny endeavour at revenge, is shown most distinctly to be a mere mass of misrepresentation, quibbling and igno- rance, though it may appear harsh, yet it is a proceeding that has been rendered, and I regret it is so, entirely unavoidable. That this description is not overcharged, but true in every respect, will become manifest, in the detailed examination of the particular points contained in the " Remarks on cer- tain parts of an account, &c." to which I now pass on. The appeal made in the " Discourse on Medical Police," at page9 8 and 9 to the names of Huxham, Haygarth, Currie, Gregory, Ferriar, Percival, Blan», Chisholm, M'Gregor, Pym, Gilpin and Wright, in a manner to impress those not conversant with the writings of these authors, that they had been all perfectly familiar with Yellow Fever, treated of it in their works, and inculcated its contagion ; I adduced as an instance of deceptious reference. What is the defence ? I am accused of " misrepresenting the language of the Dis- course on Medical Police." It is positively asserted that Dr. Hosack " is not speaking of Yellow Fever, but of conta- gion as appertaining to fevers in general." To sustain this assertion, part of the passage on which 1 animadverted, is quoted from the Medical Police. The fair admission of this defence is, that if Dr. Hosack is speaking of Yellow Fever, Jacksorfs Reply. 317 when he refers to the distinguished physicians whose names are mentioned above, then is the reference deceptious. I will now show that he is speaking of Yjellow Fever, as well as " of contagion as appertaining to fevers in general," not- withstanding the very positive denial, that is made to the contrary. I shall do this, by continuing the quotation of the writer of the " Remarks, &c." from the part at which he found it so very convenient to his purpose to close abruptly with an &c. This very handy &c. happens to cover the only part of the passage on which I animadverted, and in which Dr. Hosack is " speaking of Yellow Fever. " Are the investigations and the accumulated experience of Huxham, Haygarth, Currie, Gregory, Ferriar, Percival, Blane, Chisholm, M'Gregor, Pym, Gilpin, Wright, and a host of others, to be prostrated by the arrogant assertions, the overweening con- ceits, and flippant remarks of those juniors in knowledge and in years, who have lately obtruded themselves upon the public at- tention ? Although they do not merit a serious and laboured refu- tation of their mistaken views, it will be at least proper, under the various points which they consider at issue, to call their attention to those important facts, and those sources of information, with which they appear to be unacquainted, or which, in their eager- ness to promulgate their effusions, they have totally disregarded. With this view, I shall notice their lucubrations under the several heads in which they dissent from the truths that appear to have been established by the experience and observation of the distinguished physicians to whom I have already referred, (viz. Huxham, &C.) In the first place, they deny the peculiar character of yellow fever as distinct from the ordinary bilious and typhus fevers of our country." This plain language admits of no misconstruction; Doctor Hosack does speak of yellow fever, in connexion with his references to the names of the " distinguished physicians," and it follows, that by the mouth of his defender, is his con- demnation pronounced. I do not hesitate to confess, that I was led astray by the loose, unphilosophical, and disorderly method of quoting au- thorities, as a cover to every sort of license which a writer 318 Jackson's Reply. may choose to exercise with them, pursued in the Discourse of Medical Police, and mistook the Dr. Wright to whom re- ference was made. . I inquired of several friends to ascer- tain who was this Dr. Wright, but ineffectually. I ransacked several extensive Medical Libraries for his works, but to no purpose. The truth is, it never, for a moment, occurred to me, that the writer of a few essays in a periodical work, would be associated with some of the standard authorities of the science, without a special reference to the work, con- taining the paper on which the appeal was authorised. If it can afford to Dr. Hosack and his defender, the slightest satisfaction, to convict me of ignorance of Dr. Wright and his essays, I freely afford it to them. I plead guilty.—I will go further.—I put in the same plea with respect to some hundred other essayists, in the thousand vo- lumes of Medical Periodical Literature, which the spirit of the age threatens to render interminable, of whose names and writings I have no knowledge. The able defender of the Medical Police gravely informs his friends, that " Dr. William Wright of Jamaica, (why could not Dr. Hosack have been as particular), is known to every student of medicine, who reads his dispensatory, for his description of the Cinchona Cari b a and Geoflfroea Iner- mis." If I understand the meaning intended to be conveyed by this observation, it is, that as Dr. Wright had given a description of the Cinchona Caribaea and Geoffroea Inermis, he should have been known as an author on Yellow Fever. This is most admirable logic. The sequitur, an induction that admits of no refutation. I feel myself incapable of an- swering such an argument, but must cry mercy, and quietly submit to this irresistible proof, that I am an ignoramus ! The writer of the "Remarks, &c." has placed beyond a doubt, the propriety of Dr. Hosack's reference to Dr. Wil- liam Wright, as a writer on Yellow Fever. But, in estab- lishing this point, he contradicts his own positive assertion, Jackson's Reply. 319 and destroys his own argument. He had just asseverated most peremptorily, as it then suited his object, that "Dr. Hosack does not assert, even by implication, that any of the writers referred to (Dr. William Wright one,) had seen yel- low fever or treated of it in their writings. He is not speak- ing of yellow fever." Yet, in the succeeding paragraph, he furnishes the proof that Dr. H. is "speaking of yellow fever," by adducing the evidence, that in referring to Dr. Wright as authority in yellow fever, Dr. H. could not be charged with a " deceptious reference." Thus, like an unskilful engi- neer, whose works, disposed without judgment or system, bat- ter down each other, this writer refutes his own arguments, and overturns his own statements. While on this point, on which this "able writer," as he is styled by Mr. Coleman, (a profound judge) has exhausted his wit; there is one observation, intended to be so very sarcas- tic, I would not hurt his self-love so much, as to let him sup- pose it had been unfelt, by leaving it unnoticed. Dr. Wright, I mentioned, had written a history of the Walcheren Remittent. A few pages preceding, I had as- serted, that the writings of the authors quoted by Dr. Hosack (a Dr. Wright one of them), " are confined to diseases ob- served in England. It was supposed I had here committed a lapsus, that is pounced on with all the voracity of a vulture ravening its prey, in the expectation of finding food for malice. " Without pretending," observes the writer of the remarks, in the least to call in question, his knowledge of geography, I would beg the Philadelphia President (biting sarcasm) to inform me, whether the Walcheren fever (remittent) occur- ed in England ? This question, I by no means consider "im- pertinent," of which he expresses an apprehension. It has too much of simpleness in it, for so harsh an appellation ; it is best answered by asking another. Does not Dr. Hosack contend, that yellow fever is an inter-tropical or West India 320 Jackson's Reply. fever, and cannot be generated in New-York ; and does not thi* inquirer know, that Dr. Hosack has written on tins West India fever as it occurred in New-York? There is no diffi- culty to prevent the Walcheren remittent, from occurring and being observed in England. A (ew hours sail brings those whose systems are imbued with the exhalations of the Walcheren marshes into Great Britain, where the disease subsequently unfolds itself. This is not a hypothetical oc- currence, but a well established fact. Few medical readers have now to be informed, that the Walcheren fever occurred extensively in England, on the oc- casion of the memorable and disastrous operation of the English forces against Zealand. The following passage from Dr. Wright's History of the Walcheren Remittent, a work composed from the observation of the disease in Harwich Hospital, and not in Walcheren, is one, amongst numerous proofs that could be adduced. " For, healthy regiments, (as I have it from Dr. Patrick, an authority 1 must ever respect,) brought over without sickness from Walcheren, and quarter- ed in Colchester, were universally seized with the continued remittent of Walcheren in its characteristic form, and the sequel was the same as at Walcheren and Harwich, so that no proof was wanting to ascertain their identity."* I hope this inquiring gentleman's " anxiety to become intimately acquainted with my novel views" on this subject, is now gra- tified. As this gentleman professes an ardent desire to be made acquainted with novelties in geography as well as medi- cine, he may gratify his curiosity, by turning to page 19 of Dr. Hosack's Discourse, where he will find the novel infor- mation, that Naples and Palermo are inland towns. I should not have thought it necessary to have noticed this " novel view," but for the *' exceeding anxiety he expresses to in- * History of Walcheren Remittent, page 19. Jackson's Reply. 321 form himself on such subjects," and the pleasure it gives me to enable him to indulge such very laudable desires.* Having pointed out the deceptious reference of Dr. Ho- sack to Huxham, as authority on yellow fever, I selected a few quotations of the general principles of that most sound and accurate observer, to show their hostility to the views entertained by Dr. Hosack. The force and point of these quotations, are incontrovertible. They are all admitted, except one, to be the very reverse of the doctrines^" Dr. Hosack. Yet from this single passage would the decider of the Medical Police boldly account for the conformity of Dr. Hosack's principles with those of Huxham, and the pro- priety of his reference to this great authority. But the doc- trine contained in the passage 1 cited from Huxham, and which is more largely extracted by the writer of the remarks, has no resemblance to the opinions of Dr. Hosack. Huxham, in union with Hippocrates, ascribes to the depraved consti- tution of the air, the causes of most epidemic diseases. The influence of this constitution is so great, (it is the opinion of Huxham,) as to affect " the increase and duration, but not as in other epidemics, originate such as are properly stiled con- tagious." This is the doctrine of Huxham, that the writer of the " remarks" avers, is precisely the same as " the views of Dr. Hosack concerning the contagiousness of yellow fe- ver." I am sure Dr. Hosack must have felt surprised at this discovery. There is not a syllable in the writings of Dr. Hosack, in reference to the influence of "atmospheric constitutions," on the character and prevalence of epidemic diseases. " The views of Dr. Hosack on the contagiousness of yellow fever," are evidently different. An atmosphere vitiated by the de- * This passage of the Discourse on Medical Police, is taken nearly from Blane's Elements of Medical Logic, page 150, though it is not ledged. The blunder, however, is Dr. Hosack's, and not Sir Gilbert s. 322 Jackson's Reply. composition of vegetable and animal matter, he teacher " lends wings to the emanations proceeding from the diseased body."* But has this puerile notion the slightest resem- blance to the philosophic doctrine of " atmospheric consti- tutions," as illustrated by Hippocrates, Sydenham, Huxham, and Stoll ? Who can form any definite and precise ideas from terms so vague and unphilosophical ? Examine the ex- pressions in every possible manner, and it will be found, that they really mean nothing. Dr^Iosack, in the most positive terms, adduced Pringle as having "abundantly drawn the distinguishing characters of bilious and yellow fevers. I proved beyond the possibi- lity of cavil or denial, that Pringle was a zealous opponent of the Professor's doctrine, and endeavoured, not to dis- tinguish between, but to identify " the characters of bilious and yellow fevers." Here was another open, manifest, un- deniable conviction on my charge of a deceptious reference. What course does Dr. Hosack's champion take in this instance 1 Does he, like an honest and candid inquirer in the great cause of truth, acknowledge and lament the error of his hero ? No; like a true Swiss, he knows no other cause than that which employs him. He seeks to screen the au- thor of the Medical Police, from this most palpable misre-* presentation, by accusing me " of sophistical reasoning," in my observations on the reference to Lempriere. The ob- ject of Dr. Hosack. in establishing the distinguishing charac- ters of bilious and yellow fevers, was to give support to his favourite theory of the contagiousness of yellow fever. This was the sole intention of the Discourse on Medical Police. In quoting Lempriere, therefore, as an authority to prove the distinct characters of the two diseases, it was Dr. Ho- sack's duty, as a candid writer to acknowledge, that Lem- priere did not consider contagion as a diagnostic of either. * Discourse on Medical Police* page 26. Jackson^s Reply. 323 Although no positive assertion is made in the discourse, that Lempriere believed in the contagiousness of the disease, he calls the continued endemic or yellow fever; yet, the manner, in which he is quoted by Dr. Hosack, leads unavoidably to that inference. The context admits no other conclusion. It was to guard against this source of error, arising from the cul- pable omission by Dr. Hosack of an important circumstance, that I mentioned the' particular opinion of Lempriere, so little calculated to support the theory, into the service of which it had been pressed. How is it possible, that the most captious, having the smallest regard to truth, can con- vert a plain proceeding like this, into sophistical reasoning? But, admitting, for the sake of argument, that my statement of Lempriere's opinion, was sophistical reasoning, by what "process of critical legerdemain," can this juggler cause it to make the positive proof of the deceptious reference to Pringle, "a baseless fabric of a vision?" One of the most glaring instances of a deceptious refer- ence to writings, for facts and opinions that are not contain- ed in them, is the appeal made by Dr. Hosack to the dis- eases of Seamen, by Sir Gilbert Blane. I repeat, that not a single fact or observation, is to be found in that very excel- lent work, to justify the reference made to it. The defender of Dr. Hosack, has the hardihood to assert, "that the whole of this is nothing more than the creation of Dr. Jackson's heated imagination." He avers, "that Sir Gilbert Blane in this very work, relates one of the strongest facts ever ad- duced in support of the contagiousness of yellow fever;" " it is contained," he continues, "in a letter addressed to the Hon. Rufus King, then minister at the court of St. James." Now mark the frontless imposition, that is here attempted to be played on the reader. The work on the Diseases of Sea- men was published in 1787; the letter addressed to Rufus King, is dated 1793; a difference of eleven years in the pe- riod of the publication of the two productions ; besides, the Vol. 7. 42 324 Jackson's Reply. facts related in that letter, were only reported to Sir Gilbert. and are not his own. If Dr. Hosack's reference was to the letter to Rufus King, why did he not so state it ? why did he particularize " the facts adduced in the diseases of Seamen ?" Did it arise from his knowing that the relation of facts con- tained in that letter, had been invalidated, by the persever- ing researches of Dr. Bancroft ? The letter to Rufus King may very probably be added, as an appendix to subsequent editions of the Diseases of Seamen, but this will not autho- rize a reference to the body of the work. The edition in my possession is the first, and I again reiterate, that there i9 not the slightest allusion to any occurrence, observed by Sir Gil- bert, in the numerous fleet of which he was Physician Gen- eral, in the West Indies, that appears to have even awakened his suspicion, that the disease was contagious. He has not been, 1 believe, in the West Indies since ; or had an oppor- tunity to acquire any additional experience from personal observation. In the Discourse on Medical Police, Dr. Hosack lays down, as a position of important bearing, " that until the affirmative testimony contained in the writings of Dr. Chisholm, Dr. Wright, Sir James M'Gregor, Dr. Pym, and Sir Joseph Gil- pin, &c. shall be disproved, the negative declarations of the late writers to whom I have referred, must be discredited." Those who have not investigated the question at issue, must have supposed from Dr. Hosack's statement, that the '• affir- mative testimony of Dr. Chisholm," &c. had never been dis- proved. I instanced this position of Dr. Hosack, not so much as a deceptious reference, as an attempt to deceive the unin- formed. The affirmative testimony of Dr. Chisholm. is the most important of that of all the contagionists; it may, in reality, be considered, as constituting the basis on which the whole system of the contagion of yellow fever rests. It is not surprising, therefore, that Dr. Hosack lays so much stress on it; but the refutation of thU •• affirmative testimony," has been so complete and entire, and has proceeded from so Jackson's Reply. c. "» * o2j many sources of the highest authority; even from those, whom Dr. Chisholm had cited as witnesses, that not a loop is left on which to hang a doubt. No one, who has devoted a small portion of time to the investigation of this subject, can be ignorant of this well-known circumstance; and it is incre- dible, that it should have been unknown to Dr. Hosack. How then, could he, as a conscientious investigator of the truth, cite the "affirmative testimony of Dr. Chisholm," as having never been disproved, when he could not but have been aware, that not a single point of it remained unques- tioned or unrefuted ? The apologist and advocate of Dr. Hosack, with his accus- tomed aberration from correctness, founds his defence of this art of deception, by mistating Dr. Hosack's language and meaning. He asserts, that Dr. H. merely "adduced these writers, as having furnished affirmative testimony in favour of the contagiousness of yellow fever." This is an unfair representation of Dr. H's. assertion. The position taken by Dr. H. is, that " the affirmative testimony adduced" had bc- ver been " disproved ;" a point altogether different from that stated and defended by the advocate of the discoure on Me- dical Police. We might be led to suppose that the frequent mistatements of this writer, arose from an incapacity to com- prehend the plainest language. Reflection must, however, convince, that such cannot be the case ; but, that the task he has undertaken is of so hopeless a character, no other course is left for him to pursue. With a generosity, that can scarce- ly be commended, though it is rare, he seems willing to share the fortune of his friend, and the conduct he can neither fairly justify uor defend, he will boldly imitate— " Common the crime, then common be the pain." In a virtuous cause, self devotion like this, constitutes the noblest character; but, in a cause intrinsically bad, it only makes " An artful manager, that creeps between His friend and shame, to be a kind of scrcn." 326 Jackson''s Reply. But this writer is not willing to be considered as sophistical and erroneous only, he must be inconsistent and absurd. Dr. Chisholm's testimony on the contagion of yellow fever, con- sists principally of the romance of the ship Hankey, and the circumstances connected with her arrival at St. George's in Grenada ; all of which have been manifestly shown to be the mere coinage of his brain. Separate the story of the Han- key from Dr. Chisholm's proofs, of the contagion of yellow fever, and they become a nullity. The doctrine of the im- portation of yellow fever, from Bulam to Grenada in 1793, and thence to all the other West India Islands, and our con- tinent, rests on the truth of this story. Destroy this founda- tion, and down goes the whole structure of contagion. Yet, this logical writer avers, that the overthrow of this ground- work of Dr. Chisholm's testimony, "is not fairly meeting it; does not weaken or destroy its force ; is flying off from the subject matter of the dispute ; is mistaking one thing for ano- ther." This Quixotical mistake of mine, as he considers it, differs in one respect from the famous adventure of the re- nowned knight, to which it is facetiously compared : it pro- duced more of anger than smiles, tears than laughter. Dr. Hosack and his friends, judging from the passion they are moved with, do not appear to consider it a joke. Nay, if Cervantes had made his hero guilty of no greater hallucina- tions, than such as taking Dr. Hosack for a wind-machine, instead of a giant, the world would have wanted many a hearty laugh, in the dull recital of sorry realities. " The affirmative testimony" of Mr. Pym, which Dr. H. made of so much importance, as not having been disproved, is in the same predicament as that of Dr. Chisholm. I al- leged, that part of it had been refuted by Dr. William Fer- guson, and, as his system was built on the correctness of Dr. Chisholm's account of the origin of the Bulam fever, the testimony of both fell together. But, nearly the whole of the testimony of Dr. Pym, has been clearly and amply con- Jackson's Reply. 32,7 troverted by Dr. Bancroft, in a late work, which my friend, Dr. Chervin, had in his possession, and which I hastily pe- rused, while he was prosecuting his interesting and valuable researches in this city. 1 have not been able to meet with any other copy, or I might have it in my power to show what is the degree of credit to be attached to the Stoney Hill story. The advocate of Dr. Hosack, however, denies that " Mr. Pym builds his system upon the origin of yellow fever, on board the ship Hankey." I contend, that he does assign its origin, which involves the character of the disease, to its importation from Bulam by the Hankey, as related by Dr. Chisholm. Here we are it issue; let facts decide. The ti- tle alone of Mr. Pym's work, is sufficient to estahlish my po- sition, and gives a flat contradiction to the assertion of my opponent. Mr. Pym's work is entitled " Observations on the Bulam fever, which has of late years prevailed in the West Indies, on the coast of America, at Gibraltar, and other parts of Spain." Does not this title page present an epi- tome of Dr. Chisholm's doctrine ; which is, that the yellow fever was imported by the Hankey from Bulam, into the West Indies, whence it was carried to America, and communicated to Spain, &c. But Mr. Pym settles the question himself, by defining his meaning of Bulam fever, viz. " Bulam fever, a contagious disease of foreign origin, and supposed to have been imported from the coast of Africa," page 4. He is still more explicit. At page 199, the following observation will be found in a parenthesis; " without any reference to the introduction of the disease into Grenada, as mentioned by Dr. Chisholm.''' The extract of his letter to Sir Richard Keates leaves no doubt, as to the correctness of my asser- tion, and the unfounded, though bold declaration of my accu- ser: " In my opinion, the fever, which prevails on board the transports from Carthagena, is the contagious fever of the West Indies, known by the name of the Bulam fever, from its having been imported from that settlement to the island of 328 Jackson's Reply. Grenada, in the year 1793." It is the same disease which prevailed in Spain in the years 1800 and 1803, aud at Gib- raltar in 1804," page 236. Notwithstanding this plain and positive avowal of his be- lief by Dr. Pym, the defender of Dr. Hosack, who pretends to doubt, whether I had read Mr. Pym's work, and must of course be familiar with it himself, denies that Mr. Pym builds his system upon the story of Dr. Chisholm. Of whom else does he get the name of Bulam Fever? Of whom else does he derive its importation from Africa ? That the opinions of Mr. Pym are precisely as I stated them ; after this exposition, it might be supposed the most daring would hardly deny. Now, of what value is the " affirmative testimony" of Mr. Pym, who makes the disease, that has afflicted the different cities of our continent, Gibraltar, and various cities of Spain, to be derived from Bulam, where no such disease has been known j and to have been imported from that settlement, when no such importation can be established ? Thus is this vaunted "affirmative testimony" overturned by the positive contra- dictions of Drs. Ferguson and Bancroft, and falls into ruins of itself from the sandy nature of its foundation. I know not whether the numerous egregious errors, and dashing groundless assertions of this writer, are attributable to a flippant ignorance, or perverse malversation. Painful as it is to see any individual with pretentions to respectabi- lity, and powers to make himself esteemed and respected, place himself in the predicament of being hung on either of the horns of so worrying a dilemma, it becomes unavoidable, from the nature of the attack made on me, and the defence which 1 must employ. The reference made by Dr. Hosack to Diemerbrock, Ron- deletius, Clavigero, and Howard, in order to prove, that ani- mal matter in a state of putrefaction " will not generate pes- tilential fever," I instanced as strong proofs of the inaccurate reference to authors, for opinions and facts not contained ia their writings. Jackson's Reply. 329 I was fully persuaded, that Dr. Hosack had not read either Diemerbrock or Rondeletius, when he cited them as testimo- ny, with so much confidence, and, that he had been led into the error he committed, by a careless perusal of Dr. Ferriar's paper, on the " Origin of Contagious and New Diseases." For the information of Dr. Hosack, with a view to guard him against a repetition of the blunder, I stated concisely the par- ticular opinions of Diemerbrock, which I sustained by quo- tations from his work. The Belgian philosopher distinguishes between plague " pestis," and pestilential and malignant fevers—" febres pestilentes"—" febres malignae." The first, " pestis," does not result from natural causes, but proceeds immediately from the most just anger of God, "justissima summi Dei ira," for the sins of men. Dr. Ferriar's essay could have furnished this information, had it been read with attention. " Diemerbrock, Dr. Willis, and some other emi- nent medical writers of the last century, supposed the plague to be always an affliction from the Deity."* It is to support this opinion, that Diemerbrock mentions the fact, that ani- mal matter in putrefaction, will not generate plague, although pestilential fever i? not an unusual consequence. It is this last circumstance, that gives the point to the argument of Diemerbrock, which would be futile in the extreme, with the interpretation of Dr. Hosack, and his obstreperous advo- cate. The expressions of Diemerbrock, are " nulla tamen pestis insecuta est:" "nulla peste subsequente"—no plague succeeded—no plague followed. The word " pestis," is used by Diemerbrock to designate the plague. In no in- stance does he employ it as meaning pestilential fever.— "Febris pestilens," is the phrase with which he uniformly expresses himself, when speaking of pestilential fever—a dis- tinct disease, as he considers, from the plague. * Medical History and Reflections, first American edition, page 11!> 330 Jackson's Reply. vThe very next sentence to the quotations of Dr. Ferriar, copied by the writer of the Remarks, is conclusive, as to the truth and correctness of this representation of Diemerbrock's views; while the whole of the concluding part of the para- graph, is hostile to the theory of Dr. Ferriar, which shows, that, even that respectable writer had not, with perfect fair- ness and candour, quoted his authority. "Si aliquando," i9 the language of the sentence succeeding the quotation of Dr. Ferriar: " ex foeda cadaverum putredine aliqui morbi orian- tur, illi vel erunt putridi simpliciter vel putridi maligni ac pes- tilentes privati, non autem vera pestis. Liquet id ex historic Paraei citata, qui ex cadaveribus in puteum projectis inquit multos tanquam peste interiissc ; non dixit simpliciter peste, sed tanquam peste, id est, morbo tali quern propter malignita- tem assimilat pesti."* No pertinacious cavilling, can inva- lidate the force of these expressions, and they must put to shame the bold animadverter, who with the most perfect as- surance pretends to speak of the opinions and doctrines of a writer, whose works he has never seen. It is easily to be perceived how Dr. Hosack has been led into his error by mistaking Dr. Ferriar's theory, for Diemer- brock's opinion, in consequence of his ignorance of the works of this last author. Dr. Ferriar observes, " it is ne- necessary to mention some of the principal theories relating to the rise of plague and pestilential fever. I place these to- gether, for I apprehend the plague to be a fever, attended with some unusual symptoms, chiefly produced by its vio- lence, "t This opinion Dr. F. formed, he says, principally from Diemerbrock's cases ; but it is his own view, and not that of the Belgian physician. Had Dr. Hosack cited Dr. Ferriar as the authority, he would have been perfectly cor- * De Peste Caput, viii. Problema iv—4. ■ Medical Histories and Reflections, American edition, page 11> Jackson's Reply. 331 rect, but to display his erudition, he quoted Diemerbrock, who is directly opposed to him. That Diemerbrock was decidedly of opinion, that animal matter in a state of putrefaction did generate pestilential fe- vers, the several passages I referred to in his work, " De Peste," must have satisfied the most prejudiced. The facts he mentions are positive ; his language unequivocal—" pu- tridos foedores semper febres pestilentes inducere et experien- tia docet." Can words be more explicit ? The references and quotations 1 selected are unimpeached by the reviewer of my essay, yet, thus admitting their correctness, with this perspicuous language in which Diemerbrock delivers his opinions placed before him, he has the audacity to deny that such are Diemerbrock's doctrines. The gross errors and misstatements of the defender of Dr. Hosack, as it respects the sentiments and doctrine of Die- merbrock, I should be charitably disposed to believe, were the result of his acknowledged ingnorance of the work, of whose contents he speaks so confidently ; and his miscompre- hension of Dr. Ferriar. But what apology can we frame to excuse, or what plea imagine to explain his tergiversation as regards Rondeletius; and the object of Dr. Ferriar's cita- tion of this author: both of which are mistated, with an ob- stinate perversity. Dr. Hosack is the only person, who ever thought of mentioning Rondeletius, as an authority to prove, than animal matter in a state of putrefaction, would not ge- nerate pestilential fevers. Rondeletius, in no part of his works, expresses an opinion on the subject, and the only fact he mentions, that has a relation to it, proves the reverse. The quotation was given in my essay, and need not be re- peated, especially as it is not challenged by my reviewer. Dr. Ferriar, when discussing a question entirely different, viz. the power of a dead body to communicate infection, cites Rondeletius to prove, that it cannot. The language of Dr. F. is too clear to admit of any misapprehension. "Another Vol. 7 41 332 Jackson's Reply. question, connected with this (whether contagion assimi< lates all the fluids to its own nature) and illustrative of it, is, whether the dead body of a person destroyed by a plague or fever, be capable of communicating infection. On this subject facts are wanting. Rondeletius (as quoted by Sen- nertus) asserted that he had dissected bodies dead of the plague, in the presence of many of his pupils with perfect safety. * But let Rondeletius speak for himself. " Quare corpora ilia mortuorum, quae amplius non expirant nullum venenum ejaculantur. Quod si aliquid contrahatur, hoc po- tius ab eorum pannis contrahitur; quam ulla re alia. Si- quidcm dissecuimus aliquando corpora mortuorum ex peste, multis spectantibus studiosis sine aliquodamno; propterea quod mortuo animali perit omne venenum." From some ex- traordinary inadvertence, Dr. Hosack evidently misunder- stood the passage that has just been extracted from Dr. Feriar's essay, and quoted Rondeletius in his discourse on Medical Police, as an authority in support of his position " that animal matter will not generate pestilential fevers." The error was pointed out in my essay, the entire irrelative- ness of the observation of Dr. Ferriar, as well as of Ronde- letius, to the subject that Dr. Hosack was discussing, was shown. A single glance at Ferriar, must make the correct- ness of my remarks manifest to the dullest capacity. What is the course pursued by our veracious reviewer ? He insists that the fact mentioned by Rondeletius is demonstrative that animal matter will not generate pestilential fevers, because dissecting a body recently dead of the plague the contagion of plague was not communicated by it. But he goes fur- ther. He avers, that Ferriar viewed the testimony of Ron- deletius in the light that Dr. Hosack had placed it, and quoted it to show, that animal matter in a state of putrefac- " Medical Histories and Reflections, American Edition. Page 124. Jackson's Reply. 333 rion will not generate pestilential fevers." Now mark the deliberate deception practised. The only passage of Dr. Ferriar's essay, in which Rondeletius is mentioned, is the one that has been given above. But instead of quoting this passage, to sustain his solemn asseveration, he extracts a passage from another part of Dr. Ferriar's essay, in which Rondeletius is neither mentioned nor alluded to, and where a subject is treated wholly different from that, to sup- port which he appeals to the evidence of that writer. A deception precisely of the same character, as that which has been exposed in the instance of Rondeletius, is practised with respect to Howard's testimony. An obser- vation of the distinguished philanthropist to show that the contagion of plague," is not communicated when the corpse is cold, of a person dead of plague," is perverted, by Dr. Hosack's partisan, to mean that animal matter will not gene- rate pestilential fevers." The note which the reviewer tran- scribes from the work on Lazarettos, will bear no other inter- pretation than that I have given to it, but the text to which it is connected rendered the intention of the author more ex- plicit. " It is by these ideas of the communication of the plague that the foregoing rules have been suggested." * It is lamentable to behold such a felo-de-se of character on so trifling an occasion. This writer seems as though scorning every species of management, by which his repu- tation might be covered, he would throw off all reserve, and bare his forehead to the brand of shame. One more authority remains to be examined, and this dis- gusting exposition of quibling sophistry, and misrepresentation is terminated. Clavigero as well as Diemerbrock and Ron- deletius with the appearance of great erudition and laboured research, was quoted by Dr. Hossack, as an author, whose work he had consulted. It now appears that this writer, • Dr. Howard on Lazarettos. Page 2-1 334 Jackson's Reply. and I presume Herrera also, was known to him, as well as the other authorities, only at second hand. On examining this writer to test the correctness oi the reference made to his publication, 1 found nothing to justify it, but facts chiefly opposed to the doctrine of Dr. Hosack. How is this an- swered ? by appealing to the truth of the extracts, I made from Clavigero, or an attempt to point out their incongruence to the subject for which 1 produced them ? Not a word is said in opposition to the accuracy of my quotation, or to lessen the overwhelming force with which they prostrate the reference of Dr. Hosack to the history of Mexico." To meet the positive testimony I adduced from the work of Cla- vigero, a negative fact is produced which had been employ- ed by Dr. Chisholm for some object, in some of his works into which I feel no necessity of inquiring, as negative evidence cannot be admitted to possess the slightest weight opposed to testimony of the most positive character. 1 have now completed this part of the task that has been imposed on me, by the necessity of self vindication. It has been by no means a grateful employment. I possess not that species of taste, which derives a gratification in displaying and contemplating the "human form divine" blurred with defoim- edness. Infinitely more ungracious has it proved to my feelings, though in the strict performance of duty ; to make bare this picture of moral disfiguration. The charitably disposed reviewer, in borrowing the language of Junius fancies, that he becomes clothed with the powers of vindic- tive vengeance with which that eloquent but uncandid and often malignant writer was so liberally endowed, and which he so often unsparingly exercised; but the borrowed tinsel can impart no sharpness to the leaden dart. The bed of torture " he prepared with so much complacency, I am a- fraid, he is doomed himself to occupy. If not callous to every emotion of shame, the public exposure, he has called down on his head must awaken a keen sense of shame and Jackson's Reply. 335 give birth to the deepest regrets. Let him employ the severe lesson he has received to its proper purpose, and learn, that no circumstances can justify or palliate, especially in a Med- ical writer, the slightest deviation fom the most religious adherence to candor and truth. I am perfectly sensible that the subject of this discussion is of little moment. The knowledge that consists in an ac- quaintance with the opinions of writers, is of the lowest spe- cies :* although it is that, which, carrying with it all the weight of erudition, most frequently imposes on the judgment of man- kind. Dr. Hosack attempted in his " Discourse on Medical Police," a liberal display of this kind of learning. It made no inconsiderable impression on the public, spread before it through every medium, and on a subject, the correct decision of which, involves its highest interests. A slight acquaint- ance with some of the writers, to whom Dr. Hosack so con- fidently referred, rendered me conscious of very extraordi- nary and important inaccuracies that he had committed. Engaged in the same discussion, I thought it my duty to cor- re t them. This measure has occasioned me to be assailed with a most intemperate spirit. All my statements are con- tradicted ; I am charged with having never seen the works, from which 1 made extracts, which of course must have been fabricated by me ; with having misrepresented the sentiments of writers, and descended to the mean arts of sophistry and evasion. To repel these injurious aspersions, that, "lost in the labarynth of their fury," my antagonists have sought to cast on me; this idle and tedious discussion, for such I fear it wili be thought by those not immediately interested in it, was, rendered necessary. If it be of any conseqtKMice to have determined who are the guilty, and by whom decepiion has been practised, the facts and authorities are now so am- *This sentence must be uiid^rstro. ' wilh sumo limitation, and i> only true when it is used for the purpose of erudite parade. Ed. 336 Jackson's Reply. ply spread out, as to enable every one to form his own con- clusions, independent of any cavils and angry comments. Having disposed of the " Remarks on Certain Parts of 'An Account of the Yellow or Malignant Fever, &c. &c.'" there remain to be examined, tested, and justly valued, the pretensions, arguments, knowledge, accuracy, and truth, of Dr. Ducachet's "Reply to the remarks of J. &c." The passages of the remarks of J, that touched acutely this gentleman's sensitive faculties, stirred into a ferment the bile of his meek disposition, so that, without offending him personally, he has made me the object of his petulant invec- tives and injurious detractions ; why ? 1 am at a loss to divine. But, feeling, and acknowledging the obligation he has fa»d on me, I would not, that he should deem me forgetful of it, by not returning, to the extent of my poor ability, the debt most de- servedly his due. Was it necessary, however, that I should track, step by step, as in the preceding examination, the doubles of hie course, I might be deterred from the labour, disgusted alrea- dy with its loathsomeness. Happily the unpleasant task is Spared me. Without threading the wiles and shifts of an ex- perienced cunning, I shall break his cover, and placing in full view, the varied artifices, skilfully contrived to deceive, strip him of their resource. Dr. Ducachet's essay purports to be " A Reply to Remarks of J, on the Review of the papers relating to the Fever in New-York, in 1820." To ascertain the relevancy of his statements and arguments, it is proper to determine what are the remarks, which Dr. Ducachet pretends to answer and refute. The committee of the New-York Medical Society, in a " Report explanatory of the causes and character of the Epi- demic Fever, which prevailed in Bancker-street, &c." offer- ed three essential characters, as designating Typhus Fever. The 1st was, that medical writers apprise us that typhus dis- Jackson's Reply. 337 appears in warm weather; and that it is most prevalent dur- ing cold weather, more particularly if accompanied by hu- mid it) of the atmosphere : 2d. that the young and robust are the least liable to its attacks, but the old and debilitated are its most general subjects : and, 3d. that it is unexceptiona- ble a fever of continued type, and of protracted and uncer- tain stages. This Report was reviewed in the Medical Recorder for April, J 821, by B, who particularly selected these diagnos- tics as the subject of his animadversion. The first position he contested, and declared himself entirely ignorant of the writers, who, according to the committee, inform us, that '.* typhus disappears in warm weather, and is most prevalent during cold weather, more particularly if accompanied by humidity of the atmosphere." Proclaiming his ignorance on this subject, he solicits to be enlightened. The 2d. position of the committee, B admits to be correct; and the 3d. he meets with cavils and exceptions, instead of argumentation or general observations. The avowal made by the reviewer of his total unacquaint- ance with any medical writers, who entertain the opinion at- tributed to them by the committee of the New-York Medical Society, appeared of the most extraordinary character. This ignorance, whether real, from a limited acquaintance with medical writers, or feigned, for the purpose of sustaining an argument; equally disqualified him for the office he had as- sumed. If he truly had not, in the course of his medical read- ings, met with the writings alluded to by the committee, in- stead of presuming to criticise the performance of others, he should have been engaged in his studies, and been laying the forndation of his medical information. If his disavowal of a knowledge of these writers was false, then is the character of all his observations vitiated, prostrated in the mire, and strip- ped of every title to credence or respect. Crediting his de- claration of an absolute ignorance in this respect, and the 338 Jackson's Reply. sincerity of the desire expressed, to be informed, "who the 'medical writers' are, that gave the committee this wonder- ful information," that information was communicated to him by J. It appears to have been received by B. as it was in- tended, in a friendly way, for he has not thought it necessa- ry to make any observations in reply. He has no doubt pro- fited by the instruction. Why Dr. Ducachet has thought it necessary to feel himself aggrieved, is quite incomprehensi- ble. Dr. D. asserts, that I " accused the reviewer of being ignorant of one of the commonest and best established facts in medicine." This is not the only instance, in which Dr. D. violates the truth. It was the reviewer who proclaimed his own ignorance, and I did no more, than believe what B. said of himself. It is not J, but Dr. Ducachet, that in- sults the reviewer, by refusing credit to his words; and he does this under the mask of friendship. That the authorities cited by J, established in the most in- controvertible manner, the point for which he adduced them, viz. to support the first position of the committee of the New- York Medical Society, that there are " medical writers that apprise us that typhus disappears in warm weather," &c. is beyond the reach of cavilling captiousness, or crooked prejudice. Dr. Ducachet, by the disingenuousness of his con- duct, shows it in the strongest light: he undertakes to con- trovert the correctness of J's references, but, instead of ho- nourably and manfully meeting the question; by an artifice that would be esteemed disgraceful in the meanest disputant of a tavern forum; he distorts and mistates the point in con- troversy, in order that he may be able to frame an argu- ment, and find a plausible excuse to give vent to malignant passion, and indulge the disposition to detraction, that forms so conspicuous a portion of his elaborate essay. A reference to the Remarks of J., will convince any can- did mind, that the only intention of the writer, in quoting his authorities, was to demonstrate to the reviewer B. that there Jackson's Reply. 33S were " medical writers, who apprize us that typhus disap- pears in warm weather, &c." The establishment of this fact, and the confession of an ignorance of such writers by B, was conclusive evidence of his incapacity for the task he had undertaken. Dr. Ducachet finding the subject placed by J. in a position that was impregnable, resorts to the pitiful eva- sion I have mentioned, on which he no doubt prides himself, as an admirable ruse de guerre; and makes a new question, viz. " that Dr. Jackson is bound to show that typhus never prevails in warm weather," examines the authorities as to their bearing, not on the point for which they are cited by J. but on his interpolated question; and then accuses me of deceit, because all of the authorities do not prove to the fullest extent, " that typhus never appears in hot weather." Practising this duplicity, Dr. Ducachet dares to talk of ho- nesty !! In my account of the malignant or yellow fever, in Phila- delphia, in the year 1820, I stated as a diagnostic of typhus, " that it never does appear epidemically in hot weather, and ceases on the approach of cold." I have no hesitation in admitting, that the position as laid down, is too general; that it does not apply uniformly to the variable climate of Eng- land, or some other temperate climates equally marked by versatility. But, it is apparent from the context, that J. was alluding to typhus in this country, and not in cold, moist climates. As it respects this country, where the thermo- meter averages from 78 to 83° during the summer, I hold the observation to be incontrovertible, as well with respect to other climates of an equal or greater temperature. Had it been my object to have supported the position, " that typhus never appears epidemically in the hot weather of this country, or of warmer climates, as Dr. Ducachet would have it that I was bound to do, (why ? it is impossible to con- ceive), different authorities and arguments would have been resorted to. Vol. 7. 44 340 Jackson's Reply. In that case, I should have undertaken to have shown, that genuine contagious typhus, the disease to which the pame it given by Cullen, and to which it should be strictly confined, is absolutely unknown in the hot summers of this country. I should have shown, that under the denomination of typhus, in this country, and it may be added in the West Indies ; are vaguely included several species of fevers, such as the gastric gastro-enteritic ; the mucous fever, febris pituitosa of Stoll, adeno-meningee of Pinel; the slow nervous fever and others, are all, without the least discrimination, classed as typhus, especially complicated, as they so frequently are, with an adynamic state of the system. In these instances, the type of the disease or state of the system, is confounded with the diagnostic symptoms—the accident is taken for the essence. I would have established by indubitable authorities, that in Africa, in India, throughout a large extent of Asia, countries including a population of from 2 to 300,000,000, under the most favourable circumstances of filth and confined situations, crouded with human beings, that fever is unknown ; and when carried thither, cannot be propagated. While on this subject, without entering at large into its discussion, a single observation of a most competent authority may be cited* "Before dismissing the subject of fever, 1 may observe, that no well-marked case of typhus occurred to us in Egypt. In India we never saw a case of this species of fever. To the existence of this fever, which in Europe has committed such havoc in our fleets and armies, the climate of India u inimical. We know instances where, in transports, typhus had broke out, and, on the passage to the Cape of Good Hope or India, had proved little less destructive than the plague could have done ; but the disease never reached In- dia. If a case was landed there, it never propagated the contagion : a second case never appeared on shore. On in- quiry, I found that no case had ever been known on the wes- Jackson's Reply. 341 fern side of the peninsula, nor have I ever heard of its ex- istence in the eastern." * Dr. Ducachet was not contented with resorting to the de- ceptious practice 1 have exposed, but he also attempts a si- milar imposition in individual instances. Sir Gilbert Blane prides himself, as having been the first, who noticed the fact, that " there is something in tropical climates unfavourable tO the production and continuance of infectious fevers." t Dr. Ducachet has not the hardihood to deny openly, the cor- rectness of the quotations 1 made from Sir Gilbert Blane's work. The first and third quotations are as positive of his belief, of the effect of a warm climate in destroying typhus, as can be expressed in the English language. Dr. Ducachet does not pretend to controvert, this accuracy ; he passes them by without notice, although embracing the main and import- ant part of the question, and only notices six words of the second quotation, and those but correlative, as though they constituted the only quotation, and the only opinion for which Sir Gilbert was referred to. And yet, Dr. Ducachet has the face to pretend to honesty as a controvertist! I But this is not the only deception practised with regard to this writer. Dr. Ducachet asserts, that " in his observations on the diseases of Seamen, he (Sir Gilbert) tells us of the existence of a low ship fever on board of two vessels on the West India station, in the June of 1780." By referring to the " Observations on the Diseases of Seamen," it will be found, that Dr. Ducachet has grossly misrepresented the ob- servation of Sir Gilbert. The words are, " The fever in these two ships resembled rather the low ship fever of Eu- rope, than the bilious one peculiar to the climate." \ And Dr. Ducachet is an honest man! *M«Cregors Medical S! etches of the expedition to Egypt from India, page 16?, i Observations on diseases of ^amen, edit 1785. p. 287 t Observations to edition 1785, page 80. 342 Jackson's Reply. Other misstatements, were it necessary, would be exposed, but they would swell this communication, already too ex- tended to an unwarrantable size. " Crimine ab uno, disce omnes." The disingenuous proceeding of Dr. Ducachet, in misstat- ing the arguments of J. and the sophistry of which he is guilty by replying to those misstatements, as though they had proceeded from me, and testing the accuracy of the authori- ties quoted, by the same standard ; have been amply exposed. It is deemed quite unnecessary to occupy any additional space, in illustrating the adaptation of the references to the points, intended to be established by them. It is conceived, that they are not invalidated in a single circumstance, by the cavil and objections brought against them by Dr. Ducachet, which are evidently the result of a want of extended and gen- eral information, as to the diagnostic symptoms of the differ- ent febrile affections. The utter impossibility of ever arriving at truth in any discussion, without employing terms in a certain and defined sense, is too obvious a principle to require an argument for its support. To avoid the errors and misconceptions arising from the use of terms in a loose, general, and different mean- ing, two positions were laid down by J. The first was, that there is a disease answering completely to the definition that Cullen gives of Typhus, of which contagion is an essential attribute. The term typhus having been bestowed on this disease, and universally adopted, should be confined to it ex- clusively. The second was, that diseases will often assume various types without losing their specific characters. Thus gastric, mucous, yellow, slow, nervous, and other fevers, will appear with a typhoid or adynamic, or an ataxique type. It is common to mistake fevers with these complications for typhus, though they are very distinct. The following ex- tract from " Medical Sketches" of Mr. James M'Gregor, presents a striking example of the various types that are Jackson's Reply. 343 sometimes witnessed in a single disease. " In the Indian ar- my, when the disease (plague) first broke out, the cases sent from the crouded hospitals of the 61st and 88th regiments, were from the commencement attended with the typhoid or low symptoms. The cases sent from the Bengal volunteer battalion, and from the other corps, when the army was encamped near the marshy ground at El Hammed, were all of the intermittent or remittent type. The cases which occurred in the cold rainy months of De- cember and January, had much of the inflammatory diathesis. Mr. A. Whyte remarked, that every case admitted into the hospital at Rahamania, had the symptoms of pneumonia. In the end of the season, at Cairo, Ghiza, Boular, and on crossing the isthmus of Suez, the disease wore the form of a mild continued fever." * In all these instances, the plague never lost its distinctive character, though presenting so many aspects or types. Si- milar observations have been repeatedly made in other dis- eases. Dysentery will be sometimes attended with a highly inflammatory diathesis, and require actual depletion ; at other times, it is accompanied with a typhoid or adynamic state, and demands a totally different management. Even the symptomatic fever, succeeding upon large wounds, espe- cially gun-shot wounds, is frequently of a typhoid character. The principles that have been stated, were laid down by J, to anticipate and obviate the objections and arguments that are employed by Dr. Ducachet. Those principles he has not pretended to controvert; yet heedless of these dis- tinctions, that are sustained on the highest authorities in me- dicine, in a most strange confusion, he jumbles together fe- vers that are totally distinct. If an author employ the term ty- phus, though the symptoms described demonstrate the disease to have been gastric, slow nervous, mucous, or other fevercom- * Medical Sketches of the Expedition to Egypt from India, page 3—112. 344 Jackson's Reply. plicated with an adynamic or ataxique state of the system, or, as it is in this country termed, typhoid type, it is seized on with avidity. If the author gives another name than ty- phus, as Hillary does to the fever of which he treats, Dr. Ducachet insists it is typhus, and typhus it shall be. whether the symptoms correspond to that disease or not. By this most ingenious manoeuvre, as the candid Doctor no doubt thinks it is, he creates typhus, whenever and wherever it will suit his argument.. But, dexterous as is the stratagem, the liberality with which he has employed it, and the mon- strous incongruities of which it is productive, entirely des- troys the effect it was intended to accomplish. No one it deceived, unless it be the Doctor himself; while his reputa- tion as a medical observer, as a physician versed in the ele- ments of his. profession, and capable of distinguishing the discriminative features of different febrile diseases, without which, no one merits the character of a physician; is impli- cated by his own art—is sacrificed to the petty artifices of a controvertist. The pyretology of Dr. Ducachet, appears like that of De Haen, to consist of but two fevers. A fever without acute inflammation, is, with him, typhus. Thus, the slow nervous fever described by Hillary, (" known to be" such, and not typhus, " from the description he gives of it," by all who are acquainted with the characters of the two diseases); the fever mentioned by Lind, as " approaching nearest to what is called a nervous fever;" the slow nervous fever of Huxham, febris mucosa—adeno-meningee of Pinel; the gastric fever of our summers and autumn, complicated with adynamic symptoms, so frequently described by Dr. Gallup, it is true, under the name of typhus ; the same disease in the Philadelphia alms- house in 1820, described by Dr. Joseph Klapp—all these, and other fevers of different characters; of species wholly distinct; by the sinister management of Dr. Ducachet, are in utter confusion, heaped together, and confounded with ty* Jackson's Reply. 345 phus. He breaks down, through an irreverent vanity, or un- skilful ignorance, the ancient land marks of the science, con- secrated from the earliest period, by all that is revered and esteemed in medicine, for genius, experience, observation, and truth. The beautiful harmony, and exact disposition, that now manifest themselves in the classification of diseases, through the prevailing influence of an analytical observation in medicine, would be dispersed, and "chaos come again," could the legerdemain tricks of the " Reply" of Dr. Duca- chet possess an influence, equal in their magic to their pre- tentions. Devoid all discrimination, the various species of fever have lost, in their levelling system, their peculiar cha- racteristics—"nulli sua forma manebat." With a view to prop the most pitiful of all cavils, resting on a want of discrimination of the terms typhus and typhoid, Dr. Ducachet most pertinaciously insists, " they are abso- lutely synonymous." Nay he is bold to affirm, that " no au- thor of established repute in medicine, recognises the differ- ence contended for by Dr. Jackson." Notwithstanding this bold affirmation, a few lines subsequent, he " grants, indeed, that," typhoid, " when used by medical writers, is seldom intended to designate typhus fever itself, but rather some disease in which the fever is of a typhus character"!!! Can any thing be so ridiculous as the bold affirmation, and this palpable contradiction of it, jumbled together in the space of a few lines. Dr. Ducachet, amongst the rest of his honours, appears ambitious of adding the cap and bells. The prize will be accorded to him without contest. After so many centuries of fruitless observation, on the ever fluctuating ocean of undefined terms, of idle opinions, of unmeaning words, and conjectural opinions; the introduc- tion of sound philosophy into medicine, has placed the sci- ence on the immoveable basis of observation and experience. At this day, when clearness, precision, and order, are es- teemed essential requisites of the science, the inexact and 346 Jacksorfs Reply. inaccurate views of fevers, displayed throughout the labour- ed essay of Dr. Ducachet; his total want of discrimination between things of a distinct nature; his practical efforts to prolong the disgraceful era of confusion and discordancy, too long lamented ; and his abortive attempt to justify a loose and negligent employment of terms, cannot be tolerated. He places himself under the censure of every medical philoso- pher, and friend to the advancement of truth. The prac- tice is justly condemned, and its object properly designated, by the enlightened and profound author of the "Nosographie Philosophique," with whose expressive and appropriate lan- guage these observations will be closed. "G'est une heu- reuse ressource pour un esprit peu exact et peu propre a mettre de la justesse dans les expressions, que I'usage de certains termes d'une signification indeterminee, et qu'on peut employer a. tout propos sans crainte d'etre trouve en defaut."* Note.—I should not have felt justified in introducing the name of Dr. Ducachet into the discussion, but for the cir- cumstances already related. I conceive, that, by his con- duct, he has outlawed himself, and is not entitled to the ob- servance of those rules of literary courtesy, I ever wish to obey. A question of science can be discussed, without any mixture of personal reflections. When the discussion is ano- nymous, the obligation to abstain from them is more binding. Without the slightest offence having been offered to Dr. Du- cachet, he assailed me with a degree of rudeness, violence, and even maliciousness, for which it would not be possible to account, had not others, respectable for their age and stand- ing iu the profession, been equally the object of his coarse- ness. The law of retaliation, I hold to be as necessary to preserve decorum in the republic of letters, as of manners in society. It is a duty to visit this law on the disturbers of either community ; and, if there is exhibited a harshness in some of my remarks, that, in other circumstances, would be unbecoming, my apology must be, that it was the discharge of a painful duty, in return for an unprovoked and wanton outrage. * Vol. 1st. page 186. ( 495 ) Remarks on the Epidemic of this State, in a Letter from Dr. Daniel Hudson, dated Geneva, January 12th, 1813. The pestilential epidemic, which has for some time past been raging on the Niagara frontier, is now making its ap- pearance in our neighbourhood, and seems to have excited some alarm, from a belief that it is of a contagious character. I have been requested to give a short description of the na- ture of this disease, with a view to quiet fears which are alto- gether groundless. Having been constantly employed in cases of this destructive malady, from its commencement at Niagara, I am, from actual experience, enabled to assert that it is not of that class of diseases which may be communicated by contagion. The cold humid state of the atmosphere, for some months past, has, no doubt, been a powerful agent in producing a pre- disposition to pestilential and inflammatory diseases. In ad- dition to this, our unfortunate army has been unavoidably ex- posed to hardships, fatigues, and privations, which are inci- dent to a campaign at a late season of the year, and in a new country. The most common form in which it makes its at- tack is with cold chills, succeeded by acute lancinating pains in some part of the thorax, which are greatly aggravated by a full inspiration. The pain is sometimes more severe in one tide than the other, and sometimes occupies the whole re- gion of the chest. The pulse becomes full and frequent, the respiration difficult, great thirst, furred tongue, and frequent- ly a severe pain in the head. In those cases which terminate fatally, these symptoms increase; respiration becomes much hurried, painful, and. laborious, a rattling in the throat, pro- fuse expectoration, sometimes streaked with blood, a ghastly appearance of the countenance, cold feet and extremities: the difficulty of respiration continuing, the patient, as if 496 Hudson on the Epidemic of New-York. suffocated, expires in the most distressing agony. In other cases the disease, after a few days, assumes the typhoid type, and is sometimes, though not always, connected with the last mentioned symptoms, and in this complicated state puts a speedy termination to the life of the patient. The blood, when drawn, exhibits the most unequivocal signs of exten- sive inflammation. The following are the appearances on dissection. The heart, pericardium, lungs, pleura, and diaphragm are generally found in a state of inflammation: in some instances, the liver is inflamed, commonly that portion which lies in contact with the diaphragm. In some cases a complete hy- drothorax is found to have taken place; the pericardium con- taining a pint or more of water, of a semi-transparent or pearl- coloured appearance, and the cavity of the thorax a quart or more of the same kind of fluid; the heart much enlarged and abraded of its fine delicate membrane; the lungs adhering to the pleura, and much diminished in size, when the hydrotho- rax is very considerable. I have, in this statement, given a description of the dis- ease in its most violent form; but as it makes its attack with different degrees of severity, it is obvious that the method of treatment will require to be graduated accordingly. I consider this disease as in nowise different from peripneumo- nia, excepting, that a more general inflammation commonly takes place than what that disease has heretofore assumed. This, however, is referable to the pre-disposing causes above mentioned, as well as to the immediate exciting cause, which is generally that of a violent cold. I am well aware, that much clamor has been raised against bleeding, the propriety of which, in some cases, and in some stages of the disease, would be very questionable ; but from my own observation, in more than one hundred cases, and from the authority of Dr. Craige, (whose experience in this Mann on the Pneumonia of New-York. 49? complaint has been very extensive, and in whose skill and veracity I have much confidence,) I am prepared to assure the public, that in recent and violent attacks, bleeding is in- dispensable : blistering and profuse sweating also have been of eminent service. If the disease assumes the typhus symptoms, nothing has proved so successful as mercury, ex- hibited in such a manner as to produce ptyalism. If much acute pain remains during this stage of the disease, stimu- lants are not found so successful as in common cases of typhus; the stimulating plan, therefore, if entered upon, should be conducted with great caution, for if much inflam- mation remains it will bring on a recurrence of all the syrupy toms in an aggravated form. DANIEL HUDSON. Geneva, Jan. 12, 1813, Observations on the Prevailing Pneumonia of New-Yorkj in a Letter to Benjamin Waterhouse, M. D. Src.from James Mann, M. D. Hospital Surgeon of the United States Army; published in Jan. 1813. Dear Sir* At the time of making the statement, which first appeared in the Vermont Centinel, respecting the sickness among the soldiers of the army, at Burlington, and which was made pub- lic with the sole view of counteracting false and exaggerated reports ; it was my intention, when more at leisure, to give in detail, a particular history of the disease, not only as it appeared at Burlington, but at other cantonments of the army. The prevailing epidemic is denominated by nosologista, Pneumonia. Its attacks are made under the various form* vol. ru. 3 <4 498 Mann on the Pneumonia of New-York. of sthenic and asthenic diathesis, while those varieties of the disease mostly depend upon the habits established prior to the attacks. In many of the first cases, among the soldiers at Burlington, the disease proved fatal in a few days, in some instances, within twenty-four hours. The following are the most prominent features of the disease, under its most deadly form: heat of the body below the standard of health, extre- mities cold, pulse contracted and hard, not so hard as is usu- ally found in pleurisies, which indicates the necessity of bleed- ing ; respiration very laborious, not apparently so much from sharp pains through the sides and breast, as from a sense of suffocation. When asked, the patient says, that he does not feel much pain, but a weight upon the chest, an oppression arising from inability to inhale the air ; a sensation, one would imagine, similar to that which might be produced by breath- ing atmospheric air deprived of its oxygen. This suffocation, accompanied with small pulse and general coldness, may be the consequence of some condition of the lungs, which ren- ders that organ incapable of absorbing through its membranes, in due quantity, the vital principle of the atmospheric air, or its oxygen. There i* often a copious expectoration of glairy viscid phlegm, sometimes uniformly coloured, or streaked with blood, while no relief is procured by its discharge from the bronchial tubes. The above form of disease is the Perip- neumonia Notha of the ancients, and it is not unworthy of notice, that it generally falls upon those who are in habits of intemperate potations of spirituous liquors. Upon laying the chest open to view after death, there is the appearance of inflammation upon the lungs, and congestions within the vessels of that organ, with adhesions to the circumadjacent parts, without suppuration ; its surface covered with a yel- lowish, gelatinous, semi-putrid extravasation ; its spongy tex- ture is lost, and assumes, in some measure, the firm compact state of the liver. The physician, in the above described Mann on the Pneumonia of New-York. 499 cases, hesitates, and cautiously employs his lancet. These cases, however, are few, compared with the multitude seiz- ed, which generally proved liital under every method of treatment: while a fortunate administration of stimulants, in a solitary case of the disease within my knowledge, induced by an indiscriminate use of them, a most deadly practice. Such a practice was introduced, for a short period, by a phy- sician who was called to attend the sick, at a time when the physicians of the army were overburthened with numbers. Could you have believed, that at this enlightened period, brandy and wine in profusion, with soups, were the remedies principally depended upon by him in every form of these pneumonic affections ? However, prior to the employment of stimulants, an emetic and cathartic were administered; blisters were employed ; the lancet was forbid by him under every form of this formidable epidemic. It has been already observed, that cases occurred where the physician hesitates and doubts the propriety of bleeding. The cases under tlm type are not one in twenty. It is worthy of notice, that in two, which came under my observation, where blood-letting was cautiously employed, the accidental opening of the ori- fice, during a restless night, produced so much relief, even a solution of the fever, as led to a persuasion, that in some in- stances, where the disease had proved fatal, bleeding had been employed with too much timidity. In one case, the patient apparently sinking under the above form of the dis- ease, seemed to be rescued from the grave by six grains of opium, administered in divided doses of one grain every two hours, and a tea-spoonful of aether every half hour. The same treatment in other similar cases, was not attended with the like success. In all cases of the above form of the disease, blisters are employed upon the sides, breast, and back; in somr, these seemed to be of use. Where the body i.s torpid and cold, 500 Mann on the Pneumonia of New-York. sinapisms, warm and heated applications to various parts of the body, especially to the lower extremities, are necessary. It is proper to observe, that neither the stimulant, diaphoretic, nor depleting method of treatment is but seldom accompanied with success, in the most violent form of the disease. Its pro- gress is rapid, and assumes in a few hours, the strongly mark-> ed symptoms of approaching dissolution; and it may be addf ed, that even where suffocation with a rattling is comment ed, and the heart ceases to perform its office, that the mus- cular strength of the patient is not remarkably impaired. Several have been seen to walk the room a few hours before death Much the largest number seized with this extensive epi- demic, are under a sthenic form, with strongly marked symp- toms of inflammation, and require the depleting and antiphlo- gistic method of treatment to its full extent. Stimulants here evidently hasten the patient into the first described fatal state of the disease. At the first attack, with strong arterial action, paint through the sides and breast, much heat, difficult respiration, little or no expectoration, and this tinged frequently with blood, bleeding is employed, from one to two pints. It is often necessary to repeat the operation. In a few instances two quarts have been drawn from the arm of the patient in the course of the fever with good effect. A cathartic of jalap and calomel, or calomel per se, is then ad- ministered. This, it is found necessary to repeat in some cases ; but as the disease is frequently accompanied with di- arrhoea, drastic purges are employed with caution. The diarrhoea, at times, is so profuse, that cathartics are not indi- cated while it is necessary to check these alvine discharges by opiates. The diarrhoeas, which accompany this fever are not critical, they are not checked as the fever abates, ex- cept by opium: remaining obstinate for a long time even a£ ter the return of the appetite. After bleeding and cathartics, Mann on the Pneumonia of New-York. 501 under this form of pneumonia, calomel in small doses, com- bined with opium, is administered with benefit; and where a gentle spitting is produced by its employment, pain in the breast is mitigated, or abates,'laborious respiration subsides, copious and laudable expectoration, and moist skin supervene. To promote these last, vin. antim. and elix. paregor. prove an excellent medicine. When the antimony occasions too frequent evacuations by the bowels, small and repeated doses of pulv. dover. are substituted. When, afler the inflammato- ry state of the disease is in a measure removed, more especi- ally, where nausea and anorexia exist, emetics of ipecac, are advantageously administered. Blisters, in the course of the disease, are indispensable to remove stitches in the breast and sides, after blood-letting is carried to its proper extent ; believing with others, that there is a blistering, as well as a bleeding, and emetic period in fevers, the bounds of which being ascertained, should never be intruded upon by each other. As this disease has not been confined to the soldiers of the army, but has made its attacks and ravages in various places, about the same time, over a very extensive tract of country, it may be fairly inferred, that its spread far and wide is not the consequence of its contagious nature, any more than it is the effect of severe duty, negligence of officers, want of the necessaries of life, as it has appeared among the soldiers, as has been repeatedly represented in the public pa- pers. It may be viewed as an epidemic produced by some latent cause : an unknown state of atmosphere, and, like all extensive epidemics, is more severe and fatal to such as are unavoidably, and in many instances, imprudently exposed to various additional exciting causes. Those who have attend- ed to the progress of epidemics, may have observed, that among thousands who have been subjected to their influence, that a few have been treated with severity by the disease, and some have fallen victims to its rage; while the deaths 502 Mann on the Pneumonia of New-York. which have occurred, might be imputed much less to the na- ture of the epidemic, than to the various exciting causes which co-operated to produce its mortality. The first, per- haps, in all cases, cannot be avoided; while the exciting causes, giving to the disease a severe or fatal form, is with- in the ability of man to obviate. Among the various excit- ing causes productive of a severe disease, under the present epidemic, only one will Be noticed, viz: an intemperate use of ardent spirits. It is a fact, well known among the physi- cians of the army, that the disease has been fatal mostly among the men who are in habits of great intemperance. It has been also ascertained from various sources, that this dis- ease has been most severe and fatal among that class of citi- zens who indulge in spiritous potations. It is a vulgar and mistaken opinion, that the use of spirits secures the body from the attacks of disease, and fortifies it against cold, or its ef- fects ; so far from effecting either of these, ardent spirits ag- gravate the injurious consequences of cold, and frequently predispose the body for the reception of a disease, under its most severe and perhaps mortal form. Is it not a singular fact, that no notice is taken of the pre- vailing epidemic, and its mortality, among the citizens, by the several printers, when with much avidity they swell their columns with exaggerated reports of the disease, and its dis- astrous effects among the soldiers ? Since it is well ascer- tained, that less in proportion to numbers who have been at- tacked with it, have become victims in the army, than among the citizens ; although the last are better accommodated in houses, less crowded than hospitals, and surrounded by friends for nurses, generally more assiduous and attentive to their wants when sick, than soldiers, who are bound to each other by ties less strong than those of consanguinity. Is it a new and singular circumstance, that soldiers are more subject to diseases than citizens, independent of latent atmospheric Mann on the Pneumonia of New-York. 503 agents, as causes ? When it is known, that more than four thousand soldiers have been seized with this epidemic, will it appear strange and mysterious that many deaths have oc- curred, and the officers not be implicated among the causes of the disease and its fatal event; when citizens are daily falling under its effects in towns and villages far and wide, in every district of the country. After being acquaint- ed with the above facts, will it appear candid or ingenuous to state, that the physicians of the army are ignorant, more ignorant than the physicians of the country. Are not the means of information open equally to all T Were not the physicians of the army educated at the same school with the citizen practitioner ? Did not government, out of a flood of applications, select and appoint those who had the fairest pretensions ? The communication is concluded by observing, that there is no essential disagreement among the physicians of the army, respecting the nature of the prevailing epidemic, and method of treatment. That it is not a new disease, as has been re- presented by some, the physicians of the army are all agreed. Perhaps it would appear invidious to say, that the epidemic is represented a non-descript by some physicians, as an apo- logy for the want of success in the management of it. Iu con- sequence of the swelled accounts of the deal lis in the can- tonment at Greenbush, where there were from one thousand five hundred to three thousand, during the summer and au- tumnal months, and through which more than seven thousand men have passed since the month of May, and at which place have been left all their sick, aud many of their convalescents, while passing, it may be necessary to state, that the whole number of deaths at this post, from that period to the pre- sent, does not exceed eighty-five. With much respect, I am, &c. JAMES MANN, Hospital Surgeon, U. S. Army. Dr. Benjamin Waterhoise. ( 504 ) Remarks on the Prevailing Epidemic, by John Steamy M. D. of Albany. Read before the State Medical Soci- ety in February, 1813. Although a few sporadic cases of the epidemic, which now prevails in this city, and the country adjacent, made their appearance in the fall; it was not till the middle of Decem- ber last, that it began to be much noticed. From this time it gradually increased to the present period. The symptoms which characterise this disease, are : 1st. Cold chills, which, in some instances, continue twen- ty-four hours, and are sometimes succeeded by a tempera- ture, unequally distributed over the surface; while the face and trunk of the body are of a heat higher than natural, and considerably flushed, the extremities are cold. In some in- stances the chills are but slight; the violence and danger of the disease are generally proportioned to the length of the chill. 2d. Great and general prostration of strength, frequently accompanied with fainting. 3d. Extreme pain in the head, thorax, and sometimes in the extremities, accompanied with dyspnoea and hurried res- piration ; when the pain assails the head with severity, it ge- nerally terminates in delirium. The pain is sometimes se- vere in the back part of the head and neck, but generally af- fects the forehead, producing an extreme soreness in one, sometimes in both eyes. When the pains are not violent, the patient complains of a vertigo, and a dull, heavy sensation in the head, with an oppression at the stomach, nausea, and sometimes vomiting. 4th. The tongue is generally, at first, dry and covered with a white fur, which, as the disease advances, is in some in- stances converted to a dark brown. Stearns on the Epidemic. 505 5th. In violent cases, the face appears tumid and livid; the eyes are remarkably protruded, exhibiting ay ellow aspect. 6th. The urine generally flows in unusual large quantities, and is sometimes very high coloured. 7 th. The pulse in the incipient stage is small, weak, tre- mulous, and in some instances suspended ; as the cold stage subsides, the pulse rises, but seldom to a degree of natural strength or fulness ; it appears to labour under a violent op- pression, is often irregular, and generally slower than na- tural. 8th. The stomach is generally loaded with a vast quantity of gelatinous slime, which in tenacity resembles the white of an egg. 9th. When a diarrhoea does not usher in the complaint the bowels are torpid and extremely costive; ordinary cathartics seldom produce their customary effects. 10th. A cough, with an expectoration of yellow mucut tinged with blood, in some instances, commences with the dis- ease ; as it advances, clear blood is often discharged from the lungs and nose. 11th. A viscid sweat is generally thrown out upon the sur- face spontaneously, which is never critical, and if copious, is always injurious. This viscous fluid is not confined to the surface. The saliva, gastric juice, and, indeed, every secreted fluid partici- pates of the same disposition, and evinces a morbid affection of the whole secreting system. The preceding phenomena indicate the existence of a dis- ease entirely unknown in this section of our country. It ap- pears to participate of two distinct and opposite natures; pneumonia and typhus. A peculiar constitution of the at- mosphere appears to predispose the system to a typhus fe- ver, under circumstances peculiarly favourable to the pro- vol. in. 3 R 506 Stearns on the Epidemic. duction of pneumonia: hence that state of disease is induced which may be denominated Typhoid Peripneumony, or Pneu- monia Typhodes; a disease which, in some respects, strong- ly indicates the free use of the lancet, and in others,.the libe- ral administration of stimulants. Hence originates a contra- riety of treatment, which experience has proved to be very injurious to the patient: while some bleed copiously, others resort to the most powerful stimulants. When the promi- nent and opposite symptoms of this disease are nearly balanc- ed, prudence would dictate the use of neither of these classes of remedies ; while depletion increases the symptoms of typhus, powerful stimulants produce delirium, and aggravate all the fatal symptoms of pneumonia. It is only when one of these classes of symptoms clearly and distinctly predomi- nates, that either of these remedies are ever proper. Indis- criminately to condemn both in all stages of the disease, therefore, evinces an imperfect knowledge of the complaint, and is the height of absurdity and presumption. This is the same disease that prevailed in some parts of this and the eastern states, during the last winter, and is ex- clusively confined to this season of the year. It prevailed in England in the year 1685, and was faithfully described by Dr. Sydenham, under the name of the winter fever, which in a subsequent treatise, he denominated the new fever. In attempting to account for the origin of the fever, he traces its causes to the plague, which had preceded it a few years, and of which he considers this as completely " depuratory." Since his time we do not find it described as prevailing in any country till the year 1811. " Doctor Macbride considers it as a mixed fever, and terms it febris hyemalis. Sauvages, a species of Synochus, and names it synochus hyemalis, though he thinks it merits more the denomination of catarrhalis. Both these authors have taken their account from Sydenham. Dr. Cullen classes Steams on the Epidemic. 50? it as a variety of the synocha, or inflammatory fever. Hux- ham, in his observations de aere et rnorbis epidemicis, de- scribes a fever, which he says nearly resembles this; and Dr. Swan thinks the mild catarrhal fever of Hoffman, which thai author so accurately describes, and treats with so much judg- ment, bears to this a great similitude."—Wallis. After premising this brief sketch of the symptoms and his- tory of this disease, I shall proceed to examine the remedies which have been prescribed. 1st. Bleeding. This, as I before observed, is extremely hazardous, unless symptoms of pneumonia or synocha decided- ly predominate, and even in this case it should be used with extreme caution, and in small quantities, otherwise the typhus tendency of the disease prevails, and the patient sinks and dies. I have seen but one case in which it was indicated, and in which I took but four ounces. Letters from eminent practitioners in some of the count its where it prevailed the. last year, inform ine, it was occasion- ally practised there with success. This was the practice of Sydenham, and is used by many the present season. 2d. The warm bath. In tins disease the blood recedes from the surface and extremities, accumulates in the large vessels, and completely oppresses the action of the heart and arteries. A universal coldness and frequent chills con- sequently pervade the whole surface of the body till the tor- por of the extreme vessels is overcome. The first indication of cure is, therefore, to restore action to the surface and extremities, and thence to preserve that equilibrium of the circulation which has been entirely de- stroyed. This indication is successfully answered by the total im- mersion of the body in warm water, in the incipient stage of the cold chill. If the warm bath is applied at this early period, the disorder is effectually subd::ed in forty-eight 508 Stearns on the Epidemic. hours; but if delayed till the cold stage is considerably ad- vanced, its operation is less efficacious. Immersing the extremities in warm water, and general fo- mentations to the surface, may be substituted when the warm bath cannot be procured. This should be continued till the chills have entirely subsided; it should then be discontinu- ed, otherwise the copious sweats thereby induced will de- bilitate and sink the patient, or accumulate the morbid heat of the system, and thence induce delirium. Warm diapho- retic teas should accompany the use of the warm bath. 3d. Emetics. When the head is affected with pain or a vertigo, or a dull heavy sensation, accompanied with an op- pression at the stomach, or a nausea and vomiting, an emetic is indispensably necessary. It invariably ejects a quantity of cold, viscous slime, which resembles, in tenacity and colour, the white of an egg. If this fluid is not evacuated, a torpor of the stomach and bowels ensues, which enhances the dan- ger of the disease iu its progress, and essentially impedes the cure. When the emetic has been given early in the disease, and its operation proves effectual, the preceding symptoms rea- dily yield ; but if they continue obstinate, the emetic may be repeated, and succeeded by 4th. Cathartics. Calomel, or calomel and jalap, if given early in the disease, and repeated as the symptoms may re- quire, soon obviates the obstinate costiveness of the bowels, and restores their natural tone, by evacuating their extreme- ly offensive and debilitating contents. 5th. Diaphoretics. Although profuse and long continued sweats are evidently injurious, as they induce debility with- out, in the least, promoting a crisis, yet a naturally soft and moist state of the skin is always accompanied with a mitiga- tion of the pain, and ought ever to be encouraged. To pro- mote this object, I make a liberal use of snake root, sage, Partridge's Meteorological Observations. 509 boneset, or hemlock tea, and every four hours, or oftener, if necessary, give a powder very similar to Dover's: to this powder I sometimes add calomel, if the pneumonic symp- toms do not readily yield. 6th.. Epispe.tic.s. When the pains in the thorax are vio- lent, and respiration difficult, and do not yield to spiritoua fomentations, I generally apply a large blister to the breast or side. In most cases the fomentations will succeed alone, and are more efficacious than blisters. 7th. Demulcents, occasionally combined with opiates, are necessary to alleviate the cough and pains of the breast. This course of treatment will generally promote a crisis iu five days, and sometimes sooner ; but should the disease be protracted to the typhus stage, the remedies usually pre- scribed in that type of fever then become necessary. Meteorological Observations, by Capt. Alden Partridge, of the Military Academy, West-Point, N. Y. meteorological table, Containing the results of a series of Observations, made at West-Point, State of New-York, from the 5th of April to the 1st of November, 1810. s © THKRIMOMETER. BAROMETER. REMARKS. 12 16 13 11 !.'• 14 16 101 a 8 13 13 15 9 5 a o )2 70 17 2-3 29.30 28.75 23.67 .54 9tb. 20th. 18 9 1 a Sept 84 31 (■") S3 51 5 29.24 28.56 2".94 .69 27th 4th. 17 7 2 i Oct. 83 17 75 ,7 58 18 29.42 2".50 28.99 .92 27th. 12th. 3 5-10 13 12 3 i Nov. 82 12 >1 32 1-2 39 14 1-2 29.44 28.40 25.95 1.04 26th. 9th. 5 7 13 3 3 \ Dec. 87 -I. 48 19 1-2 64 13 29.20 28.09 28.74 1.11 23 9-10 a 2 8 9 y Jan. 8f -24 :(R 14 60 5 1-2 29.23 28.09 2K.6C 1-14 18th. 26th. 23 4-10 5 0 16 6 6 Feb. T.- -31 35 15 66 1 29.14 28.15 28.77 .9! 25th 4th. 38 7 1 13 2 6 Mar. 8b - 4 51 24 2-3 47 9 1-3 29.25 28.45 28.90 ,8f 2d. 27th. 14 1-10 10 3 7 4 7 April. 79 23 35 10 42 15 2-3 2926 29.44 28.38 28.09 28.89 28.83 .88 1.3£ 12th 25th 5 5 71 3 2 13 794 -31 92° 399-10 I2r Fb.25 ljul.18 [ll2 9-1C w< I7C |">2 |32 54 Note.—The town of Norwich is situated in the east part of the state of Vermont, adjoining Connecticut river, and opposite Dartmouth College, in the state of New-Hampshire, in north latitude 43° 33'. The altitude of that part of the town where the observations were made, above tide-water, I found by a barometrical calculation to be 917 feet, and 629 feet above Connecticut river. In the second column of the above table, whenever the sign - is prefixed, it denotes that the thermometer was below cipher ; thus, -16, denotes that thermometer was 16 degrees below cipher. Partridge's Meteorological Observations. 511 METEOROLOGICAL TABLE, Containing the results of a series of Observations made at West-Point, State of New-York, from the 1st of April to the 31st of May, 1811, and also from the 11th of May to the 30th of November, 1812. THERMOMETER. BAROMETER. 2 0 "5 1 1 , ■g1 Pi ^> v. •S '<, ^ es S « .? 5 «.; _; _ ^i* fc. x- :-■ ~ a, <*> ■3 o ! a 1 1 e H "5 •3 "5 ■i "a • 1 (3 •a "a be 5 V 1 t a. 1 y. o a ,© < 55 55 55 <3 . 55 2 ►3 0 53 ■3 0 £ !c, £ > •* i 1811 ~ A pril. 90 27" 32" 52 55° 30.10 29.1C 29.44 1.00 2d. lUli ( M 1 0 6 May. 75 40 77 60 37 8 30.06 29.10 29.10 29 cr 2J.5f. .96 3d. 7th. 0 0 17 11 0 1 1 165 27" 82° 56 55" 30. in 1.00 Apr. 2d. Ap.18. -i1 8 1812 May. 59 46° 79° 61 33° 29.91 29 2. 29.BI .68 17th. 31st. 0 3) !• 1 7 June. 77 57 86 71 1-3 29 10 1-3 29.71 39 21' 29.4S .56 5th 9th. 0 3|li ! i' 9 July. 92 56 91 76 35 4 2-3 29.80 L"> :(; 29.59 .40 Ml. 7th. 0 8|11 S.1-. * 1 '■ '3 Aug. 78 B3 37 73 1-3 24 2 2-3 29.85 2'1 4' 29.6€ 45 Kith 25th. 0 1 1 I'J Sept. 89 48 81 66 1-3 33 7 8-15 29.93 2:< ~. 29.72 .71 2bt. 2d. 0 Rill 0 : 11) Oct. 57 40 78 55 2-3 18 10 8-15 30.00 2'1.2(> 39.66 .80 21th. 2d. 0 51 *• r ] in Nov. R9 22 67 44 15 11 2-3 30.16 30.16 2J.W. 29,01- .'9.67 29.60 1.08 1.08 25 th. 5th. 0 0 5| 7 2 " 13 541122" 91" 64 Nov. 25 .Inly 7 35'7L 2I 79 Note.—In the above, as also in all the preceding tables, the barometer used was graduated in French inches. Literary and Philosophical Society of Liverpool. This society, whose objects are similar to those of the Li- terary and Philosophical Society at Manchester, was institu- ted in February, 1812. The number of members already exceeds sixty ; and their meetings are held monthly, from October to May, inclusive. The officers are, the Rev. Theophilus Houlbrooke, President; Rev. Joseph Smith, Dr. Boslock, and John Theodore Hostor, Esq. annual Vice-Pre- sidents ; Dr. Thomas Steward Traill, Frcretary. ( 512 ) Address of the Students of the College of Physicians and Surgeons. At the particular request of the chairman and of the students a place is given to the following address. The wishes here so ardently and so ingenuously expressed, we have the fullest confidence will be realized, and that at no distant day, the students of medicine will unite in re- sorting for instruction to this College, as the medical esta- blishment of the state.—Ed. At a meeting of the Students who attended the several courses of Lectures in the Col- lege of Physicians and Surgeons of New-York, held at the College Buildings, Pearl-street, on Monday the 2d of March, 1813; Wm. F. Quitman, Cliairman, James Seaman, Secretary, it was unanimously resolved, that the following Address of Thanks to the Professors be made public : The students of the College of Physicians and Surgeons, in the city of New-York, unwilling to suppress the emotions of gratitude they feel for the instruction they have received during the session of the college, just closed, avail them- selves of this opportunity of manifesting, thus publicly, their acknowledgments. Sensible of the importance and dignity of the profession, of which they expect shortly to become members, it is with peculiar satisfaction they have wit- nessed the increased zeal and spirit of our legislative, and other public bodies, for the establishment and support of a state medical school. Every member of the community is vitally interested in whatever adds to the facilities of medical instruction; and the exertions of the legislature in organizing the College of Physicians and Surgeons in this city, have al- ready produced effects the most important and beneficial. Public instruction can be effectually imparted only by means of public munificence; and it will not be disputed, that the science of medicine has the first claim to the patronage of a great and powerful state. It would be idle here to recount Mitchell on the Fever of Virginia. 181 but no conscientious surgeon could refuse it a trial, because the choice lay between that and amputation. Its merits were soon amply confirmed, and it would now be reckoned mad- ness to amputate for aneurism. In the above proposal also, the choice may fairly enough be said to lie between am put a tion and tying a main artery. It would not have been made public with only one case in confirmation, if the op- portunities of private practice had justified the expectation of being soon able to test it by more extensive experience. I am Sir, with great consideration, Yours, &c. HENRY U. ONDERDONK. Dr. Hosack. IV. Account of the Yellow Fever which prevailed in Vir ginia in the years 1737, 1741, and 1742, in a Letter to the late Cadwallader Colden, Esq. of New-York. from the late John Mitchell, M. I). F. R. S. of Vir- ginia.* sir, In giving you an account of the pestilential distemper which has lately raged in Virginia, I shall not touch on any • A series of highly interesting papers on the Yellow Fever which many year* ago prevailed in Virginia, embracing the account written in 1744 by the late Dr. Mitchell of that state, with a reply of Dr. Colden to Dr. Mitchell, and a suhse qnent letter of Dr. Mitchell on the same subject, was placed in the hands of Dr. Hosack by the late Prof. Ruth of Philadelphia, a short time previous to his death. As these papers were intended by Dr. Rush for publication in the Re- gister, we have commenced in this number with the first in order, the letter of Dr. Mitchell to Dr. Colden. Some of our readers may recollect that extracts from this account formerly appeared in the Philadelphia Mstiital Museum; they howev»-_ 182 Mitchell on the Fever of Virginia. thing relating to it, which you liave had a full account of al ready in the same or like disease; that I might the better consult leisure for writing, and spare you the tedious trouble bf reading. For which reason it would be needless here, to enter into a particular enumeration and description of all the symptoms which accompany this dire disease; they being no more, and no fewer, than what are commonly ascribed to, and may be observed in most malignant fevers; besides, they are already enumerated by Dr. Warren. The symptoms and three remarkable stages of our disease, arc much the same as those observed by the said author in the malignant fever of Barbadoes; but I shall recount those symptoms, which appeared to me to be pathognomonic and inseparable from the disease, at least when rightly formed, as they seem not yet to be so well known; by which this fever will ap pear to be of the malignant kind, as it generally resembles those that are contagious, by its first appearing with a pain in the head and back and about the stomach, succeeded by grievous anxieties and oppression about the praecordia. And in general this distemper may be defined to be, a pestilential fever proceeding from ^contagious miasma suigeneris, which inflames the stomach and adjacent viscera, obstructs the biliary ducts, and dissolves the adipose humours ; to which generally succeeds an effusion of a bilious or other yellow will now be furnished with an entire copy. Few papers we believe will be read with more interest, particularly when it is known how extremely important Dr. Rush considered it in affording him new views of the nature of the same epidemic at the time it prevailed in Philadelphia in 1793. On the character of Dr. Mitchell it is unnecessary particularly to remark. He was a distinguished Fellow of the Royal Society of London, and eminent as a physician and philosopher. With Chalmers and Lining, of South Carolina, and Alexander and Golden, of New-Vork, he has done much for the advancement of medical aud physical science on this side of the Atlantic. Editors. Mitchell on the Fever of Virginia. 18 J humour upon the external or internal surface of the body, unless prevented by some means or other. Those pathognomonic symptoms appeared to be the fol- lowing six, of which the three last are more peculiar to it. 1. Avery great and sudden debility, without any manifest cause. 2. A feverish anxiety, generally very grievous. li. A short, quick and difficult orthopnoeic respiration, after the fever is formed. 4. A contracted deep pulse; the ar- tery feels tense, but the pulse is compressible, to which suc- ceeds a depressed, or soft and low pulse, after the state of the disease, or after the yellow effusion appears. 5. A pain of the scrobiculus cordis, either much complained of, or to be felt on pressing that part; and more or less severe ac- cording to the severity of the disease. 6. A yellowness in the eyes or all over the body at the state of the disease; unless prevented by colliquative or critical discharges; to which may be added a violent and unusual kind of pain of the head, unless it is drowned, as it were, in the more griev- ous complaint about the praecordia. The proximate causes and state of the body in this dis- ease may be pretty evident, to those versed in the animal economy, from the following anatomical dissections. February 14, 1741-2. At the request of Richard Chi- chester, Esq. in Virginia, and in the presence of him and several others, I opened the body of one of his slaves who died of this disease. This was the body of an elderly wo- man, past forty, who died the day before, on the fourth of the disease, with the following complaints: grievous and violent anxieties, occasioned, as she said, by the sickness of her stomach, severe pain of her head and back, returning by intervals, contracted bypochondres, and the scrobiculus cor- dis painful to the touch, short, quick and interrupted respira- tion, with deep sighs and heavy groans; a slight raving rather 184 Mitchell on the Fever of Virginia. than delirium, a black tongue, unquenchable thirst, tremors, very quick and depressed pulse, the eyes very yellow, a sudden and severe pain about the navel a few minutes before death. After cutting the teguments of the abdomen, the fat of the body appeared very yellow, so as to be noticed by the bystanders, and was indeed as yellow as the eyes common- ly are in a jaundice. Upon penetrating into the cavity of the abdomen and laying the teguments aside, I was surprised to see no such thing as an omentum; at first I imagined I had torn it off, or removed it to one side with the teguments ; but in vain was it sought for in the whole body. There ap- peared a few things like the blood vessels of the cawl adhe- ring to the place where it is generally connected to the sto- mach and colon; the traces of which connection might be discerned ; but there were no more remains of its substance, than a little yellowish thin oily liquor floating up and down among the intestines and about the mesentery. The liver appeared turgid and plump without any ble mish on its outer convex surface; but on the concave sur- face, two thirds of it was of a deep black colour, round the gall-bladder seeming to be mortified or corrupted. The gall-bladder appeared outwardly of a deep yellow, but within was full of a black ropy coagulated atra-bilis, which sort of substance likewise obstructed the porus bilea- rius and ductus choledochus. This atra-bilis was hardly fluid; but on opening the gall-bladder it retained its form and shape without being evacuated, being of the consistence of a thin extract, and withal glutinous and ropy like soap when boiling: this black matter seemed so much unlike bile, that I doubted if there was any bile in the gall: it more re- sembled bruised or mortified blood, evacuated from the mortified parts of the liver surrounding, although it would Mitchell on the Ftver of Virginia. 18j stain a knife or probe thrust into it of a yellow colour, which, with its ropy consistence, seemed more peculiar to a bilious humour. The duodenum was of a deep yellow colour as usual upon its outside ; but where contiguous to the cystis fellda, had a mixture of a deep green or eruginous colour intermixed with its yellow; within, it contained a viscid bile, or rather i yellow mucus, closely adhering to its tunics, mixt with a little of the black bile, like that contained in the cystis. Its villous coat appeared to be lined with .a thicker fur or slime than ordinary, which being scraped or peeled off, the other vascular and muscular coats of the gut appeared red and inflamed. The stomach seemed manifestly inflamed; it had on its outer surface, towards its upper orifice, two large broad spots of a dark red colour, somewhat resembling the flushings in the cheeks, or a rose on the leg; it had nothing within but a little drink which had been just swallowed, and some of the black choler, resembling that in the gall-bladder, floating upon it, which was of a blacker colour here than iu the gall-bladder itself; it looked ruddy within as if it had been inflamed there likewise ; its villous coat appeared, like that of the duodenum, more fuzzy and slimy, as if it were swelled or distended, which was particularly remarked by all others who opened any bodies that died of this disease. The lungs, instead of being collapsed, were rather infla- ted as in inspiration; they were all over full of black or livid spots, some as broad as the palm of the hand, others much smaller; on which spots, generally, were to be seen small ve- sicula, or blisters, like those of an erysipelas or gangrene, con- taining a yellowish humour. I did not so curiously examine the other parts, as I saw bo defect in any: and these seemed sufficient to show the vol. iv. i :» 186 Mitchell on the. Filer of Virginia. cause of her death, and account for the several symptoms of her disease: only the blood vessels in general seemed very empty of blood, even the vena cava and its branches; but the vena portae was full and distended as usual; the blood seemed to be collected in the viscera ; for upon cutting the lungs, or sound liver, or spleen, they bled freely. The brain was not opened, for want of conveniences at hand ; but it did not seem to be affected in the disease, and was not af- fected in three more who were opened. This woman was taken with a pain in her head and back, extending from the loins as far as the region of the liver, with great sickness at her stomach, succeeded by chilliness, burning fever, anxieties, &c. and was treated with a snake- root sweat in the time of her disease; but took a vomit at its first seizing her, which brought up much dark, bitter choler, without any relief. She was in perfect health be- fore this distemper seized her all of a sudden, as she was at work. The day before, I opened likewise a girl about twelve or thirteen years old, who had been dead about two or three days, and was preserved on purpose for me to open. She died on the sixth or seventh day of the same disease, with which the other and several in that family had died. In her, the distemper was left almost entirely to nature, except her losing about four or five ounces of blood, and the plenti- ful use of diluting teas which she had recourse to. A little be- fore her death, she complained in the same manner with the other, of a most violent pain in her belly about the navel, succeeded by grievous and intolerable anxieties: they had no suspicion of a yellow fever at that time, and so did not notice her eyes. There was little difference between the affection of the parts in her, and the one whose case has been related. The Mitchell on the Fever of Virginia. 18? fat of the body did not appear quite so yellow; but the liver had a much greater and deeper mortification or blackness on it, the whole under concave surface of it was very black as far a^, to the very edges, which penetrated very deep into its substance about the gall-bladder, which was full of the same atra-bilious, glutinous, ropy humour as in the other. The omentum was entirely consumed or destroyed in this subject, in the same manner as in the other, whose case has been re- lated ; and a little yellow oily matter floated up and down in her abdomen. The stomach and duodenum were affected much as in the preceding case, only there was little sign of any external inflammation on the stomach. The lungs were affected in the same manner, but not with so large or deep black spots. In the spring of the year 1737, there were two more opened, who died of the same distemper, in whom the parts were affected in the same manner as has been related in the first case, particularly as to the destruction of the omentum, blackness of the concave surface of the liver, contents of the gall bladder, inflammation of the stomach and spots on the lungs ; as he who made the dissection, and others who were present at it, particularly informed me. September, 1742, another was opened who had died of the same distemper, as the two persons above related; although got from a conta- gion which was supposed to have come from a different place: in him the omentum was likewise entirely consumed and de- stroyed ; the stomach a little inflamed, but no blackness was discerned on the outer surface of the liver, and its inner sub- stance was not looked into, although the cystis fellea and biliary ducts were full of the same black, glutinous, coagula- ted matter, as in those cases I have related. The following account of the state of the blood which | have carefully observed in this disease, may likewise help 188 Mitchell on the Fever of Virginia. to illustrate its nature, and show the state of the body in it. The blood extracted by venesection is of a deep red or flo- rid colour, appearing to be thin and fluxile, with no sizy in- flammation, crust, or skin whatever upon it when cold: the crassamentum is broad, shallow and floating, being easily di- vided by the fingers; the serum makes about two thirds of the whole blood, or more, when let at, or nigh the state of the disease ; and about one half at the beginning: after the state or height, it seems by the pulse to be more ; a large propor- tion for an acute continual fever. Even those who are bled after a received contagion before the fever is formed, have a thin dissolved florid blood, even in winter. This was the constant state of the blood in about thirty or forty whom I have known to have been bled, at all seasons of the year. But the arterial blood which I have had an opportunity of seeing was very different. Feb. 17, 1741-2, five or six ounces of blood were taken from the temporal artery of one labouring under this disease, on the fourth day, just as the yellowness began to appear in the eyes, attended with a stu- por ; this blood was not more florid than what the veinous blood generally is in this distemper: when cold it had a purulent yellow skin or inflammatory crust on the top, exact- ly resembling the crust on the veinous blood of pleuritics, but not very thick, although tough and not easily divided; the crassamentum was very cohesive, thick and blackish at bottom ; the serum made not above a sixth or eighth part of the whole, which was of a deep yellow or saffron colour, and would tinge the finger or a linen rag dipped into it, of the same colour as if dipped in gall; deeper than is commonly to be seen on a rag dipped in the urine of persons in a jaun- dice. On this every one that saw this blood was convinced that the distemper was what is generally called the yellow fever in America. Mitchell on the Fever of Virginia. 18& Dr. Langrish says, we are not yet well informed of the itate of the blood in malignant fevers; this perhaps may be some help to a more certain and general determination of that necessary point. Q«. Whether this difference between the blood of the veins and arteries is not a confirmation, or rather an ocular demonstration of the ingenious Bellinian hypothesis, which supposes a viscid lentor to be joined with a more dissolved acrid blood in malignant, fevers ? It is true, there was no blood taken from the veins of this person, but there was from one labouring under the same disease, in the same house, on the same day of the disease, but a few days before, which was like what I have described the blood of the veins to be; and was always found to be by all that ever saw it in this dis- temper. If this is the case in other malignant fevers, what surer sign, or more powerful cause can there be of their ma- lignity than that the arterial blood should be viscid, thick, and sizy, whilst the blood in the veins is thin, dissolved, and fluxile ; so contrary to all the laws of circulation. Whence colliquations and obstructions at one and the same time ; ir- ritations joined to viscidities! Spasms brought on inflamma- tions. Hence a mortification of some, and total destruction of other internal organs in a few days time! I cannot pass over two other remarkable circumstances of this disease: I i.iean the total destruction of the omentum and yellowness of the body which seem so peculiar to it. As for the first, it anpears from these dissections, and likewise from the whole course and symptoms of the disease, that there is an inflam- mation of the stomach, joined with spasmodic constric- tions and convulsive motions of that and also other parts about the praecordia. These spasms hinder the flux of the bile throughout the ductus choledochus into the duodenum ; (vid. Hoffman, de Inflam. ventris,) which by the heat of the 190 Mitchell on the Fever of Virginia. adjacent inflamed parts, is thickened to that degree which we have described to be in the cystis and ducts; hence an obstruction of the liver as well as of the biliary ducts. This obstruction of the liver causes a slower eflux of the blood and dissolved adepts from the omentum through the venae portarum; whence the blood is accumulated, stagnates, fer- ments and corrupts in the omentum: at the same time the inflammation and spasms of the stomach cause an obstruction and slower circulation of the accelerated blood through the gastric arteries; hence the blood will be propelled in greater quantities and augmented force through the other branches of the coeliac artery, but especially through the gastroepip- loic, which arise or proceed immediately from the gastric. Hence the blood is more forcibly impelled into the omen- tum whilst it is denied a passage through it, or exit out of it, by the veins: from whence, not to mention other concur- ring causes, as spasm and heat of adjacent inflamed parts, distortions, from anxieties, &c. arises a large, sudden, and to- tal inflammation, strangulation of the circulation in that whole organ, which necessarily brings on mortification, putrefac- tion, and dissolution; especially in so tender and delicate a part, used to the slowest circulation, and the mildest, smooth- est humours of the body, and through which a thin, hot, sharp blood is now propelled with an augmented force and celerity. Surely the inflammation and suppuration or mortification by aboil is brought about and breaks through the skin, a much thicker membrane than the fine subtile membrane of the omentum, in as short a time, in the analogous membrana adi- posa. But another no less powerful cause concurs to this destruction of the omentum, the inflammation of the stomach spreads over it, in another manner, and from another cause, which is no less destructive to it. It is well known that the inflammation accompanying malignant fevers is of the erysipelatous kind. AH the circumstances of this disease., Mitchell on tlie Fever of Virginia. <9i and the very looks of the inflammation of the stomach seem to confirm the same. But the nature of an erysipelatous inflammation is to spread from one place to another; and from hence this inflammation, when it is once fixd on the stomach, easily spreads over the contiguous omentum: and any one may easily imagine, what havoc the sharp and ulcerating blood of an erysipelas, must make on a tender and delicate omentum; being moreover so contrary to its natural hil- mours; but perhaps some may imagine this cause not to be 'lifferent from the other before mentioned. I need only hint, what dire and fatal effects, such a spreading pernicious affection must produce among the other adjacent or con- tiguous organs to the stomach, the liver, spleen, pancreas, pylorus, intestines, mesentery, and especially the dia- phragm, but above all the upper orifice of the stomach; from an inflammation of which those who escape, as Forestus ex- presses it, may be reckoned the sons of Jove; hence those syncopes, convulsions, hiccups, sudden, and unexpected deaths, and most other fatal symptoms of the disease. For if such an inflammation totally destroys a part in a few days, how dismal and fatal will its effects be* when it seizes the vital nerves and organs! But perhaps it may not be amiss to take notice of the symptoms which seem to be di- agnostic signs of this destruction of the cawl, an accident which happens, or is taken notice of so seldom, that its signs seem to be unknown. These appeared to be more than or- dinary anxieties, a fear and dread of any thing touching the region of the stomach, great and intolerable pain on press- ing the scrobiculus cordis, no sign of respiration below the ribs, a palpitation of the abdominal muscles, contraction of iypocondrics and violent excrutiating pain about the navel, forerunning death. In the next place I shall consider the cause of the yellowness which is so remarkable in this dis- 192 Mitchell on the Fever of Virginia. temper, as to have given it the name of the Yellow Fever Although this is rather an accidental symptom than an essen- tial mark of it, as the vulgar believe, yet it is far less to be deemed a critical discharge or appearance or salutary effort of nature to get rid of her oppression; it is rather the most threatening symptom which appears in the whole dis- ease, as will be evident to those who consider its causes. These causes may be referred to the following affections of the body, of which sometimes one and sometimes all these seem to conspire to produce this dreadful appearance. By what has been related above we may see that, the blood is dissolved in this distemper, and it is probable that the serous parts may be dissolved or attenuated by the disease as well as the red globules: these dissolved humours will be apt to enter the lymphatics, &c. vessels, designed to con- vey a more subtle aqueous, and consequently more pellucid fluid, than they; for we know that the lymph is much more clear and pale than even the serum of the blood, in time of health, but more especially in many inflammatory fevers. But this does not seem to be sufficient to account for that universal deep and intense yellowness, which is often to be discerned in the skin, but especially in the eyes of some peo- ple labouring under this disease; nor is it sufficient to ac- count for the yellowness of the urine, which I have seen of as deep a yellow in this disease as in those that labour under jaundice. We see that the omentum is much dis- solved, so as to be sometimes totally consumed, and it is very probable from the great and sudden prostration of the body without any manifest copious evacuations,that the other adipose humours are likewise dissolved in this ^disease, as contained in the analogous membrana adiposa. This dis- solved adeps will not easily incorporate with a thin dissolved Wood in such a precipiiate circulation ; but be left to stag- Mitchell on the Fever of Virginia. 193 nate in the extreme capillaries, wherever the circulation is slowest; besides, by the heat of the body in the fever, it Will be turned more yellow, and by incorporating with the acrid salts of the blood, now disengaged from its other com- ponent parts, whose texture is broken or operated upon by the miasma, or effects of the disease, a bilious humour will be generated, not unlike true bile itself; as bile is nothing but a humour resulting from such a mixture, its oily parts being more particularly supplied by the omentum. This seems to be the more particular cause of that yel lowness which is so peculiar to this disease, and may particu- larly distinguish this symptom of it from the same ap- pearances in other distempers. But when the liver is in- flamed, as we see it is in a'few days, or the spasms or inflam- mation of the stomach and duodenum or inspissation of the bile in the cystis, puts a stop to the eflux of the bile through the common duct, then no one will doubt, but that a true and genuine icterus is produced from the true bile, in the manner commonly explained. And indeed this symptom, when the yellowness is great and very deep, appears to pro- ceed chiefly from this cause, as it first appears iu the eyes, then in the urine, and goes off by a tinctured Iateritious urine, or bilious stools ; in all which it resembles a true icterus from hepatic bile. It is often, likewise, attended with a sin- gultus, a sign of an inflamed liver; at other times this yellow- ness comes on with a rigour, as Hippocrates likewise observ- ed, (de vict. an. lib. 4. j. 7.) like a true abscess or transla- tion of a heterogeneous matter from one part to another. \or is it very probable that that deep yellowness of the blood, taken notice of above, is occasioned without some admixture of the hepatic or cystic bile with it. To this cause seems to be owing that icterus which if it does not appear before the seventh day, continues during the apyrexy, but proves dan- VOL. IV/ b b 194 Mitchell on the Fever of Virginia. gerous iu the relapse, which is seldom attended with any yellowness with us. It is of the greatest importance in the cure, to know the course aud stages of this disease, and the different changes it undergoes from first to last; with the times when they may be expected. By an account of this we may satisfy au in* genious query of the learned Dr. Clifton in his Hippocrates* p. 260, to wit, c Whether the observations concerning the course and periods of acute diseases, delivered by Hippo- crates, hold trne in places at a greater distance, such as the East and West Indies, America, &c.?' This is reckoned a diseass as peculiar to our new world as any other, and conse- quently as fit to adjust this matter by; which, if once de- termined, may make those excellent observations as univer- sal and extensive as they are useful. But I have not only observed this; but likewise other epidemic diseases, which owe their rise to a certain uniform cause, which seem to be the diseases chiefly pointed at by Hippocrates in his Prog- nostics, to have the same course and periods in Virginia as delivered by the father of physic. This fever was exasperated on equal or unequal days, till the fourth, which was what is called the state of the disease in Virginia, in the winter and spring season, when the disorder has chiefly raged here : on this day the signs of the yellow effusion began to appear, either in the eyes, or by vomiting and purging; this day was the index of the seventh. AH good changes or favourable symptoms now denoted re- covery on the seventh, as any bad appearances on this day portended death on the sixth. If the exacerbations were on equal days, they generally died in the third paroxysm, or the sixth day; but if on unequal days, they recovered oa the seventh. Relapses happen either on the eleventh or fourteenth, which were adjudged on the fourteenth or seven- Mitchell on the Fever of Virginia. 195 tecnth respectively; and this without exception in any, ex- cept those in whom the natural course and tendency of the distemper was prevented by a preposterous method of cure, or sudden and extreme severity of the disease, and all the regular efforts of nature overset thereby. This distemper is remarkably contagious, of which we had the better opportunity to be satisfied here in Virginia, where we live in separate and distant plantations, consisting of numbers of servants and slaves; any of whom, if the dis- temper once seized, there was little security for the rest, but removal. The distemper spread rather slower than I have observed the measles or small-pox to do here; but it spreads faster and rages more violently in the spring season, or from Christmas to Whitsuntide, than any other time of the year; which I have likewise observed of these other dis- tempers in Virginia. But the vicissitudes of our seasons in Virginia, where the changes in the seasons are reckoned greater than in any other place whatever, or our care in pre serving against it, seem to have put a stop to the contagion. But it is likely that jn the West Indies where they have no such vicissitudes of seasons, which are generally observed to put a stop to a pestilential contagion in northern climes, they may hardly ever get rid of this distemper, (no more than the Turks in Asia and eastern nations do of the plague,) without a purification of the infected places, or separation of the" sick. As this was the case, several prophylactics were sought for, when it got into large families; the com- mon alexipharmic method with snake-root drams I knew to prove ineffectual. The following seemed to be the only effectual prophy- lactic I ever knew tried, and which proved effectual in fif- teen in one family, where none escaped without some pre- servative or another; and wherever it was duly complin; 196 Mitchell on the Fever of Virginia. with, the good effects of it were very evident. I observed, that before the fever formed itself, the sure sign of a received infection, ready to display its tragical effects, was a sudden and unusual pain of the head, generally above one or both eyes, which in some remitted with short intervals, and caused a giddiness or vertigo, rather than sharp pain, attend- ed with an unusual feebleness and languor of the body, and often a sickness at the stomach; these complaints, I observ- ed, were little regarded till the fever seized them very often all of a sudden, a few hours afterwards. Upon the first com- plaint of this pain of the head, they had six or eight ounces of blood taken from the arm. Some fell into large sweats or plentiful breathings, soon after bleeding; by which their disorders went off: but those thai did not sweat, and their complaints continued, took a vomit of ipecacuanha soon after bleeding, and the night after the vomit fell into the like sweats, by the plentiful use of tepid diluents and warm co- vering. After these applications the distemper never form- ed itself, as it ever did when these complaints were neglect- ed ; although many had a brisk acute fever after, or in the time of their administration, for the space of twelve or twen- ty-four hours, of the same nature with this fever when once formed; and all were less or more feverish in the time of their sweats, which, however, went off with them, and never returned. In all those that were bled, even in these circumstances, the blood was thin, watery, and seemingly dissolved, and that in winter; a very uncommon thing at that time of year in Virginia. Some few were seized so suddenly as not to give room for this method of prevention; which, however, in most, proceeded rather from inadvertency and neglect, of a slight sudden disorder, for want of knowledge of what it meant, than from want of warning. Mitchell on the Fever of Virginia. 197 But although I can say that I never knew this prophy- lactic method fail where it was rightly tried; yet we cannot always perhaps expect such good effects from it: still, even then it might be well worth while to put it into practice in these circumstances in all large families, towns, camps, or ships, in which this distemper has chiefly raged in America; for it has chiefly got among sea-faring people, who sail these seas, and has been twice brought to Virginia by his majesty's ships of war, from whence great loss is sustained, both in pri- vate commerce and the transaction of public affairs ; which may make any account of it there more interesting, for if it were to prove ineffectual for preserving against it, yet it seems to be the best preparative for the body to undergo the disease. Nam prima et praecipua in medicatione indi- catio est, ut venenum susceptum ocyus citius e corpore pellatur. Jam vero miasma contagiosum primo omnium salivali sese immiscet latici, cum hoc ad ventriculum de- scendit et inde ad sanguinem transfertur. Hinc optimum uti- que consilium, ut venenum brevissima, qua subiit via, iterum exturbetur, simulatque cruditates primae regionis, quae deleteriam ejus virtutem mirifice intendunt per sto- machic os everrantur. Sed opus est ut cito id fiat, simulac quis se infectum et languorem cum cardial^ia sentit, &c. Hoffman. Medicinae Syst. vol. iv. p. 299, 300. In this manner we come to use emetics safely in this dis- ease, which are supposed to be necessary by many, and sometimes much relied on; as they do, indeed, when given lime enough, help to prevent its worst symptoms, although they are little less than fatal in them; so that it may be truly said of them, what Celsus said of bleeding in an apo- plexy, ' They either kill or cure.' The bounds of this epistle will not allow me to be par- '.icular about several remarkable things which occur in this 198 Mitchell on the Fever of Virginia. disease ; especially in the cure of it, and in the considera lion of the different leedentia et juvantia; but I shall take notice of four things indicated in the cure, which, if duly complied with, afford much relief at first, and security at Fast, and which seem to be the chief, from which art seems to afford any considerable and signal assistance to nature. The first and chief scope of the cure is to conquer the power of the disease, before it has produced any of its ill effects on the body, so as to render it more mild and tracta- ble, than it usually is, when left to take its course; else the event will be precarious. The worst of these effects, and most to be dreaded and avoided, as we may learn from the above dissections and course of the disease, proceed from an inflammation of the viscera. The principal way to pre- vent which, is generally to be by large evacuations at first; so that the chief indication of curing this disease is the same as in other inflammatory fevers, viz. to keep off any local Inflammation, or more universal obstruction of the capilla- ries by evacuations. Plentiful bleeding is a means com- monly found most effectual to obtain this end in the benign inflammatory fevers; but we cannot apply this most effectual remedy in this disease, because it evacuates only or chiefly the red globules of blood, which as we see by its state taken notice of above, are in too small a proportion already; and bleeding further breaks the texture of the blood, which above all things is to be avoided in this disease: for after plentiful bleeding the pulse sinks, or at least is so low and feeble about the state of the disease as to prove of dange- rous consequence ; which some instances I have known seem to confirm. So that the only way to make this necessary evacuation at first, is by such outlets as discharge the se- rous dissolved parts of the blood, and perhaps the miasms Mitchell on the Fever of Virginia. 199 of the disease within them, but leave the globular part, that strength of the body, whole and entire. For a discharge ot these, by bleeding, causes that debility which cures other inflammatory fevers, but is one of the pathognomonic or most threatening symptoms of this ; whereas a discharge of the dissolved serum, which distends and burdens the capil- laries, the springs of action, restores that strength, which is ever to be desired and aimed at in the cure; not by cordi- als, &c. as is the common practice, but by evacuating that matter which thus oppresses the body and impairs its strength. But I would not be understood to discard bleed- ing entirely, which I have generally found serviceable in small quantities, and necessary to make way for other eva- cuations ; but it cannot be depended on as a sufficient evacua- tion, to keep off the impending inflammation. I. There are but two passages by which we can drain off the over abounding serum or dissolved blood; to wit, the outer or inner surface of the body by means of sudorifics or cathartics; for the evacuation by urine is uncertain, and not always in our power. Sweating takes place in this aa iu most other pestilential diseases. By this manner of evacuating, we can drain off the greatest quantities of the dissolved humours, and make the largest evacuation that can be safely made, which seems to put a stop to the vio- lence of the fever, and the danger of inflammation; but it must be observed, that the heat of the medicine, which pro- cures this evacuation, often frustrates the good effects to be expected from it; for which reason the sweats ought to be increased to such a degree, that the largeness of the evacua- tion may cool the body more than the medicine which causes them heats it; to which plentiful dilutions ought to contribute. From a neglect of these necessary cautions, this method of sweating often contributes to bring on an in- 200 Mitchell on the Fever of Virginia. flammation, when antiphlogistics are really indicated. Two things ought to be observed and duly complied with, to ren der this method of cure safe and beneficial, and never detri mental or hazardous. 1. That there be no great dissolution of the blood, nor colliquation of the humours, when it is put in practice. 2. That {the spasms and constrictions of the fibres, very remarkable, and easy to be discerned in this disease, and inflammation of the viscera, be not come on, when we give any heating sudorific medicine whatsoever. On this account it is, that this method of cure is not so suc- cessful in our cold winter and spring weather, when the hu- mours are more sizy, the fibres more rigid, and the body more dense and less perspirable, by which we do not sweat so freely and plentifully as is necessary ; on which account I have known this method of practice brought into such dis- repute as to be entirely laid aside; whilst at other times, in a milder distemper, it has been used successfully. II. When the sudorific course has been neglected, oi cannot be attempted with safety, on account of the sudden and violent symptoms, height of the fever, plethoric habit, or load of humours in the stomach and intestines, or other abdominal viscera, or has not been so successful as might be expected; then the only relief that I could ever find from any application, is from the mild relaxing chologogue apo- zems, taken frequently in such quantities as to keep up a constant diarrhoea, rather than speedy purgation, till there remains no further danger of an inflammation. This is often the first thing necessary to be done ; for the great quantity of humours proceeding from the dissolution of the blood, which now possesses a greater space than when compacted into red globules, and the quantity of choler which is gene- ■*?"' rally poured out of its ducts, joined with the other impuri- ties of the first passages, which add much to its quantity and Mitchell on the Fever of Virginia. 201 ill effects: these, I say, cause such a turgescency of the morbid matter, as it is called, at the beginning, that nature is never able to rid herself of these two loads, unless they are partly drained off at first by vomiting or purging. This is the practice of both the ancients and moderns in like cases: for, in this case, sudorifics endanger an inflammation which can hardly be avoided in the use of them, wherever there is a plethora of the vessels, or any fullness of the body; for which reason, all those who abound with humours of another kind, or have a great proportion of fluids to their solid parts, stand in need of this timely evacuation: and this is the condition of most of your well fed Englishmen and other new-comers to America, who have not undergone the sudorific course of our summers But it must be observed, that this evacuation is more ne- cessary in this, than in most other fevers; even so as to be- come more beneficial than any other, as I have experienced, although it is generally neglected in other malignant fevers; for which reason, I shall sum up in a few words the principal reasons and observations, which show its usefulness. The abdominal viscera are the parts principally affected in this disease; but by this timely evacuation, their feculent cor- ruptible contents are discharged before they corrupt and produce any ill effects; and their many emunctories and secerning vessels are set open, so as to allow a free dis- charge of their contents, and consequently a security to the parts themselves, during the course of the disease. By this evacuation likewise, great part of the offensive over- abounding serum of the blood is discharged in time. The very rainera of this disease proceeding from the putrid mi- asma, fermenting with the salivary, bilious, and other inqui- line humours of the body, is sometimes eradicated by timely emptying the abdominal viscera, on which it first fixes; VOL. IV r '" 202 Mitchell on the Fever of Virginia. after the discharge of which, a gentle sweat does, as it were, nip it in the bud. Where the primoe viae, but espe- cially the stomach, are loaded with an offensive matter, or contracted and convulsed with the irritation of its stimulus, there is no procuring a laudable sweat, till that is removed ; after which a necessary quantity of sweat breaks out of its own accord; these parts promoting it, when by an obster- ging medicine, they are eased of the burden or stimulus which oppresses them. Hence I have often seen a more laudable and copious relieving sweat break out after such a deterging medicine given even in the height of this disease, than after a sudorific. Premature evacuations are generally dreaded in most fevers, especially such as proceed from a depravation of the inquiline humours of the body; but these contagious malignant fevers proceed from a veno- mous miasma received ab extra; which, like all other poisons, ought to be discharged as soon as possible, qua data porta. The morbid matter in other pestilentials may be most easily and conveniently discharged by sweats; but this fever requires discharges from those parts, which secern the most viscid humours from the blood, either to pre- vent or carry off the viscid humours which cause the yellow effusion, which we have shown to be bile, or of the nature of bile: and the rule for evacuations is, ' qute educere oportet, quo maxime vergunt, eo ducito, per loca convenientia,' (Hippocr. Aph. 21. §. 1.) But bilious hu rnours are only to be discharged by stools or urine, which are the passages by which nature rids herself of this disease, as we shall see below. (Galen. Com. in I. c.) This is only the inverted method of the alexipharmic, in which we first sweat and afterwards purge; whereas in this method we make discharges of the redundant humours which oppress the parts principally affected, after which sweat breaks out of its own accord, or is more easily pro Mitchell on the Fever of Virginia. 203 cured by art. All concerned in the cure of this fever will find both these evacuations necessary; but which ought to precede the other, the skilful may be helped to determine from these considerations, joined to the following ob- servations. There are not wanting many other practical observations to support these reasons for timely purging in this disease. I. This method I was directed to by nature herself. I ob- served tL... rroderate, thin, bilious tools, raised by nature for a day or two, at the beginning, prevented in a great measure the yellowness at the height of the distemper, which then terminated by sweats. And endeavouring to imitate these efforts of nature, I obtained the same good ef- fects, from the like stools procured by lenitives. This is the best guide and surest warrant for physicians to direct their practice by, whose business it is to imitate nature by art. 2. Several, treated in this manner, had no relapses, which all had here in Virginia in the winter and spring sea- sons, that were treated in any other manner. Does not the doctrine of Hippocrates confirm this practice ? who tells U9, that improper and untimely discharges in distempers, or those things that are left behind after a crisis occasion re- lapses. (Epidem. 1. 4. 1132.) 3. Where the crisis is by sweat, relapses are dangerous and frequent; but where the bilious humours are carried off by stools or turbid icteri- tious urine, at any time in the disease, the relapse is but slight, and seldom or ever mortal. 4. In young persons under the age of puberty, of whom I have cured many, and in whom sweating cannot safely be attempted, this fever is as easily subdued, for the most part, and in the same man- ner, as their other fevers, which proceed from a load and corruption of the humours in primis viis, generally are; to wit, by absorbents, altemperauts, and antispasmodics, min- 204 Mitchell on the Fever of Virginia. gled with clysters and lenitives, at any time in the disease ; by these, the fatal convulsions and hemorrhages in those and other tender people are prevented. 5. Sweating can only be safely attempted in the first hours of the disease, whilst the matter is fluxile; which short lived opportunity is generally let slip, and sometimes does not offer; after which, the only security against an inflammation of the vis- cera, is to be expected from lenitives given in the remis- sions, but not in the paroxysms of the fever. But it must be observed, that however these evacuations may prevent, yet neither one nor the other cures such inflammations till after concoctions ; and that purgatives are offensive on ac- count of their stimulating, as sudorifics are for their heating quality ; for which reason they ought not to be given after any signs of an irritation of the vessels or spasms about the prascordia, severe anxieties, contractions of the hypochon- dres, or convulsive motions of the stomach: and none but the mildest diluting laxatives are ever proper, such as whey made with cremor tartari, or tamarinds, potions of manna and rhubarb, or solutive syrup of roses, a mixture of rhu- barb, sal. nitr. in broth or gruel, or aperient relaxing apo- zems given in divided doses. III. The next thing necessary to be considered in the cure, is the concoction (as it is called) of the morbid matter, whereby to render the remains of the morbid humours which have not been carried off by previous evacuations, but keep up the fever, a yellow effusion or inflammation of the viscera, fit to be separated and expelled in due time by proper eva- cuation. We need not dwell so long on this, although of great consequence in the cure, as it is to be effected by the same means as in other malignant fevers, where the same indications prevail: but the chief thing here is to establish a Mitchell on the Fever of Virginia. 205 true indication of cure for this disease.* On this account, it will be necessary to consider what are the indicantia and state of the body and proximate causes of this disease, which I shall do only in general; each particular symptom and the various cases which occur in practice would require a trea- tise by itself to discuss them thoroughly. The following seems to be the state and condition of the solids and fluids in this disease from whence the indications of cure ought to be taken. 1. The fluids are manifestly dissolved from the beginning by the miasma of the disease, and are much more so by the effects of the fever succeeding it. 2. The blood is much accelerated in its motions, when it is thin, dissolved, hot, and acrid: to this succeeds an effusion of a rancid, oily, adipose humour, or a more pernicious, heated, acrimonious bile about the height of the fever. Hinc illae lacbrymae! 3. The solids are not rigid, and the body dense and imper- spirable, as in most other acute continual fevers; they are rather lax than weak; the dissolved blood is not able to keep their diastole ; but they are apt to be drawn into spasms and convulsions, as weak fibres generally are, by the heated, ac- celerated acrimonious humours, especially in the more sensi- ble membrane about the praecordia. 4. Hence a stagna- tion or inflammation in those membranes, especially the sto- mach and contiguous viscera: which as it proceeds from a thin, hot, acrid blood, or bilious humour, is of the erysipela- tous kind. This seems analagous to pleuretic inflammation in other acute distempers, and in like manner is produced from the effects of this fever. 5. These bring on an univer- sal spasm or systolic motion of all the nervous membranous parts; hence the arteries are contracted or nigh to a con- * Id probi distioguendum etprobi noscendunj, &c- Bagliv. deFebr. malign 206 Mitchell on the Fever of Virginia. ^inued systole, as is felt by the pulse, which makes the dis- solved blood, lymph, and bilious, oily humours stagnate in the extreme capillaries; whence mortification of the infla- med parts. From these causes likewise the blood will be drove out of the more rigid contractile parts ; the muscles, &c. will be accumulated in greater quantities in the weaker, laxer glands, and in the more dilatable, spongy, viscera, the liver, spleen, pancreas, omentum, mesentery and lungs ; whence, in the dead bodies, these parts were distended and gangrened, and the blood drove out of the other vessels into the vense portarum, which proceed from, or tend to those softer vis- cera, where the circulation is slowest. But in all this the brain was not affected in the dead bodies, nor did it appear to be so in the disease, but by consent of the nerves and stomach: perhaps the rigid contractile dura mater and su- perior situation or distance from the stomach and prrecordia, which are most affected, defends and preserves it. In these circumstances the following indications seem naturally to occur, besides the evacuations already taken notice of. 1 . To prevent the dissolution of the blood by correcting the acrimonious salts of the peculiar miasma, heat, and biliary acrimony of the fluids, which seem to occasion it. 2. To relieve or guard against the spasms of the vessels. 3. To remedy the inflammation, and prevent the sphacelation of the viscera ; especially those situated in the hypochondres. The particular remedies which I found most successful to answer these indications of cure, were the following: aqueous diluents are well known to be serviceable in all acute diseases; but besides their moistening, cooling, diluting quality, they are serviceable in a peculiar manner in this disease; they are generally earnestly desired and greedily swallowed, in large draughts, on account of the heat at the stomach, which draughts distend the stomach, that is often closed and con Mitchell on tlie Fever of Virginia. 207 traded ; this loosens the spasmodic constriction, as the ano- dyne quality or pleasant sensation which such draughts af- ford, procure a pause from the grievous restlessness; but when the convulsed stomach acts on such a full load, it throws it off both upwards and downwards, by vomiting and purging, which evacuate that offensive humour, impacted ou its tunics, or floating on its contents (as was observed in one of the dead bodies above,) that causes the worst of all the symptoms, the cardialgia and anxiety; so that such large draughts of grateful aqueous liquors should not be denied the sick in this disease. For I have seen them procure as much speed, relief, and security, as could be expected from opiates in many sorts of pain: but some would give them cold, as they are coveted, which is dangerous in in- flammation of the viscera, (Alexand. Trail, lib. 12. c. 3.) particularly in an erysipelas of the stomach. But dilu- ters alone are not sufficient iu this fever. It is further necessary to guard against the heat and acrimony of the hu- mours by attemperating, incrassating, cooling remedies such as decoct, hord. oryz. absorbents, &c. &c. but above all the acrimonious salts of the pestilential miasma, which dissolved the blood, are to be corrected, which as they proceed, in all probability, from putrid animal sub- stances, are best cor rected and destroyed by acids ;* which were found to be of service in this disease. But there is much in the choice of acids; the harsh, mineral acids, irritate and fret the stomach: the mild, native, vegetable acids, well diluted, only agree with it. Acids rather pre- vent than cure the inflammation of the stomach. Where • Hales Hemak. cur. Method, r.8. 212 Mitchell on the Fever of Virginia. nature does not do the business herself. On this accouiu an ill-timed scrupulousness about the weakness of the body is often of bad consequence in these urging circumstances, for it is that which seems chiefly to make evacuations neces- sary, which nature ever attempts, after the humours are fit to be expelled, but is not able to accomplish, for the most part, in this disease. And I can affirm, that I have given a purge in this case, when the pulse has been so low, that it could hardly be felt, and the debility extreme; both one and the other being restored by it. Another thing which makes artificial evacuations the more necessary now, is the diffu- sion of a new morbid matter through the blood, which causes the icterus different from that which first brought on the fe- ver, when nature is almost overcome by the conflict with the first. Evacuations are likewise the more requisite at last, if the necesary ones have been neglected at first. The next thing to be considered, is the kind of evacua- tion to be promoted; the most beneficial I have always found to be procured by lenitive cholagogue purges. Sanctorius indeed tells us, that the matter of malignant fevers is dis- charged by insensible perspiration, which is the general aim of physicians to obtain in these kinds of fevers, in which they seldom consider that hardly any putrid continual fever comes to a perfect crisis by sweats alone.* But in this particular fever, whenever any yellowness, even in the eyes, appears, we are entirely frustrated in our expectation of any relief from diaphoretics, in order to carry it off. This icterus proceeds from a matter which seems to be too viscid to pass off through the narrow pores of the skin, and never goes off entirely and perfectly by any ways whatever, whether the contrivance of nature or art, that ever I could observe, but by a tuibid * Kernel. Feb. cur. Method, c. 8. Mitchell on the Fever in Virginia. 213 yellow lateritiou3 urine or loose stools. The same observa- tion is confirmed by Hippocrates, who adds to these saluta- ry discharges, in an icterus coming on a fever, a plentiful bleeding at the nose. (Epidem. 1. 1. § 3.) Nay, the fever it- self, when little or no yellowness appears, is hardly to be carried off entirely without purging; for when this indication is neglected, when it first offers (all changes being generally Sudden) the fever returns with exacerbations, like the putrid fever coming after an imperfect expulsion of the variolous matter in the small-pox; and as often proves mortal in this case, as in the other. It is true we do sometimes see the fever brought to an apyrexy without purging, when accom- panied with little or no yellowness, but very seldom when it is; but even then the crisis is imperfect, and the distemper is subject to frequent and severe relapses ; and often degen- erates into a slow periodic and long continued fever which gradually wastes and consumes the body, when this necessa- ry rule of practice is not rightly complied with in time. And here I cannot pass over a further comparison of the method of curing this distemper and the small pox, in both which purging is found of equal benefit, much in the same circumstance. They both proceed from a subtile conta- gious miasma, which brings on the fever at first; towards the state or decline of which, another foreign, more viscid, ill conditioned, matter, gets into the blood; to wit, the va riolous matter in one, or bilious humours in the other; which raises a new conflict from a different cause, which is hardly to be overcome but by evacuating this foreign mat- ter by purging. The only danger of this evacuation iu both diseases, which some complain of,* seems to proceed from the crude state of this matter, when it is either not * Allen, Synop. Medic, 214 Mitchell on the Fever of Virginia. rightly prepared or duly determined to proper emunctories for an expulsion, like the febrile matter in other acute dis- eases. The proper tinurfor this evacuation next to be con- sidered, is the first signal remission of the fever, or abate- ment of the most threatening symptoms, after or about the state of the disease, which we have said, is generally on the fourth day here in Virginia; or when any signs of concoction appear in the urine, especially if it is yellow and turbid, or other signs which indicate purging in other acute distempers, are observed. (Vid. Helvet. Aniiu. Econ. p. 4 1) But if there is no exacerbation or paroxysm of the fever on this fourth day, which is generally a promising sign, and none of these symptoms appear which denote an inflammation, or threaten a gangrene of the bowels, then I have ordered a purge with signal relief and good effect in the height of the disease, before few or any of those signs appeared ; thereby preventing the yellowness in a great measure, which was to be expected that or the next day; and obtaining a perfect and entire crisis, by copious sweats, ensuing after a few loose, stools. It is true the necessary maxim, cocta non ■ ruda sunt medicanda, ought to be had regard to in all dis- eases ; but as little in this as in any other, on account of the necessity of evacuating the bilious humours, which can only be carried off this way. So that if a purge at this time could always be safely given, it would afford more relief than all the applications generally used; for the icterus and dan- gerous conflicts which it raises, are thereby in a great mea- sure prevented, the good effect of which are so signal, espe- cially if purging has not been used at first, that thev are apparent to all who have ever seen the course and event of the disease without them. But iu all acute diseases, there is great caution requisite in applying remedies of such sig- nal efficacy; especially where the humours are dissolved, Mitchell on the Fever of Virginia. 215 the disease so severe and acute, and the debility so great as in this distemper. For as Hippocrates tells us in general. Quod prodest, ob rectum usum prodest. So where there is a critical dissolution of the blood, or collection of the humours, it is unsafe and prejudicial. At other times this fever is of a lypirian, which, as Hippocrates tells us, is not to be car- ried off, but by a cholera (Coac. I. 4. aphor. 6.) which I have seen verified more than once in this distemper. But the discharges in this, vomiting and purging, are rather of the colliquitive kind; which colliquitive discharge hap- pens at other times ; both which ought to be stopped or mo- derated ; for which purposes I have found the same good effect from warm opiates, (theriac. laud. liq. cum pulver. bozoard. absorbent, aq. alex. Sec.) as from purges at other times. So that there is iio depending on any ge- neral method of cure in the different cases of this dis- ease, however specious or successful at some times: but circumstances must be well considered and rightly judged of, by those who would avoid the imputation of Pocteus Neapolitanus. Multi sunt moibi, in quibus, si medicus erret aliquando tamen parum, et quod vix notari possit, nocet: ubi vero <^(|jgeret magnus, fortis et periculosus morbus, tunc ipsius imperitiu baud levia adfert incommoda. Paraph, in Hipp, de veter. Medicin. (216) REVIEW. Art. I. The Lectures, corrected and improved, which have been delivered for a series of years in the College of New-Jersey, on the subjects of Moral and Political Philosophy, by the Rev. Samoel Stanhope Smith, D. D. LL. D. &c. &c. New-York. Whiting & Watson. 8vo. 2 vols. Vol. 1st. pp. 324. Vol. 2d. pp. 386. 1812. (Concluded from our last) Having now taken a survey of human nature, as com- posed of body and spirit, he enters into a more immediate analysis of its powers. These powers may be compre- hended under the head of sensation, of sentiment, of ima- gination, of reasoning, of reflection, of volition, and of the moral principle. Sensation is either external or internal. External sensation 13 that perception which we have of ob- jects without the mind, and their qualities, through the in- strumentality of the corporeal organs^? sense. Internal sensation, on the other hand, is the perception we have of the operations of our own minds by the inward powers of consciousness. Sensations also, are divided into those which are secondary, such as our perceptions of grandeur, beauty, proportion and harmony in objects. In treating on the nature of the external senses, and the manner in which they impart the knowledge of their objects to the mind, without attempting to explain the mode in which matter acts upon mind, which is probably one of the impenetrable arcana of nature, or adopting the ridiculous jargon of Hart- ley's vibrations, he assumes merely as a given truth, that Mott on the Malignant Epidemic, #c. 165 the plagues, has this remarkable passage: " La cause qui la propage et le foyer qui la conserve, se trouvent 1'une et 1'autre, chez Ies marchands frippiers a Constantinople." So that, ac- cording to this author, if the sale of old clothes were prohi- bited in that city, that terrible scourge might be arrested in us awful and deadly progress. The application of this re- mark is too evident to need further observation. Nothing in this description is intended to apply to ships arriving from more northern countries, nor to ships of war. The writer has, in many instances, witnessed the active clean- liness of large ships to and from Europe, and along our own coast; and he has, with great satisfaction, observed the effi- cacious use of wind sails in this and other harbours. But the necessity of these judicious preventives, under such favour- able circumstances, serve more strongly to enforce all the foregoing observations, when applied to such small, confined, and generally unhealthy vessels as are usually employed in the West-India trade, and the infectious kind of cargoes im- ported in them. IV. An Essav on the Malignant Epidemic Peripneumony, which prevailed at Newtown, Long-Island, in the Spring of 1812—By Valentine Mott, M. D. Professor of Surgery in Columbia College, Corresponding Member of the Medical Society of London, 8rc. in a letter to J. C. Lettsom, M. D. &c. London.—Communicated to the Editors of the Register. The occurrence of epidemics ought to be carefully and faithfully recorded, for the instruction of posterity. Every age presents to us more or less of novelty, in the commence- ment, progress, and termination of pestilential diseases; we 16$ Molt on the Malignant Epidemic »eed only refer to the historic page for a satisfactory illustra- tion of this position. The history of the prevalent e of epidemical diseases, wrould form a very interesting subje t of inquiry« It is a theme, rich in matter, both cirious and in- teresting, and very considerably instructive and important; and it is by the industry and diligence of our worthy and venerable predecessors, that so many invaluable legacies have been bequeathed to posterity; which will long continue as land marks, or beacons, to direct the medical traveller. Every attempt, therefore, however feeble and imperfectly performed, will be considered as praise worthy, if not sub- stantially and practically useful. With this impression, I shall venture to give somewhat minutely, an account of a very malignant and fatal form of disease, which prevailed at Newtown, on Long-Island, in the spring of 1812, and which, from its character, I would call a Malignant Epidemic Perip- eeumony. The weather, during the prevalence of this epidemic, was very remarkable for a great quantity of rain, and the easterly and north-easterly winds. For the space of more than a week, frequently at a time, the wind would be from the west in the morning, with a clear atmosphere, and by mid-day, from an easterly quarter; and if not attended with rain, the atmos- phere would be loaded with a mistiness, accompanied with an unusual degree of chilliness. This peculiarity in the season, did not fail to arrest the attention of the most careless and common observer. As late as the first of fifth month, (May) but very little appearance of vegetation was observable, even in the warmest and most favourable situations; and on the third and fourth of the month, a rain and snow storm, occur- red from the north-east, which was more than commonly severe and cold. After this kind of stormy weather, a great increase in the number of new cases was generally observed. The whole month was uncommonly cold and unpleasant; in- which prevailed at Long-Island. 16,7 somuch that the common fruit trees of the season were not fully blown till ihe beginning of sixth month, (June) which is unparalleled in the memory of the oldest inhabitants among us. This disease attacked all ages and constitutions, and was mosily confined to those districts, which were inhabited by the lower and more indigent classes : exceptions to this, how- ever, now and then occurred. It was ushered in, in all cases by a very severe chill, which lasled for some time; this was fol- lowed by a great degree of heat, pain in the back, limbs and head, and most intense pain in the chest; great difficulty of breathing, and in some instances the oppression was so great as to vhreaen immediate suffocation, with violent cough,and expectoration of yellow matter, and generally very bloody. The secretion from the lungs, when not bloody, was so }relIow as to stain linen on which it was received. The expectoration of blood was much greater than had usually been observed to take place in any peripneumonic affection. The pulse generally was small and frequent, and by no means tense; Bkin hot and dry; tongue white and moist; bowels more or less relaxed, with nausea, and in many instances violent and repeated vomitings, attended from the commencement of the chill. In some instances a profuse diarrhoea attended fiom the first attack, so as to exhausi the patient very much, accom- panied with a most distressing nausea. In these cases, much less affection of the chest was observed; still, however, suffi- cient to claim particular attention, accompanied with the yel low expectoration, and even blood. After the lapse of one or two days, great prostration of strength would take place, without a comparative abatement in the oppression and distress at the breast; which continued. though in a lesser degree, accompanied with an augmentation of :he pain in ihe head, heat of ihe skin, and other symptoms of ardent fever. At this time, frequently a corisiderarik 168 Mott on the Malignant Epidemic yellowness would be manifest in the eyes and face, and gene rally over the body; in some cases to as great a degree an was ever observed in the autumnal bilious remittent, or yellow fever of our cities. This bilious discolouration lasted through the whole course of the disease, and even during the conva- lescent state, which was generally very protracted and tedious. It was very natural, when called to a patient labouring un- der the symptoms which have been enumerated, to deplete the sanguiferous system by bleeding, and that not very spa- ringly; especially in those cases where the peripneumonic affection was the greatest. Not only the symptoms would seem to warrant such practice; but the blood too, when drawn, exhibited the sizy appearance, and buffy coat, though less viscid than common. But the effect of the bleeding upon the patient was not such as to warrant a repetition of the operation: once was enough, and in some, it is feared, more than enough, even when only three or four ounces were taken. It is a fact, not a little remarkable, that even so small an eva- cuation from the blood-vessels, as last mentioned, would in- duce the most astonishing prostration, with small and feeble pulse, &c. convincing the physician, before he left the cham- ber, of his error ; though the evacuation seldom failed to give temporary relief to the distressing affection of the chest. The state of the stomach and bowels was such as generally to forbid the use of evacuants, except of the mild or laxative kind; for even these, in some instances, would be followed by delirium, if they operated at all freely. However much I may be attached to the Hamiltonian plan of free evacuation from the alimentary canal, and from what I have seen in the practice of this learned gentleman, most certainly am ; yet, in this disease, it ought to be used with the greatest care and circumspection. As the most urgent affection seemed to be that of the chest, no time was to be lost in attempting to relieve it; and which prevailed at Long-Island. 169 for this purpose a large blister should be applied, and one sufficiently large to cover all the fore part of the thorax. This must be several times repeated ; and it is better to re- apply it, than to promote a discharge from the first; and each plaster will be found to give great relief: indeed they appear almost the only remedies to relieve the thoracic distress be- fore mentioned. To aid the plasters, we must now endea- vour to excite a free discharge from the skin by perspiration. This is one of the most important indications in the treatment of this disease; To effect this object, in the fullest and most speedy manner, not only warm teas must be exhibited, but the external application of warm and relaxing means, must be resorted to. For internal use, a strong decoction of seneka and aq. ammon. acetat. as much as the stomach would bear; or small quantities of opium, ipecac, and camphor, and fre- quently repeated; together with the external application of the steam of warm bricks, wet with vinegar, and wrapped in flannel; or bottles of warm wTater, placed close to the patient in bed, and the warm bath,* were found the best calculated to produce this effect. When sweating is once excited, it ought to be kept up from twenty-four to forty-eight hours, without intermission; as the relief afforded to all the symp- toms, never failed to justify the practice. The exhaustion of the powers of life was So great in some instances, in a short time from the first attack, as was shown by a coldness of the extremities, weak and small pulse, and coma, that no time was to be lost in throwing in stimulating and cordial medicines; as toddy and wine whey, even though * The sage Hippocrates, when speaking of the warm bath in hie hook on acute disease^, has the following words: "Convenit autem in totum niagis peripneumo- niis, qnain febribus ardentibus. Nam dolorcm latcris et pectoris at dorsi, balneum lenit, et sputum raaturum facit, ac educit; et facilem spirationem reddit, et Taesitudinem eximit, articuios enim et cutis superficiem mollit." Hippoc. lib. de vie. rat. in morb. acut. Tom. I. p. 226 vol. in. v 170 Mott on the Malignant Epidemic they might appear to be contra-indicated by the affection of the chest. If epispastics were previously applied, the pec- toral affection never appeared to be aggravated by it; but, on the contrary, was relieved as soon as a general warmth was restored, and especially if accompanied with sweating. When the diarrhoea was profuse, the addition of a little tinct. opii to the decoction of seneka and aq. am. acetat. or the exhibition of a little solid opium, would generally keep it within proper limits. As soon as the affection of the chest was removed by the means above mentioned, cordial and stomachic remedies were loudly called for; such as wine whey, infusion of camomile flowers, or decoction of quassia, which latter appeared to answer the best. The relief of this affection was accompa- nied with a corresponding abatement of all the other symp- toms ; the tongue became moist and clean; in fact, the patient would appear to be convalescent. The cough would now be troublesome, with the yellow expectoration, but not bloody ; the whole body would be sometimes as yellow as an orange; and it was at this time the patient required the most careful nursing, owing to the most remarkable exhaustion of the pow- ers of life. The cough was relieved by the tinct. opii camph. and decoct, senekae, or the mistura sperm, ceti; but it conti- nued to annoy during the convalescent state, which was as before observed, commonly lingering. Its duration was very various. In some instances it proved fatal in the course of eight-and-forty hours, three and five days, and in some cases as late as the second and third week. In the protracted cases, death was always preceded by ty- phoid symptoms, accompanied with an urgent cough and ex- pectoration. But in those that terminated the most suddenly, there were no typhoid appearances. May not death, in these instances, be occasioned by gangrene of the lungs, as has which prevailed at Long-Island. 171 been observed by some of the older authors ?* It observed the ancient law of epidemics, of being more severe and fatal in its commencement, than at its termination. The average mortality was about one third, and one in four that were at- tacked. This disease continued to be very rife and fatal, till the beginning of sixth month, (June) when a number of cases occurred, in which there was but little difficulty and pain on breathing, and but little cough. In these cases, violent deli- rium attended from the commencement, with ardent fever, with scarcely the slightest remission for three or four days. In these instances the sickness at the stomach and diarrhoea were considerable, and the prostration that followed very great. They all yielded to the use of blisters, and the general sudo- rific plan that we have already laid down, without any typhoid state supervening. The disease which has now been described, was not con- fined to the township of Newtown, but took a very extensive range through our state. It was prevalent in many places on the north side of Long-Island; mostly confined, however, to that tract of country which extends from Newtown to the town of Huntington. In the counties of East and Weil Chester, it has likewise prevailed; but Dutchess County, more than any other part of the state, will long recollect its dreadful and fatal ravages. The inhabitants of our own city, while they deeply sympathized in the distress and calamity upon their borders, were not free from consternation and dis- may at home.f * See Van Swieten's Commentaries, vol. 8. p. 261. Also, McBride's Practice of Physic. t-----Terruit urbem; Terruit gentcs,-------. Hor, Cann. II. 172 Mott on the Malignant Epidemic As there is a great diversity of opinion, even among me- dical gentlemen, who have been conversant with the spotted fever, it will not, I hope, be deemed impertinent to subjoin, that I believe in the identity of the late disease in different parts of the state. I venture to do it, however, as it is pre- dicted upon information that cannot be questioned : it is not from supposition or conjecture. The disease was prevailing through a great tract of country at the same season of the year, though no doubt in a slight degree differing from some peculiar local and individual circumstances, yet it was essen- tially and virtually the same epidemic. Huxham informs us, that he has known a catarrhal epidemic fever, in very cold and mountainous situations, to assume the nature of pleuro- peripneumony; whereas in very low situations the same has run into a slow nervous fever. The same popular disease therefore, reigning in different places, may require a very different mode of treatment. We surely cannot denominate the disease which we have described, a pure or simple fever; or, as many have called it, spotted fever! If we look into Dr. North's book, on the malignant epidemic, which is called spotted fever, and which fee has described with great accuracy and care, no one will hesitate to say, that the present epidemic is a very different disease. Dr. North has been at more pains than any of his colemporaries, in collecting and embodying a stock of impor- tant information, relative to this very extraordinary and novel disease. The annals of our country will have to record this new hydra, or monster, to be enrolled on the endless catalogue of human maladies. After contrasting it with the plague, scarlatina, cynanche maligna, &c. he is of opinion, that each has its peculiar shades and complexions, though they belong to the same family of diseases; and that the spotted fever is a new species of Typhus. In giving a nosological character, he sayB, " I think it ought not to be arranged under the order which prevailed at Long-Island. 17-3 phlegmasia,for the following reason: although in some few cases local inflammation has been induced by the disease; yet this has not oftener happened in this epidemic, than in oiher ma- lignant fevers. Whether it more properly belongs to the or- der febres, or exanthemata, is not so clear." Dr. Arnell states, that they did not bear bleeding, and the Wood showed no buffy appearance. In enumerating the symptoms of the disease, no mention is made of any perip- neumonic affection, as pain and difficulty in breathing, or cough, nor bloody expectoration ; it attacked all ages, and proved fatal to six in seven who were affected ; in some, as early as fifteen hours from the first attack, and from one to three days. Petechiae appeared all over the body, and of a large size in many instances.* Dr. Strong, in his Inaugural Dissertation on the spotted fever, as it appeared in the town of Medfield, Massachusetts, in ihe spring of 1806, and in Hartford and Windsor, in 1807, has taken great pains to describe the disease, having had many opportunities of observing it. From his essay, it appears, that the inhabitants of high and low situations are equally sub- ject to it; and though there is some variety in the commence- ment, the leading symptoms are well marked.—" Wherever it appears," says he, " in whatever manner it makes its ap- proach, that debility, which is more to be dreaded than a strong man armed, is the most striking characteristic." In another place, he says, the most distressing symptom, and one the most to be dreaded, is a peculiar sensation about the upper orifice of the stomach, which patients call " a deadly feeling, a death like coldness or faintness." In the Massachusetts Medical Papers, may be found a very- detailed and minute account of the spotted fever, as it pre- * See Dr. Arnell's account of the spotted fever, as it appeared in Orange fVnin- fcy, in 1808-9, in t«je 1st vol. of the Medical and Philosophical Renter 174 Molt on the Malignant Epidemic vailed in different parts of the eastern states. The zeal and interest which the members of the Medical Society of Mas- sachusetts have manifested in their investigations into the nature of this extraordinary and novel disease, will be a last- ing memorial of their philanthropy and benevolence. In de- tailing the symptoms of this disease, they say, " The respi- ration is much and variously affected; in general it is difficult. Cough rarely occurs, and the difficulty of respiration has*not commonly appeared to rise from an inflammation of the lungs."* The cause, whatever it may be, which produces this new form of fever, must have a powerful and deadly operation up- on the energies of the nervous system; more extraordinary than even the pestilence of the Levant. There is no exam- ple in the whole of medical records, as far as I know, of a morbid poison producing such sudden death, as we are told takes place in this disease.f The sudden and unexampled prostration of strength, together with the great subduction of animal heat, constitutes a very important and prominent fea- ture in this new epidemic; insomuch, that Dr. North says, " most physicians who have had experience in it, consider their patients relieved from a most deplorable state, as soon as they get the surface of the body warm, by any remedies. which may be in their power." The conclusion, we there- fore think unavoidably follows, that this is altogether a new form of disease in the land;% and as Dr. North very proper- ly says, may be considered a new species of typhus. No form of typhus which we have heretofore had described by the celebrated Dr. Cullen, the Febris Nova of Sydenham, * Vide Massachusetts Medical Papers, vol. IJ. part 2. f See Dr. North on spotted fever, and the Mas. Med. Papers, vol. II. part '2. \ Jam nova progenies calo demittitur alto. Virg. Eclog. IV. Hie vero subitum, ac dictu mirabile monstrum Aipiciunt; Virg. Geor*sed no animal food, lived chiefly on vegetables, drank lemon- ade in great quantities, made as follows : take the sour orange or lemon, peel it quite clean, cut in quarters, take out- all the seeds, then put them into a vessel, put as much sugar as will make it pleasant, pour boiling water thereon and let the vessel be well covered, and stand in that condition until cold; thus prepared it is pleasant drink for the sick. The French people disapproved of mercury in any way. They saved a young lady, (after she had the black vomit,) by wrap- ping her up in sheets wet in warm vinegar, putting her U* bed, covered over with blankets. That you may judge of our climate, I send you extracts from my diary of the weather for two seasons during our hottest months ; the cause of its not being continued during the time of the fever, was owing to the confusion we were all in, aiid my nephew, who attended to the thermometer, was taken with the fever and died ; he had just copied the last inclosed be- fore he was taken down. I think well to mention, that dur- ing the sickness the weather was dryland not by any mean* unpleasantly hot. The committee of health kept coffins ready made, graves dug, and buried the dead without delay; had all bedding and clothing, used by the sick, burnt: after the fever subsid- ed, had the town cleansed as well as possible; the wells and pumps attended^ to; the old privies filled up and new ones made. I am persuaded, that with proper attention to cleanli- ness and our quarantine laws, we shall escape, at all limes. the yellow fever. Our climate is nearly salubrious, (I mean St. Mary's,) we are open to the sea, are surrounded with salt water, and have the sea breeze or trade winds, with which we are visited almost every day in summer. As a proof of the health of St. Mary's, I have to mention, that I have lived here for twenty years, and have scarcely been a day sick, though I have undergone great fatigue and exposure. At the 424 Francis on Mercury. present day I do not know of a single person of my acquaint ance in town or in the country, for twenty miles around, that is sick or complaining. I think that by the time you have read thus far of my un- connected scrawl, you will be tired. I shall therefore close it by referring you for further information, to the different en- closures ; and by requesting, as a particular favour,.that you will indulge me with your opinion of the sickness alluded to, and should you publish a book on fevers, which I understand you intend, you will confer a favour on me, and render a ser- vice to the inhabitants of this remote country. With sentiments of respect, I remain Your humble servant, JAS. SEAGROVE. Dr. Hosack. IV. Observations on Mercury : embracing its Medical His- tory and its abuse as an article of the Materia Medico. By John W. Francis, M. D. Fellow of the College of Physicians and Surgeons of New-York, Member of the New-York Historical Society, Src. The general properties of mercury, as found in a native "state, and its various combinations with other substances, being generally detailed at some length in the several works on chemistry and mineralogy, all that the writer intends, on the present occasion, is, to offer a concise view of its me- dical history, and to consider the abuse of this powerful re- medy as an article of the materia medica. From the sacred volume may be derived considerable in formation, relative to the state of chemical knowledge, in the earliest ages of society. Numerous passages therr ( 3*5 ) ARTICLE II. An INQUIRY into the Came of the Prevalence of the YELLOW FEVER in New-York. By Valentine Seaman, M.D. THE following inquiry into the history of the epidemic Yel- low Fever that has appeared in this citv, at different times since the year 1791, was instituted for the purpose of ascertaining its most probable and essential causes. If I have succeeded, my end is answered, and my trouble fully compensated ; if not, I still gratify myself with the thoughts of having established, with a con- siderable degree of accuracy, facts, that may be useful to some more fortunate inquirer. The great difficulty of coming at the simple truths even near at home, has made me cautiously avoid attending to hearsay stories bf what has happened abroad ; obscured by their distance, often warped by their relators, and too generally eagerly caught at by their favourers, and equally neglected by the adverse party. An instance of the impropriety of giving a currency to such fly-about tales, is glaringly exhibited in William Currie's letters to Benja- min VVynkoop: this penetrating man having convinced himself, notwithstanding a bulwark of opposing evidence, (Webster's pa- pers on Bilious Fevers, and Bayley's Acxount of the Epidemic of 1795,) impassable by any body else, that the Yellow Fever that deso- lated our city in 1795, was introduced into it by the brig Ztphvr. One naturally would conclude from Dr. Currie's acceunt, that he had confined his inquiries merely to the superficial scum of newspa- per observations, and flying reports; but his subsequent reflections prove him to have been acquainted with what ought to have cor- rected his premature and ungrounded conclusions. But these cir- cumstances, so discordant to his wishes, it seems he has thought proper not to attend to, but rather to rest his opinions upon the slender support of his ipse dixit authority; while he soothe.s his feeling-;, by flying from the narrow path of reason and truth, into the unbounded field of hard-strained invetftive and feeble scurrility. I cannot, in this place, forbear noticing the different effects that opposite opinions have had on the subsequent tate of Philadelphia and New-York. While the physicians of the former place,* I will • I do not hereby mean to include all their phyfkians, but only the majo- rity of them, as feveral worthy characters among them have rifqued their very reputation at the fhrine of public welfare, in attempting to call the attention of that afflidted city to its true inter efts. 316 MEDICAL REPOSITORY. not say, " actuated by some malignant motive,"* as I can hardly conceive human nature capable of such depravity, have been flat- tering the pride and vanity of their fellow citizens, with a notion, that their city was all-perfect, and its situation, in regard to healthi- ness, beyond amendment; and that to keep up a sharp look-out to their neighbours was all that was necessary; they have induced them to disregard that attention to cleanliness, which the terror of their first attack had driven them into; and hence have those who unhappily confided in their judgments, returned to their former neglect of domestic causes, which has again involved them in a ca- lamity, as general, and, perhaps, as fatal, in proportion to the re- maming predisposed inhabitants,]- as that of 1793. In the mean- time, the kamed physicians, as they have, in a sneering way, been called, of New-York, have had honesty and independence enough to speak their minds freely, and to let their fellow citizens know, that " without the air of putrid effluvia, they need have no ap- prehension of a Yellow Fever spreading among them;" and their silly hearers, from being so weak as to put confidence in their opi- nions, have removed most of the suggested causes of pestilence; and hence have confined the effects of tne disease, this year, to the narrow limits of a few filthy spots; and the number of deaths to within thirty: notwithstanding the severity of attack, and malig- nancy of the complaint, where it prevailed, were fully equal to that of 179;. I shall not impose upon the time of the reader, with quotations from different authorities, in various parts of the world, in proof of the particular prevalence of Yellow Fever in places especially favouring the accumulation and fermentation of putrefactive ma- terials of some sort or other; these facts being too well known to need recapitulation t but shall endeavour to trace the history and progress of the disease, for the purpose, if possible, of ascertain- ing its true cause, as it has occurred to my observation, in this city , for several years past. In the autumn of 1791, the Yellow Fever was considerably prevalent in a part of Water-street, in the neighbourhood of Peck's- blip, noted, at that time, for having the docks near to it loaded with every kind of filth that could be scraped up out of the adjoining slips, which had been long collecting every species of corruptible materials that the citizens wished to get rid of. (See also Jonas Addoms' Inaug. Dissert.) In 1792, at the season wherein those complaints mostly prevail, a long indisposition confined me to the house, and prevented * Currie's charge upon thofe who dare to think differently from him. f liy the remaining predifpofed inhabitants, I mean to include only fuch nf thofe that continued in town, who had not undergone the complaint be- fore, as a former generally icreen* us from a future attack, at leaft a fatal one. PlaU, L i i TUiH. If- MEDICAL REPOSITORY. 317 my knowing much about what was going on out of doors, or of the state of the city, either as favouring health, or threatening dis- ease. However, I did not understand that there was much alarm of Yellow Fever that year. Probably there was little or none. Nor, in 1 793, was the alarm of Yellow Fever heard of among us, excepting from a few solitary cases imported from Philadel- phia, and which was lost in the fate of the unfortunate individu- als who had brought it from its source, without the least injury to the healths of our citizens, either in the capacity of friends, nurses, physicians, or neighbours; none of these patients, as far as I could learn, having been permitted to seat themselves in places abound- ing with putrefying substances. ■ The complaint in the year 1794, appeared to such a degree, as to occasion considerable uneasiness in the minds of many of the Citizens. The Committee for fireventing the introduction of contagious^ diseases, met regularly to establish measures tor Uie weliare $ the city. To them, in a communication made the nth of 9thf-~ month (September), among other circumstances, I intimated as a reason tor believing that it was supported by causes within our- selves, " Tnat most of the patients that had been, or then were, " affected with dangerous fevers, were either such as resided in the " neighbourhood of the slips, (which then were or lately had been " cleaning Out) or whose employment led them to frequent those " places; as cartmen, measurers, labourers, &c. at least such was " the situation of the,cases that I had heard or known of, and " respecting which I had taken some pains to inform myself. I " then had, at that early part of the season, attended four patients; *' and they were all of that description. Two of them were boat- " men, who lay at the New-slip; another lived not far from it; " and the business of the fourth obliged him to frequent the slips." It was observed, that during the very time that these persons were taken sick, the Mud-turtle (as the machine was called, the temporary suspension of whose operations was the object of that Communication) was performing its pestiferous purgations on this filthy slip. In 1795, that part of the town that bore the chief burthen of our calamity, was remarkably distinguished by peculiarity of cir- cumstances and situation (aided by t,.e singular regularity of our r.iins), seemingly well calculated for the accumulation and decom- position of all kinds of perishable animal and vegetable substances. (Webster's Collection of Papers on Bilious Fevers.) The chief prevalence of the disease in 1 796, seemed evidently fixed where, from our former experience, we ought reasonably to have expected it. For no doubt, at that time, the neighbour^ hood of the Whitehall, from the nature of materials wherewith a large dock was there liljing up, aided by the noisome exhalations, Fol. I. No. 3. E ji8 MEDICAL REPOSITORY. from the exposed bottom of the Exchange-slip at low water, must certainly have been rendered the most noxious part of the city. (Bayley's Letters, Medical Repository, No. I. Appendix.) But it was not intirely confined to that particular neighbourhood. in 1796. Four deaths from the Yellow Fever occurred, during that season, within fifty yards of where Roosevelt-street drain empties itself into an inlet which was then open quite up to the southerly side of Water-street; the bottom of which (S on plate I.) was frequently in part left bare even at high water. Every ebb-tide exposed at least eight hundred square yards of its surface, covered with the numerous perishable materials, furnished by the different streets of that crouded part of the town, which descend into this common sewer, in addition to the other putrid matters that such handy places are always collecting. One of them, James Callender (marked .1 on plate I.) was an Irishman, who had resided about five months in this city, and was the first that I could hear of who had the disease m that neigh- bourhood. He died on the zzd of 7th month (July,) after a few days illness, with a yellow skin, and smelted extremely offensive, as I was told by those who assisted in burying him. Two others, of the above cases, came under my own particular observation, and were decidedly of that complaint. Both of these patients were foreigners just arrived from London. One of them (.2) I attended. He had been in town but five days when he was taken sick: On the fifth day afterwards, 19th of 8th month (August), he died, with coffee-ground vomitings and yellow skin. To the second (.3) I was called a few hours before his death, to deter- mine whether he was a proper object for the New-York Hospital. He had been more or kss indisposed, from the second day after his arrival, which was on the ad of 10th month (October), but was not seriously taken till the fifth. He died on the seventh day of his disease, very yellow, but I know not what was the nature of the matter he puked up. I was told he had been much dis- tressed by his sickness of stomach. The last (.4) of these four patients died the 20th of 9th month (September), after five days illness, with yellow skin and dark vomiting. Another person also died with this complaint, some little dis- tance off, in Cherry-street (.5). I saw him in the latter stage of his complaint, in conjunction with the physician who had attended bim from the beginning; and we were perfectly agreed as to the nature of his disease. He died the 21st of 8th month (August), on the seventh day of his complaint, with yellow skin. Besides these fatal cases, there were a number of persons also, that were seriously affected by severe fevers, but yet recovered, ^designated -0 in the plate.) I attended three of this description; one of them lived in a house built upon piles, over a part of the MEDICAL REPOSITORY. 319 above-mentioned flat; another passed a great proportion of his time, during the day, in a store adjoining it; and the last lived in Cherry-street, and the yard of his house backed upon Water- street, about eight rods distant from the same spot. Dr. Bor- rowe informed me, that he had also attended one, at the corner of Water and Roosevelt streets, with the complaint well marked, and from which he, with difficulty, recovered. There were several other cases of fever, of a suspicious nature, though slight and soon recovered from. Their situations are marked (o) on the plate. It may not be amiss here to observe, that none, as far as I could learn, that had the fever in 1795, suffered with it in this neigh- bourhood this year, excepting one of the slight cases above-men- tioned : Its general prevalence the year before was, perhaps, the reason why no more were affected about this spot this year; their former indispositions probably securing them against a second attack. This much is certain, that the nine patients first above- mentioned, had not had it in 1795. Indeed, seven of them might be said not to have been exposed to its cause; one having lived only a few months in town, two having just come from Eng- land, one absented herself from town in the sickly season, two had lately come from the country, and one that year lived at the Whitehall; and one of the others continued in town for only a part of the time during the epidemic of 1795. Why the disease did not become as general about the easterly low part of the city in 1796, as in the year before, probably was owing to the removal of most of the causes that were supposed to have promoted such complaints; and perhaps also, in a degree, to not having such regular rains, to favour the deadly operations of remaining deficiencies. ;(See Webster's Collection of Papers.) Many of the lots in that part of the town had been filled up; the filth and dirt of the streets and yards had been more carefully cleared away; the unpavgd streets, in general, had been paved and regulated, so as to prevent any water from standing in them; and several of the slips and vacancies under the stores set upon piles, had been filled up with wholesome earth. But, in this de> voted spot, partial neglect, we see, was followed up by its predict- ed, I had like to have said merited, consequences. It remains to notice the disease as it has shewn itself among us this season. The cases that have occurred being too numerous to attempt to get an accurate history of them all, and the want of proper marks to identify it where it is slight, if attempted, would, at best, leave but a very objectionable result: I have therefore only noted the fatal ones; nor do I think we need much to regret the omission of the others, since, from the number of deaths, we can nearly calculate upon its degree of prevalence, and particularly j2b MEDICAL REPOSITORY. since the proximity of cause will, most probably, correspond with its mortality. To proceed, ist. William Cummings, two days after having taken his lodgings in East George-street, was attacked on the ist of 9th month (September), with chilis, head-ach, and the other common symptoms of fever, which increased in the night with delirium, &c. The next day many circumstances giving occasion to suspect his complaints to be of a dangerous nature, he was car- ried to the Lazaretto, on Bedlow's island, where, in a few days, I have understood, he died. 2d. Margaret Wiggins, in the same street, was taken on the 14th of the came month. On the fifth day of her disease, accord- ing to the account of the person with whom she lived, she puked a black, offensive, ropy matter. Two days afterwards, on the morning of the 22d, she died very yellow, and with black effu- sions about her! cast. 3d. ----Biown was taken the next day, the 15th, and died also on the morning of the 22d. He had vomited, during his disease, much blackish bloody matter, and was very yellow. 4th. -----Price, after having passed a part of the evening of the 16th of 9th month (September), in East George-street, was taken in his return home at midnight, with dizziness and lassitude, succeeded by a chill, followed by a hot fever, &c. He died on the 19th, very yellow ; he had, during his disease, puked a black matter. 5th. William Templeton sickened on the 16th, with chills, &c. and died in the afternoon of the 22d, very yellow. 6th. John Busson was taken on the same day with Templeton. During his disease he puked much: the nature of the discharge I could not learn. He died on the 23d, with yellow skin, and black- ness about his neck and breast. 7th. A lad, by the name of Parcells, died in Cedar-street. His mother lived in Henry-street, two doors from the corner of East George-street, where he used frequently to pass his evenings, and sometimes to stay the whole night. He became sick on the 19th, of the complaint of which he died on the 23d. According to the account of his physician, his must have been a decided case of Yellow Fever He had the black vomiting and yellow skin. 8th. Seth Fairchild was taken on the 27th of 9th month (Sep- tember), and died ont he 2d of 10th month (October), with black vomiting and yellow skin. 9th. George Ross was taken sick the nth of 10th month (Oc- tober), and died on the 20th. He had puked a blackish matter. His skin was yellow. 10th.----Hulshart was taken on the 12th, and died on the 1 7th of 10th month (October). He was yeilow, and had puked, during his illness, a greenish brown matter, and purged clear blood. MEDICAL REPOSITORY. 5*« All the above cases appear to have originated in East George- stieet; and all, excepting Price and Parctils, resided within the small compass of seventeen home.-, in the lower part of the street. nth. On the 13th of 9th month (September), John Holmes, after having been a little complaining lor a week, accoiuing to the relation of his landlady, was taken with a chin, succeeded by a hot fever, violent head-ach, red eyes, &c. On the 19th he was sent to the New-York Hospital, where he died on the 230, with a yellow skin, after having puked up a dark brown feculent looking matter. He had taken lodgings in Chesnut-street three days previous to his indisposition. 12th. -----Havens, who lay on board a vessel at Lynch and Stoughton's wharf, from the time of her arrival, the 25th of 8th month (August), was taken unwell the 14th of 9th month (Sep- tember), more unwell the next day, still more the day after, but not to such a degree but that he walked up tof^|oosevelt-streer, where he took lodgings. He was confined the next day; on the i8ch he was very yeliow, and vomited, in great quantities, a biack matter, mixed with coagulated blood, almost incessantly. He dis- charged the same by stool, and died in the night of the 19th. 13th. On the 17th, Samuel Suydam, who resided near the Ex- chai>yt, in Water-street, but who passed the greatest part of his time, during the day, in his store, a little to the east of Lynch and Stoughton's wharf, in Front-street, was taken down with his com- plaint, which terminated fatally, on the morning of the 23d. His physician informs me, that his disease appeared to him to be a Yel- low Fever of the most mr.lignant type. He had the biack vomit- ing to a great degree, and Lis skin was very yellow. I+lh. -----Kelly (1 of [late II.) was taken on the 7th of 9th month (Sept.), with fever, attended with a particular determination to his head, hot skin, snd great derangement of his mind. His complaints being suspected of a malignant nature, he was conveyed to the Lazaretto on the 13th; where, a Jew days afterwards, he died. 15th. Daniel Wiggins, who lived in the lower house on the west side of the Fly-market, (.2) his physician tells me, was, on the 20th of 9th month (September), attacked \\ ith a fever, which assumed a most malignant appearance, attended with black vomit- inos and a yellow skin. He died on the 28th. fti6th. John Van Deventer, (.3) as the family informs me, was taken on the 20th of 9th month (September), and died on the 29th, with a vellow skin. 17th. Samuel Hitchcock, at the corner of the Market and Front- 'tiett, (.4) sickened on the 23d, and died on the39th, in Fletcher- street, where lie had been conveyed after he became unu til. His r.tu :idant, in her simple narrative of his case, *.;•>>, he puktd mailer just like the grounds of coffee, but he was not yeliow. $2* MEDICAL REPOSITORY. 18th. James Hamilton belonged to the schooner Ellice, which arrived on the 16th of 9th month (September), after eight days passage from Richmond, in Virginia. He was employed in assist- ing to unload her, at the easterly side of Murray's wharf (.5). He was taken sick on the 27th, and then took lodgings at the Crane wharf; where he died in the morning of the 30th, with pakings of a greenish matter, and with a yellow skin. 19th. T. Comstock resided in Front-street, between the Market and Depeyster-street (.6): he was taken on the 28th of 9th month (Sept.), and was afterwards carried to the New-York Hospital; where he died on the 3d of the next month, with a yellow skin. 20th. J. Rogers (.7) was taken in the night of the 20th of 9th month (September), with chills and sickness at stomach, followed by a hot fit, which was succeeded by a sweating. In the morn- ing he was so well as to be about house. His complaints returned towards evening, without a preceding chilliness, and continued, with little or no abatement, till his death. He did not have much sickness at stomach, nor great pain in his head. The tunicae con- junctivae, of his eyes appeared bloated, with a reddish yellow fluid: his skin was yellow; his pulse most of the time soft, and not fre- <|uent; and he was much harrassed with a very painful hickuping, with short intermissions, lor about twelve hours before his death j which occurred on the morning of the 26th. zist. Abel Beers attended a store in Water-street (.8). He was taken with chills, pains in his head, &c. on the 10th of 10th month (October), and died on the 16th. During his fever, which regularly remitted every morning, he was much deranged in his mind; his bowels were constipated, and stools, procured by art, dark; his eyes and skin became yellowish on the fourth day; he puked a brownish matter several times on each of the two last days of his illness, and vomited a great quantity of blood just before fcis death. After death, the skin was observed to be universally yellow, except that there were purple effusions about the neck, breast, and on the lower extremities. 22d. Elias Mowatt, in William-street, died on the same day, of a fever with which he was attacked on the 12th. During his com- plaint, he had, several times, puked a black matter: he had some yellowness about his neck. From the foregoing list, which comprehends all the deaths from this fever, which have occurred in this city this year,* up to the present date, as far as I can learn, it appears that nearly one half * Since writing the above, one other death, and only one, has come to my knowledge, and the prefent ftcady coldnefs of the weather and hardnefs of the froft, feems intirely to have checked the difeafe; it is not probable a fiegk cafe of it exifts in the city at this time. MEDICAL REPOSITORY: J* 3 of them originated in a small part of East George-street; and the greater part of the remainder near about, and just below the Fly- market. We are, therefore, naturally ltd to examine the situation of these afflicted 6pots, to ascertain the cause of its particular pre- valence there. And, indeed, the southerly part of East George- street, where the complaint prevailed, (if we can suppose filth and putrefaction of any kind to produce it,) seemed well prepared for the purpose. The street itself, unpaved, was so rutted and broken up, in particular parts, as effectually to prevent it from being kept dry. Frequently, for some time after wet weather, it was almost impossible for footmen to pass through it, without miring half shoe deep; and, at the best of times, one fourth of this particular part of it was a filthy mud-puddle. Besides this, most of the houses are occupied by several families; all of whom have the yard in com- mon; and really, upon inspection of these places, all of which are lower than the street, one's mind is struck with an idea that the several joint-tenants are not only determined not to clear away the other's dirt, but also that each one exerted himself to put, at least, his share into the noisome collection; because he had as good a right to make dirt as his neighbours. Hence these sunken spots became a dreadful mass of garbage and offal matters of every kind. This, however, was not the case with all: One house, the cellar of which" contained fourteen persons, men, women, and children, black' and white, all huddled together, having no yard at all. But here there was no loss in the end; for what of every refuse and excre- mentitious matter the yard would otherwise have gained, was here thrown into the open street; the common place for all kinds of putrefiable substances. But, beside this, at the upper part of this af- fected portion of the street, between four and five rods up Lumber- street, is a declivity that appears to crave every kind of rubbish that comes near it; nothing seems to be too gross for it; even the night- man's filthy load, as I have observed, here finds a free reception. The cause of the prevalence of this disease near the Market, appeared very evident upon examining the spot. The south- eastern end of Pine-street, {S on plate II.) lies considerably lower than the dock which is continued from it; so that it there keeps a constant puddle of stagnant filthy water and mud. But this is a mere trifle in comparison to its pestilential neighbours. The slips (i S) on each side of this central spot, have been left, during the summer, to be fortuitously filled up by the free contributions of the neighbourhood. Hence they became the common receptacles of rubbish and filth of every description. I have seen in them the guts and trimmings of fish, shavings, the clearing of shops, mud, that appeared to have been the cleaning of sinks, cabbage leaves, potatoe peelings, &c. &c. and further, to render this noi- some collection the more complete, the necessary night-man did 324 MEDICAL REPOSITORY. not fail to do his part: more than once have I observed their ful- some loads exposed in these places, and that even above the ordi- nary mark of high water. But beside all this, the spaces on the annexed plate, marked S with crosses, particularly that to the north- eastward of the dock, has, from its being open and so contiguous to the Market, become the common convenience to a multitude of people; and indeed so effectually have they bespattered the ground wit;; their excrementitious depositions, that it requires a good degree of circumspection in walking there, to tread clear ol the film. Havens and Suydam appear to have taken their complaints in an atmosphere contaminated by the emanations from the exposed fiat a: the inlet by Lynch and Stoughton's wharf. This inlet, in- cluding the spaces under the adjoining buildings on each side, which are set upon piles, exposes a surtace of mud and every kind of filth that is constantly gathering in such places, of at least one hundred square yards at low water: and, as though it was feared that the parts under the stores should not receive their share of what is so freely thrown into such reservoirs, several of the boards of the platform before the door are left loose, so as to be taken up at pleasure: and, indeed, the pile that is heaped up under the opening shews that it has well answered its purpose. Still more completely to involve this dock in the most offensive effluvia, at the end of it is affixed a convenicncy, erected, it is true, over the wiiter; yet, with seeming care, such obstructions are introduced under it as to support great piles of matters, not less offensive to the smtll, than disgusting to the eye. Havens attended and slept in a vessel that lay at this very wharf; while Suydam attended his itore about eighteen yards from it, and in a direction for the regu- lar southerly wind to blow the whole power of this loaded atmos- phere upon him. Rogers lived in a part free from the circumstances attending the residence of the afore-mentioned persons. Might he not have picked up his complaint at the Market? Beers (.8) spent the day in a store between Beekman and Burling slips, which is remarkable for backing upon an inlet in the form of a T, that opens,into Front-strett. This place is unpaved, *'id, too much like many of the Philadelphia alleys, is bounded by the backs and gable ends of houses, and by yards, without a single hoi ie fronting it. It contains upwards of 200 square yards; one third of wiiiu>, at the most moderate calculation, is constantly covered with mucky filth of one sort or other. It may be thought strange that this place should furnish us with but one death. This may have been owing to two causes. In the first place, to its being surrounded, in great degree, by stores that are only inhabited dur- ing the day; anu secondly, to most of the inhabitants near it being MEDICAL REPOSITORY. jSj old residents. However, two other persons, to my knowledge, have here suffered with the complaint, both of whom recovered. One, Moses Judah (02), occupied and slept in the same store that -Beers attended: and the other, George Burchell (01), resided in a house .at the corner of this place and Front-street. They both had removed to this place this year, and Abel Beers (Judah's ap- prentice) had never spent a summer in New-York before. Holmes, who died at the Hospital, took his complaint in Chest nut-street, the next door to the corner of Bancker-street, This same spot, at the junction of these two streets, is unpaved and sunken, and seems not only to solicit the accumulation of every thing worthless or unclean, but also to forbid the idea of any at- tempt to clean it out, lest it would make the pond the deeper. Inr d^ed, so remarkable was this spot, as to make me, as early as the 7th month (July) last, request both of the. Health Commissioners and the Alderman of the ward, to give some attention to it; as I considered it a place highly favourable to the promotion of Yellow Fever. However, it was not amended. Fortunately for the re- maining inhabitants, they were a hardy set; most of them had undergone the,fiery trial of 1795, in their families, and the reT mainder were old residents in town, as I have been informed, ex- cepting one person, who lived the very next door to where this man was taken; but he luckily had been several months of the summer out of town, and did not return till some time after Holmes died. The last person mentioned as having died of this complaint, resided in a healthy, cleanly part of the town: and how or where he £euld have taken his disease is still a mystery. Possibly he might have received it at some one of the sources above-mentioned. These circumstances, being well considered and candidly exa- mined, I think must clearly prove to every unprejudiced mind, that in this city there appears to be an intimate and inseparable con- nection between the prevalence of the Yellow Fever, and the exist- ence of putrid effluvia: whether it be septon or hydrogene, or avhatsoever other peculiar principle that is the active ingredient of ■their composition, is not my business at present to inquire into; nor shall I pretend to decide whether these effluvia alone are the sole or original cause of the complaint; or whether, merely like a smoak- ing hot combustible, it burns only after having received a spark-from elsewhere. However, from some facts, particularly that from the Jiusbridge Indiaman, (Annals of Med. vol. I.) and others that might be brought if necessary, it seems highly probable, that such matters may, of themselves, sometimes burst out as it were, into actual flame at some point; from whence a general conflagration •may spread through and involve the whole of these susceptible jiutcriaU Fol. 1. Xo. 3. ■; F 526 MEDICAL REPOSITORY. In 1795, from the inseparable connection observed to exist be- tween this disease and putrid miasmata, I had strong suspicions of their being its sole cause; and, indeed, the evidence then adduced to the contrary, by the advocates of importation, being so weak and ungrounded, seemed rather to support the idear however, from subsequent inquiry, and more minute information, in regard to some circumstances, not then so generally known, it now appears to me probable, that a fore'ignfomites might at first have excited our pestilential vapours into the action that spread such devastation in the most afflicted part of our city. The brig Caroline arrived from Hispaniola on the 19th of 7th month (July), r-795, and hauled in at Dover*street wharf on the aoth; where, on that and the two following days, she discharged her cargo. She had lost one hand on her passage, his symptoms unknown. George A. Valentine, who attended th'e vessel after her arrival, was taken ill with the fever on the 25th of the same month, but recovered. On the same day, " four persons from " on board the ship William, from Liverpool, which arrived here " several weeks before, (all the hands having, previous to that day *' and during the voyage, been perfectly healthy) were taken ill " with fever, attended with a yellow skin, hemorrhagies, vomiting " of black matter resembling coffee grounds, &c. and all died " within seven days." (Health Committee's Letter to the Go- vernor.) It may be observed, that this ship and the Caroline lay at opposite sides of the same wharf, and that the people of both were employed on this wharf, at the same time, in unloading their cargoes. On the same day also, " the owner of the ship Connecticut^ " that had lately arrived from some part of England, and which " had drawn in at the next wharf, about the 20th or a ist of this " month, was seized with the fever, from which he recovered; " and about the same time, one of the mates, the steward, and two « of the hands, were seized in the same way, and all died." (Smith's Letter to Buel.) Benjamin Paine, a custom-house officer, who was at that time attending the brig Active, which lay in the same slip, was like- wise attacked on the 25th: he died on the 30th. William Fitch's clerk, who was occupied in a store on the next wharf to where the Caroline lay, was taken on the 26th, and died a few days afterwards. A. Jenkins, at the head of the wharf, was attacked on the 30th or 31st, and died. A few days afterwards, several of his family were taken sick, and the disease began to spread through the sur- rounding neighbourhood. The circumstance of so many persons being taken on the same day, renders it highly r"-k,>ble. &-* c--- ' : -' —h*- ^f this MEDICAL REPOSITORY. 32/ ti-.xase must have been introduced by the Caroline; since, had ■the contagion arisen from the pre-existing circumstances of the place alone, it is not likely that it would have shewn itself in so many instances at the same time. In that case, we shouid have looked for one to have been first taken, from whom a prin- ciple might be derived to stimulate the vapours of that noxious neighbourhood into their pestiferous operations. Had the disease, in these instances, originated solely from the surrounding filth, we should not have expected to find the men of the Connecticut, and those of the William, taken at the same time; since the former had drawn in there only about four or five days, whereas the latter had lain there for "several weeks" before they were taken sick. In 1796, the brig Patty, Capt. Snow, from -St. Bartholomews, arrived on the 28th of 6th month (June), and not July, as er- roneously stated (probably by an accident of the press) in Dr. Bayley's Letter. (Medical Repository, No. I. Appendix.) This vessel drew in at Delafield's wharf; which is the next to the dock that was then filling up, and is adjoining the Exchange-slip; and although " none of the crew had been sick of a malignant fever," still she might have brought z.fomites sufficient to set the putrid mias- mata of such a place into a pestilential action. Jonathan Thomp- son, a shop-keeper, who lived No. 24 Moore-street, but a short .distance from this dock, and upon which he was in the daily habit ,of taking his walk, became sick on the 4th of 7th month (July), and died on the 10th, with well marked symptoms of a highly malignant Yellow Fever. Capt. Neal's wife, who resided half way between the Exchange-slip and Moore-street, in Front-street, was seized on the 7th, and died on the 10th. Nathan Strong died on the 17th; from which time the disease became more and more general about the neighbourhood of the dock that was filling up, as stated in the letter just referred to. The first person who died this year about the disemboguement of Roosevelt-street drain, if I am informed rightly, was James Callender (.1 on plate I.). He was a labouring man, who was employed somewhere towards the lower end of the town; and perhaps he was affected with the complaint from being about the Exchange; and transported, by his disease, the seeds of infection to that fertile neighbourhood in which he lived. In 1797, the first person that was taken sick in East George- street, was W. Cummings: he arrived the 13th of 8th month (Au- gust), in the sloop Polly, from George-town, South-Carolina. One hand died on the passage, and Cummings was slightly indisposed at the time of his arrival, with what he supposed an ague and fever, but was not taken seriously unwell till two nights after he hat! lodged in this street. It may be, that a partial principle of death lurked in his s)stem, during the whole time after the death of his 3cS MEDICAL REPOSITORY. tomrade, and most likely, never would have seriously act ed Up6ri him, had he not immersed himself in this or some such like fury- fostering miasmata. From him the disease seems to have spread. Two ot his next door neighbours fell under its power, and it ex- tended itself, as above related, through all the most offensive part of this street. -----Kellyj of the brig Bellona, (which arrived the 3d of 9th month (September), from Savannah, with all her hands and passen- gers in good health) unfortunately pitched himself within the noxi- ouseffluviaof the Fiy-market; and, still more certainly to fix his fate, lodged in-a room, two of the windows of which .opened towards the places where the putrid collections were gathered, and from whence the southerly winds must have brought their vapours im- mediately upon him. He is the first that appears to have had the disease in that neighbourhood; and perhaps the effluvia arising from his body, united with the putrid vapours emitted from the collections before noticed, spread the complaint around this little vicinity. Another of the hands from the same vessel, took up his quar- ters at Chesnut-street; where he met with the necessary ingredi- ents to bring his latent poison into life. He was afterwards taken to the New,-York Hospital, where he died. It may seem some- what strange, that the cause of disease that must have been kin- dled up at this spot did not affect any of his neighbours; probably, from circumstances already mentioned, they wtre proof against its operations. The systems of the two persons who lived at.or near Lynch and Stoughton's wharf, being richly loaded with the emissions from that offensive spot, might possibly have catched a spark of excite- rnent in passing near the Market. George Burchell may have taken his disease, after having been immersexi in the effluvia from the inlet between Burling and Bcek- nian slips, from the hands of the same vessel, as they frequented his shop immediately after their arrival. He probably^set the whole materials in action, whence Beers and Judah were afterwards af- iefted. The other persons mentioned in the list of deaths, may have received the cause of their complaints at one or other of the afore- mentioned sources. These circumstances render k probable that the cause of Yellow Fever, in the particular parts of our city, has, of late, been set in action by an enlivening spark from abroad. However, I do not .consider it as decidedly determined. It is possible that Cummings, having suddenly changed from a purer air, with his already infirm body, to this hot-bed of putrefaction, may, from those predispo- sitions, have had the disease created in him, before it had ripened MEDICAL REPOSITORY. 5ig in the bodies of his neighbours; and he thence may have intro- duced the principles of his complaint to the surrounding air. Just arrived from :;ea, and of a profligate habit, Kelly might thence have been a person, more than any other about the mar<- ket, prepared for the deleterious operation'of the putrid vapours in which they were enveloped 5 and tr.erebv have been first affected by surrounding causes of fever; and, in turn, mav have imparted a principle to the air, that usurious!)- repaid it k'r its fatal effects upon him. And although James Cullender worked towards the lower end of the town, there is no proof of his having brought his com- plaint, or even of his having been at Whitehall. Nor, indeed, is it certain that the Patty imparted any principle of disease to the poisonous vapours of that neighbourhoods The Caroline, it is true, lay at Dover-street wharf for some days before the people thereabout became sick; and although such a number becoming suddenly sick, at the same time, and°so soon after her arrival, render her very justly suspected, still it is pos- sible, that, from the particular and similar predisposition of most of them, only one having been an old resident, and* all excepting rhree, having lately come from the snme place, ?nd having been alike accustomed to the same habits of diet, exercise, &c. they may have had the complaint generated and arrived to maturity in them all at the same time. From which beginning, the disease mi, in.the one case, as, in the other, we should be of the vile incendiary's .match or the careless neighbour's spark. As the latter would die in their own combustion, so the former would end in the fate of the single sufferers. To rest our security from the Yellow Fever (should it finally appear that it is always imported) solely upon the slight precaution of making such vessels, from the West-Indies and Southern States, as mav have, or may have had persons with that complaint on board them, do ten days or two weeks quarantine, must certainly be a very venturesome business. The Patty had not had any of her crew sick with a malignant fever. The people of the Bellona were in good health from their leaving Savannah, till some days alter they were in this city. And the Polly might have done the .usual quarantine, without any security to us, as Cummings was not seized with his disease till seventeen days after his arrival. . Nothing less than completely prohibiting all commercial inter- course from the Southern States and the West-Indies, during the summer and first fall months, or (what would, in the end, amount ,to the same thing) making every vessel from thence do lull qua- rantine, and have their cargoes unloaded and properly unpacked and ventilated, before they are permitted to come into our* city, can ensure us against the introduction of a cause of the Yellow Fever; however, these severe restrictions may be superceded by merely having ourselves properly prepared. If we only keep decently cleanly, it will be perfectly indifferent to us, whether a Carolinaman or a West-Indian should die with Yellow Fever in pur "city or in our harbour, since," then, we should'be guarded against any ill effects from them. Nt.v-York, loth Month, 1797. ( 183 ) V. Observations on tlie Nature and Treatment of the Malig- nant or Yellow Fever, which prevailed in the Island of Grenada, W. I. in the years 1793, 94, and 95, in a letter to David Hosack, M. D. Sec. from John Stewart, M. D. #c. #c* New-York, Nov. 12th, 1805. Dear Sir, I have received your favour of this date, desiring informa tion concerning the fever which appeared, and proved so fa- tal, in Grenada, in March, 1793. I feel much disposed to comply wilh your request, but regret that my time will not allow me to do so in a manner satisfactory to myself; at all events, I hope you will make allowance for any inaccuracy I may commit in referring to circumstances which occurred so long as twelve years ago, especially, as 1 am possessed of no memorandum respecting the disease, all my papers having been destroyed in the insurrection which occurred in that island in 1795. It may be necessary to premise, that I had been engaged in an extensive practice in the quarters of St. Andrews and * None can be ignorant of the name of Dr. Stewart, who are at all acquainted with the controversy which has so long engaged the attention of medical writers, relative to the nature and character of the yellow-fever, as it has prevailed in the United States, and in different parts of Europe. Our readers will recognise in him one who occupies a distinguished place in the list of those great men who have sup- ported and defended the doctrine of the contagious nature and specific form of this disease. His great learning, and extensive practical knowledge, eminently qualify him to act as umpire on tins subject, and stamp his opinions with an authority not to be impeached by the gross aspersions and futile reasonings of a host of ordinary writer*.—Ed. l;J4 Stewart on the Yellow Fever of Grenada. Si. Patricks for nineteen years previous to the period refer- red to. My place of residence was on the east side of the island, and on Ihe confines of those two parishes, about twenty- four miles from St. George, the capital, and upwards of four miles from Grenville Bay, the second harbour in the colony; the tract of country between my abode and the latter, is flat, and the shore low and swampy ; it is consequently extremely unhealthy in the fall of the year. I had become, of course, well acquainted wiih tertian fever, under its various forms, of intermittent, remittent, and continued types. It is, however, worthy of remark, that I do not recollect an instance of an epi- demic disease occurring among the white inhabitants, in any part of the island, from January to July or August, previous to the year 1793. My first acquaintance with the fever in question was as fol- lows : In the month of March of that year, I went on board the ship Adventure, then lying in Grenville harbour, to visit the carpenter, at that time under my charge, for a gunshot wound in his hand. 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 wind- ward. He then complained of being feverish, and seemed low spirited; he had heat of skin, his pulse full, and under one hundred, head-ache, pain in his back 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, neither exhibited the buffy coat, nor the coagulum any degree of contraction, or conse- quent separation of serum. He took an emetic of ipecacu- anha in the evening, and a dose of glauber salts the following morning. During three days, I continued to visit him, his pulse did not exceed one hundred, 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 Stewart on tlie Yellow Fever of Grenada. 185 free use of tepid drinks. At the end of that time, I was un- der the necessity of putting him under charge of a neighbour- ing practitioner, having a call to the other side of the island. On leaving him, I certainly did not entertain any idea of his being in danger; I was, however, forcibly struck with, and could 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 least 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 hemorrhage from his nose, stomach, mouth, and urinary bladder. On this occasion, while in conversation with some gentlemen on the fate of this unfortunate man, I could not help noticing the malignancy of the case, and the difference in the train of symptoms from what I had ever witnessed to take place in the worst cases of our endemic fever. But a few minutes had elapsed, when a gentleman arrived from St. George's; I had no sooner men- tioned Capt. R.'s death to him, and my surprise thereat, when he instantly replied, it was none to him, for Capt. R. had eat and slept on board the ship Hankey during several days that he was in town. This was the first notice I had of such a vessel being in the colony, and, therefore, anxiously requested he would explain himself. This'he did, by saying, that the Hankey, Capt. Cox, had arrived some time before, after carrying a number of settlers from England to the Coast of Africa, where she had remained for some months, and that during her stay, the greater part of those unfortunate people had been carried off by fever; and concluded, by saying, that there was at that time a cursed infection lurking on board of her : that the mate of the ship Baillies had died, or was dying, and several other seamen were very ill when he left town. The melancholy scene that afterwards followed at St. George's, in '93 and '9 1, is well and amply described by my respecta- vol. in. * a ib6 Stewart on the Yellow Fever of Grenada. ble friend, Dr. Chisholm, in his well known work on West- India Diseases. Capt. Remington had been removed on shore the day pre- ceding his death ; but no case of fever occurred, either in the family where he died, or on board of his own ship, his cloaths and bedding having been destroyed, and every precaution taken to guard against infection, in consequence of the infor- mation above referred to. The fever was, however, brought soon afterwards to Gren- ville harbour, by a ship or two that came from St. George's to load for England; and from them the disease was communi- cated to other vessels lying there. A few cases of this fever also occurred in the village of Grenville, but it did not spread. An insurrection of the negroes broke out in the island early in March, 1795, and soon thereafter, I believe in May, this fever again appeared. It became frequent in the town of St. George's, in the course of the fall, and proved fatal to many of the inhabitants, in consequence of the deprivation of their usual comforts, and the fatigue they had undergone for several months before. I resided then chiefly in town, and had an opportunity of seeing a great many people labouring under the disease. As to the character of this fever my experience has fully satisfied me, that it was specifically distinct from every form of the indigenous tertian remittent which I had ever observed ; because it appeared at a season of the year which I had always found healthy, during a period of nineteen years I had resided in the colony. Because it did not particularly appear in those situations where bilious remittent fever usually prevailed during the un healthy season of the year. Because there was an evident difference in the character and type of the two diseases; there was a greater despon- dency of mind in this fever; the eyes were more muddy and inflamed; there was commonly a deep seated pain in the ere- Stewart on the Yellow Fever of Grenada. 187 aockets; the motion of the eye-balls was attended with unea- siness ; the pain in the back and limbs was greater than in bilious fever; the vomiting was not of so violent and straining a nature, nor were there such evacuations of bilious matter 5 the black vomit, which I consider one of the characteristics pf this disease, generally occurred at an early period; the yellowness was of a dingy hue, not of the real icteric tinge accompanying cases of bilious fever; the delirium was in many • instances of a peculiar nature and much resembling a state of intoxication; haemmorrhage was more frequent, particularly by urine and from the stomach and intestines. Patients, on several occasions, made exertions, not long before death, that I never witnessed in bilious fever. 1 have known a patient to get up, dress himself and walk about his chamber a very short time before his death. Medical practitioners, before getting well acquainted wilh the deceitful nature of the disease, not unfrequently declared their patients out of danger when the fatal issue took place an hour or two after their departure. Because I never knew this fever terminate within a few weeks in intermittent, as tertian, remittent, or bilious fever commonly does. Because the degrees of weakness produced by this fever is greater, and the recovery of flesh and strength are more gradual and slower in this than in bilious fever. Because I did not find the same mode of treatment conso- nant in both cases of fever; for the early, bold and free use of bark, which I have found very generally to answer in bilious fever, seemed to aggravate this fever, and to hasten the fatal issue. Do not consider me whimsical when I assure you, that I was very often sensible of a peculiarly bad taste in my mouth while by the bedside of my patients, and particularly if blank- ets were used as a covering. That this fever was contagious, I concluded from the man- ner in which it broke out and spread. It first appeared in two or three vessels that had a communication with the Hankey ; 188 Stewart on the Yellow Fever of'Grenada. and from these sources it gradually extended itself to other vessels in the harbour; but not to all, for where attention was paid to prohibit communication with infected ships, such ves- sels escaped- After some time it got on shore, both into town and in ihe garrison. There is also reason to think that it was carried ft om thence to the adjoining islands, as it ap- peared at most of those to windward within two months of its breaking out at Grenada; and some time thereafter it showed itself at Jamaica, and alternately, I believe, in September at Philadelphia. Its contagious nature also appeared from many instances of men, in 1793, and 1794 going to St. George's on business, and being attacked a few days after their return to the coun- try with this fever, to seveial of whom it proved fatal; but I must observe that I met with no instance of the disease being communicated to others, either visitors or attendants. It is indeed true, that every attention was paid to keep the cham- ber of the sick well aired, their linen frequently shifted ; and when a fatal issue took place, every article of wearing ap- parel and bedding was commonly destroyed. From knowing several instances of young men who got wounded in 1795 and 1796, having been sent for convenience and proper attendance, to town, and during their cure were attacked by this cruel disease, and on some occasions fell a sacrifice thereto. From instances occurring of people expressing a conscious- ness of the time when they received the contagion while visit- ing acquaintances labouring under the disease. From a thorough belief in the minds of all the medical gentlemen in Grenada who witnessed the disease, that it was so; let it be observed, however, that one of the most respec- table practitioners in St. George's, and a particular acquaint- ance of my own, would not allow at first, that it was conta- gious. And lastly, Stewart on the Yellow Fever of Grenada. 189 From a full conviction that I, as well as some other medi- cal gentlemen, contracted the disease in our attendance on the Rick. Respecting the propagation of this fever, I am decidedly of opinion that it was occasioned by visiting infected apart- ments, or by the near approach to, or contact wilh people labouring under it. There is every probability also, that the infection was brought to Grenada by the Hankey ; but what its nature was, or whether it originated on board in conse« quence of the number of sick crowded together while labour- ing under the endemic of a warm climate, and that in a sultry, moist atmosphere, or whether it proceeded from the infection of jail fever, carried from England,, and which only showed itself in circumstances favourable to iis propagation, are ques- tions I do not take upon myself to answer. That vegetable and animal matters in a state of putrefaction do produce disease, is not to be denied ; but that vegetable matter only in a state of corruption is on many occasions harmless, is evident, from the very offensive heaps of cotton seed, and the pulpy covering of the coffee berry which are daily to be met wiih in Demerara without being considered as a cause of fever; nor should this circumstance be omitted, that when fever does prevail, it is at a season when those cau- ses do not act powerfully. In respect to the cure, various methods were tried by dif- ferent practitioners ; but I am sorry to say the proportion of deaths was great under every mode of treatment. The plan I generally pursued was to administer as early as possible a brisk purge of jalap and calomel; and after the operation of this medicine I had recourse to small doses of James' powder from lime to time while the febrile action lasted ; to this was occa- sionally added a little calomel to keep the bowels open ; and the warm bath, with a large allowance of lime juice, was some- times had recourse to, in order to aid the antimonial in deter- 190 Stewart on the Yellow Fever of Grenada. mining to the surface ; ultimately bark was given; blisters, opium, spirit, nit. dul. asth. were had recourse to according to the nature and the urgency of the symptoms that occurred. When the fever first appeared, I had great reliance on a free and early use of the bark, but a little time convinced me of my mistake. Blood-letting I used in two cases only, but it afforded no abatement of the symptoms, nor did the patients bear the evacuation well; the appearance of the blood also, on which I place much confidence, did not indicate the proprie- ty of repeating the operation. Few men had made a more free and general use of calomel than I had done from the year 17 HO, in all cases of fever originating from a local cause, particularly in pulmonic and hepatic inflammation, and in dysentery. I had, however, never exceeded fifty grains in the 24 hours ; nor did it occur to me that the free use of this medicine could be had re- course to with benefit in the fever until it was strongly recom- mended by Dr. Chisholm. I accordingly tried it; sanguine in expectation of benefit therefrom, but I am sorry to add that it did not prove an effectual remedy in my hands. Under these circumstances you may readily suppose I felt much alarmed when this fever again appeared in 1795 ; and it gave me pleasure to hear of a new remedy which had been tried and proved successful in one case; this was the cold bath. I instantly had recourse to it, and the more rea- dily on recollecting to have used it myself so long before as 1776, in a number of cases of confluent small pox, and with the most evident beneficial effect. The consequence was, that I had reason to think many lives were saved by it. The manner of applying was by dashing two or three large pails-full of sea-water on the head and shoul- ders wilh force, laying the patient immediately after between blankets and supplying him frequently with warm tepid drinks; the effect expected, and that frequently ensued, wa* Hosack on the Yellow Fever of Huntington, L.I. 191 a full and free perspiration. If this did not ensue the James' powder with a little calomel was occasionally repeated, as was the cold bath generally three or four times a day. I trusted to the cold bath entirely in my own case in Sept. 1795, having previously taken a dose of jalap and calomel. The good effect of the cold bath on this occasion I mentioned to Dr. Chis- holm, but not having perused his second edition, I do not know whether he has noticed it. He also was made acquainted with the little benefit I derived from exhibiting the calomel, as re- commended by him in my practice. The above is the restdt of my knowledge and experience in the treatment of the fever as it occurred in Grenada during the years 1793, 4 and 5. Yours, &c. JOHN STEWART. Dr. David Hosack. VI. Facts relative to the contagious nature of the Yellow Fe- vtR in the pure air of the country: In a letter to Dr. Wil- liam Currie, of Philadelphia, from David Hosack, M. D. member of the College of Physicians of Philadel- phia, #c* Ner York, May 30th, 1805. Dear Sir, You wrill find among some of my letters addressed to you upon the yellow fever, an imperfect memorandum of this dis- * The yellow fever is generally considered a non-contagious disease in the pure air of the country : yet that it is at times contagious even in such situation, the accounts published by the College of Physicians of Philadelphia, have fully prov- ed. For further evidence, if it were necessary, we would refer to the interesting .■oramunicalion of Dr. R. C. Moore, contained in vol. 2d, p. ~~—25, of the Regis- »cr:to r" l~7rof thr "me volumr. arrirothe present ?rticl«> now first printed -Ft. 192 Hosack on the Yellow Fever of Huntington, L. t. ease having been communicated by contagion at Huntingtoil on Long-Island. I this morning availed myself of an opportunity which pre- sented of obtaining a more saiisfa ory and circumstantial statement of the facts than I have hiiherto been able to pro- cure. This information I received fom Mrs. Dorothy Conk- lin, the present wife of Mr. Ri< hard Conklin, who resides at West Neck, four miles distant from the vown of Hunt ington, and in whose family the disease prevailed with almost unexampled mortality. The present Mrs. Conklin, at the time the yellow fever prevailed at West Neck, was a friend and neighbour of "Mr. Conklin ; attended his family in their sickness ; saw them in every stage of the disease, and had the best opportunity of knowing the fads she has stated to me: these I shall relate as nearly as possible in the order and language in which she commuaicated them. In the summer of 1795, when the yellow fever prevailed in New-York, Mrs. Smith, the daughter of Mr. Conklin, resided at Peck-slip, to which part of the city the disease was chiefly confined in that year. Mi s. Smith, upon being taken sick, went immediately to her father's house at West Neck, where she died three days after with the black vomit, and her skin, to use Mrs. Conklin's expression, as yellow as saffron. Her brother, who resided in New York, was taken sick about a fortnight after; he also went to his father's house at West Neck, where he died after three or four days illness with the black vomit and a yellow skin. During his illness, Mrs. C adds, he bled much at his nose. His mother, Mrs. Conklin, who had constantly attended upon him, and washed his clothes, was next taken sick, and died in less than a week after the death of her son. The present Mrs. C. (then Mis. Bush,) was constantly with her, and states that she laid in a state of stupor several days; that she had the black vomit, that her skin turned yellow, and was remarkably spotted. Hosack on the Yellow Fever of Huntington, L. I. 193 Doctor Sandford, who was the physician of the family, and had been very constant in his attendance upon them, was next taken sick. He felt much indisposed while Mrs. Conk- lin was dying; he went home, but never afterwards left his house ; he died in a few days. His attending physicians unanimously pronounced it to be the yellow fever. Mrs. Conklin visited him in his illness. His bed being opened by Mrs. Sandford, 4Mrs. C. observed his skin to be very yellow, and was at the same time sensible of an extremely offensive smell, such as she had observed in no other sort of fever. She now was fearful of having taken the disease, especially as she had been so much exposed to it. She immediately took a dose of salts, and the day following began the U3e of bitters, to which remedies she ascribes her exemption from the dis- ease. In the summer of 1798, when the yellow fever prevailed with its greatest mortality in New-York, another daughter of Mr. Conklin, named Polly, fifteen or sixteen years of age, came to town upon a visit to her friends. At this time she very imprudently visited Mrs. Jones, (wife of William Jones,) who was then dying of the yellow fever. She re- turned home to the country ; and immediately upon her re- turn was taken sick with an acute pain in her head, back and limbs, attended with a very violent fever; a profuse purging came on, which Mrs. Conklin considers as having been very serviceable, as her fever soon after abated, and she recovered. As to the nature of the fever she states, that the physician had no doubt; he pronounced it to be unquestionably the yel- low fever. The result proved an unhappy confirmation of his opinion. Her niece, the daughter of Mrs. Smith, about three years old, who was constantly with her during her ill- ness, and laid upon the same bed, was next taken ill with fever, attended with an incessant vomiting: she died in less than a week. Another daughter of Mr. Conklin, named Patty; 194 Hosack on the Yellow Fever of Huntington, L. I. about twenty years of age, who had had the particular charge of the child, had never left the cradle, and who had also attend- ed upon her sister, was next taken sick. She began to com- plain before the death of the child ; she was attacked with chill and fever. Dr. Udall, who had resided in the West Indies, and had been very conversant with this disease, was called ; he pro- nounced it to be the yellow fever, but encouraged Patty very much, telling her she would no doubt get well. As is frequent- ly the case in this species of fever, the physician saw no cause of alarm even when the greatest danger existed. The black vomit soon succeeded, she became delirious, her skin assumed ihe yellow colour, and she died in less than three days from ihe time of her attack. A boy about 12 years of age who had been taken into Mr. Conklin's family as a domestic, was next taken ill; he had been frequently in the room of the sick, and had been especially attentive to the youngest child, (the daughter of Mrs. Smith,) of whom he was very fond : he was attacked as the oihers had been with acute pain in the head and back, with vomiting, in a short time he be- came very yellow, and the discharges by vomiting, as black as the grounds of coffee, to use Mrs. Conklin's expression. Although he was taken sick a day or two before Patty diedy he did not survive her more than two days. Mrs. Conklin being very much alarmed by the great mortality of this dis- ease, did not visit him but once, and only when he was first taken ill. Her husband, Mr. Brush, was obliged to lay out this lad, which disagreeable office Mrs. Brush had performed for all that had already died in the family. Such was the dread excited by this disease that it became almost impossible to procure the necessary assistance for the sick; the mother of the lad was so much alarmed that she never visited her child during his illness. The boy, it was supposed, took his disease from the youngest girl whom he had caressed and fre- Hosack on the Yellow Fever of Huntington, L. I. 195 quently carried about in his arms during her sickness. The next person in this distressed family who was seized was Sal- ly Long, about 17 years old, a cousin of Mr. Conklin. She had lived in the family of Mr. Brush as a spinster. Mrs. B. now Mrs. Conklin, having by her dread of the disease been compelled to return home, Sally Long volunteered her ser- vices and attended upon Patty and the boy. In a day or two after ihe death of the latter she was attacked with the same symptoms as the others had been. As the disease proved so contagious, Dr. Udall now advised the family to remove from ihe house. Sally Long was immediately conveyed to the house of her father Capt. Long. She recovered after several days severe illness. Mr. Conklin's eldest daughter, Mrs. Place, wife of Capt. Place of the town of Huntington, had visited her sisters at West Neck ; had been a few days at the house, and had at- tended some of the family last sick. She was next taken ill, and was removed to the house of Mr. Place, her fa.he.-in-law. Her symptoms were similar to those of the other si. k, but not in so violent a degree. Her skin, Mis. Conklin observes, was yellow and ihe irritation of her stoma h considerable, bui she recovered. Upon ihe day Pat'y was buried, her brother, Ha-iy Conklin, who had attended upon her in her illness and was at her funeial, was !aken sick. On his return from her funeral he began to complain, expressing to his uncle Jesse his disagreeable feelings, and his apprehensions ihat he had taken the fever. He remained that night at his father's house, but upon ihe succeeding day was removed to the house of his faiher-in-law Mr. Gilbert Carr, where he died in a (eve days. He was attended by Dr. Udall. Mrs. Conklin also adds that his skin became yellow; that he had the blai k vo- mit, but that he, to the astonishment of every person, regain- ed his senses to the last moment, conversing upon religious subjects with the most, perfect composure. 196 Fulton's Account of the It will be proper to add that the town of Huntingdon and its neighbourhood, is remarkably healthy; its situation high, and has a northerly exposure. If it were necessary Mrs. Conklin will at any time add her affidavit of the correctness of the foregoing statement. I send it to you without comment, to make such use of it as you think proper. Your's with respect, D. HOSACK. The following is the certificate of Dr. R. Udall, who attended the family at the time they laboured under this calamity. New-York, Nov. 15,1809. Sir, After a careful perusal of the statement made by Mrs. Conklin; of the fever as it appeared at Huntington, on Long- Island, in the years 1795 and 1798, I have no hesitation to say that the facts it contains are correctly related by Mrs. Conklin, and that she is a lady of respectability and veracity, and can give you a more correct statement of it than you can otherwise obtain. RICHARD UDALL. Dr. Hosack. VII. Account of the Powles Hook Steam Ferry-Boat, in u letter to Dr. David HosACK,/rom Robert Fulton, Esq. Fellow of the American Philosophical Society, #c. (See the annexed Engraving, by Leney.) [The perfect success of Messrs. Livingston and Fulton iu their invention and establishment of steam boats for the ac- commodation of passengers between the cities of New- York and Albany, drew the attention of Mr. Durand, Judge AN ESSAY o.v , THE EPIDEMIC, WHICH PREVAILED IN THE NORTHERN DIVISION OF THE ARMY OK THE UNITED STATES, DURING THE AUTUMN OF 1812; AND WINTER OP 1312—13. Addressed to Wm. M. Ross, M- D. Hospital Surgeon of the United States Army, SfC. eye. COMMUNICATED BY J. B. WHITRIDGE, m. d. Corresponding Member of the Society. Read the 3d of December, 1816. SackeW's Harbour, April 20th, 1815. Doctor Ross, Sir,—Permit ine to offer to you, a few obser- vations on the Epidemic of 1812—13, which pre- vailed throughout the northern division of the ar- my, (stationed at Plattsburgh, Burlington, Green- bush, and Buffalo,) and throughout an important section of the Union, but particularly as it appear- ed in Burlington, Vermont. I cannot say any thing of this Epidemic from any actual observation or experience, prior to De- cember 1812; at which time I was stationed at 268 epidemic in the Burlington, where, during the autumn and winter of 1812—13, prevailed in its most violent form, that Epidemic, which pervaded the army, and a very considerable portion of our country which proved so destructive to the soldiers, and so dead- ly to the citizens; and which excited so much controversy, and speculation among physicians. Many of the causes of this public calamity, are, perhaps, enveloped in darkness; some of them, however, are explicable upon the princi- ples of physiology and philosophy. Without entering into a minute and elaborate disquisition, on this very interesting and important subject, I shall leave it to your more mature judg- ment and deliberation, after noticing it in the fol- lowing order: I. I shall give a brief description of the disease, so far as it came under my observation. II. I shall then cursorily mention its most proba- ble causes. III. Make some remarks on the mode of treat- ment, by different practitioners. And, IV. What ir. my humble opinion, I conceive to be the best. In order to be useful, it is necessary not only to know and describe the opinions of others, but to relate our own observations and particular expe- rience. It would here be proper to observe, that, pre- vious to the appearance of the Epidemic among the soldiers of the army, who were first seized, and U. S. ARMY, IN 1812—13. 269 among whom it raged with more violence than among the citizens, our army was at that time in its infant state; it was almost wholly composed of raw recruits; unaccustomed to the fatigues and hardships of a camp life. Their accommodations generally very bad; and that part which was on the northern frontier in October and November preceding the Epidemic, was very much exposed to the inclemency of the weather, on their march from Plattsburgh to Champlain, and also during their encampment upon the borders of Canada. After remaining there some time, they broke up their encampment, marched southward, and went into winter quarters at Plattsburgh and Burling- ton; which terminated the campaign of 1812. It would here also be proper to observe, that pre- vious to the appearance of the Epidemic among the troops, a diarrhoea prevailed among them; they were afterwards attacked with the rubeola. This contagious disease spread generally through- out the northern division of the army, ■'which, to- gether with the local situation of the troops, the badness of their accommodations, (which were tents,) the scantiness of their clothing, and the cold- ness and dampness of the weather, produced a very irritable state of the lungs, which laid the foundation for the subsequent Epidemic. I. The first stage of this disease, like most other febrile diseases, was generally ushered in by cold chills, preceded and accompanied by languor and debility. These symptoms were soon followed by 270 epidemic in the heat of the body, above the healthy standard; flushed countenance, and, in some instances, eyes suffused with blood. Severe lancinating pains were felt through the thorax, and sometimes in the head; accompanied by painful and laborious res- piration, with a sense of weight and suffocation. The anxiety was great, and the skin dry;—where the disease proved mortal, the latter circumstance was remarkable, in so much, that perspiration could not be induced by any means whatever. These symptoms were not unfrequently accompa- nied by diarrhcea. Severe cough attended, and an expectoration of a yellow or white mucus, which was at first inconsiderable, but afterwards more copious, and generally mixed with blood. The tongue was at first dry, and coyered with a white coat, which, in most instances as the disease ad- vanced, soon changed to a dark brown, or black colour, especially in those cases that terminated fatally. The pulse was sometimes small, con- tracted, and hard; at other times, full, hard, and rebounding. In some instances, the pulse was said to have been soft and small; but I saw no cases, where there was not more or less hardness of it at the commencement of the disease. It may be observed, however, that I did not have an opportunity of witnessing the complaint when it first made its appearance, and when it raged most: perhaps I did not see the worst cases, particularly those that occurred in the fore-part of December. U. S. ARMY, IN 1812—13. 271 The disease appeared to me to be in a great measure local, notwithstanding the inordinate ac- tion of the heart and arteries, which produced an excessive action of the blood-vessels of the lungs, and, consequently, of the respiratory organs ;—the extremities were not unfrequently cold. According to the statement of Drs. Mann, Lo- vell, and others, the complaint, in many instances, ran its course rapidly, and terminated suddenly; frequently in twenty-four hours, but generally last- ed from four to six days, and sometimes longer. One very severe case fell under my care, in which the fever continued twelve days, and had a favour- able termination. In general, it appeared to possess a disposition to run rapidly into a state of indirect debility; this circumstance gave rise to the opinion among phy- sicians, that it was a disease of debility ; but which, in my opinion, only proves that it was a highly in- flammatory disease, and of course required the most active antiphlogistic remedies at its com- mencement to obviate the inflammatory diathesis, and consequently, to prevent the subsequent debil- ity. The constitution unquestionably suffers more from the inordinate action of the heart and arte- ries, where an inflammatory disease is suffered to progress without interruption, than from the sud- den abstraction of stimuli, by the most powerful antiphlogistic means. The strength of the system is wasted ; or, what is called by Brown excitability, and by Darwin sensorial power, becomes so far 272 EPIDEMIC IN THE exhausted, as to induce that state of the system which is called by the former indirect debility ; and which is more difficult of cure, than direct debili- ty,* or what Rush calls debility from abstraction. II. When a disease is regularly described, it is requisite to mention, or at least to inquire into, the remote, (viz. predisposing and exciting,) and proxi- mate causes. REMOTE CAUSES. Of one of the remote causes of this disease, I believe very little is known. I confess, I am igno- rant of it, and like others in similar difficulties, refer it to an unknown source, viz. some pecu- liarity in the constitution of the atmosphere.^ To this, may be added with much reason and plausi- bility, previous diseases, and also dejection of spi- rits, occasioned by disappointed hope, in conse- quence of the unfavourable termination of the campaign.t " Hippocrates, who has noted with accuracy the peculiarities of various years, togeth- er with the prevalent species of disease, attributes the variation of the maladies, to a divine some- thing, «*«•»; which some of his commentators consider as signifying merely the atmosphere at large; but others, among whom is Galen, suppose • Vide Elementa Medicinse, Sec. XXII. XXXIII. XXXIV. and XLV. f See a brief History of Epidemical and Pestilential Diseases, by Noah Webster, 1800. \ See Rush's account of the influence of the military and political events of the American Revolution, upon the human body. Med. Inq. and Obser. Vol. ist, page 133.—Also, Vol. 3d, p. 4th and 49th, fourth edit. u. s. army, in 1812—13. 273 that he intended to express a latent and inscruta- ble cause in the air, which produced these surpri- sing effects.* Galen observes, in his commentary upon this point, " non quaecunque causas habent abditas et obsuras, divina vocamus; sed ubi admi- rabilia videntur duntaxat." The modern Hippo- crates, Sydenham, states that he had observed with the utmost diligence, the different peculiari- ties of different years, as to the obvious changes and conditions of the atmosphere, with a view to ascertain the causes of Ihe great varieties of Epi- demic disorders; but that he had not made the smallest approximation to such a discovery; on the contrary, that he had remarked, that seasons of the most decided similarity, in respect to the man- ifest qualities of the air, were infested by diseases altogether dissimilar, and vice versa. " For the constitutions of different years are various;" he says, " yet they do not depend upon the degree of heat or cold, of dryness or humidity, which accompa- nies them ; but probably originate from some oc- cult and inexplicable changes, wrought in the bowels of the earth itself, by which the atmos- phere is contaminated with certain effluvia, which predispose the bodies of men to one or other form of disease. This predisposition continues during the prevalence of the same constitution, which, in • See Hippoc. lib. i. dc Prognost.—Galen in Com.—Also, Sennert. lib. ir. cap. ii. de Causis Pestilentie. Zm 274 EPIDEMIC IN THE an uncertain period of time, is superseded by an- other."* From a consideration of the same facts, several writers have attempted to account for these sup- posed occult changes in the qualities of the atmos- phere, which induce epidemic diseases, by tracing them to some of the obvious phenomena of nature, by which such changes may be supposed to be effected, "f A cold and damp atmosphere.—Cold, however, applied to the body, but particularly the cold and damp atmosphere of the newly plastered barracks, into which the soldiers were crowded in great numbers, at Burlington. Some chemical combination of the vital principle of the air with the lime of the newly plastered barracks, thereby rendering it unfit for respiration. This cause was very much increased by the numbers crowded! into each room, for want of a sufficiency of barracks, which were not properly ventilated.^ Bad police, consequently foul camp.H * Syd. sect. i. c. a. De Morbis Epidem—See also, Van Swieten Com. ad Aph. 1408. | Dr. Rees's New Cyclopaedia. Article, Epidemic. American Edition. $ Dr. Rush's Observ. upon the Diseases of Military Hospitals, vol. 1, p. 148, of the Med. Inq. and Obs.—Also, Econom. Observ. on Military Hospitals, and en the Diseases incident to an Army. By Jamos Tilton, M. D. Phys. and Surg. Gen. of the Army of the U. S. § Sir John Pringle's Observ. on the Diseases of the (British) Army. ^ Vide John Hunter on the Diseases of the Army in Jamaica, page 485.— Also Sir John Pringle. U. S. ARMY, IN 1812—13. 275 Intemperance in eating and drinking, but parti- cularly in the use of whiskey. Irregularities, which produce an unequal excite- ment of the system ;—sanguine temperament— " Sudden transitions from heat to cold, and vice versa." Die^—principally of animal food, to which the troops were unaccustomed. Often deficient and depraved aliment.—This was a fruitful source of disease ; especially among raw recruits, and might have operated as a predispos- ing cause of this epidemic. It is not to be under- stood, however, that the rations, as furnished by government, were deficient in quantity, although (through the neglect of the contractors,) they were sometimes unsound: on the contrary, to an old soldier, or any one who knew how to make the best of his ration, it was amply sufficient * but it may be considered coarse living and hard fare for the militia and recruits, who have recently left their families and their friends, and the domestic com- forts of their homes ; where they had been ac- customed not only to meats, but to a plentiful use of milk and vegetables, and most of them to tea and coffee; which are almost invariably prepared, • " A soldier's ration, as established by Government, consists of one pound and one quarter of beef, or three quarters of a pound of salted pork, eighteen ounces of bread or flour, one gill of rum, brandy, or whiskey; and at the rate of two quarts of salt, four quarts of vinegar, four pounds of soap, and one pound and a half of candles, to every hundred rations." The ration of a British soldier as established by the British Government ©r by commutation, is less substantial, but more conducive to health—It consists of less meat, but more vegetable food, such as potatoes, peas, &c. and once or twice a week a quantity of rice and butter. 276 EPIDEMIC IN THE in this country, by women. Such were ignorant of dressing their own food for themselves; and un- til some system was formed, wasted one half their meat by broiling it in the ashes :—To such who had left their own fire-sides and feather beds, for the tented fields, or cold barracks of the frozen regions of the north, the situation was peculiarly hard and distressing. Although they were for a time, buoyed up by patriotism and the love of fame, which, together with the passing events of the war, and the anticipation of future successes, operated as a stimulus to the mind; yet their situation not unfrequently produced the nostalgia, or home-sickness, of Dr. Cullen. Impure Water.—This was also a source of much mischief, not only at Burlington, but at almost all the different posts along the frontier; and, in com- bination with other causes, produced diarrhoea, or dysentery, throughout the whole northern divi- sion of the army. The springs are generally impregnated with lime; sometimes in combination with some of the acids, forming neutral salts ; but generally with a predominancy of alkali or alkaline earth. The water of this placet (Sackett's Harbour) issues from a bed of limestone, and holds in solution the mu- riate of lime, which is very injurious to the health of strangers ; particularly those who come from f There are no wells here. A number of persons have been employed by Government to dig a well in the Smith Cantonment, they penetrated upwards of thirty feet, into a solid rock, obtained little or no water, and abandoned tht object. U. S. ARMY, IN 1812—13. 277 the sea board, (where the waters usually contain an excess of acid,) or from a granite country, or almost any place where limestone does not abound. Lake water is preferable to spring or well water, when taken up at a distance from the shore; but it was usually taken up at the margin of the lake, where it received all the wash and filth of the camp, and consequently, was ex- tremely pernicious to the health of the troops. Excessive watching and fatigue,—after which, great indolence, or a want of that exercise which is necessary " to give tone to the muscular fibres of the body, and to promote the general circula- tion of the fluids," and thereby to ward off dis- ease, by preventing sudden impressions and slight changes in the system. Besides the debi- lity of constitution and consequent predisposition to disease, induced by the above mentioned causes, the exhaustion produced by excessive cor- poreal exertions, loss of sleep, and the depressing passions, probably contributed in no small de- gree, to predispose the body to, or excite this disease. PROXIMATE CAUSE. Excessive local action, producing an inflam- mation of the membranes and substance of the lungs, and consequent increased secretion. Of the diagnosis and prognosis of this disease, I shall say nothing ; but pass to the third general division. 278 EPIDEMIC IN THE III. To this disease various names have been given by different practitioners, and their treat- ment has been as various as the names they have given it. Dr. Yates, in his first publication, hesitated to give it a name; but in a subsequent publication observes: " As diseases are generally named from some prominent symptom that characterizes them, I have no hesitation to entitle this, a bilious fever; and from its being Epidemic, the Bilious Epidemic Fever."* Dr. Yates was violently opposed to bleeding, and trusted wholly to emetics and cathartics in the cure of this formidable disease. He invariably commenced with an emetic, which he soon follow- ed by a cathartic, and kept up the constant repe- tition of emetics and cathartics, until the patient either got better or died. This gentleman ob- serves, in some communication on this subject, (if my recollection serves me,) that he thinks the time not far distant, when the whole practice of physic will be reduced simply to the administration of emetics and cathartics, in the cure of all diseases.f This complaint was denominated by Dr. Stearns,—" Typhoid Peripneumonia, or Pneumonia Typhoides."% He likewise trusted principally to emetics and cathartics; but gave also diaphoretics and demulcents, combined with opium ; and oc- • Med. Repos. New Series, vol. r, page 252. f The paper in which this idea is advanced, I have not now before me. | Medical Repository, vol. 1, page 164. New Series. U. S. ARMY, IN 1812—13. 279 casionally used epispastics, after having failed in attempting to relieve the violent pains of the tho- rax, and difficult respiration, by spirituous fomen- tations. Both the above named gentlemen con- sidered this a neiv disease. Dr. Hosack and Dr. Low* adopt the nosologi- cal arrangement of Dr. Cullen, and rank it under the genus " Pneumonia;" species second, " Peri- pneumonies, Idiopathicce complicatce febre;" and oi the variety, " Peripneumonia Typhoides. &" The former considers it a species of the spotted fever, or rather a modification of that disease, com- plicated with local inflammation, as will appear by the following extract:—" The causes of this dis- ease," says he, " are no less compounded than the disease itself. The local inflammatory affec- tions are probably occasioned by the sensible chan- ges of the atmosphere, while the typhoid charac- ter of the disease, is derived from Epidemic con- stitution of the air, the same which has given rise to the typhus petechialis or spotted fever, which has prevailed for some time past in our northern and eastern states, and which is, doubtless, the same disease as that now prevailing in Albany; with the exception, that the present Epidemic is complicated with the symptoms of local inflam- mation of the chest, brain, throat, &c. the effect of the present cold season of the year. With this view of the mixed nature of the disease, and of the combined causes which have produced it, we are • Vide Amcr. Med. and Phil. Kc pstcr, vol. 4, p. 3c. 280 EPIDEMIC IN THE prepared to expect the various and opposite opin- ions and modes of practice, which have been adopt- ed by different physicians."* Dr. John Bard describes a very fatal form of Epidemic disease, bearing some resemblance to the present, under the name of Malignant Pleurisy, which prevailed in the town of Huntington on Long-Island, in the year 1749.f Dr. Mott has given us a minute and learned memoir of a similar Epidemic, which prevailed at Newton, Long-Island, in the spring of 1812, which he has denominated a Malignant Epidemic Peripneumony. \ Dr. Williamson has given us some account of a disease which prevailed in North-Carolina; and which is endemical in the southern states, under the name of Malignant Pleurisy. He says:— " When it fell upon the breast, as the pain in ma- ny cases was severe, the impropriety of the name is not remarkable; but it falls upon the head nearly as often as it falls upon the breast; and in that region is exceedingly painful. Then too it is called, however improperly, a Pleurisy of the head." He considers it a similar disease to the one un- der consideration, though nearly allied to the pe- * See Med. and Phil. Register, vol. 3, p. 448. f Med. and Phil. Register, vol. 1. j: Med. and Phil. Register, vol. 3, p. 165, et seq. V. S. ARMY, IN 1812—13. 281 techial or spotted fever of New-England; and en- deavours to trace it to the same cause.* Dr. Pomeroy the medical professor at Burlington College, and many others in different parts of the country, distinguished this disease by the various names of Epidemic, Typhus Epidemic, and some- times, Typhus Fever; but more frequently Spotted Fever. Many physicians are much in the habit of prescribing for the names, rather than the symp- toms of diseases, which may, in some measure, account for the indiscriminate and improper use of stimulants in the disease now before us. It was treated by this class of physicians at Burling- ton, and through a considerable portion of the country where it prevailed, altogether by stimu- lants, and generally those of the most active kind. Wine, brandy, and opium, were the grand articles. These were given in any quantity; even from the commencement of the disease. In many instan- ces, however, they premised an emetic, which if it did not induce delirium, this was soon brought on by the brandy and opium, which succeeded it in very large quantities ; and which usually termina- ted the short, though miserable existence of the unfortunate patient. I am by no means tenacious as to the name of this disease, because in a practical point of view, I consider it a matter of very little importance, what name a disease bears, or whether it has any, * Register, voL 3, p. 4J4- 282 EPIDEMIC IN THE provided it is wrell understood;—if it is not, the name can do very little towards enabling us to comprehend its nature. " Much mischief has been done by nosological arrangements of diseases."*—" The truth is, that systematics have misled each other from age to age, without deigning to look at the phenomena of nature, as these arose before them."f In giving a description of a disease, in order to prevent confusion, it becomes necessary to desig- nate it by some name or other. I shall, therefore, adopt the name of that disease, to the symptoms of which it bears the strongest resemblance. It appeared to me to be more nearly allied to the Pneumonia of authors, than to any other com- plaint ; and particularly to that species of it, de- nominated, by Dr. Cullen, Peripneumoniae idio- pathicce simplices; and of the variety Peripneumo- niae notha;—but with symptoms of a more aggra- vated nature.% It seized more violently, ran its course more rapidly, and terminated in one of the five following forms ; either by resolution, adhe- sion, effusion, suppuration or gangrene. The in- f ammation in those who recovered, generally ter- minated by resolution, and sometimes by effusion or suppuration. Those cases which ended fatally on the first, second, or third day of the disease, * Rush's Med. Inq. and Obs. vol. 3, p. 20. f Brown's Elements, Sec. ccclxvii. (t.) \ Probably owing to local circumstances. V. S. ARMY, IN 1812—13. 283 usually terminated by effusion, which perhaps was the most common; and next to that, suppu- ration, in those cases which terminated after the third day; and sometimes by a commixture of both. The other termination now and then oc- curred, though less frequently. IV. The mode of treatment whcih I found most successful at Burlington, and which I practised in the 9th Regiment of U. S. Infantry, was the fol- lowing : If I saw a patient in the incipient stage of the disease, (which, however, was seldom the case,) I usually prescribed pediiuvium, and some mild su- dorific, which was at the same time a diluent, such as weak balm, sage, or catmint tea. In the hot stage which soon followed, I invariably commen- ced by bleeding, and repeated the operation ac- cording to the force and frequency of the pulse', the state of the tongue, and other symptoms. In the majority of cases, I bled copiously, say, from sixteen to thirty-two ounces. In one or two in- stances, particularly the case aforementioned, I drew thirty-six ounces at a bleeding, two days in succession;—sixteen in the evening of one of those days, and from thirty-two to thirty-six, at two bleedings the next day; and about sixteen each day, for two days following; and the same quan- tity at two subsequent bleedings ;—making in all, nine bleedings. Dr. Rush says: " Blood-letting should always be copious where there is danger from sudden and 284 EPIDEMIC IN IHE great congestion, or inflammation in vital parts."* This was my anchor of hope in all cases ; and it was this particularly, which I depended on more than any one thing.—" By making use of blood- letting in fevers, we are not precluded from the benefits of other evacuating remedies. Some of them are rendered more certain, and more effec- tual by it; and there are cases of fever in which the combined, o% successive application of them all is barely sufficient to save life. To rely upon any one evacuating remedy, to the exclusion of the others, is like trusting to a pair of oars in a sea voyage, instead of spreading every sail of a ship."t In many cases, bleeding was required oftener, but not so copiously as in the one above. * I have practised venesection from one to three times a day, with the happiest effect;—taking from twelve to twenty ounces each time, during the first three days of the disease. There were some cases, that would not bear copious bleeding, but required the frequent repetition of that operation. It was those peculiar cases, where there was a small op- pressed pulse, which would usually rise on open- ing a vein.f This is called by Dr. Rush, the synochula state of fever.§ » Med. Inq. and Obs. Vol. 4, p. 205. f Med. Inq. and Obs. Vol. 4, p. 195. | Med. Inq. and Obs. Vol. 4, p. 196—Pringle, p. 160.—Thomas's Practice, 5 Med. Inq. and Obs. Vol. 3, p. 26. v. s. army, in 1812—13. i'66 Next to blood-letting, I would rank the sub- mur. hydrar. I however, seldom gave it alone and uncombined, but in large doses with jalap, or with equal parts of jalap and aloes, in the form of a pill, sometimes with the addition of 1-4 gr. tart. antim. to 3 gr. of the admixture. Drastic and particularly mercurial purges were essentially necessary at the commencement of the paroxysm ; and were used to the best ad- vantage, immediately after bleeding. When the action was somewhat reduced, milder cathartics answered the purpose, such as the oleum ricini, or some of the neutral salts, as the sulphas and phosphas sodae. In the more aggravated cases, however, I not only gave mercurial cathartics, but calomel also in small doses, sometimes combined with ipecac, and opium. Expectorants and sudorifics, were useful auxilia- ries ; and when there was much coldness of the. extremities, semicupium was an important agent towards equalizing the action of the system. Uni- versal hot bath was prejudicial;—tepid bathing was preferable, though not very beneficial. Where se- vere pains in the thorax, did not readily yield to bleeding, and to the other remedies, epispastics were indispensably necessary. All fermented and spiritous liquors, and all food directly stimulating to the system, were inter- dicted until the convalescent stage of the disease. The food consisted principally of decoctions of 286 epidemic in the barley, rice, and the farinaceous substances in gen- eral.* Cold airf was freely admitted into the room. Copious draughts of cold water,! and other cold drinks were used, and in short, the whole antiphlo- gistic regimen rigidly pursued. This, sir, was my usual routine, from which there was no considerable variation in any case; and for the propriety of which I can only urge the success of the practice. I cannot accurately state how many cases oc- curred in the 9th Infantry, but of all those which did occur after I joined the regiment in Decem- ber, I lost but one; and but two or three other deaths took place during the continuance of that regiment at Burlington,—which was until the 24th of March, 1813. The case above alluded to was not necessarily fatal, but probably as much under the controul of medicine as any other of equal violence. The subject of it, from the dread of the potent reme- dies, to which he had seen his comrades subject- ed, and which he himself anticipated, was deter- red from making application until the fourth day of the disease. It was then too late—the inflam- matory stage had run through—depletion was im- practicable. Blisters were applied, and an emetic administered, but without effect—stimulants were unavailing—the extremities were cold—face and * Fordyce on Fever. Third Dissert, part i, p. 184. f Rees's Cyclopedia, article, cold. t Hoffmani Opera, vol. 1^.499.—Celsusde Mediciuae, lib. iii. cap. 7—Cur- rie's Med. Rep. vol. 1, chap.xi. U. S. ARMY, IN 1812—13. 287 lips had become of a dark purple colour—and the respiration was so difficult, as to amount almost to suffocation, from an inability in the lungs to per- form their office. The patient died on the sixth day, after severe suffering, as was usual in such cases. Four hours after death, I examined the body, in the presence of several officers of the Medical Staff. The appearances on dissection were as follows: A very copious effusion, together with an exten- sive suppuration of the lungs had taken place; adhe- sions of the pleura costalis, with the pleura pulmo- nalis, had also taken place, and large abscesses formed in the right lobe of the lungs, so as almost wholly to destroy its action. 1 have observed sim- ilar appearances in other cases, where I have had an opportunity of examining them. Abscesses were frequently so extensive, as almost wholly to destroy the substance of the lungs. Sometimes one or both lobes would be turgid with blood; the sanguiferous vessels of the lungs being forci- bly injected with black blood from the heart. In some instances, I have noticed one lobe to be wholly, or both partially collapsed, contracted, and shrunk, without air in their cells; which leads to the conclusion that one lobe at least, or a part of both, may cease to act for some time before death. In the case abovementioned, there was also some affection of the liver. The subject of it was of an intemperate habit, and his disease was ex- 288 EPIDEMIC IN THE, &C cited by exposure to a cold and damp atmosphere, while in a state of inebriation. It was an observation of Dr. Mann, which I think worthy of remark, that the intemperate were the first who were attacked, and the first swept off by this destructive malady; and he might have ad- ded, that the intemperate would have best borne, and most required extensive depletion. The appearances on dissection, (aside from the symptoms,) clearly proved, that the disease was highly inflammatory. This I think, must have been obvious to the understanding of every one, possessing the least knowledge of morbid anatomy, who would take the trouble to examine for him- self. And yet how astonishing it is, while six or eight valuable soldiers were dying daily at the post of Burlington, that the stimulating practice should have been pursued. Remarks on Yellow Fever. 151 ant, yet it is productive of no lasting bad effects. This instance may have arisen from an accidental activity of the absorbent system, consequent to a previous abstinence undertaken in or- der to promote the operation of the remedy. In concluding this subject, I may add, that in the account of the plague as it occurred at Malta, given by Sir B. Faulkner, of three cases of recovery from that disease there detailed, two of them arose from the accidental ingestion of an immense dose of this substance combined with camphor. II. Art. I. Memoires sur la Fievre Jaune consideree, dans sa Nature et dans ses Rapports avec ces Gouvernments. Par N. V. A. Gerardin (de Nancy.) pp. 91. Paris, 1820. Art. II.—Considerations sur la Fievre Jaune. Par le Baron Larrey, &c. &c. Seconde Edition, pp. 42. Paris, chez Compeu, jeune. 1822. Art. III.—Rapport presente a son Excellence le Ministre Secre- taire d'Elat au Department de PInterieur, par la Commission Medicate envoyee a Barcelone.—(Journal Generale de Medi- cine, Mars 1822.) Art. IV.—Manifeste touc.hant f Origine et la Propagation de la Maladie qui a regne a Barcelone, en Vannee 1821 ; presente a Pauguste Congres Nationale, par une reunion Libre de Mede- eins etrangers et nationaux. Traduit de FEspagnol, par J. A. Rochoux. pp. 35. Paris, chez Bechet, jeune. 1822. (From the London Medical and Physical Journal.) We have been induced, thus early in our career, to under- take the consideration of the subject of Yellow Fever, partly from a conviction of its great importance at this moment,* and partly, also, in consequence of a promise which our predecessor has held out in a recent Number of this Journal, and which promise we were most anxious to fulfil. We approach the dis- cussion with a deep sense of its difficulties, and, we hope, un- biassed by any particular theory. Recent circumstances have rendered it of such intense interest, and conflicting opinions have so obscured it, that, although we may hope to be pardon- ed if we fail to produce order out of this chaos, we should cer- tainly have deserved reprehension if we had shrunk from making the attempt. Some questions alike interesting to the statesman and the philosopher, are involved in the inquiry concerning yellow fe- * The public prints inform us that this disease has ag-ain made it* appear- mco in Barcelona- 152 Select Essays and Reviews. ver ; and upon the decision of one of these questions at least. the propriety or necessity of imposing severe and irksome re- straints upon a numerous class of the community entirely de- pends. This circumstance, which greatly enhances the value of the discussion, at the same time increases the difficulty ; since the evidence that relates to this particular point is by far the most contradictory that offers itself to our notice. The points to be resolved appear to be principally the three following :—1st. Is the disease that has of late years devastated Cadiz, Malaga, &c, and more recently committed such fright- ful ravages at Barcelona, the true yellow fever, or not? 2dly. Is it an imported malady ? And 3dly, (which appears to be in some measure, but not entirely, dependent upon the decision of the former question,) Is it contagious, in the common acceptation of that word ?—for the disease might have been contagious in- dependently of any importation: neither does it appear to us that this latter circumstance, if proved, would be decisive of its character. Before we introduce the works that stand at the head of this article to the notice of our readers, it may not be amiss to give a rapid sketch of the history and symptoms of the yellow fever of the West Indies and America, a subject illustrated by the la- bours of so many celebrated men, both English and foreign ; and it is not a little mortifying to the pride of human learning to observe how few facts have been established, beyond the reach of contradiction, by the exertions of such an host of writers : yet, when we reflect upon the prejudices of education and of country,—when we consider how many enter into the inquiry with opinions already formed, and with the mental eye closed to every circumstance that tends to weaken their pre-conceived notions,—our wonder ceases, and we can only repose in the humble hope that we, who are so sensible of their errors, may happily avoid falling into the same mistake. There can scarcely be found a more apposite illustration of the above remark, than the great variety of names that have been applied to denote this disease,—some imposed upon it in order to distinguish its supposed source or origin, as the malady ofSiam, the Bulam fever, &c.; others from a leading symptom, as the black vomit, or vomito prieto of the Spaniards ; others, again, from its supposed seat, as la fievre gastro-adynamique of Pinel ; or, lastly, to suit some nosological arrangement, as Salvages, who designates it typhus icterodes. In tracing the history of yellow fever, it is curious to observe how very conspicuous a place the doctrine of importation will be found to occupy ; and that attempts have been made, as ear- Remarks on Yellow Fever. 153 ly as the year 1690, to fix the origin of the disease upon the East Indies; but the argument in this instance is so well known to be contradicted by established facts, and the prior existence of yellow fever in the Brazils, at Martinique, St. Domingo, &c. is so amply proved, that it will not be necessary to recur to any authority to establish this point: indeed two of the authors who tell the story of the importation by the Oriflamme in 1690, give a different version of it; and, as there exists an accurate des- cription of the fever that desolated the Brazils some years prior to this supposed event, and which description can leave no doubt as to the disease having been really the yellow fever, we may be excused from any further research relative to this par- ticular point. Since the date of the above story, a formidable list of authors, upwards of an hundred in number, may be found, who have successively laboured in this field, independently of the numberless essays and papers that have from time to time been inserted in the Transactions of the various learned Socie- ties in Europe and America ; some of them describing the dis- ease generally ; others, and by far the greater number, deriving their information, and giving their description, from some parti- cular spot, or relating to the epidemic of a particular season ; to which circumstance may be attributed, trie discrepancies that are to be found in the several accounts of the symptoms and progress of the disease. The following is a brief sketch of the usual mode in which yellow fever makes its attack. Its first accession is denoted by cold chills or rigors, soon succeeded by intense heat and dryness of the surface of the body ;* the face is red and flushed ; the eyes have a peculiar and fiery expression, which has been com- pared to those of a man in a state of intoxication ; violent pains are felt in the forehead and orbits, sometimes more particularly in the back and lumbar region ; the countenance sometimes ex- hibits a remarkable expression of alarm; the tongue, at first moist, soon becomes loaded ; the patient complains of nausea and tenderness iu the epigastrium ; troublesome eructations and vomitings of bilious matter quickly succeed, which, as the dis- ease advances, becomes of a darker colour; the thirst is ex- tremely great; restlessness and watchfulness distress the suffer- er to a great degree : and this stage of the disease often lasts as long as two, or even three, days. The condition of the bowels * Humboldt tells a story of a traveller, who had passed a very short time at Vera Cruz, and, on his arrival at Xalapa, was told by his Indian barber that he would have the black vomit that evening; giving as a reason that the soap dried upon his face as fast as he applied it. Vol. I. 20 i 54 Select Essays and Reviews. differs very much : in some instances, constipation exists to a very remarkable extent. One of the distinctive marks of the complaint, mentioned by Mr. Bally, is the length of time that the energy of the muscular power is sustained, so that a person shall be able to walk the street, or shave himself, within an hour of his death. At the termination of this stage, the more pro- minent symptoms, in general, remit: the patient and his friends are induced to believe that he has overcome the malady ; but the listless and often torpid state of the patient, and a faint yel- lowish appearance about the chin, or on the sclerotic coat of the eye, too surely point out the danger that is lurking beneath this apparent calm. Dr. Bancroft observes as an alarming symptom in this stage of the complaint, that pressure made upon the region of the stomach will occasionally produce efforts to vomit; although the pulse shall have diminished in frequen- cy, the thirst and febrile heat shall have subsided ; and even the intellects, if previously disturbed, shall have become clear. This, which may be called the second period of the disease, seldom lasts above two days, and is succeeded by renewed vomitings : the matter thrown up is streaked, or altogether black ; passive hemorrhages from the mouth, anus, &c. super- vene ; the teeth and gums are covered with a black crust; the dejections become bloody, of a most offensive kind, and often involuntary; the urine is dark coloured, foetid, and in very small quantity ; petechiae occasionally appear over the whole body, some hours previous to death. Swellings of the parotids, and of the axillary glands, are mentioned by some authors, but they do not seem to be essential to the disease: they were, however, met with frequently at Martinique, in 1802 and 1803. The state of the intellects is by no means uniform; sometimes coma prevails ; in other epidemic seasons, furious delirium has been more prevalent. The whole duration of the malady is from five to seven days, although many instances occur where death ensues within thirty-six or even twenty-four hours. The state of the pulse is represented as very variable. Dr. Gordon says that, at the commencement of the re-action, it is full and strong, but seldom exceeding ninety strokes in the minute. Dr. Bancroft represents it as quick, though sometimes oppres- sed and irregular. At the end of the first twenty-four hours it increases in frequency. It appears, by the concurrent testimony of some of the best writers, that yellow fever attacks the system most commonly between midnight and noon. So much do these epidemics vary in their leading symptoms, that, in 1814, it is said that the black vomit was a rare occur- Remarks on Yellozo Fever. 100 rence. At Philadelphia, in 1798, the delirium was generally of a violent character. In some instances, a miliary eruption has made its appearance in the latter stage of the malady; and even the yellow suffusion is not always met with. Examination of the dead body presents more points of difference than would at first sight be expected ; and authors by no means agree in their accounts of the diseased appearances. These disagreements may, perhaps, be ascribed to the greater or less degree of se- verity of individual cases, or to variations in the epidemic con- stitution (to use an antiquated phrase,) of some particular sea- sons. Thus, whilst Bancroft declares that the brain has ap- peared to him more voluminous than natural, Mr. Bally has found it compressed by a red and bloody looking serum ; and Savaresi says that it is, in general, reduced to five-sixths of its usual volume. In some seasons, the lungs have been found af- fected, and the pleura inflamed ; but the abdomen is the princi- pal seat of the morbid changes, though even here we find a great contrariety of sentiment. Dr. Gordon has found the biliary organs frequently in a state of lesion ; others have observ- ed that the liver and gall-bladder remain in a healthy state, even where the stomach is loaded with the matter of black vomit. Gerardin has often seen the hepatic system unaltered ; whereas Rochoux protests that there is no example of the gall- bladder remaining in a healthy state. It is admitted that the spleen and kidneys are generally sound ; yet Savaresi observed, at Martinique, in 1803, and 1804, that they were constantly af- fected. The mucous surface of the stomach and small intestinea bears, however, the most unequivocal and universal marks of lesion, according to the unanimous testimony of all the best writers. Red and gangrenous spots are found scattered over their whole surface , and finally, Dr. Audouard informs us that, in numerous instances, the spinal canal contains a quantity of serous fluid. We will not fatigue or insult our readers by quoting authori- ties to prove that yellow fever is indigenous in the New World 5 that it is of local origin, and can be fairly traced to the extrica- tion of marsh effluvia, reigning sporadically, in a greater or less decree, among Europeans and new settlers ; whilst the natives and the black population, excepting in particular seasons, escape with impunity, or, at most, only suffer partially and occasionally from slight remittent or intermittent fever. We are still, how- ever, in darkness with respect to the causes which sometimes give vigour and activity to this poison at one period more than another, and which, after a few years' quiescence, render these climates so formidable to the inhabitants of our quarter of the io6 Select Essays and Reviews. globe ; particularly hot seasons,—the fall of an unusual quanti- ty of rain,—the direction of the winds,—the absence or pres- ence of hurricanes, and other atmospheric phenomena, would probably, if duly registered and known, solve the difficulty. But this is a subject standing in need of much illustration, and the study of which we strongly recommend to those whose des- tiny carries them to these climates. A careful inquiry into the topography of the different islands and places where the disease is to be met with, is also a great desideratum; although, since the year 1793, many important facts relative to this point have been noticed, both by English and foreign writers. It is a pursuit of the highest importance, because it leads at once to the only remedies that can prevent a recurrence of the dreadful scenes that have been too common both in America and its islands; and which remedies, it has been, we think, satisfactorily shown, consist in ventilation, drainage, and cultivation. That, from the year 1793, in par- ticular, such frightful mortalities should have occurred in St. Domingo and other of the Antilles, is not a subject of astonish- ment, when we consider the thousands of victims, in the fittest state to receive the disease, which the course of a sanguinary war poured out to these colonies. We may now fairly proceed to examine the authorities on the much-disputed subject of contagion, which we shall do as briefly as possible, and then turn our attention to the disease which has appeared so frequently, of late years, on the coast of .Spain and Italy ; which will conduct us to the question of importation, and to its application to the recent case of Barcelona in partic- ular. Several opinions appear to have been prevalent relative to the contagious character of yellow fever, by which term we understand a direct communication with the sick, or with the clothes, bedding, &c. of persons labouring under the disease. One of these opinions is, that it is contagious ; another, that it is not; and a third and respectable portion, both as to reputa- tion and numbers, hold a middle course, and believe that it is sometimes contagious and sometimes not so ; whilst others, re- fining still farther, believe that, though not originally capable of communication, it may, under certain circumstances, become so, or that the contagious property has but an extremely limited operation in point of time as well as space. Among the conta- gionists are to be found the names of Lind, Lining, M'Kettrick Batty, Chisholm, Pallone, Arejula, Pym, &c. The non-conta- gionists produce the names of Jackson, Moseley, Bancroft. Watts, Miller, Revere, M'Lean, Valentin, Savaresi, Deveze, Remarks on Yellow Fever. 15', Caldwell, Ferguson, &c. The partizans of the mixed opinion number among them Humboldt, Desgenettes, M. de St. Mery, M. de Jonnes, (not a medical man,) Clark : Baron Larrey and Gerardin must be also classed in this list. With respect to Mr. Rochoux, we know not what to say; he seems to have changed his opinion so often, that it may fairly be doubted whether he has made up his mind as to which side of the question he finally intends to espouse. It is more than sus- pected that Dr. Rush, although he had formally abjured his be- lief in contagion, retained a strong predilection for that doctrine to his last hour. In the very outset of the argument, it will be perceived that the non-contagionists have a manifest advantage over their an- tagonists, because one well-authenticated fact of non-contagion is, from its nature, of more value, than scores of cases of conta- gion as usually adduced ; for, as these latter necessarily take place upon the spot which is the alleged source and origin of the noxious effluvia,—the very cradle of the disease, twenty men may successively fall ill from breathing the same atmos- phere, without its being at all necessary to suppose they derived it from each other: nor does the exemption of secluded houses and families, even if the facts are admitted in their fullest ex- tent, entirely clear up the difficult}7; since it is well known that, in other cases of marsh fever, and upon sundry other occasions, the slightest difference of situation,—the interposition of a wall or dyke,—has been quite sufficient to preserve the atmosphere from contamination. In Walcheren, this was exemplified in numerous instances, especially at Fort Batz, where the troops suffered little or no sickness ; whereas, those stationed without the fort, though only at a very short distance, were affected by the fever to a most alarming extent and degree. But what shall we say to the instance of New-York, in 1805, where a population of more than 10,000 persons, dreading the effects of contagion, fled from the town, and encamping at Greenwich, an elevated field at one extremity of the town, established their stores, banking houses, &c. on that spot, and where, finally, the customs and the courts of justice were transferred,—notwith- standing the constant intercourse between Greenwich and New- York—notwithstanding the importation of goods of all sorts, and touched and handled by all classes of people,—the disease did not spread in any one instance. Equally strong is the case of Leghorn, in 1804, when those who fled to Pisa did not communicate the fever; and, although two of those who re- moved there actually died of unequivocal yellow fever, no far- ther sickness took place. The same thing is recorded to have happened at Gibraltar, in 1814, by Mr. Amiel. 158 Select Essays and Reviews. Mr. Valentin has adduced numerous authorities, all concur- ring to establish the non-contagious nature of the disease. Dr. Dupuy, who witnessed both the epidemics of New Orleans, of 1819 and 1820, not only is of this opinion, but declares that all the practitioners, with the exception of two or three, agree in this point. In contradiction to Dr. Gerardin's implied meaning, he says, that those who fled from the city to other parts did not communicate the complaint to the inhabitants of those places to which they fled. The mortality of the epidemic of 1820, in particular, was so dreadful, that, of those attacked by it, seven out of ten died. It appears, also, that Dr. Chervin, then at New Orleans, had, after witnessing the ravages of yellow fever at Guadaloupe, and actually examining more than four hundred dead bodies, made a tour to the Antilles, and to many parts of the United States of America, in order to collect the opinions of the profession upon the subject of contagion : the result is, that, out of about one hundred and fifty certificates which he obtained, there were not above fifteen who adhered to that doctrine. Dr. Chervin is now at Paris, preparing his materials for publication again. A committee of seven physicians was appointed to examine into the causes of the epidemic at Mobile, (Florida) : their opinion as to its local origin is unanimous, and most satisfactory. Such also is the result of the researches of Dr. Chalard, of Baltimore. Several other analogous authorities are adduced by this able and zealous writer ; but it is useless, we conceive, to accumu- late farther evidence, which can only tend to swell this article, and tire the patience of the reader. As a specimen, however, of the credulity of the contagionists, we may here mention a fact brought forward by Dr. Pym, and which, we think, can only excite a smile. He states that a man of De Rolle's regiment, in leading a comrade affected with the fever, at Gibraltar, to the hospital, turned sick, and expired on the road ; and this is ad- duced as a proof of contagion. ~ A much stronger circumstance is related by Baron Larrey : it is this :—Dr. Valli, a few days after his arrival at the Havanna, took off the shirt of a sailor who had died of yellow fever, rubbed his own body with it, then put it on, and went to dinner with his host, Don Gonsalez. He remained quite well the next day ; but, on the day following, he was taken ill, and died in twenty-four hours. Now this ap- pears quite convincing : yet, when we consider that Dr. Valli was just arrived, from Europe, and that yellow fever existed at the time, much of the force of the above case is destroyed ; and it remains at best but very equivocal evidence. Girardin also tells us that yellow fever raged at Natchez, Baton Rouge, and Remarks on Yellow Fever. 159 other places, at the time of the epidemic of New Orleans in 1820; although some of these places, the former in particular, is remarkable for the healthiness of its situation, and is distant 150 miles from the source of the malady : but he admits that all these places were crowded with those who fled from New Orleans; and he does not inform us whether the disease was confined to these refugees, or whether the untravelled and ori- ginal inhabitants suffered by the arrival of the strangers. This is, indeed, evidently implied in the account, and is in conso- nance with his own belief and opinion, but he has left the mat- ter in great doubt. It would be injustice, in this place, wholly to pass over the 9trong facts and arguments adduced by Dr. Ferguson, in corro- boration of what has been stated above, but it will be sufficient for our purpose to notice two or three of the most striking il- lustrations he has given us in support of the non-contagious na- ture of yellow fever, without entering into the merits of his opinions upon other points of the argument. The first of these facts is the exemption which all the inhabitants of Monk's-Hill Barracks, Antigua, enjoyed during the epidemic of 1816, whose duty did not oblige them to sleep out of that garrison ; whereas the soldiers who mounted guard at the dock-yard, and in other low situations, were often seized, while on their posts, with the most aggravated form of the disease ; many dying within thirty hours from the first attack. Another important observation goes to prove that a slight elevation in the immediate vicinity of a marsh is more fatal sometimes than the ground upon a level with it, the higher ground appearing to attract the effluvia. This is in conformity with our own experience in the case of intermittent fever in many situations in this country. The neighbourhood of trees is also observed by this author, to afford a protection from the poisonous effects of marsh efflu- via ; and he gives us the example of New Amsterdam, where fever does not prevail, although it is situated within a stone's throw of a most unwholesome swamp, with a strong trade-wind blowing day and night from it towards the town, and without any other protection than this screen of trees : yet it is found that sleeping under them, or remaining there after sun-set, is almost certain death to any European. It may be added, that the inhabitants are well aware that their exemption from fever is owing solely to this cause. Upon the whole then, the conviction upon our minds arising from all we have read and thought upon this subject, is, that yellow fever is not a contagious disease ; that it is of local ori- gin : that it exerts its energy principally during night, at which 160 Select Essays and Reviews. time a very transient and temporary exposure to its causes ifl sufficient to light up the flame in a habit predisposed to receive it; and that although, from causes yet unknown, it acquires such fatal activity at some particular seasons, it is always to be met with as a sporadic affection in those climates, and, if we may believe some authors, even at our own doors.* Notwith- standing all these articles of faith, we are, however, willing to admit that the conviction entertained by some very judicious practitioners, that, although not originally or necessarily conta- gious, yellow fever may, and does, occasionally become so, is not to be altogether despised; since there does not appear any thing unreasonable in the supposition, that crowded habitations, poverty of living, and personal uncleanliness, (to say nothing oi moral causes,) may so concentrate and condense the poisonous effluvia as to superadd a contagious property to a disease originally free from it. We do not knozv this to be the case ; but some circumstances within our own recollection, occurring to certain portions of the peninsular army, as well as conse- quent upon the unfortunate expedition to Walcheren, give 6ome colour to this argument, and lead us to suspect the existence of what an able contemporary has denominated contingent conta- gion. The subject is confessedly one of great difficulty ; but it 4is not a mere question of the schools, since upon the belief of contagious diseases depends the propriety of imprisoning a whole population : and we cannot but think it to be abundantly proved that both humanity and policy are equally outraged by the adoption of measures of such extreme and useless rigour. If as, in the case of New-York, the healthy population were re- moved out of the sphere of the malady, which we know to be of local origin, we conceive that a stop would at once be put to the spreading of the evil; whereas the removal of the sick tends merely to increase the alarm, and leaves only a succession of victims to be swept off, as long as the influence of the miasmata remains in activity. Still more cruel is the close circumvalla- tion of the whole population, which, after all, cannot be so com- plete as to baffle the courage and ingenuity which the dread of so formidable a disease will frequently inspire. Before we proceed to the direct question of importation, there are a few interesting facts which must be mentioned, and from which it would appear that a disease similar to yellow fever in all its leading symptoms, and unfortunately also in its fatality, has, upon certain occasions, been produced on board ship, with- * Valentin says that sporadic cases are met with at Brest occasionally. Remarks on Yellow Fever. 161 out the most remote possibility of supposing it to have been ex- ported from any of the known sources of that malady. The most remarkable of these events is recorded by M. Beguerie, who has seen the yellow fever in the West Indies, and experien- ced an attack of it in his own person. It appears from his ac- count that a French flotilla, with troops on board, which sailed from Tarentum for St. Domingo in 1802, after having been driven about the Mediterranean by stress of weather, and hav- ing been obliged successively to put into the ports of Leghorn and Carthagena, sailed from this latter place in the month of August. The heat of the weather had been dreadful in the months of May, June and July; the provisions on board are represented as of the worst quality, and the salt fish in such a state of putrefaction, and giving out so horrible a stench as to oblige them to have it thrown overboard. A fever broke out on board this fleet soon after they sailed, and lasted until their disembarkation, acquiring force as they approached the tropic. M. Beguerie assures us that the symptoms of this fever differed only from those of yellow fever by an almost imperceptible shade. In the month of August, 1802, an American vessel arrived at Marseilles from New Providence, after having touched at two Spanish ports. No epidemic reigned at either of these places ; neither had she any sick on board during the passage, nor dur- ing a quarantine of fourteen days ; but, after the crew had dis- embarked, the second and third officers and four sailors were successively attacked with yellow fever, and .died ; three in dif- ferent houses in the town, and three at the lazaretto ; but it did not spread either among the inhabitants, or to the physicians and attendants of the sick. The writer of this article (M. Four- nier) is therefore induced to believe that, in this instance, the vessel must be compared to a spot where the air is hot, moist, and stagnant, and rendered impure from many sources of cor- ruption. One more very strong instance of the development of yellow fever on board ship, is recorded by Dr. Ferguson : it is the case of the Regalia, transport, which was employed in bringing black recruits from the coast of Africa to the West Indies, in 1815. This vessel is represented as leaky, and having taken on board a quantity of green wood in Africa : her ballast also was foul, and had not been changed from her quitting England, nor for any discoverable time previously. The black recruits were crowded in this vessel, many of them afflicted with fluxes, ul- cers, &c. The provisions were defective, both as to quantity Vol.. I. 21 162 Select Essays and Reviews. and quality; and the crew, prior to^their sailing from Africa, were healthy. It appears authenticated that this ship arrived at Barbadoes with yellow fever on board, in the month of Au- gust : that, owing to some negligence, she was not put under quarantine, but communicated freely with the Saints, Antigua, and Guadaloupe, landing those dying of the disease among the inhabitants and at the hospitals of those places, without commu- nicating the disease at either, of them ; and, finally, after having undergone a thorough purification, sailing from Guadalope to Europe, crowded with French prisoners and their families from the jails, under the most dangerous circumstances of health, with a case of yellow fever dying on board the day before she left Basseterre Roads ; but without any contagion spreading to the other passengers, and without importing it at the port which she ultimately reached. Dr. Lefort, of Martinique, in a letter to M. Valentin, states that the yellow fever broke out spontaneously on board a ves- sel called the Euryalus, cruising in the tropical seas, without having touched at any port in those seas ; and this he declares to be the fifth instance of the kind, within his own knowledge, in a period of four years. M. Moreau de St. Mery adduces the following fact as an un- answerable argument in favour of contagion : we do not see it in that light; however we are bound in candour to relate it. The Palenicrus, a French brig, having the yellow fever on board, and cruising in the West Indies, encountered the English brig Carnation, coming direct from Europe, the crew quite healthy. A combat ensued, and the English brig was captured (a rare occurrence,) by boarding : the English sailors were con- sequently removed as prisoners into the French ship, and took the disease. Now, we think this and other examples quoted above will enable us to clear up this difficulty, without the ne- cessity of recurring to contagion ; for, if the French vessel was the focus of the yellow fever in this last instance, she would stand, in relation to the English sailors, exactly as a village or town surrounded by a contaminated atmosphere would stand with respect to its inhabitants, or to strangers arriving there from other quarters : but if, on the contrary, a French sailor labouring under the yellow fever had been sent on board the English ship, and the disease had spread amongst the healthy crew, we should then be under the necessity of admitting that a case of contagion had been made out, beyond the reach of cav- il or dispute. A late Number of a foreign periodical work, contains an ac- count of a sickness occurring on board a vessel called the Ar- Remarks on Yellow Fever. 163 thur, which sailed from Rouen in 1818, laden with poudrette, a species of compost made from human ordure. On the voyage to the West Indies, a disease broke out among the crew, of so alarming a nature, that one half died on the passage, and the rest arrived at their destination in a miserable state of health. Those who unloaded the vessel suffered equally from the same disease. M. Parent, who was deputed by the French govern- ment to trace the cause of this accident, discovered that a simi- lar fate had attended the crew of a little bark laden with the same material at Nantes ; although the workmen, who prepare the article upon a very large scale, and who perform the process in the open air, are found to be remarkably healthy/ The na- ture of the disease produced in both these instances was a fever of that type called by the French fievre adynamique, the most prominent symptoms being head-ach, pains in the limbs, fever, nausea, and vomiting. It is not stated whether any of the crew of the last named vessel died ; nor do either of these instances go the whole length of proving that the malady produced was actually the'yellowt fever ; but they establish this fact, that the putrefaction of animal and vegetable matter, aided by warmth and moisture, is capable of producing a disease resembling yel- low fever in some of its most prominent features, as well as in its ratio of mortality. From a due consideration of the foregoing facts, and many others equally strong, resting on authorities the most respecta- ble and undoubted, we do not perceive any thing paradoxical in the assertion, that, whilst we believe yellow fever to be in its nature non-contagious, we are clearly of opinion that it may be, and often has been, imported. That it has ever spread by im- portation, or that the mortalities that have occurred so frequent- ly in the New World, as well as in Europe, are to be ascribed to this source, we most positively deny ; but, when, from a con- currence of local causes, an epidemic has broken out, and it becomes an object to trace it to some palpable and known ori- gin, can we be surprised that it should be discovered to have existed on board some ship from the West Indies, or that it should have developed itself on board some vessel during her passage ? In fact, numerous examples of the sort are upon re- cord ; but does this circumstance establish a necessary connex- ion between the disease on board and the epidemic on shore ? We.think decidedly not; for repeated experience has shown, that men brought from on ship-board, and dying of yellow fever at different houses, have not spread the disease to any single in- dividual ; and again, epidemics have sometimes raged, of the importation of which not only no evidence is offered, but not 164 Select Essays and Revitwa. even any suspicion existed. The shores of the Mediterranean haVe enjoyed an exemption from this calamity for many succes- sive years. Is it reasonable to suppose that, in all that time, the quarantine laws have never been violated or evaded, when such instances are discovered to be of every day occurrence, when they are wanted to be brought forward as evidence of the foreign origin of the complaint ? But, in truth, such inquiries have nev- er been thought of until the breaking out of the fever has given rise to them; and, when instituted, if a solitary case of yellow fever has been traced to have occurred within a short period of the invasion of the malady, the problem has been considered as solved, and all collateral and minor evidence tortured to meet this explanation. But, if we believe that, in any one well at- tested instance, yellow fever has been traced from a West In- dian or American vessel without communicating contagion, the argument in favour of that doctrine is at an end, and importa- tion may still be credited without considering contagion as a necessary consequence. The course of our narrative has now brought us-to the consi- deration of those frightful scenes which have occasionally been exhibited on the shores of Italy and Spain, but which have, since the year 1800, been not only of more frequent occur- rence, but more fatal in their results. That Cadiz, Carthagena, and Malaga, have been visited three or four times in the course of the eighteenth century by destructive epidemics, and that these epidemics were really the yellow fever, there can be no manner of doubt. The writings of contemporary authors are conclusive upon this point, and Lind was himself a witness to one of these visitations. The more recent occurrences at Ca- diz and Gibraltar have given birth to such numerous testimonies of the most respectable kind, that there can be no hesitation in asserting that the first of our questions is satisfactorily answered in the affirmative ; and nothing now remains for us but to ex- amine the documents that relate to the fever at Barcelona in 1821, and the only point of accordance that can be discovered between the various individuals who have so zealously devoted themselves to the contemplation of this malady, is the undoubt- ed fact of its having been the yellow fever. We shall now, without farther comment, proceed—1st, to lay before our readers, as succinctly as we are able, the substance of the Report made by the French commissioners to their gov- ernment relative to this epidemic, as bearing the stamp of au- thority ; and afterwards .present them with a Manifesto, publish- ed by the spontaneous union of several physicians, both Eng- lish, French, and Spanish, in Barcelona, and which is, in fact, a Remarks on Yellow Fever. 166 direct contradiction to all the assertions contained in that re- port, without having been originally intended as such ; since, at the time of its publication, the report of the French commission- ers was not known at Barcelona. In the course of this analy- sis, all the facts connected with this melancholy visitation of Providence will become developed ; and the conclusions which we think must inevitably result, will tend, in a very satisfactory manner, to confirm the opinions attempted to be maintained in the former part of this paper. With regard to the report of the French commission, it is but cold language to say that it is one of the most extraordinary documents ever presented to public notice ; it would, perhaps, not be too harsh to affirm that it is also the feeblest in reasoning, —the weakest in fact, and the strongest in assertion, that ever issued from the press. It bears the most decided marks of pre- conceived opinions, but is, fortunately, so hastily and crudely put together as to carry the conviction of its weakness in every page : in short, it displays a determination to discover, what we are persuaded it was intended to find, an excuse for a sanitary cordon. The gentlemen composing this commission were ori- ginally five in number,—namely, Messrs. Bally, Francois, Pari- set, Mazet, and Rochoux; the whole of them, with the excep- tion of the last, most decided contagionists,—a circumstance which alone will afford a tolerable guess at the impartiality that may be expected from an inquiry conducted by such a junta. Their personal narrative is shortly thus: they quitted Paris on the 28th of September, and arrived at Barcelona on the 9th of October, at seven o'clock in the evening; and, by half past eight, they had begun their labours, and visited some sick. As the commission was so soon to be freed from the presence of M. Rochoux, we shall dismiss him at once, giving the motives of his secession as* represented to us by his companions, and which, if correct, is ludicrous enough. He escaped by a piece of logic. " The fever that rages at Barcelona," he said, (we quote the words of the remaining commissioners,) "is either the yellow fever of the Antilles, or it is not: if it is, it has no contagious property, as we shall see ; but, if the disease has any thing contagious in its nature, I am not sent here to study a malady of that kind, and therefore I shall separate myself from you immediately." In consequence of this opinion, they assert that M. Rochoux retired to Garcia on the 14th, and, after divers projects, separated himself entirely from his comrades. They more than insinuate, that M. Rochoux was induced to adopt this line of conduct in consequence of the death of M. Mazet, which took place on the 22d instant, after an illness of nine 166 Select Essays and Reviews. days : he was taken ill in the night between the 12th and 13th, having only seen and touched two sick persons. It is, however, but justice to M. Rochoux to observe, that, as the commission- ers have been detected in perverting the truth with respect to another of their countrymen, (who indeed, has proved the fact against them in the most unanswerable manner,) we are there- fore bound to give that gentleman the benefit of the doubts which such unfair and illiberal conduct has necessarily excited in our mind. The commissioners then continue their narrative as follows : Dr. Audouard, who was sent to Barcelona by the minister of war, arrived there the day after M. Mazet's death ; but he did not join them, he established himself at the botanic garden. They declare that they met him but seldom ; that he was accustomed to work independently of them; which, joined to the sickness of two of their number, separated them from each other, with- out, however, causing any division between them. Their his- tory then concludes with some account of the mode of conduct- ing their researches. In the night of the 24th, Messrs. Bally and Pariset were attacked with the disease ; M. Bally suffered most. During their secession, M. Francois continued his visits, and made the first examinations of dead bodies ; forj until then, they had no instruments. An assistant fortunately came from Perpignan, a M. Jouarii, " poor, but full of zeal." Morning and evening he attended the visits of M. Francois, and in the day wrote wl it was dictated to him by M. Bally. This latter gentleman, when enabled to go about, employed him especially in anatomical examinations. From the 6th to the 19th of No- vember, M. Bally resumed his duties at the hospital, and be- tween these dates the clinical observations and dissections are represented as having been more regular and complete. On the 20th of November they finally quitted the place, their health beginning to suffer again. - We must stop here one moment for the purpose of reviewing the last paragraph ; and it will hardly be believed, yet such is the fact, that Dr. Audouard declares that M. Francois never put his hands into the dead bodies at all; that, instead of seeing each other but seldom, he met them every day : that the first dissection made in the Hospital of the Seminary was made by him, on the'3Ist of October ; and that M. Bally did not open any bodies until the 8th of November; whilst Drs. Revera and Campmany, whose names the commissioners do not even deign to mention, had pursued their anatomical investigations through- out the month of August. Having now sketched the personal adventures of these gen- Remarks on Yellow Fever. 167 tlemen, we come to the substance of their researches : they be- gin by declaring the salubrity ofohe situation of Barcelona, .but especially of Barcelonetta, the streets of which town are wide and regular, and the foundation a bed of granite rock. They, however, confess that remittent fever occasionally reigns at this place. With regard to the condition of the port, they assert it to be perfectly clean, and that the water is pure, clear, and lim- pid : there are certain pools of stagnant water upon the beach, to be sure, but then they are only a few toises in extent, and but three inches deep ! They next call to their aid the evidence of M. Simiane, captain of the French brig Josephine, who is des- tined to make a considerable figure in this history. This con- noisseur in stinks is introduced for the purpose of proving that the morning wind, which regularly blows from the town, and which constantly conveys all the emanations from the city to the shipping in the harbour, never brought with it any odour which displeased him. Now, without disputing this gentleman's taste, we cannot help thinking that the odour from the cleanest city in the world, cannot be fragrant; but, when that city is a Span- ish one, we can only pity the cause which is obliged to have re-" course to such feeble support. It appears that the streets of Barcelona are narrow and tortuous ; that they are traversed by canals, which receive the filth of the city to convey it to the sea : these canals are covered with large stones, but so badly joined, that any odour may readily escape and mix with the air. These inconveniences, they allow, are sufficiently unpleasant where the temperature of the air is so high, but they are not much felt excepting after rain, and in Catalonia this does not often occur. They admit that it did rain for some days after their arrival; but they forget to mention the fact of the great increase of sickness that immediately followed those days of rain, and from which the ignorant had expected great benefit. However, they get rid of these suspicious circumstances by re- minding us that Barcelonetta was visited by the fever before Barcelona. The thermometer, which had been, during the months of April, May, and June, and part of July, never above 15° of Reaumur, rose at this latter period as high as 22°. On the 12th of July, the fete of the Promulgation of the Constitu- tion was to have been held, but, as the weather was badvit was put off until the 15th. The weather being remarkably fine, on that day the whole population was poured upon the ramparts, the quays, and the vast esplanade of Barcelonetta; the vessels in the port were also crowded with spectators. At this period there were a great number of ships in the harbour, both Spanish and others, recently arrived from the Havanna and Vera Cruz. 168 Select Essays and Reviews. Some of these had suffered from yellow fever at those places, some on the passage ; the dead had been thrown overboard, but their goods, clothes, bedding, &c, covered with black vomit, had been preserved on board. The eternal M. Simiane is again brought forward to prove that these things were exposed to the open air under his own eyes ; although the captains had the art to elude the vigilance of the medical police, and contrived to attribute all the deaths that had occurred to falls from the masts, or other accidents. In order to avoid the quarantine laws, the sick were forced to shave and dress themselves, and appear on deck among the crew and passengers, a* if in perfect health ; which proves, at least, that neither the crews nor the passengers had found much reason to dread the contagion. Now the mar- vellous part of the story is, that M. Simiane saw all these things, which the medical police either could not or would not see ; and yet this vigilant and all-seeing captain never said one word up- on the subject to any but to these commissioners, and that in the month of October, although the Havanna fleet arrived at Barcelona thirty-three days before any sickness was even talked of &t that place. To continue.—On the 15th of July, all the vessels in the har- bour were crowded with spectators, and it may be supposed (mark this word again in an official paper !) that many of the women and people passed the night on board, stretched upon the matrasses and coverlids of those who had died. The first ship they mention is Le Grand Turc, which arrived at Barcelona on the 29th June, 1821, in sixty-one days from Havanna. A little while after, the captain, M. Sagreras, brought his family on board, which family resided at Sitjes; they staid there but one or two nights : on quitting the vessel they were taken ill, and all, comprising the wife, children, and a female servant, died at Barcelonetta. Now this would, indeed, be an afflicting tra- gedy, and a strong case, but for one trifling circumstance,—hot one word of this story is true ; and M. Sagreras, his wife, chil- dren, and maid, are, we feel pleasure in saying, all alive and well; and, what is still better, have not had the fever at all.— This fact is stated upon the authority of M. Zaha, a merchant of Barcelona, an intimate friend of M. Sagreras. It seems that M. Rochoux was himself the author of. this strange mistake, which he communicated to M. Pariset; and therefore, though the commissioners are to be acquitted of any intention to de- ceive, they have given us, by inserting this story without making proper inquiries as to its authenticity, an additional proof of the eagerness with which they seized upon every thing which could tend to confirm the opinions they had previously adopted. Remarks on Yellow Fever. 169 It is farther asserted, that thirty-five of the people who had been on board this ship on the 15th of July, died a few days after. Now here again they make an unfortunate mistake ; for no epi- demic sickness occurred in Barcelona until the 3d of Septem- ber, just fifty days after the day of the fete. This is proved by the official documents published by the municipality. We must now proceed to dissect their second story, which relates to a vessel named the Nuestra Senora del Carmen, six ty-three days from the Havanna, and having touched at the ports ofAlicantand Carthagena. She arrived at Barcelona on the 11th of July. Three of the crew had been ill with yellow fever at the Havanna, and one had died ; the remaining three, it k added, had probably had the disease, as they had been to Amer- ica before. Now observe what follows : This ship had received a poor passenger on board at Alicant, for the purpose of convey- ing him gratis to Barcelona. Two days before the vessel reached that place, this poor man fell sick : and this is the per- son alluded to as having been obliged to dress himself and ap- pear upon deck as if in health. On the evening of their arrival he was disembarked, and died the next day. Had this man the black vomit ? Ask the commissioners, and they answer their own question in the following satisfactory and philosophical manner. Many people, they say, affirm that he had ; but, at all events, it cannot be denied but that so mortal a malady had a great affinity to yellow fever! They also think it reasonable to suppqse that his disease must have propagated itself in the house where he lodged ; for, being poor, with what could he repay the hospitality of those who received him ?—With his clothes ; and no doubt they were made use of by this family. Let us now just recapitulate this precious, this unique piece of evidence. Nothing is known of this poor man beyond the fact of his having been brought from Alicant, and dying at Bar- celona the day after his arrival; but, by the aid of three or four suppositions, he is convicted of having died of the yellow fever, —of having communicated the disease to the inmates of the house where he lodged, and that by means of his clothes, with which they suppose he paid for the hospitality he received. One more circumstance, and we have done, and this relates to our old friend M. Simiane, who, it is asserted, although in health himself, communicated the disease to the landlord of the house at Barcelonetta in which he lodged. The succeeding pages contain some information relative to the number of deaths during the whole course of this epidemic, and they are calculated at from 17 to 18,000. During its great- est height, from 450 to 500 dead were carried out of the differ- Voi.. I. 22 i 70 Select Essuya and Review*. ent gates of the city in one day. In this instance, as in all pre- \ious ones, it was observed that the bakers, and those whose occupations exposed them to great heat, suffered especially ; whilst those who were addicted to excesses of any kind were most liable to be attacked. Contrary to what is usually observ- ed, strangers from the northern countries of Europe especially did not appear so obnoxious to the influence of the fever as the natives. We trust that we may be excused from pursuing the details of this report any farther, especially as we must now bestow a little attention upon the Manifesto we have already alluded to, which will afford abundant and direct contradiction to those assertions of the French commissioners which want of time and space oblige us to pass over; but, before we remark upon that pro- duction, we beg to make an extract or two from the recantation of M. Puguillem, formerly a decided contagionist, but whose name is to be found attached to the manifesto of the adverse party, and whose abjuration is addressed to Dr. Lassis. Among the motives which induced this gentleman to change his opinion are the following : " The regular march of the fever from east *to south-west,—the existence of sick in different parts of the town before all communication with Barcelonetta was cut off, its attacking those who were most rigidly sequestered,—the fact of several individuals in one house being seized with it at the same time. Messrs. Bally, &c. (he continues,) went about seeking only those facts which appeared to favour their own cause ; and, in reply to their remark, that one positive fact is equal to thousands of negatives, he says that their positive facts lose all their force when submitted to the test of rigid criticism ; a point which, unless we deceive ourselves, we have sufficiently shown above. In the Lazaretto, in the Hospital of the Seminary, in the General Hospital, neither the medical men nor those who at- tended the sick suffered the slightest attack. The sisters of the General Hospital escaped with perfect impunity ; whereas the purveyor, the apothecary in chief, and others who never enter- ed the wards, and who studiously avoided all contact with the sick, experienced an attack. It is impossible to find, he adds, one single w:ell-attested instance of a sick person quitting the town, and spreading the disease to any of the neighbouring communes ; and he urges the strong fact of the inhabitants of Sans, Garcia, and many other places, having escaped the dis- ease, notwithstanding they were included within the cordon which enclosed Barcelona. Hence he thinks it extremely un- likelv that contagion could be brought from the Havanna. Remarks on Yellow Fever. 1 71 when even the small distance of Garcia from the city was found sufficient to impede its communication. The last remaining document (the Manifesto,) is signed by the following gentlemen: Dr. Maclean, Dr. Lassis, Dr. Ro- choux, Francisco Piguillem, Francisco Salva, Manuel Duran, Juan Lopez, Salvador Campmany, Ignacio Porta, Jose Calve- ras, Antonio Mayner, Raymuno Duran, and Benaventura Sa- hue. Upon the authority of these names, it is asserted that sporadic cases of yellow fever were met with both at Barcelona and Barcelonetta, as early as February and March of the year 1821 ; and Dr. Lopez himself was called in consultation to a man who dwelt behind the Exchange, and who died of yellow fever, with petechias and black vomit, in the early part of Feb- ruary ; and it will be recollected that the accused vessels did not reach the port until the latter end of June. After the dis- ease broke out, numbers of sick retired to Sitjes, Malgrat, &c. but no sickness ensued at those places. With regard to Tortosa, where the fever was supposed to have been introduced by a dealer in hams, the Junta of Health affirm that, many days prior, a sick man was brought from on board a bark that had never been at Barcelona. It is to be re- marked also, that towards the end of summer, that town is al- ways visited by fevers of a very violent character. With respect to the state of the port, it is asserted, that such was the condition of the sewers, the canals in the streets, &c. that, towards the end of June, it was impossible to pass along the sea-wall without being inconvenienced by the stench produ- ced by the decay of animal and vegetable matter in its vicinity. The examination performed by the commission charged with cleansing the port, proves that the Arequia was obstructed at its mouth by a sand bank, which had caused the accumulation of a mass of stinking water, loaded with the impurities furnished by all the manufactories, slaughter houses, &c. situated upon the banks of this rivulet, from whence a most insupportable stench arose. The modern works of the port appear to have increased the evil, and have produced a source of infection which did not formerly exist. The mortality was most especially great in those streets in the line of the port; whereas, in those exposed to the north, and more distant from the infected spot, but few sick were found. The time of the year in which the fever broke out is precise- ly the period in which epidemics make their invasion in hot countries: this fact has been verified more than once in Spain. The fever has not been able to establish itself beyond the 172 Select Essays and Revieios. walls of Barcelona. No person has been proved to have caught the disease out of the sphere of the operation of local causes. At the Marine Lazaretto, between the 7th of August and the J 3th of September, 79 cases were received, 55 of whom died : not one individual, out of 32 employed in that establishment, took the disease. At the Seminary, 1 767 sick were admitted, 120 3 died ; but only three cases of the fever occurred among 90 people employed in that establishment.* M. Ribera, in dissecting a body, wounded his finger deeply with the scalpel: nothing beyond a slight swelling of the axilla- ry glands took place. Many, who had suffered from the disease in America, con- tracted it again, and some of these died. Many families, who secluded themselves in the most rigorous manner, found their precautions in vain. At the time the barrier was placed at Barcelonetta, on the 3d of September, there were only nine sick in the place : on the 10th instant, they amounted to 162 ; and, finally, Those who had quitted the place with all their effects did not spread the disease at their new residences ; although some few died of yellow fever which they carried with them. Such, among many others, are the strong, and we think un- answerable facts which the perusal of this able paper has ena- bled us to lay before our readers, as confirming the view we have taken of this complicated and highly interesting subject. We, perhaps, have been tedious, and have accumulated evidence which many may consider as redundant; but we were anxious to collect in one view all the most important remarks which the experience of the last fatal year had produced ; in doing which we have been as careful as possible to exclude all doubtful evi- dence, on whichsoever side of the question it seemed to bear. In the same spirit, we must therefore remark, that, whilst we agree with the authors of the Manifesto in most of their views, we were sorry to notice some allusions to the plagues of London and Marseilles, which we think they have unnecessarily intro- duced in that paper : they savour rather too strongly of the doctrines of the gentleman whose name appears at the head of the list of signatures ; doctrines to which we cannot subscribe, since we believe the plague to be a disease quite distinct in its nature, and we are not prepared in this instance to dispense with those precautionary measures, by means of which, we firmly believe, Europe is indebted for its long exemption from the visitation of that tremendous malady. * M. Jouarii made the fourth. Remarks on Yellow Fever. 173 Having anticipated in the foregoing pages nearly all that is necessary to be said respecting the works at the head of this article, we have only to say that Dr. Girardin deserves the praise of having given us, in his little memoir, a very accurate topographical account of Louisiana, and the neighbourhood of New Orleans in particular; an example which we hope will be followed by all those who undertake to discuss the subject of all epidemics, wherever they are to be met with. It has been already shown that the Doctor is a modified contagionist. In the latter part of his book he notices, and recommends to the ruling powers, the necessity of stationing raw European troops in such situations, in the different islands, as may ensure them from the operation of the local causes of the disease. Baron Larrey's paper is principally remarkable for his specu- lative doctrines with respect to contagious virus, of which he distinguishes two kinds,—the fluid, and the gaseous or miasmat- ic : the former are the syphilitic, the small-pox, and vaccine poisons ; in the latter class he ranks, the yellow fever. The venereal virus, he goes on to say, chiefly affects the lymphatics ; it can remain a long time inactive in the system, but, when it begins to act, it continues its progress unto the death of the patient, unless arrested by curative means. The variolous poi- son has a particular affinity to the skin : it is capable of produ- cing a similar disease, but only for a determinate period, after which it becomes inert. The pestilential virus acts chiefly upon the brain and nervous system, though it is occasionally arrested at the nervous plexuses of the armpits and groins ; and M. Lar- rey does not believe it to have any connexion with the lympha- tic system. The virus of the yellow fever he considers as the most subtile and volatile of the whole ; that it has but a momen- tary existence, and which corresponds to the acme of the dis- ease. The virus resides in the cutaneous transpiration, or in the eruptions when they are met with. We see in this attempt of Baron Larrey's a love of generali- zation and system, to which we think our zealous and imagina- tive neighbours are too much addicted. It would be easy to contest this explanation step by step, but we have already devo- ted so much space to this discussion, and we think the weak points of this arrangement so evident, that it is scarcely neces- sary to point them out to the medical reader. The just reputa- tion that M. Larrey enjoys rendered it incumbent upon us, however, to state his opinions ; and we need hardly say that, in conformity with those opinions, he advocates the propriety of precautionary measures. I 74 Anatomy and Physiology. MONTHLY SUMMARY OF PRACTICAL MEDICINE. 1. ANATOMY AND PHYSIOLOGY. Mr. Shaw on the Par Vagum. '•• The par vagum connects the larynx, pharynx, lungs, heart, and stomach ; and the sympathies it produces in health and dis- ease, are very many. Disorder of the stomach deranges the secretion of the larynx ; a vomit, or nauseating medicine will loosen the viscid secretion of the larynx and pharypx ; disorders of the stomach, acting through the pulmonic plexus, will occa- sion cough; and medicines acting on the stomach will alleviate asthma. Through the plexus of this nerve, the heart and lungs are united, ever corresponding in action. When life seems ex- tinguished by suffocation, (in experiments on animals) pricking the heart will be followed by respiration ; and in the apparently drowned, the play of the lungs, in artificial breathing, brings after it the action of the heart. It is well known how disease of the lungs affects the heart; but it is not so generally observed how much disease of the heart resembles pulmonary disease. " Looking to the distribution of the par vagum on the stomach, and the plexus of the nerve, in its course upon the oesophagus, it will not appear surprising, that disorder of the uterine system, affecting the stomach, and also primary disorders of the stomach itself, should produce the globus hystericus, or paralysis, or spasms of the pharynx and oesophagus. Although the heart and stomach be separated by the diaphragm, yet through this ner- vous cord they are united : and this explains why disorder of the stomach should produce such changes on the heart's action. The pause, or intermission of the pulse, which in many diseases, is a fatal symptom, is often produced in a manner less alarming —merely by irritation, of the stomach. Seeing these many con- nexions of the stomach with the vital parts, through this nerve, our surprise ceases at a blow on the stomach proving instantly fatal."—Manual of Anatomy. (91) Art. II. The Modern Practice of Physic, &?c. fcfc. by Robert Thomas, M. D. With an Appendix, by Ed- ward Miller, M. D. Professor of the Practice of Physic in the University of New-York. New-York. Collins and Perkins. 8vo. pp. 697. 1811. About five years ago, Dr. Miller framed an ela- borate report on the yellow fever of 1805, in which, it is understood, the whole strength of the doctrine of non-contagion was, for the first time, disclosed, and all its numerous arguments concentrated. This report was first published in a pamphlet form, and addressed to the governor of the state ; next it was ushered to the world through the medium of one of our daily prints ; it came forth a third time in the Edinburgh Medical Journal; and since that time the doctor has revised and improved it, and it is now again sent forth, in the shape of an Appendix to Dr. Thomas' Practice of Physic, with the view to remove* all remaining medical heresy on the sub- ject of contagion. With Dr. Thomas' work we shall not, at this time, concern ourselves. The slight examination, which, only, we have been able to bestpw upon it, leads us readily to coincide in the opinion expressed by Dr. Miller in the introduction to his appendix, that " it is executed with a degree of ability and judgment which reflects much honour on the talents of the author." It is also added, that " in Great Britain it stands so high in public esti- mation as to have passed through several editions within a short period." So popular a work then afforded the doctor an excellent opportunity of giving currency to the tenets held by the advocates for the domestic origin of $2 Jliller on the Xelloxo Fever. yellow fever, and a co-extensive circulation of his ovrn performance on that subject. "We must however ob- serve, that this method of seizing upon a branch of a particular subject, occupying less than two pages in a vo- lume of seven hundred, and making it serve as a pretext for annexing to the work a heavy appendix, containing many gratuitous assertions, on which are founded doc- trines and arguments in their support, in direct opposition to those entertained and expressed by the author himself, is a new method of giving currency to one's own opinions, by compelling another's assistance who holds them in ab- horrence. The volume before us is thus so far perverted from the author's intentions, as that hereafter it is to cir- culate the mischievous doctrine of domestic origin, not- withstanding the author has taken some pains to mani- fest his reprobation of it. Let it be observed, that the appendix is not an answer to any thing advanced in die volume to which it is subjoined, but an independent, ab- stract essay, very improperly attached to the labours of one who dissents totally from all it contains. If this is encouraged, we shall next find Chisholm himself, by means of an artful appendix, become an advocate for the doctrine of domestic origin. How Dr. Miller can re- concile this treatment of Dr. Thomas with propriety, delicacy, and fair dealing, we shall leave to himself. Considering the appendix in the important point of view before mentioned, our object is to subject the facts and arguments advanced in it to an impartial scrutiny. Dr. Miller begins by " deprecating all personalities whenever the principles of science, especially of medical science, are undertaken to be examined.'* " Whatever regards the health and safety of mankind (he now seems to think) is too grave a subject to become the sport of Miller on the Yellow Fever. 93 passion, or the vehicle of invective and personality." We cannot too highly commend these sentiments, and have only to regret, on his own account, that they had never occurred to him before. During the thirteen years in which he has been employed in compiling and publishing the Medical Repository, what adversary has ever escaped those personalities here so much deprecated. If he has forgotten himself, we refer the doctor to his former vo- lumes and hexades for the truth of this remark. Let him turn to the articles containing reviews of Hay garth and of Chisholm, as well as of those American writers who have had the misfortune to differ from him in opinion, and he will there see how freely he and his coadjutor have been ac- customed to deal in the haughty rebuke, bitter sarcasm, or the taunting irony. And they were left to enjoy their triumph in silence ; for there was no rival work in which the injured could make their defence. But as we are now assured that all personalities will henceforth be dis- carded, we congratulate Dr. Miller on the resolution he has adopted, and sincerely rejoice at the information. Dr. Miller divides his subject into various heads, un- der the form of questions ; the first of which is, " What are the causes and nature of the yellow fever?" This ma- lignant disease (he says) has never been known to prevail except in tropical climates, or in those seasons of 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 about eighty degrees of Fahreinheit's thermometer." "There is no instance in the United States or in Eu- rope of an epidemic yellow fever, except at these degrees of heat, nor of its long continuance after the atmosphere has been reduced to a much lower degree of temperature." " The primary and essential cause'of the yellow fever is a miasma or pernicious exhalation floating in the atmosphere." " In order to produce these miasma, it is neces- sary that there should be a concurrence of heat, moisture, and a quan- tity of decaying animal and vegetable matter. It is therefore exhaled S4 Miller on the Yellow Fever. fry heat from Ipw and moist grounds, overspread with the offals of animal and vegetable substances, from such substances collected in large ma?ses, from any place where the process of putrefaction is go- ing on to a considerable extent." " This exhalation is uniformly more frequent and virulent in sea port towns, in situations along sea coasts, in plains or near rivers, lakes, marshes, and swamps, or wherever stagnant waters are found, than in the interior high and mountainous districts of the country." Such is Dr. Miller's theory as to what he calls the " primary and essential cause of yellow fever." To this, however, must be added, he says, " certain secondary or exciting causes," which are, " exposure to heat, fatigue, cold, dampness, intemperance, fear, anxiety," &c. We mean not to employ our time in opposing hypothesis to hypothesis, which, in the end, is generally found to ter- minate without satisfaction to either party concerned, and least of all that of the reader ; but we mean to come, at once,» to plain matter of fact, and on that alone we shall rely. We shall oppose facts to theory, and so long as we find ourselves armed with the former, we shall hold our- selves invulnerable, though Dr. Miller should continue to build speculation upon speculation, and to imagine cases to support them without end. To this test, then, let us now subject the foregoing extract. Those who have lived in this city for the last ten years, and have taken notice of the different times and seasons when, and places where, the yellow fever has broken out and prevailed, on both sides the East-river, sometimes in New-York, sometimes at the Wallabout or Brooklyn, will find it extremely difficult to comprehend how anv one of these local causes, or all of them united, can embrace these different seasons and places, and satisfactorily account for what has appeared in them all. Is it not well knovm, that during the above period it has at one time prevailed Miller on the Yellow Fever! $$ in New-York, and not at the Wallabout; at another, at the Wallabout, and not in New-York ; a third time, in New-York, and not at Brooklyn; and a fourth time, at Brooklyn, and not in New-York ? Now, as these villages, are only about a mile distant from each other, and as New-York is separated from them only by a river of about eight hundred yards in its width, it is manifest that the " tropical heat" is about the same at one place as at ano- ther, and therefore climate cannot be allowed any agency in producing the disease. But Dr. Miller mentions this heat as being essential to produce that " pernicious exha- lation which floats in the atmosphere," and is the " pri- mary cause of the yellow fever." But he says there must be a " concurrence of heat, moisture, and a quantity of decaying animal and vegetable matter." From the above, we repeat, it is apparent that the degress of both heat and moisture of atmosphere must be nearly the same at the same time in all the different places mentioned. Nothing then remains to enquire after but the doctor's " decaying animal and vegetable matter." We shall not be contra- dicted by any one who recollects facts, or will turn to the publications of tke times, that when the yellow fever broke out at the Wallabout, in 1804, it was proved by the undeniable testimony of several witnesses, delivered under the solemnities of an oath, that the place was liable to no imputation of any one of Dr. Miller's enumerated causes, nor of uncleanliness of any sort. The Wallabout is a small hamlet, consisting of about twenty dwelling houses only, erected at suitable distances from each other, and then contained a number of ship-carpenters, all of whom were well accommodated : far from being situated in " low and moist grounds," it stands upon the hard, gravelly and sandy bottom which forms the shore of the % Miller on the Yellow Fever. river; nor is there a foot of made ground in the place. In short, there was not the shadow of a pretence for sup- posing, any where near it, the doctor's " decaying animal and vegetable matter." We are not forgetful that a long and particular state- ment of facts, totally different from this account, came out in the Medical Repository ; and when the truth was af- terwards made to appear incontestibly, we cannot conceal that we experienced a degree of indignation, that the editors should have never taken the least notice of it, but shewed themselves so utterly destitute of that candour and magnanimity, which readily acknowledges error, and hastens to correct it, as to persist in propagating false statements wherever their book obtains circulation. What, permit us "to ask, what must the public think, what ought it to think, of a literary work which propagates im- portant mistatements of material facts, and when it is af- terwards convicted of so doing, instead of retracting, ne- ver permits the corrections to find their way into the work ? Is not such conduct an injury to the cause of truth, and an imposition on the community ? While the yellow fever was raging at the Wallabout with a degree of malignity and mortality, as great in pro- portion to the number of the inhabitants, as perhaps ever was known, New-York remained entirely exempt. Such also was the fact, when the yellow fever prevailed at Brooklyn two years since ; but concerning this we stated v - the case so fully in a former number, that it is quite unne- cessary to re-examine it here. In a word, the disease has prevailed alternately in each of the three places, alone, all lying in the same latitude, and subject substantially to the same local causes. A single fact affords a simple, satisfactory solution of every difficulty.. While the ship- Miller on the Yellow Fever 97 ping were permitted to come along side our wharves, the yellow fever prevailed in New-York; but since 1805, that isy since they have not been allowed to approach within three hundred yards of us, but are at liberty to approach the op~ posite shore, and lie at their docks, the disease has been communicated to them, first to the Wallabout, and next to Brooklyn, "while New-York has remained totally exempt. With this single fact before us, why should any man of common sense perplex himself to divine the origin of this epidemic, by having recourse to theories about " rivers, and lakes, and marshes, and swamps, and made ground V In neither of the above villages are rivers, or lakes, or marshes, or swamps to be found ; and as to " made ground," there is not a foot at the Wallabout, little at Brooklyn, and in New-York there is nearly as much at the North-river side, where the yellow fever has never first appeared, as at the east side ; and be it pernicious or be it otherwise, this same made ground has been going on with the same industry and success, for the last six years, as before, during which a whole street nearly has been made on the North-river, yet the epidemic has not once appear- ed in the city, although it has in the same period of time twice depopulated the villages on the opposite side of the river. How long is theory to bear down plain and undis- puted facts, and sophistry to stifle common sense ? But, says Dr. Miller, as the materials of putrefaction and the degrees of heat in a large city, greatly exceed what is found in the adjacent country, so the diseases arising un- der such circumstances must be proportionally more ma- lignant. Such is the doctor's reasoning, but such are not the facts. The yellow fever was as malignant and as fatal when it prevailed in the adjacent country villages, as it Vol. II. k 98 Miller on the 2'ellow Fever. was when it appeared in this city ; once introduced, there was no apparent difference. We pass over the next head for the present, in order to come to the third question, viz. Is the yellow fever a con- tagious disease P The doctor, who has long stood pre- eminent among the non-contagionists, takes the negative of the question. " But (he observes) before proceeding to offer reasons in detail against the non-contagiousness of the yellow fever, it is proper to premise some general obser- vations on the subject:" and then he goes on to give a definition of contagion, in which, like a dexterous combat- ant, he exerts himself to obtain a point, by defining it so as to suit himself, begging the very question in controversy. After talking very learnedly about secreting contagious matter by a morbid action "of the vessels,'' he says, "its ac- tion (the action of contagion) is altogether independent of external circumstances, such as the state of the air," &c. According to this, it must, to be sure, be admitted that the yellow fever is not contagious ; but then, neither is any known disease whatever. The small-pox, although allow- ed to be the most contagious of all diseases, is not indepen- dent of external circumstances. "If forty persons, (says he) who have never undergone small-pox, be closely exposed to the effluvia of a number of patients lying ill of that dis- ease in the ward of a small-pox hospital, thirty-nine cer- tainly, and probably the whole number, will be infected." But has the doctor forgotten the case of the Royal George, on board of which, while at sea, the small-pox broke out but nearly one hundred out of eight hundred and eighty totally escaped the contagion, and the disease disappeared altogether. Now, then, if the contagion of small-pox is so universal in its operation, as certainly not to spare more than Miller on the Yellow Fever. 99- one, and probably not one of forty in a hospital, how is it to be accounted for that in the above case it should have spared adaout one hundred out of eight hundred and eighty ? Will the doctor have the goodness to explain to us the cause of this difference ? If it was not deprived in a great degree of its malignity in this instance of the Royal George, by being exposed to the ventilation of a constant sea-breeze, but is always altogether independent of external circum- stances, to what was its comparative mildness owing ? The doctor is not at liberty to say that in the hospital the air was less pure, for we have his word in the same paragraph, that " none of the truly contagious diseases derive any ad- ditional force from impure air." Neither will it do for him to say (as he does in p. 633) that " the greater con- tagiousness arose from the concentration of a greater quantity of contagious matter within a small space," be- cause he afterwards (p. 6 76) says, although " the mias- mata which produce yellow fever, are more or less noxious as they are more or less concentrated, yet this is a proper- ty which does not belong to the specific poison of small- pox." A man who thus contradicts himself without cere- mony, sets refutation at defiance. We leave the doctor to his own reflections ; but he must recollect, that the web in which he finds himself entangled is one of his own weaving. " The agency of contagion in the propagation of the yellow fever," says he, " is rejected for the following rea- sons," and he proceeds to give us ten. The) shall be examined in the order in which they stand. But before we go any further, it is certainly fit and necessary, that one should come to an understanding as to the subject of the dispute : What is meant by the contagion of the yel- Iqw fever ? If Dr. Miller means one thing, and we mean 100 Miller on the Yellow Fever. another, it follows, that we are not at issue, and all further controversy must be useless. By the contagion of yellow fever, then, we mean that peculiar species of contagion only which is peculiar to that disease ; we do not mean, as our antagonists have, more than once, strove to make us mean, the contagion of small pox, or syphilis, or measles, or any other contagion but that of the yellow fever itself. But they say a truly contagious disease is one that repro- duces itself in the same manner, and with the same cer- tainty, under all possible circumstances ; as if any such disease ever existed. This attempt on their part to place us on ground which we do not intend, and never intend- ed to occupy, is both unfair and disingenuous. It may be an adroit method of managing a dispute, but it is do- ing the highest injustice to an adversary, and to the cause of truth. Nothing, perhaps, has contributed more to blind and mislead the public in this controversy, than this very artifice of representing us as having maintained a doc- trine which we never advanced, and then undertaking gravely to refute it. This certainly they can do, but then they claim the honours of a triumph, as though they had gained a victory, when there has never been a contest. It is necessary the public should be completely disabused on this point; and therefore, although we took some pains to explain ourselves in a late number of the Regis- ter, we shall do it once more, here. When we say the yellow fever is a contagious disease, we mean to be understood as saying, and saying only, that it is a disease which, under certain circumstances favourable to such operation, may be communicated.spe- cifically from one person to another, either directly from person to person, or indirectly, by means of clothing, bed- ding, or any thing capable of receiving and conveying Miller on ihe Yelloiv Fever. 101 the disease. This is precisely our meaning, expressed. in the simplest manner, carefully avoiding all attempts to account for the manner how this is brought about, or how it operates ; and therefore we say nothing respecting se- cretions or excretions, or morbid actions, he. &c. a deal of which is sure to be brought forward on all occasions, as if the object of our antagonists was to perplex, in order to confound. We express our opinion in a word, when we say that the yellow fever is communicable from one person to another. But it is communicated, or not communicated, according to. circumstances. This is the whole extent of our doctrine. Nor is it necessary to any useful purpose that we should advance a step farther. This doctrine, once established, we may then with pro- priety call upon our law-givers for a system of qua- rantine laws to prevent any intercourse whatever between the diseased and the healthy, as the only known, safe and certain course. To what practical use, we ask, as it regards this subject, has all this learning been bestowed on secre- tions and excretions, and morbid action ? And of what possible concern to the public is the distinction between koino-miasmatic atmosphere, and idio-miasmatic atmos- phere ? And why all this violent controversy which has been raised about the exact degree of certainty with which any disease must communicate itself, before it can be en- titled to rank as a contagion ? If only two out of twenty, for instance, become diseased by infection, to what pur- pose would you show the other eighteen escaped ? If those gradually accustomed to its action escape altogether, to what valuable purpose is this mentioned as to those who, under different circumstances, do not escape ? The only purpose, in either case, must be to show by argu- ment, that the disease is not a contagious disease ; but tU2 Miller on the Yellow Fever. this argument must vanish before the reply, " We ac- knowledge that, as to those who escaped, from whatever cause, the disease was not contagious, such was their si- tuation, or such the circumstances in which they were placed, that they were not subjest to its action ; but on the other hand, as to those who did not escape, the dis- ease as to them certainly was contagious ;" to argue, that it was not as to them, because it was not so as to the others also, is nothing less than to set up inference against fact. Hence it is, that the non-contagionists are so desirous of establishing their own definition, that a disease must be communicated with equal certainty in all places and sea- sons, independent of external circumstances, before it can be denominated contagious. If so, if this be the only cor- rect definition of contagion, then we admit, that the yel- low fever is not a contagious disease ; it is only a commu- nicable disease. But what advantage do the non-conta- gionists gain by this concession ? They contend that no disease ought to be called contagious, that does not affect every one exposed to its action, and this under all circum- stances and in all seasons ; thus excluding the yellow fever from their list. We, on the other hand, maintain, that every disease which is communicated from person to person, under any circumstances, or at any season, is, quoad hoc, contagious or communicable, and that the yellow fever, therefore, comes v/ithin the definition. Why should not its introduction into our cities, we ask, be guarded against, if at first only one in fifty is liable to be attacked by it; since we know its nature to be to multiply in regular progression, and every new instance increases its force and activity, until from being at first but one in fifty, it soon becomes one in twenty, then one in ten, then one in five, until at length the atmosphere becomes so impure and infected, that not merely a majority of those exposed do not, but scarcely Miller on the Yellow Fever. 103 one in ten does escape ; thus equalling in malignity and certainty the small-pox itself. Can we then, whether we- call it contagious or communicable, can we be too anxious- ly vigilant to provide against its introduction ? Our great object is to obtain a good and effective sys- tem of quarantine laws, and such, we contend, if well and faithfully executed, will forever secure the city of New- York against a disease which, when once introduced and become an epidemic, makes more frightful havoc than any other in the known world, the plague only excepted. The object of those opposed to us, is to show that the disease is not a contagious one ; that quarantine laws are absurd, because it is not possible to introduce it from abroad ; that it is the produce of our own climate ; to bor- row their own libellous expressions, that " we live in the latitude of pestilence," and that, therefore, all attempts to prevent its introduction from a foreign country, are futile and ridiculous, while at the same time, these very gen- tlemen make so wide a difference between their theory •and their practice, that for a bountiful reward, they have no scruple to undertake the superintendence of those very quarantine laws which they thus hold in derision. " Is the yellow fever a contagious disease P" This is the question before us in order. " The agency of conta- gion (says Dr. Miller) is to be rejected for the following reasons,'' of which he gives us no less than ten. Be it so. They shall every one be put fairly to the test in the order in which they stand. It will be a business of some labour, and will consume some considerable time ; but since the- non-contagionists repose themselves on this body of learn- ing and ingenuity, we will not be deterred by the length of the way from going through with it, and we trust we shall do so to the satisfaction of every impartial lover of trutru (To be contented) ( 104 ) DOMESTIC INTELLIGENCE. Medical School of New-York. In the last number of the Register, page 523, some ac- count was given of the recent re-organization of the Col- lege of Physicans and Surgeons in the city of New-York, and a list of the appointments in that institution, inserted from the official report of the regents of the university. Though the laudable views of the regents, in uniting the respective talents of the two medical schools, have in a partial degree been frustrated, on account of the non-ac- ceptance, by some gentlemen, of the professorships to which they were chosen, it affords us particular satisfac- tion to add, that the college is now in a most promising state of advancement. As an evidence of this fact, it need only be stated, that at the first medical com-** mencement in this institution, held on the 15th of May last, (subsequent to the late act of the regents) the degree of doctor in medicine was granted to the following eight young gentlemen, who had previously undergone the ne- cessary private examinations, and publicly defended their respective inaugural dissertations. This was a greater number of degrees in medicine than was ever before granted at one time in this city, since the estab- lishment of a medical school in New-York. The honours of the college were conferred by the learned and venerable president, Samuel Bard, M. D. in the presence of the chancellor and regents of the university, the trustees of Lectures on Natural History. 16s To render his geology interesting and instructive* Dr. Mitchill has in his possession, a grand and extensive collection of the materials of our primitive rocks in the eastern regions, of the secondary strata at and around Niagara, from the western border, and of extraneous fos- sils from almost every memorable section of the United States* ( 104 ) REVIEW. Art. I. An Appendix to Thomas''s Practice of Physic, iy Edward Miller, M. D. Professor of the Practice of Physic in the University of Ncru-2'ork. New-York. Collins and Perkins. 8vo. pp.697. 1811. (Continued from page 103.) According to our promise we resume the review of the Essay before us. Dr. Miller informs us, that the agency of contagion is to be rejected for ten reasons. We arc told of a certain mayor in France, who not having saluted the entry of a French monarch into the city over which he presided, with the discharge of cannon, went out to meet his ma- jesty with a formal speech, for the purpose of informing him that he had ten reasons to offer why the discharge of cannon had been omitted: first, because they had no can- non ; he was proceeding to his second, but the king in- terrupted him, and told him, that his first reason was suf- ficient, and he would spare him the trouble of mentioning the other nine. Right glad should we have been to dis- cover any one among the doctor's ten reasons so potent as to spare us the trouble of examining the rest; but after all our labour, we have the misfortune to confess, that in vain have we diligently examined the ten to discover anv one that ought to satisfy a mind seriously engaged in the pursuit of truth. That our readers, however, may judge for themselves, we shall proceed to set them in order be- Miller on the Yellow Fever. 165 fore them, accompanied with a tew remarks upon each as we go along. No. 1. " No relation is observed between the source of the sup- posed contagion and the spreading, of the disease to individuals or families ; nor was there ever any successful attempt to trace in regu- lar series, the propagation of it to any number of persons, from the first case, or from any single point of infection. If the first ten or twenty cases which occur in any season be strictly scrutinized, most of them are found in their origin to be distinct and independant of one another. Instead of gradually pervading, or creeping slowly from one neighbourhood to another in the tract of infection, as is invariably the case with contagious distempers, this disease is often found scat- tered at distant and unconnected points, and cases start up singly, in situations where contagion could neither be traced nor suspected.'* We should hope that the single, unsupported assertions of Dr. Miller, or of any other party writer, is hardly to be received in the place of evidence; hardly to be considered of so unimpeachable a nature as to defy the contradiction of proof. The above statement we are compelled to de- clare is wholly unwarrantable. We might refute it by a multitude of familiar instances ; by every case of the yel- low fever that has been the subject of serious investiga- tion. 1 o produce them here, would fill not only a whole number of this work, but a volume : However, to put the fact beyond question at once and forever, we shall content ourselves, by introducing to our readers a few extracts from Dr. Miller's great authority, Dr. Rush, of whom Dr. Miller thus speaks, in the very appendix now under review. u Dr. Rush, who has treated the subject (in question) at much greater length, and who may justly be considered as the leader in the investigation and es- tablishment of the doctrines [of domestic origin'] respecting that disease, (yellow fever) which are now maintained by a great majority of the physicians in the United States." 166 Miller on the Yelloiv Fever. That Dr. Miller should think the great majority of phy- sicians were of his opinion, is not an unnatural mistake, but with that we shall not meddle at present; our busi- ness is with his assertions, and those of his confessed leader, Dr. Rush, of whose authority we avail ourselves, considering it the best way of settling the point in dispute, to appeal to the identical authority which is quoted with respect by our opponent himself. " The first cases of the fever (says Dr. Rush) have been clearly traced to the sailors of the vessels who were first exposed to the effluvia of the coffee,"* p. 156. " The rapid progress of the fever from Water-street, and the courses through which it travelled into other parts of the city, afford strong evidence that it was at first propagated chiefly by exhalation from the putrid coffee," p. 155. With Dr. Rush's coffee we have nothing to do. Dr. Miller has boldly and unqualifiedly asserted, that " there never was any successful attempt to trace, in regular se- ries, the propagation of the yellow fever from any single point of infection ;" yet here we find his acknowledged leader declaring, that it was clearly traced to the sailors of a certain vessel; and further declaring, it was traced from Water-street, through which it travelled into other parts of the city. Dr. Miller has also asserted, that " no relation is ever observed between the source of the sup- posed contagion, and the spreading of the disease to indviduals." But Dr. Rush, (p. 157") says, " from three of those persons who came under my notice, the disease was evidently propagated by contagion ; from one * Rush's Account of the Bilious Remitting Yellow Fever, as it ap- peared in Philadelphia in 1793, 2d edit. Miller on the Yellow Fever. 167 of them, to nearly a whole family ; from another, to a girl of eight years old." And again, he says, (p. 107) " Citizens thus impregnated with the contagion, commu- nicated it in several instances to their country friends." Another case must also be adduced, which at this moment occurs to us, and which we deem it the more proper to give, because it comes from a gentleman of Dr. Miller's own principles, and because he has himself re- corded it in his own work, the Medical Repository, vol. 2, p. 402, which, therefore, he ought to have borne in mind if he did not, or if he did, he ought in common decency to have refrained from making the broad asser- tions, to which it is now offered in direct contradiction. In a letter to Dr. Mitchill, giving an account of the yel- low fever in New London, in 1798, and where it never appeared before nor since, the writer states : " We ascertained with precision to be relied on, that the whole number of persons whose complaints clearly indicated the pestilen- tial, or, as it is called, the yellow fever, did not exceed two hundred and forty-six ; and I give it you as a very important fact, on which you may rely, that, of the above number, two hundred and thirty-one cases were clearly traced to the spot where the sickness commenced, that is, the patients were conversant, or had been in that part of the city a few days before they were seized." And yet, Dr. Miller, with this very communication be- fore him, and which he speaks of in high terms in a sub- sequent volume, had the hardihood to assert, that " no relation was observed between the source of the supposed contagion, and the spreading of the disease to individuals or families ; nor was there ever any successful attempt to trace, in regular series, the propagation of the yellow fever from any single point of infection." 168 Miller on the Yellow Fever. Let Dr. Miller reflect upon his broad assertions, let him consider the above, and reconcile them if he can. Dr. Miller ought to know, that in a work of science, and on a subject of such immense importance to our country, and more particularly to our city, a scrupulous regard for accu- racy would better fulfil the expectations of the public, than rash and unqualified assertions in the very teeth of* fact. Dr. Miller finishes by saying: " Instead of gradually pervading families, or creeping slowly from one neighbourhood to another, in the track of infection, as is invaria- bly the case with contagious distempers, this disease is often found scattered at distant and unconnected points, and cases start up in situations where contagion could neither be traced nor suspected.** It is truly astonishing, it is in the highest degree pain- ful, to find a man of sense and character, thus desperately attempting to impose his own unqualified, unsupported, and unsupportable statement upon the community, in the place of facts. We can truly say, that ever since the origin of the yellow fever began to be more particularly and care- fully investigated here, that is, since the year 1794, we have uniformly found facts directly the reverse of what is above stated; and we may safely appeal to the publications of the time for the correctness of this assertion.* Uniformly has the disease been found to have gradually pervaded families, and to have slowly crept from one neighbour- * Vide the " Opinion of the Medical Faculty of Baltimore relative lo the yellow fever of 1800," all of whom are non-contagionists; yet they say, " the gradual mariner in which this disease becomes epi- demic is an additional proof that it is not derived from foreign sources."—Med. Rep. vol. 4, p. 354. This is very well—the same conclusion from opposite premises ! Miller on the Yellow Fever. 169 hood to another in the track of infection ; nor do we recol- lect that ever we heard of an instance, scattered at a dis- tant and unconnected point, which could not satisfactorily be traced to the source of the disease, or communication with the sick. In support of this fact, we beg leave to make the following extract from the address of tha Board of Health, issued on the 12th of September, 1805. ** The Board have formed a decided opinion, that the principal peat of the prevailing disease is that part of the city included between Burling-slip and Old-slip, as far west as Pearl-street. Almost ^11 the cases of disease which have occurred, can be distinctly traced to a communication with that part of the city." But let us once more hear what Dr. Rush, the pride of Dr. Miller's sect, has said on this point. " For a while this fever was confined to the above mentioned part of the city, but the disorder is spreading, and now appears in other places, so that several are affected in other parts of Water-street; some in Second-street; some in Vine-street; some in Carter's alley; some in other streets ; but, in most cases, the contagion can be traced to Water-street" p. 19. In order to strengthen his proofs, that the yellow fever is not contagious, Dr. Miller says : " The proportion of single cases in the midat of families is always great, and the instances of any large portion of families being attack- ed, were comparatively very rare in the last epidemic." But the case is imperfectly stated. To have enabled the writer to draw his inference, he ought to have gone further, and told us, that after the attack of an individual in a family, the remainder of the family still continued to reside in the same house; but it is well known, that the directly contrary was the case. The alarm given by the attack of an individual was so great, that the rest of the family generally made their escape as soon as possible, v 170 Miller on Yellow Fever. leaving the sick to the care of a single nurse; some few instances excepted. And this abandonment of the sick is one item of accusation brought by the Medical Repository against contagionists; considering it a consequence of their doctrine. But we are saved the trouble of refuta- tion, for by turning back only two pages, we shall find the doctor refuting himself. " It is proper (says he, p. 662) to premise, that the attack of many persons in the same neighbourhood, or even of whole families by a reigning disease, afibrds no proof of contagion." Thus, in one page he tells us, that the agency of conta- gion in yellow fever is to be rejected, because, among other reasons, u the instances of any large portion of families being attacked with it were comparatively rare;" and in another, he maintains, that " the attack even of whole families by it, affords no proof of contagion." But to proceed: u In order to explain this scattered, remote, and unconnected oc- currence of cases, the advocates of contagion are obliged to resort to the extravagant supposition of the contagion being diffused through an extensive range of atmosphere by the effluvia of the sick." By any one not acquainted with the licences habitually taken by Dr. Miller, this would be regarded as a piece of no ordinary assurance. When, we demand, have the advocates of contagion resorted to such an hypothesis to account for such facts i So far from it, they have never even admit- ted the existence of such facts ; they are only to be found we aver, in the artful misrepresentations of Dr. Miller. The only instance we ever heard or read of, that comes any where near this statement of remote cases caused by contagion being diffused through an extensive range of atmosphere, is to be found in a letter from Dr. Miller's Miller on the Yellow Fever. 171 friend and guide, the celebrated Dr. Rush, to the citizens of Philadelphia, published by him in the fever of 1793 ; and in which he attempts to account for the yellow fever's making its first appearance at Kensington, which, he says, was generated and received on board a Danish ship, by putrid coffee, as she lay at Race-street wharf, in Phi- ladelphia, about three miles off. " Upon inquiry (says the Dr.) it appears, that the first person who died with this fever, about the 5th of the month, in that village, had been previously exposed to the atmosphere of the wharf; [between Arch and Race-street] and that three of the crew of the Danish ship, who are now ill of the disease at Kensington, received the seeds of the disease on board -.heir ship, while she lay at or near Race-street wharf. If these facts could not be ascertained, it does not follow, that the disease was not generated by the coffee; for, morbid exha- lations, it is well known, produce fevers at the distance of two and three miles, where they are not opposed by houses, woods, or a hilly coun- try." Thus saith Dr. Rush ; and if he had been speaking of remittent fever, we should not perhaps have any dispute with him about the fact, but it is the specific yellow fever he is speaking of; and we venture to say, that he is perhaps the only man on record who has ever attempted to explain such " remote cases" in such a manner. Let not Dr. Miller then attempt to palm such fancies on the advocates of contagion ; it is the physician he boasts of, as one " who may justly be considered as the leader in the investiga- tion and establishment of the doctrine," [domestic origin and non-contagion] to whom it is attributable. By the way, in this compliment, (as, doubtless, Dr. Miller consi- ders it,) there is, we fear, more of flattery than truth, for Dr. Rush is not the leader ; on the contrary, while others were strenuously contending for such doctrines, Dr. Rush published the first edition of his works, for the purpose of 172 Miller on the Yellow Fever. maintaining and propagating the diametrically opposite doc- trine. Nay, so far did this distinguished physician then carry his ideas of contagion, as seriously to maintain, that the yel- low fever was conveyed across a street of one hundred feet in width; that one man took the fever from another sick of the dysentery, and that two cats were infected by licking some milk that a patient had thrown up. But a little flattery sometimes does wonders. After all, who but must experience some small astonishment at the effrontery of the man, that, after ascribing to the contagionists an opinion advanced by his own acknowledged leader, pro- ceeds to ridicule it as an " extravagant supposition," to brand it as a " new and inadmissible doctrine, utterly re- pugnant to all the principles and laws of contagion," and " inconsistent with itself ?" Dr. Miller, having thus suffi- ciently ridiculed the above opinion, finishes the paragraph by giving his own. Here it is, and let him who reads stare with what wonder he may. " Nothing can account for this local, stationary, inexhaustible poi« son, but the exhalations from the masses of filth and corruption over* spreading a large area of ground, forming a vast hot bed of putrefac- tion, incessantly teeming with miasmata, and thereby, in despite of currents of air, leading with the seeds of disease every successive portion of atmosphere that sweeps or stagnates over the pestilential surface." Thus, then, the yellow fever is disposed of once and forever. In the first place it is a poison, although, ac- cording to the same gentleman and his party, it is nothing more than a higher grade of our common bilious remittent; here it is however not only a poison, but it is a local poison, a stationary poison, and an inexhaustible poison. It is local, because it makes its appearance in some place or other; and this must be granted. It is stationary, because it ne- Miller on the Yellow Fever* 17"3 ver moves ; it is once in New-York, and always in New- York ; and it is inexhaustible, like a grain of musk, be- cause----because the more it poisons the more it may; it never ceases to poison whoever comes in its way. It is the true object of a definition to point out wherein the object agrees with, as well as wherein it differs from all other objects : Hence the precision as well as eloquence of this paragraph. Nothing can account for such a ter- rible poison, we are informed, but exhalations from masses of filth and corruption overspreading a large area of ground (witness ye people of New-York, Philadelphia and Boston !) forming a vast hot-bed of putrefaction, (wit- ness, O ! ye inhabitants of New-Haven, Haddam, and New-London ; of the Wallabout, Brooklyn, and Amboy!) incessantly teeming with miasmata, [bringing forth little atoms,] and thereby, in despight of currents of air, [and common sense,] loading with the seeds of disease every successive portion of atmosphere that sweeps or stagnates [pretty alliteration !] over the pestilential surface."—Yes, the pestilential surface of the sandy shores of the Walla- bout, of Brooklyn, and of Amboy! Well might the learned and elegant Chisholm exclaim, on reading the above pas- sage in Dr. Miller's Essay : " Such hyperboles are un- worthy the man who affects accurate observation and acute discrimination. As well might he, with the poet, describe the approach to the infernal regions to be the eastern shores of the Manhattan : " Vestibulum ante ipstim primisque in faucibus Orci, Luctus et ultrices posuere cubilia curs : Pallentesque habitant morbi, tristisque senectus, Et metus, et malesueda Fames, et turpis egestus, Terribilea visu form*." 174 Miller on the Yellow Fever. And he justly observes, that " the very labour bestowed on this picture of local contamination manifests its ab- surdity." " When we compare this (he adds) with many known instances of accumulations of filth in the cities of other countries, from which no such consequences result, even towns within the tropics, we must be satisfied that the whole is the fabrication of Dr. Miller's fancy,." Dr. Miller's second reason for rejecting the agency of contagion in yellow fever, is because, as he says, " The pretended contagion is admitted to produce no effect in our climate, except in particular situations, at a particular season of the. year, when an impure and noxious atmosphere, which ought to be considered as a sufficient cause, is acknowledged to exist. But, (says he) to consider a disease as contagious, which at the same time exhibits no appearance of that quality but in certain climates, and in such climates only in certain places ; at such places only in certain seasons, and even at such seasons only after a particular degree of heat and moisture, is undoubtedly to lose sight of all the established properties and laws of contagion." All this is easily said ; but it is sometimes much easier to pen a flippant assertion than to prove it afterwards. And to do the doctor justice, he has not, in the present instance, even attempted it. What Dr. Miller means by contagion we know not; but according to the definition given of it by Dr. Hosack, in No. I. Vol. II. of the Re- gister ; a definition more accurate, precise and satisfac- tory than any we have yet seen, and which we therefore fully adopt, we cannot, at all, understand how it is at va- riance with the laws of contagion to consider the yellow fever as a contagious disease. For instance, why mav not a disease be considered as contagious because it is so only in certain climates ? Though this, by the way, is only another of the artifices which abound in this Essay ; Miller on the Yellow Fever. 17$ for nobody has contended for such a qualification in the case under consideration ; but admitting the fact, what then ? Why may not such a disease be contagious ? No one, we presume, will contend that the sibbins, or the laanda, or the yaws, or the leprosy, or the plica polonica, are not all of them contagious diseases : Yet the first is only found in Scotland, the second in Africa, the third in the West-Indies, the fourth in Asia, and the last in Po- land. The third of them only appears in the low coun- tries, never in the mountains. As to the pretence, that the contagionists admit that the yellow fever is only conta- gious after a particular degree of heat and moisture, it is wholly unfounded. 3. " It is admitted, (the doctor proceeds) that the disease does not spread when the sick are removed from the impure air in which it was contracted. By breathing this impure air, without exposure to the effluvia of the sick, persons are every day attacked; while, on the contrary, without breathing it, however exposed to such effluvia, no person is attacked. The conclusion, therefore, is irresistible, that the impure air is the cause." In the first place, we do not by any means make the admission to the extent here stated. On the contrary, in our last, we published a letter from Dr. R. C. Moore, containing a circumstantial account of the deaths of no less than five different persons on Long Island, all of whom received the yellow fever there, in the country, by contagion from the sick who came there ill, from town; and the narrator himself also received it from a gentleman who took it in town, where it prevailed, and removed into the country, where he was confined " in an airy, well ventilated chamber, surrounded with every comfort which the tenderness and opulence of his parents could bestow." 176 Miller on the Yelloxv Fever. We shall once more take the liberty of presenting, also, a few cases to Dr. Miller's notice, extracted from his own work, the Medical Repository, vol. 3. p. 8. It is taken from a dissertation, by Lyman Spalding, lecturer on chemistry, Sec. &c. « Since reading the above dissertation, I have seen Dr. Rand's ob. servations to the A. A. S. on the same subject, (yellow fever in Boston in 1798) in which, he seems to think the fever was not contagious from tl* diseased. With due deference to the opinion of so good a man, I must beg leave to add the following cases in support of my former opinion. " My brother, hearing of my sickness, came twenty miles to my assistance, remained in my chamber almost continually for sixteen days, taking the sole care of me. About two weeks after his return, lie was attacked with the fever, no other person within three miles bein^ affected. « In Windsor, a Miss Bailey was very severely attacked, in the s>ickly part of the town, three miles from her fathers; an elder sister came to her assistance, and was immediate nurse until she recovered. On her returning home, she was herself attacked, and died. Another sister, who was her immediate nurse, and had seen no other person labouring under the disease, nor been in the infected part of the town, was also attacked, and died." Lastly we beg leave to present an extract from Ad- doms* Dissertation, containing the following facts, as com- municated by Dr. William Moore ; whose testimony, Dr. Miller will not, we are sure, in common gratitude, dis- pute ; for Dr. Moore was the first gentleman on the list of physicians in this city, who once published a most de- lectable address to Dr. Miller, for the very memoir on malignant fever, now under review, which they scruple not to declare, " contains a transcript of their best, and most matured professional opinions," and which " pre- sents a view of malignant fever, at once, correct in its prin- ciples, solid in its arguments, and perspicuous in its de- Miller on the Yellow Fever. 177 tail.*' These gentlemen also add, " that they have read the memoir with attention!" which we should certainly be very sorry to think. Perhaps, if they would give the memoir another, and a litde more attentive perusal, they would find it neither so " correct in its principles, solid in its arguments, or perspicuous in its detail," as they first imagined, and would see ample cause to regret what they have done. But we are wandering from our purpose. To the ill judged and too inconsiderate panegyric referred to, Dr. Moore was the first to set his hand. Permit us now to introduce this gentleman as a witness against the very object of his public admiration. «' Dr. William Moore, (says Mr. Addoms, p. 7) an eminent phy- sician, of New-York, informed me, that a gentleman from Lime, in the state of Connecticut, was on a visit to this city, when he became a patient of his, in whom the disease was very evidently marked, at- tended with large vibices ; he however recruited considerably before he left the city; on his passage to Lime, he relapsed, and died shortly after he reached home. The greater part of this family caught the contagion, and soon became affected with a similar disease, which proved fatal to his mother, and some other persons in the family." Addoms' Dis. p. 7. note. Now, on the supposition that the inference drawn by Dr. Miller from his fancied premises be correct, it fol- lows irresistibly, if there is truth in logic, that in the cases just mentioned, not the breathing impure air, but expo- sure to the effluvia of sick persons was the sole cause. But it shall in candour be allowed, that, in the definition in our last of the contagion peculiar to four diseases, of which, yellow fever is one, it is expressly stated, that " these diseases are only, in general, communicable through the medium of an impure atmosphere." ' Dr. Miller's No. 4 might have more properly found a place under No. 3, and is already answered in our notice Vol. IL Z- 178 Miller on the Yellow Fever. of that number. We will, however, remark, that in his zeal to shew that the disease is only caused by breathing impure or pestilential air, and not by communication with the sick, the doctor has proved too much for himself. " In the last epidemic, of 1805, (says he) all the per- sons 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, escaped without infection." This, we presume, is the latest, as it is the most interesting discovery of the non-contagiousness of yellow fever* Here we have evidence, that persons may, with safety, not only expose themselves to the effluvia of the sick, of which, indeed, they had been informed in the preceding page, but that they may likewise walk into the most pestlv lential quarters of the town, enter the most filthy apart- ments, and, in short, breathe the most impure air with perfect impunity. We congratulate the public on the dis- covery announced, for, henceforth, there is nothing to be apprehended from the prevalence of yellow fever; indeed, there can be no such thing as a prevalence, for, since it can neither be communicated by the effluvia of the sick, according to page 666, nor propagated by a pestilential at- mosphere, according to 667, there is nothing to keep this " inexhaustible poison" alive, and it must inevitably die ; it must violate its own nature, and become exhausted, that is to say, cease to have an existence. One thing only is wanting to render this the most comfortable doctrine in the world, and that is, to be able to believe it. 5. " The extinction of the disease by eold weather, is an insupera- ble objection to the doctrine of its propagation by contagion. That the disease in reality depends upon an atmospheric poison, appears from the fact, that all the means which operate to arrest and destroy Miller on the Yellow Fever. 179 H, such as, cold, heavy rains, and high winds, are merely atmospheric agents." Shall we never be indulged with a single instance of any thing but bare assertion? Will Dr. Miller deal in nothing but apetitioprincipal It is not true that heavy rains, or high winds, or cold, unless accompanied with actual frost, have ever been known to have the least per- ceptible influence in arresting or destroying the yellow fever, as may be seen by turning to any one of the histo- ries of its prevalence at any place in the United States. Dr. Rush, in the very page that at this moment happens to lie open before us, observes, that in six particular in- stances, it has declined or ceased only about the middle of October; and he also observes, that in the year 1762 it continued to prevail in the months of November and December, and that the deaths were nearly as numerous in November and December as in September and Octo- ber. Dr. Miller has told us in this memoir, that " the pesti- lential fevers of our cities differ only in grade from the milder remittents of the country.** Let us now see how his argument stands thrown into the form of a syllogism. Remittents and yellow fever, are only different grades of the same disease, and governed by the same laws. The yellow fever is extinguished by frost, therefore, " it depends on an atmospheric poison," and, therefore, again, " cannot be communicated by con- tagion.'' The remittent fever is not extinguished by frost, therefore, it depends not " on an atmospheric poison," and, therefore, again, may be communicated by conta- gion ; and, therefore, lastly, is not the same disease. But if it results, that the yellow feve r is not a contagious dis- ase, it equally results that the remittent fever is so. We 180 Miller on the Yellow Fever. confess, that if left to ourselves, we should have held the diametrically opposite opinion, viz. that the yellow fever is, and the remittent is not, contagious ; and, we believe» the world holds it with us, and that we are amply support- ed by facts. The doctor has now, however, proved, that we and all the world have always been wrong, and him- self and Dr. JNIiichill only right. " Hot climates and seasons are universally held to be unfavourable- to the spreading of contagion. The reason is obvious. In warm weather, the doors and apartments of the sick are kept open, and ven- tilation is carried to the highest degree." " But if this disease de- pended on cold weather, when houses are more closely shut up, it would be then more certainly communicated, and more widely de- structive." Does Dr, Miller then contend, that the small pox is more certainly communicated in summer, when houses are kept open, than in winter, when they are shut? If he does, we refer him to the first part of this same memoir, where he may see another pleasant sample of self-contradiction. If any thing more frivolous, more puerile than this, has ever proceeded from any writer of reputation, when en- gaged in treating didactically a seiious subject of contro- versy, it has totally escaped our observation. 6. " Yellow fever does not prevail in countries where the heat is' not sufficient to exhale the miasmata of foul grounds, and other cor- rupting matters, in the requisite quantity and virulence." Will the learned gentleman inform us what is the dif- ference in the comparative degrees of heat, between New-York, and the adjacent villages of Brooklyn, the Wallabout, and Amboy ? And if there are none, or none worth mentioning, will he proceed, and inform us how it Miller on the Yellow Fever. l&U happens that all these places have each in turn, but no two at once, experienced the prevalence of the yellow fever ? When this is done, then shall we be ready to discuss his sixth reason more fully with him. . 7. " Many persons who had contracted the yellow fever in New. York, during the several seasons of its prevalence there, died of it at B'>sion, Albany, and other cities, at a distance, &c. In no instances did these victims of the epidemic communicate contagion." This is just what is said in his reason No. 3, and is already answered ; but adepts in controversy know that the majority of readers are very apt to believe, that where numerous reasons are set forth in form, something must of course be proved. 8. " The remarkable exemption of physicians from this disease, provided they attended to a few simple precautions, is also irreconcila- ble to the doctrine of its contagiousness." Why so ? But we question the fact here taken for granted. If Dr. Miller will turn to the histories of the yellow fever in 1795 and 1798, he will find no such exemp- tion mentioned there ; on the contrary, he will find a nu- merous account of their deaths ; and, on the sad list, some of the most valuable of the faculty, both at Philadelphia and at New-York. Have we not lost all our health offi- cers who attended the quarantine ground? a Treat, a Bayley, and a Ledyard ; a Rodgers, (thanks to a gracious Providence, and a good deputy,) still lives for the benefit of himself and family. But this exemption of the phy- sicians, we observe, has a proviso annexed; just a few simple precautions must be attended to. What are they ? The doctor, rightly supposing the secret would be eagerly sought after, has very properly and kindly communicated it. 182 MiUer on the Yellow Fever. ** The more happy escape of physicians in this last than in former -epidemics, is to be attributed chiefly to their having secured a resi- dence in the higher and safer parts of these cities, and to the compa- rative unfrequency of their visits to the districts of envenomed atmos- phere." The " simple precautions," then, is a late thing, and consisted in their taking good care to keep more out of harm's way. Truly a very good, as well as a a very sim- ple precaution" ! Happy thought, and thrice happy the brain that first engendered it. In vain, however, have we strove to comprehend how this exemption of those physi- cians, who took such care to keep clear of the disease, is a proof of its non-contagiousness. But supposing this greater exemption of physicians than others, independent of the precaution, we then say, that it must be owing to the same cause that secured exemption to those employ- ed in removing the sick, as mentioned by the doctor a few pages before, who, it seems, could not take the disease one way nor tV>ther, neither from the diseased, nor from a pestilential atmosphere, in short, they were completely bomb-proof, as we say in the army. The doctor adds, " It is understood, at the same time, that these physicians, in their confidence of the non-contagiousness of the disease, generally spent more time in the apartments of the sick, and were in the habit of making a more deliberate and minute examination of the cases which fell under their care, than in preceding epidemics." It is apparent that the doctor advances this without feeling any confidence himself in its correctness. It would appear after all, then, that it was those physicians, onlv, who believed in the non-contagiousness of the disease that were exempted. What egregious trifling! 9. " The failure of every attempt to arrest the progress of the dis- ease, by the separation of the sick from the well, is also incompatible with the doctrine of contagion." Miller on the Yellow Fever. 183 Forever begging the question. Does the writer mean, that the progress of the disease was never arrested by an abandonment of the diseased place ? If he does, we must contradict him on that fact. Wherever it has been found practicable to abandon it, as it has been in several villages, the disease has entirely disappeared, and the place might be visited with perfect safety in a few weeks afterwards. Such was the fact at Newburyport, a number of years since ; that it was so at the Wallabout, in the year 1804, we were witnesses ; the writer of this visited and exami- ned the spot for himself within three weeks, and such has also been the case at Brooklyn. But this is only ano- ther instance of that disregard of correctness, that disin- genuous artifice, which marks every page of this elaborate essay. If any thing more is necessary, the doctor shall furnish it himself. In the 8th volume of the Medical Reposito- ry, he states, that at the Wallabout the inhabitants aban- doned their houses, &c.; and, " in consequence of this, (says he) the disease was suddenly arrested."" Thus, the effluvia of sick bodies no longer prevailing, the disease disappeared, notwithstanding all the '* marsh miasma*. exhaled by heat, and floating in the atmosphere." 10. " The inconsistency and contradiction which constantly attend the application of the doctrine of contagion in this disease, make it altogether inadmissible. To explain one set of facts, it must infinitely transcend the small pox; to suit another, it must entirely forfeit the power of communicating itself by contagion. On some occasions, ijt is more subtle, penetrating, and rapid than the electric fluid; oft others, more sluggish and dormant than the grossest matter. Con- trary to all other noxious substances, it is often more destructive at a distance than near to its source ; for, at one time, it cannot reach a single individual among a great number surrounding the bed of the patient, and in frequent contact with his person, while at another, i must strike at the distanceof several hundred feet" 184 Miller on the Yellow Fever. We feel ourselves bound to pronounce, that all this is but a tissue of perverse misrepresentation; and it is diffi- cult to conceive that any mind which could thus descend to the employment of such pitiful artifice, must not be as de- ficient in correctness of reasoning, as it is in candour. But the singular manner in which the author finishes the para- graph is both absurd and ludicrous. *' The noxiousness (says he) of the miasma of foul grounds, ex- haled by heat, and floating in the atmosphere, explains all these fact•«*. and reconciles all these contradictions." So then, after all his attempts to fabricate a mis-state*- ment, which he falsely and ungenerously imputes to his opponents, and then heaps upon it all the ridicule he can command, he acknowledges it to contain sober facts, which he has a theory at hand to explain, and contradictions which the same theory Can reconcile. Only allow him his idio and koino miasmata, and he can do what has hither- to been supposed to transcend the powers of man ; he can explain what is inexplicable, and reconcile contradictions. We have arrived at the end of his ten reasons, but as ho seems himself not quite satisfied with them, but goes ou with other ** reasons annexed:" we must follow him a lit- tle further. " If it were necessary to add any tiling to the evidence of these ir> ^esistible facts, it might be subjoined, that yellow fever cannot be Considered as a contagious disease; because, unlike all other conta- gious diseases, it has no specific character, no definite course or du- ration, and no essential or pathognomonic symptom." We have in candour to confess, that we are altogether at a loss for language to express our astonishment at this paragraph. Scarcely a writer among the very numerous ones that have treated on the yellow fever, but have begun Miller on the Yellow Fever. 185 by very properly describing the disease, its specific charac- ter, definite course or duration, and its pathognomic symptoms. If it were possible to believe, that the learned author had never read, or had forgotten the descriptions of this disease, given by Warren, Moseley, Chisholm, and a score of others, what shall we think of his having totally overlooked his own volumes ? his fourteen volumes and nearlv three hexades of the Medical Repository ? a labour in which he has been engaged for no less than fourteen years. Finally, what shall we, what must we think of his having forgotten the beginning of the very essay under re- view before he had quite reached the end of it ? The first volume of the Medical Repository opened with two es- says, by one of his colleagues, for the express purpose of proving that our yellow fever was the same disease which, in the year 430, a. c, was called the plague, and depo- pulated Athens. For which purpose, it became necessary to describe, in the first place, what were the pathognomonic symptoms of our yellow fever ; and this, again, necessa- rily obliged him to describe the fever itself minutely, in order that he might identify it with the Athens plague, which he also describes. " This disease [the Athens plague] (says he) broke forth suddenly j its attack was generally sudden, commencing without any previous illness or apparent cause. It began with violent head ache, inflamma- tion and fiery redness of the eyes, soon succeeded by inflammation of the throat, difficult respiration, and offensive breath; a sneezing and hoarseness followed, with cough and other pulmonary affections. But the progress and nature of the disease will be more clearly compre- hended, from the following disposition of the particular symptoms.'* This is followed by an enumeration of no less than ten dif- ferent symptoms. How far these symptoms go to prove the writer's proposition, we shall not here trouble ourselves t* Vol. II. A a 180 Milk? on the Yellow Fever. examine, as it is not necessary to our purpose. They are, al any rate, pertinent to show, that the editors of the Medi- cal Repository, when it suits their views, have no difficulty in admitting the character, duration, and symptoms of yel- low fever; and, as we now see, when they have different views, they are equally ready to deny their existence. To come, at once, to the point, we will produce a few extracts from the Medical Repository itself. We find the doctor engaged in describing the yel- low fever in the city of New-York, in 1803, and he has one division of his subject entitled " symptoms," and be- ginning thus: " The phenomena of yellow fever in this season, did not materially differ from such as heretofore have been observed to characterise the disease." Med Rep. vol. 7 p. 180. And, we find him in another volume of the same work, in an article, entitled " yellow fever at Cadiz." speaking thus: ,c We learn that this Spanish disease was precisely such an one as 8. Verruca. 69. Molluscum. 70. Vitiligo. 75. Ephelis. 76. Naevus. Ord. I.—PAPULA. 42. Prurigo. Ord. II— SO.UAM.ffi. 45. Pityriasis. 46. Icthyosi*. Ord. III.—EXANTHEMATA. 50. Roseola. 51. Purpura. 52. Erythema. Ord. IV.—BULLjE. 55. Pompholyx. Ord. V.-PUSTUL.E. 59. Scabies. 60. Porrigo Ord. VI.-VESICULjE. 64. Miliaria. 65. Ec/eina. 66. Aphthae. Ord. VII-TUBERCULA. 71. Acne. 72. Lupus. 73. Elephantiasis. 74. Frambcesia. Ord. VIII.-MACULffi. 77. Spilus. CLASS. IV.—PROFLUVIA. 78. Epistaxis. 79. Haemoptysis. 80. Haematemesis. 81. Hepatirrhoea. Ord. I.-HJEMORRHAGIiE. 82. Hematuria. 83. Haemorrhois. 84. Menorrhagia. • In thi» class, Dr. Wfllan's lucid arrangement of cntaneous diseases is adopted. 668 Hosack's Classification of Diseases. 85. Ephidrosi?. 86. Epiphora. 87. Otirrhcea. 88. Ptyalisraus. 89. Galactirrhoea. 90. Cholera. Ord. II.-APOCENOSES. 91. Diarrhoea. 92. Dysenteria. 93. Diabetes. 94. Enuresis. 95. Leucorrhoea. 96. Gonorrhoea. CLASS. V—SUPPRESSIONES. 97. Icterus. 98. Obstipatio. 99. Ischuria. 100. Dysuria. 101. Dyspermatismus. 102. Amenorrhcea. 103. Dysmenorrhcea. 104. Suppressio mensium. 105. Dysiochia. 106. Agalactia. CLASS. VI.—NEUROSES. 107. Apoplexia. 108. Paralysis. 109. Amaurosis. 110. Dysopia. 111. Pseudoblepsis. 112. Strabismus. 113. Dysecoea. 114. Paracusis. Ord. I.—PARALYSES. 115. Anosmia. 116. Agheustia. 117. Aphonia. 118. Paraphonia. 119. Psellismus. 120. Dysphagia. 121. Anaesthesia. Ord.'H.-ADYNAMLE. 122. Asphyxia. 123. Syncope. 124. Dyspepsia. 125. Pyrosis. 126. Bulimia. 127. Satyriasis. 128. Nymphomania. 129. Anaphrodisia. Ord. III.—SPASMI. a. Infunctionibus Jnimalibus. 130. Tetanus. 131. Trismus. 132. Dolor faciei. 133. Tremor. 134. Convulsio. 135. Chorea. 136. Epilepsia. b. Infunctionibus Vitalibus. 137. Palpitatio. 138. Angina Pectoris. 139. Asthma. c. Infunctionibus Naturalibut. 140. Colica. 141. Nephralgia. 142. Hysteralgia. 143. Hysteria. 144. Hydrophobia. 145. Amentia. 146. Melancholia. 147. Hypochondriasi?. Ord. IV.—VESANIjE. 148. Mania. 149. Oneirodynia. Hosack's Classification of Diseases. CLASS. VII.—CACHEXIJE. 269 Ord. I.-lNTUMESCENTIffi. a. Adiposes. 150. Polysarcia. b. Flatuosa:. 151. Pneumatosis. 152. Tympanites. 153. Physometra. c. Aquosce. 154. Anasarca 155. Hydrocephalus. 156. Hydrorachitis. 165. Atrophia. 166. Rachitis. 167. MollitirsOssium. 168. Lithi.isis. 169. Scrophula. 157. Hydrothorax. 158. Hydrops Pericardii. 159. Ascites. 160. Hydrops Ovarii. 161. Hydrometra. 162. Hydrocele. 163. Hydrops Articuli. d. Solid*. 164. Physconia. Ord. II.-VITIA. 170. Syphilis. 171. Sibbens. 172. Scorbutus. 173. Petechia? sine febre 174. Plica Polonica. CLASS. VIIl—LOCALES. Ord. I.—DYSESTHESIA. ¥75. Caligo. Ord. II—TUMORES. 176. Aneurisma. 177. Varix. 178. Ecchymoma. 179. Schirrus. 180. Carcinoma. 181. Bronchocele. 182. Sarcoma. 183. Fungus Haematodes. 184. Polypus. 185. Lupia. 186. Ganglion. 187. Exostosis. 188. Hernia. 189. Prolapsus. 191. Vulnus. Ord. III.-ECTOPIJE. 190. Luxatio. Ord. IV.—DIALYSES. 192. Ulcu*. Ord. V.-DEFORMITATES. ( 270 ) REVIEW. Art. I. An Appendix to Thomas's Practice of Physic, by Edward Miller, M. D. Professor of the Prac- tice of Physic in the University of New- York. New- York. Collins and Perkins. 8vo. pp. 697. 1811. (Continued from page 189.) We hasten to conclude our Review of this extraordi- nary Appendix. We have examined and disposed of Dr. Miller's ten cogent reasons why the yellow fever is not and cannot be a contagious disease: but our task is not yet finished j for, to these ten reasons the doctor has annexed various additional reasons, under separate heads, which must be examined and disposed of also. In our last we have al- ready made some progress, in considering these, and an observance of order brings us now to his question, " Can the yellow fever be imported and exported ?" The nega- tive, he says, may be indubitably maintained for several reasons. 1. " The non-contagiousness of the disease, if admitted, must entirely destroy the belief of its introduction from abroad," &c. True. Nobody doubts that. But as, instead of being admitted, it happens to be the identical question in issue, it would strike us unaccountably strange to find an ad- mission taken for granted, had we not so often before met with similar conduct on the part of Dr. Miller : it is the doctor's great reliance throughout this controversy; and entitles that gentleman at least to the character of a bold sophist. Miller on the Yellow Fever. 271 2. " If the alleged importation were possible, in any case, it might happen at any season of the year. In the active sea-ports of the United Sta es, shipping from the West-Indies are very frequently arriving at all seasons ; and it is known that the yellow fever may be found in those islands at any period of the year." In this second reason, the doctor is, we fear, equally unfortunate as in his first. If the reader will turn back six pag'js, he will find the doctor answering himself ; for he there says that, " the extinction of the disease by cold weather is an insuperable objection to the doctrine of its propagation by contagion.""* If so, if the winter extin- guishes the disease, it seems hardly fair to expect us to prove that it propagates it also, or to give up the doctrine of importation. But, notwithstanding the doctor's assur- ance, we think it still remains for him to explain, how the extinction of the disease by the cold of winter proves it cannot be "imported during the heat of summer. His argument is this ; its importation is not possible in sum- mer, (when the requisite degree of atmospheric heat pre- vails) because it never happens in winter, (when the re- quisite degree of atmospheric heat is absent.) 3. " If the yellow fever could be introduced from abroad, it is impossi- ble to explain its non-appearance in the United States for a long series of years, when no means were used to secure its exclusion. For more than fifty years preceding 1795, no importatoin of the disease into the city of New-Tork was suspected." * After all the stress laid by Dr. Miller on this argument, arising from " the extinction of the disease by cold weather," is it not a little) singular, to find this gentleman furnishing us with a case in the Me- dical Repository, vol. 9. p. 395, as communicated by Dr. V. Seaman directly in the teeth of his own doctrine ? This case happened in January 1806, when " the earth was locked up by frost and covered with snow." We mean not, however, to claim any advantage from this case, for, from Dr. Seaman's own description, it is very clear it \v as a case, not of yellow fever, but of ordinary typhus. 272 Miller on the Yellow Fever. What ? Is it indeed so, that for more than fifty years together, New-York has been entirely free from yellow fever, and yet its air be a " local, stationary,"" and " in- exhaustible poison ?" that it be subject to constant " ex- halations from masses of filth and corruption, overspread- ing a large area of ground, forming a vast hot-bed of putrefaction, incessantly teeming with miasmata, and thereby, in despite of currents of air, loading with the seeds of disease every successive portion of the atmosphere that sweeps or stagnates over the pestilential surface," [engen- dering yellow fever ?] Has this always been the case with the inhabitants of this ill-fated city, and yet have they, for more than fifty years together, never once been visited by yellow fever ? Have they, then, for such a long period respired " currents of air loaded with the seeds of disease," and yet remained exempt fro*m it ? Has " every successive portion of atmosphere" they breathed, been thus contaminated, and yet have they not been aware of it for fifty years together ? Has " a vast hot-bed of putrefaction, incessantly teeming with miasmata," been the soil they have, all this time, inhabited ? Has a " pes- tilential surface" formed the ground under their feet for upwards of half a century ? Has a " local, stationary, and inexhaustible poison" constituted the climate in which they have lived, moved, and had their being, and yet have generation passed away after generation, without this " terrible scourge of yellow fever" being ever known and felt by any mortal man among them, until up rose Dr. Ed- ward Miller to inform them of their direful misfortune, and to assure them that they " live in the latitude of pestilence ?"* But before Dr. Miller can imke his • Vide Dr. Miller's first edition of the essay under consideration ss originally published in a letter addressed to Goy. Lewis^jn 1805. Miller on the Yellow Fever. 27'J deduction that the yellow fever's not being imported from the West-Indies during the period of fifty years, is evi- dence that it is not importable from thence, is it not, in fair argument, incumbent on him first to show, that dur- ing that period, and its great occasional mortality, it was not the common fever of the climate, but the pestilential yellow fever, that proved so fatal in the West-Indies ? He mentions, indeed, several instances of great mortality among the English troops there, and he says that thousands of sick were landed in New-York ; but let him produce any one medical writer of the day who denominates that sick- ness the yellow fever, or whose description of its pathogno- monic symptoms shows it to have been such. If not the yellow fever, he is certainly entitled to no such inference as he has drawn. But, on the other hand, if, as he says, our climate, itself, is " the latitude of pestilence ;" if this ruinous charge which he has brought against our city, be well founded, and there be any truth in the axiom that like causes produce like effects, let him account to us, if he can, by what magic or miracle it was, that the course of nature was arrested in its operations for more than fifty years ; during part of whick period, namely, the revolu- tionary war, the city of New-York was not once swept or in any way cleaned for seven years ; the streets being the receptacles of carrion, spoilt vegetables, and thereby ren- dered one mass of filth ? Or will Dr. Miller, in order toes- cape from one difficulty, plunge headlong into another, and say the mortal diseases of the West-Indies above spoken of must have been yellow fever, because all febrile diseases, whether bilious or remittent, by a happy " arrondissement in the doctrine of fevers," are the same ? ".The pesti- lential fevers of our cities differ only in grade from the bilious and remittent fevers of the country." This is, Vol. II. m m 274 Miller an the Yellow Fever. indeed, all that is left to he said ; but this opens the way for a question of some importance to the doctor and his party, and his answer must be a decisive one. We ask you then, sir, whether, when you allow that the yellow fever did not appear in the sea-ports of the United States for more than fifty years, you mean to be understood as saying, that during this length of time neither remittent nor intermittent fever made their appearance ? An answer in the affirmative would discover an ignorance of facts not to be suspected, and therefore we shall suppose you to answer, without hesitation, in the negative. If so, we only desire you to remember, that, in the very essay under consideration, you have assigned as one reason to prove the yellow fever is not contagious, that " it has no specific character, no definite course or duration, and no appro- priate, essential, or pathognomonic symptom." How then, we ask, can you, or any other man who thinks as you do, know the disease when you see it ? 4. " JVb importation of this disease, so as to become epidemic, was evei known in any part of Great-Britain, Ireland, or France." This is admitted ; and what then ? The Doctor him- self shall solve the difficulty. Let us once more turn back half a dozen pages and see what he says there. " Yellow fever does not prevail in countries where the heat is not sufficient to exhale the miasmata of foul grounds and other corrupting matters in the requisite quantity and virulence. We hear nothing of this dis- ease in Great-Britain, Ireland, or France." " For want of the atmospheric heat and other circumstances requisite in the generation of yellow fever, they are happily exempt from its epidemic prevalence;." All very well ; but how Miller on the Yelloxv Fever. 275 this proves that the yellow fever cannot be brought from the West-Indies into the United States, where there is no ' want of atmospheric heat,' we are altogether at a loss to comprehend. This argument seems to be a-kin to that which infers that the yellow fever cannot be brought hither in the heat of summer because it cannot exist in the cold of winter, and that, because it cannot exist in the cold of winter, therefore it cannot be brought hither during the heat of summer : thus affording a pregnant example of what logicians call reasoning in a circle. 5. " The appearance of the yellow fever in tlie interior parts of tire country, inaccessible to foreign contagion, confirms the opinion of its do- mestic origin, while it entirely invalidates that of its importation." Certainly : The appearance of the yellow fever in the interior of the country would completely invalidate the opinion of importation. Once produce a case, a single case of yellow fever, in any interior part of the country, inaccessible to importation, and unvisited by newly arrived passengers or sailors, and it shall be granted that there is an end to the question. We fearlessly venture, however, to assert, that no such case ever yet existed ; certainly no such case is to be found in the volumes or hexades of the Medical Repository ; and if not, we think we may, with- out apprehensions of contradiction, deny their existence ; for it is utterly incredible, that such a case could exist, and yet elude the never ceasing and unlimited researches of the zealous partisans who conduct that learned work. We take it to form a correct test by which to judge of the nature of a disease, to inquire into the treatment em- ployed ; similar remedies generally indicating similar dis- eases, and vice versa. The editors of the Repository, in proof of their assertion that the epidemic fevers of the inte- rior parts of the country are no otherthan our yellow fevers 276 Miller on the Yellow Fever. of the city, have produced several letters from medical gentlemen and others, which they have published, and on which they entirely rely. Many of these letters, we admit, hesitate not to declare the same opinion, but on examination it will be found that while they pronounce one doctrine they prove another. They certainly confess that the remedies they have employed with success were " emetics, followed by the bark and tonics."" Now, every physician conversant with yellow fever, knows that this treatment of that disease would prove certain and immediate death. We find it also stated in a letter to Dr. Hosack, as found in u Barton's Medical and Physical Journal," that "the general duration of the lake fevers may be said to be about nine days," and that " when the disease proves fatal, it is, in general, on or about the twentieth day." Is it still seriously contended that this is the yellow fever of cities ? But what shall we say to the following passage taken from the fourth volume of their work ? " The plague of Asia, like the yellow fever or pestilence of our own country, is a disease which delights in the devastation of popu- lous cities. Perhaps neither of these calamities has ever been known to originate, as an epidemic, in villages or country situations." Vol. 4 p. 403. This is the language of Dr. Caldwell of Philadelphia, one of their most zealous and certainly most able partisans. 6. " A comparison of the summer of the year 1804, with the corres- ponding season in 1805, the period of the last epidemic at JYew-York, will go far to show the dependence of the yellow fever on the condition of the atmosphere, and of course to overthrow the doctrine of importation The summer of 1804 was mild and cool to a remarkable degree, on all the Atlantic coast of the United States, lying to the northward of the Carolinas" " All the Atlantic cities north af the Carolines without ex- ception, entirely escaped the epidemic that season." Miller on tin Yellow Fever. 277 We observe that the writer, in the latter sentence, makes use of the word cities, " all- the Atlantic cities ;" but, as in the fore part of the quotation, he sets out with a general proposition, embracing ** all the Atlantic coast" when he afterwards says " all the Atlantic cities north of the Carolinas," we are authorized to understand the words as no more than a repetition of the former assertion a little varied, but equally extensive in meaning. To suppose any thing else, would be to suppose a iSiserable quibble, and would make the latter part of the sentence incongruous with the former. We understand Dr. Mil- ler, then, as saying, that in the summer of 1804, " all the Atlantic coast of the United States, north of the Ca- rolinas, without exception, escaped the disease." This escape he accounts for, by telling us, that it was owing to the remarkably mild and cool summer of that year ; and this single circumstance, he says, goes far " to show the dependence of the yellow fever on the condition of the atmosphere; and of course, to overthrow the doctrine of importation.''* How far the facts, when investigated and established, will go to show " the dependence of the yel- low fever on the atmosphere," may not, perhaps, be so very clear; but that they go far, very far indeed, to show how little dependence can be placed on the correctness of Dr. Miller's statements, or the legitimacy of his conclusions, shall presently be made to appear. When the impartial reader comes to peruse the follow- ing very particular account of the epidemic which raged at the Wallabout, in the summer of the very year 1804; a summer which we see so highly commended for its remarkable coolness and mildness, and during which, therefore, it is asserted, no yellow fever appeared on kt all the Atlantic coast northward of the Carolinas ;" 278 Miller on the Yellow Fever. when, we repeat, he comes to read the account which fol- lows, what will be his surprise, his astonishment ? As this is one of the most leading cases ever known, and one of the most satisfactory that can be imagined, to prove the importation and contagiousness of the yellow fever, we shall take the liberty of giving the particulars and the evidence at full length, as furnished by the editor of the New-York Evening Post at that time. We begin with the ensuing article, taken from that paper of Septem- ber 11, 1804. " Epidemic at the Wallabout: " Being of the number of those who view the question, whether the yellow fever is imported into the United States, as one of the most interesting that can occupy the attention of this community, deeply involving the lives and fortunes of its members, it would be affectation to apologize for devoting a few columns to its investiga- tion. It will be allowed, that if a single instance can be produced and authenticated, in which the disease has been introduced from abroad by means of vessels, it will be decisive of the question: that instance I now offer to produce and authenticate. " In June last several persons living at the Wallabout were attacked with the yellow fever ; from these it was communicated to others, in all seventeen, of whom eight died ; after which it ceased, in consequence of the remo- val of the inhabitants. For the information of the distant reader it is proper to observe, that the Wallabout is a little hamlet situate on the eastern shore of the East river, which divides the city of New-York from Long-Island and consists of eight dwelling houses and two or three out-houses, the distance between the two extreme houses being about one third of a mile. The situation, soil, and circumstances of the place will more particularly appear Miller on the Yellow Fever. 279 from the affidavits that are to follow, accompanied by the letter of John Jackson, Esq. who is the proprietor of the soil. The following is a correct statement, obtained from the inhabitants at the Wallabout, of the manner in which the disease showed itself, and the order of the cases. Isaac W. Browni Bdward Livingston, Samuel White, James Castles, and Mrs. Little, (since dead,) on the 20th of June : Mrs. Little died on the 24th or 25th, the rest recovered. Philip Dring sickened the 21st, died the 23d. Mrs. Sherlock sickened the 22d, died the 28th, Jane Johnson sickened the 23d, died the 27th. Mrs. Dring sickened the 30th, recovered. Sally Wakeman sickened the 29th or 30th, died July 3d. William Arbutton sickened the 28th, died at the Ma- rine Hospital July 3d. Benjamin Rhodes sickened the 29th, recovered. George Little, Mrs. Gentridge, (who laid out Mrs-. Little) and Patty Helme, sickened the 30th, all recovered. ---- Helme sickened July 1st, recovered. Patrick Proffer was a labourer who took the fever at the Wallabout, day unfhoAvn, came over to New-York, and after laying sick some days, recovered ; after which his case was made known in the Medical Repository. After five days from the removal of the brig La Ruse, no new case of fever appeared. The above will furnish a sufficient description of the patients for the present. The letter and affidavits will supply all the reader can want to know further. " On the evening of the 28th of June, I met Dr. Hosack in Wall-street, who informed me that the yellow fever had unquestionably appeared at the Wallabout, and that he had that day seen a man in this city, at No. 40 Pearl- .'80 Miller ok the Yelloiv Fever. street, labouring under clearly marked symptoms of the dis- ease, but which the Resident Physician (Dr. Miller) had pronounced to be only an ordinary cold ; that this man, al- though his habitation was here, was a labourer at the Wal- labout, and had slept in the very house out of which a wo- man had been buried, having died of the fever; desiring me to make a memorandum of the conversation, which I did. The next morning I saw Dr. Hamersley, Dr. Stringham, and Dr. Gamage, who informed me they were going over to the Wallabout for the sole purpose of examining into the facts, and making a statement of them. " A statement of facts was accordingly made by them from minutes taken on the spot; which they immediately sent to his honour the Mayor. The statement of these gentlemen it is not necessary to repeat, because one more in detail is now to be presented; it was substantially correct; in one or two particulars incorrect, but on the whole as near the truth as could be expected for the short time they were at the place collecting it; and in my opinion the public are highly indebted to them for the duty they voluntarily undertook, and which, had it only been persisted in, with spirit and firmness, to the end, would have given them very extensive claims on our gratitude. • For, had they not have gonj to the Wallabout at the time they did, I very much suspect we should not have been more fortunate in coming at the truth in this, than in for- mer instances. " As was foreseen, the Health Officer appeared in the very next Citizen in a full length vindication of his offi- cial conduct, and controverting the statement of the three physicians throughout. This vindication was published in this paper of July, but as it is now to be subjected to an examination, it may be convenient to bring it to Miller on the Yellow Fever. 281 the readers recollection by a short summary of its con- tents. " After complaining of * the misrepresentations of facts, distortion of truths, and malignant reflections,' which had been made on the occasion ; and after a perti- nent and proper approbation of the quarantine laws, Dr. Rodgers proceeds to state the situations of three vessels which lay at the Wallabout; to wit, the schooner Union, schooner Greyhound, and the brig La Ruse. With the first I have nothing to do, and therefore dismiss her at once. " The Greyhound, he says, was from Cape-Francois, 4 her cargo, coffee, in a very sound condition,' ' she was also cleansed, her bilge-water completely pumped out, and the water from the pump completely clear and free from smell.' 1 The brig La Ruse arrived June 4th, from Guada- loupe, in stone ballast, and light. Her crew consisted of six in perfect health ; four passengers, all well. She lost one man on the homeward bound passage, (the cook) whose complaint was declared by the physician at his arrival, to have been inflammatory, and not to have par- taken of the nature of yellow fever at all.' * The brig at this time was clean, she was free between decks, nothing in her hold but stone ballast, and this free from smell, and apparently very clean ; she had never been sickly, or in such a situation as to have given mistrust.' c Captain Chammings declares the hatches were closed the first six days after her arrival at the Wallabout, that he was the first person that opened them, and went down directly into the hold, that he did not perceive any disagreeable smell at all, nor was in the least incommoded.' * The ballast on board the La Ruse was dry clean stones,' &c. Vol. II. n n 282* Miller on the Yellow Fever. 1 Dr. Bailey went up by my direction on the 25th ult. to know the state of the vessels in the Wallabout ; he found them in such a situation as to warrant him in say- ing that no evil could possibly have arisen from them.' ' La Ruse hauled first to the navy-yard, where she lay till the 23d of June, when she moved to the wharf, op- posite to the house where a woman sickened on the 20th and died on the 24th or 25th. She lay there without dis- charging her ballast or even touching it till the 25th.' ' Upon the whole, I am confident no evil has arisen from La Ruse at any one 'time.' 41 can and do declare that no vessel has passed to the city of New-York from any place where malignant fever prevailed at the time of her departure, since I have been health officer.' ' All the ports from which the vessels now in the Wallabout, or which have been there since the first of June, sailed, were at the time of their departure, in great health.'— ' Edward Livingston and another man from the Walla- bout, labourers at the saw-pits, but not on board any vessel there, have been admitted into this hospital with malignant fever, and are recovering ; neither of them had ever been on board the La Ruse.' He then refers the Mayor, to whom the letter is addressed, to Dr. Mil- ler, the resident physician, as being a person better able to give an account of the misfortune at the Wallabout than himself; and concludes with some reflections on the conduct of the three physicians, accusing them of having been either purposely vague, and therefore disingenuous and uncandid, or with being guilty of reprehensible neglect in omitting to state material circumstances. " Such are the leading contents of the letter of the health officer ; and, if it shall appear that he is so very un- fortunate as to have been mistaken in all the leading par- Miller on the Yellow Fever. 28^ ticulars that he has thus stated, the detection will not, we hope, be chargeable to a wish on my part to distort the truth, nor to ' a misrepresentation* of facts,' nor the ' malignant reflections' of the three physicians. " As to the Resident Physician, to whom he refers as being more competent to f lrnish an account of the affair than himself, that gentleman has given his account in print. It has appeared in several of our morning papers and shall be republished in this to-morrow. It is hereaf- ter to be shown that the Resident Physician has been equal- ly unfortunate in his facts as the Health Officer." In confirmation of the above statement, the following appeared the next day, taken from the Medical Reposi- tory for July. " Malignant disease at the Wallabout. " About the twentieth of June cases of the malignant fever sud- denly appeared at the Wallabout, on Long Island, at Mr. Jackson's 9hip yard, near the navy yard of the United States : where a large number of ship carpenters and other labourers were collected, and where ship building is carried on to a considerable extent. The East river separates this place from the city of New-York. " Qf the persons attacked with this disease, eight are said to have died; two of these, however, are believed, by many, to have been affected by other disorders. Two labourers were seized with it soon after quitting the ship-yard and making their way into this citv ; one of them recovered, and the other died at the Marine Hospital, where he had been sent as soon as symptoms of decided malignity came on. " Difference of opinion, as usual, arose concerning the origin of this disease; some ascribe it to imported contagion, or the foul condition of certain vessels recently arrived; others to the accumulated filth and crowded state of the dwelling houses at the ship-yard. " The vessels charged with the importation of the contagion were the brig La Ruse and the schooner Greyhound; the former from Guadaloupe, the latter from Cape-Francois. It appears, from incon- testible evidence laid before the public by the health officer of this port, that the vessels in question came from ports which were in a ve- ry healthy state ; that no malignant disease had occurred on their passage; that on their arrival here they were completely cleansed by ventilation, washing, white-washing, &c.: that the clothing, bed- ding, &c. of the crews had been carefully ventilated and washed ; and that particularly the lime-stone ballast of La Ruse, which afterwards became the object of some ridiculous suspicions, had been perfectly 284 Miller on the Yellow Fever. washed as it lay in the hold of the brig, while she rode quarantine, by repeated taking in and discharging water in great quantities from along side. " Notwithstanding this remarkable, and, as it may possibly be thought by some, excessive scrupulousness in the health officer, ma- ny reports of the uncleanness in these vessels were industriously circulated. It was asserted, in particular, that the disease appeared after the discharge of the ballast from the brig La Ruse, which was just mentioned; but it is ascertained that three or four of the worst cases commenced before this ballast was moved. It was likewise as- serted, that the crew of La Ruse went ashore to the grocery store of Mr. Little, in whose house one of the first cases occurred, to pur- chase such things as they wanted; this, however, is positively contra- dicted by the testimony of Mr. Little himself, who declares (and whose certificate has been published) that no seaman or other hands from the brig had come to his house, or held any communication with his family, while she lay at the Wallabout. It was further as- serted that the brig in question lay close to the house of Mr. Helme, in which one of the most malignant cases commenced on the 20th of June : whereas there is the best evidence that this vessel lay at the navy yard of the United States, a distanse of more than one hundred and fifty yards from the spot referred to, until the 23d of the month, when she moved tothe wharf near to Mr. Helme's house, a day or two after some of the malignant cases had commenced. It would occupy too much of our time to mention and refute several other glaring mis- statements concerning those vessels, which were collected and laid before the public with all the confidence of the most authentic facts. " It does not appear that a single person of those attacked with this malignant fever had been on board either of the vessels charged with the importation of it, or held any communication with them, or any thing belonging to them. On the contrary, many persons, gene- pally from five or six to seventeen or eighteen in number, were on board of the brig La Ruse, for the purpose of repairing her, from the time of her arrival till her departure from the Wallabout: not one of whom suffered any sickness. On board of the Greyhound, whose bilge-water was said to have been offensive at a particular time, and which on that account, became an object of suspicion, there lived a family, consisting of a man, his wife, and several children, who all enjoyed perfect health while the sickness was prevailing on shore. To believe that these vessels could emit noxious effluvia to such a distance on shore, while, at the same time, so many persons on board of them remained in the best health, is to admit the incre- dible supposition that such effluvia are less pernicious in their con- centrated state, near their source, than being greatly diffused and diluted in the atmosphere. Besides, Mr. Middleton, with his family, lived nearer to the wharf were the suspected vessels lay than either Helme or Little; yet they all continued in perfect health, which must have been owing to their not being at all crowded, a circumstance very material, as will be presently seen, in the condition of the other fa- milies It deserves also to be mentioned, that a large proportion of all the victims to this disease, and some of the earliest, were women t Miller on the Yellow Fever. 285 whose occupations did not lead them to the wharves, who were em-« ployed within doors, and who had not been concerned in washing seamen's clothes, or in any intei course with them, which could ac- count for the communication of the disease. " But while the most decisive facts show thatthe disease in question could not have originated from either of the suspected vessels, or from any foreign source whatever, the local circumstances of the ship-yard itself, together with the condition of the inhabitants, will be found sufficient to satisfy any reasonable inquirer that the mischief was generated there. " A veryhigh and steep bank, beginning a few feet from the houses inhabited by the sick, effectually deprive persons residing there of the benefit of all refreshing breezes from the south and south-west. The principal houses are so situated, with their rears to the east- ward on the line of the navy-yard, that, for want of doors and win- dows on that side, they uhnost entirely exclude the n >rth-east, east, and south-east winds. Two ships on the stocks, surrounded by their scaffolding, together with large quantities of timber deposited in dif- ferent situations, prevented, in a great degree, the approach of cur- rents of air from the west and north-west. From these circumstances it results, thatthe only wind which had free access to the ship-\ aid, or could ventilate it with any effect, was a north wind, which seldom blows during the hot season The effect of these circumstances was strongly felt and acknowledged by the inhabitants of the place, who described, in striking terms, the unfavourableness to a free circula- tion of air, and their sufferings in consequence of the very hot and Stagnant air they were obliged to breathe. " The boarding-houses allotted to the numerous workmen at this ship-yard wereexcessively crowded. The number of lodgers stowed in single rooms was, in several instances, so large, that great danger must have resulted from this source, in a situation ever so favourable on other accounts. Iu one instance, it is asserted that nine labour- ing men, with their bedding, &c. were obliged to pass their nights in a room about ten or twelve feet square, with only one window or door. in several other cases which have been distinctly related, the degree of crowding was nearly as great. There was but one instance of a family at this ship-yard enjoying the comfort of apartments sufficient- ly spacious and commodious in proportion to their number; and thesr all preserved good health, while the neighbours around them were sickening and dying. " The quantity of vegetable and animal filth overspreading the ground, and lying about the boarding houses, taken in connection with the other circumstances of the place, was sufficient to generate great mischief. No plan of properly cleansing the yard seems ever to have been adopted ; of course this filth has been progressively ac- cumulating, and becoming more dangerous ever since the establish- ment at this place was first undertaken. " The number of persons at this place was sufficient to carry on the work of building two large ships, and of occasionally repairing others. Yet these workmen did not possess the convenience of a privy, the want of which must have added exceedingly to the other sources of the accumulation of tilth. When all these facts are considered in 286 Miller on the Yellow Fever. connexion with the local circumstances of the spot, which rendered ordinary ventilation impossible, it will not appear strange that a malignant disease should have been generated at this place. There would be no reason to resort to the vessels for the source of mischief in this case, even if the proofs of their clean andinoi:ensive state had not been so clearly establishedi " After the disease had continued to prevail for some time, the inha- bitants abandoned all the houses where sickness had appeared, dis- persed themselves in the adjacent neighbourhood, and caused the for- saken houses to be thoroughly ventilated and cleansed. In conse- quence of this the disease was suddenly arrested. And it deserves to be mentioned, that, on this, as on all similar occasions, nothing like contagion was communicated from the sick who were distributed throughout the neighbourhood of the Wallabout, made their escape into New-York, or were sent to the Marine Hospital; although in all these different situations, they were surrounded by nurses and at- tendants in the usual manner. " It is to be hoped, when all the circumstances of this affair are duly considered, it may have some effect hereafter in preventing the public credulity from being again so much abused, as it was in this case, by the fabrication of reports grossly unfounded, and which could answer no other purpose than to prop a declining doctrine, and to injure the reputation and commerce of New-York." "This is certainly taking very lofty ground, and adopt- ing language towards gentlemen of the same profession, not altogether civil or proper. In my opinion they would have been justified in answering instantly in the same style ; and, supported as they were, by having taken the right side of so plain a case, it was in their power to have replied in terms of tenfold severity. They, how- ever, notwithstanding they feel indignant at such an attack, have chosen the moderate course ; they have pre- ferred to observe, themselves, a dignified silence towards their illiberal opponents, and to leave it to me to sum up the cause before the court. I shall do it to the best of my ability, nothing doubting but the public verdict will be on the side of truth and justice. " I have pledged myself, to produce to this community such a body of testimony as to satisfy every rational man of the righteousness of the cause, which, from pure and Miller on the Yellow Fever. 287 disinterested motives, as I trust, I have espoused. This testimony shall now be submitted without further intro- duction. In the next paper but one, I shall endeavour to sum up the case. DEPOSITIONS. (No. I.) King's County, ss. Simeon Helme, of lawful age, being duly sworn, deposeth and saith, tli** he has lived with his family at the "Wallabout since March last, as master builder of the large ship now on the stocks at Jack- son's-wharf; that he well remembers when the brig La Ruse came up from the quarantine ground, and hauled along side the wharf at the navy yard, where she discharged part of her ballast before the sick- ness broke out; that some days after discharging the first load of bal- last, Mr. Philip Dring, son-in-law to the deponent, was taken with the yellow fever; he was taken ill on the '2lst, and died on the 25th. And the deponent further saith, thatthe said Philip Dring lived in the same family with himself, and slept in an adjoining room with his wife and child, but at the time he was taken sick, his wife's two sis- ters also slept in the same room; that this was a small bed-room, but that the door of the room adjoining, which was a large room of eighteen by sixteen feet square, was always kept open. And the de- ponent further saith, that this large room had a window that opened into the navy-yard, at the wharf of which the brig La Ruse lay when his son-in-law was taken sick, and within thirty yards of this window by admeasurement. And the deponent further saith, that the even- ing before Philip Dring was taken he told this deponent that he never in his life smelt any thing so very bad as the smell from the vessels ; meaning the brig La Ruse and the schooner Greyhound, which lay at a little distance from the wharf, but which had been pumping out their bilge-water, and that he heard Mrs. Little make a similar ob^ servation. And the deponent further saith, that Dring worked every day on the stern of a ship on the stocks, within about twenty-five yards of where the La Ruse lay at the navy-yard, and used to go re- peatedly to a blacksmiths shop to get iron work, within eight or at most ten yards of the brig. And the deponent further saith, that as soon as Mr. Dring was taken sick he was removed into the large airy room adjoining the one where he used to sleep, where he remained till he died ; but in a few days after he died, his wife was taken with the fever, and then the deponent and his family all moved off to an open and airy situation about a quarter of a mile to the south or south-east, but nevertheless on the 30th of the month, one of the de- ponent's daughters was taken down, and, on the first of July, the other, but all of whom recovered. And further saith not. SIMEON HELME. Sworn before me, September 7th', 1804. WJLLIAM FURMAN, J. P. 288 Miller on the Yellow Fever. (No. II.) ATwjr's County, ss. Simeon Helme, jun. of lawful age, being duly sworn, saith, that he, the deponent, is by occupation a wharfinger and has resided as such at the Wallabout, Long-Island, since before the appearance of the yellow fever at that place in June last, but has slept at Brooklyn ; that the deponent remembers when the brig La Ruse first came up from the quarantine ground, and hauled along side the wharf at the navy-yard, which was, according to the best of his recollection, about the 12th of June ; that a few days afterwards, and before the sickness appeared, this brig began to unload her ballast at the navy- yard; that he heard some of the persons employed in unloading this ballast say, that it was so very offensive, they could not throw out but a few stones at a time, without being obliged to put their heads up the hatchway to obtain a breath of fresh air : and the deponent saith, "that after unloading one sloop load, for some cause she desisted, and on the 23d she moved about her length westward to Jackson's wharf, which is only separated from the navy-yard by a fence ; and that after laying three days at this wharf, during which time she unloaded most of her ballast, Dr Bailey came up from the quarantine ground and ordered her down ; but before she went off the deponent saw one or more barrels of tainted beef thrown overboard by Dr. Bailey's orders. And the deponent further saith, that he frequently saw Mrs. Little, the woman who was first taken ill and died, down upon the wharf near where the brig La Ruse lay, and near the brig, looking for her child, which used to play about the wharf The deponent further saith, that when the La Ruse lay at the navy. yard, the schooner Greyhound lay at about one hundred or one hun- dred and fifty yards distant from the wharf, and while there, on the morning of the 18th or lyth of June, as the deponent was at work in the ship-yard, he perceived a most shocking smell to come from the water, the wind then being about north, and looking up he observed the schooner was pumping out her bilge water, which was the cause of the smell. At this time Philip Dring and Isaac Brown both com- plained to the deponent very much of this offensive smell, and the latter was obliged to leave his work in consequence, and go and get a drink of brandy and water ; in a day or two afterwards they were both taken with the fever. And the deponent further saith, that he views the Wallabout to be a healthy situation, well accommodated as to a free circulation of air, and the ship-yard as clean as ship-yards usually are any where, nor is there any animal or vegetable filth lying about or near it, so as to cause any kind of inconvenience to any per- son in the place. And further saith not. SIMEON HELME, Jun. Sworn before me, September 7th, 1804. WILLIAM FURMAN, J. P. (No III.) King's County, ss. Isaac M. Brown being duly sworn, deposes and saith, that being at work on the stern of a new ship on the stocks, which was then only in frame, with but three streaks of plank on her bottom, the deponent Mller on the Yellow Fever. 289 on either Saturday the 16th, or Monday the 18th of June, was ad- dressed by Philip Dring, who was at work on the stern of an adjoining ship, and asked what was that nauseous and disagreeable smell, to which die deponent said it was the bilge-water then pumping out of the schooner Greyhound, which lay, as near as the deponent can judge, about one hundred and fifty yards to the windward, or that it- came from the brig La Ruse, which was also then pumping out her bilge-water, and which lay within about thirty yards of where the de- ponent was at work. The effect was so disagreeable that the depo- nent got off the stage and went and got a ghjss of brandy and water. On the Wednesday following, to wit, on the 20th, the deponent found himself attacked vdth a pain in the head, back and limbs, on which he told Mr. Middletons that he hoped for the best, but he felt just as he formerly did when he had the yellow fever ; soon after he was attacked with it, and was sick about three weeks, when he re- covered. And the deponent further saith, that he bearded in the house of Mr. Middletons, adjoining, north-east,the house of Mr. Helme, and under the same roof; that he slept in a room alone, except- ing for one or two nights, when another person slept in the room, but in a different bed; that he never experienced any inconvenience from too many persons being crowded into one bed-room, nor did he ever hear of any such instance at the yard; nor has the deponent ever heard of any complaint by any person at the yard, of a want of cir- culation of air, nor has he ever perceived that the yard was less clean or the ground about it, than other ship-yards in New-York. And the deponent further saith, that he heard Mrs. Little complain of the bad smell of the bilge-water, and that she asked him what it was that smelt so bad at the time he went up and got the brandy and water ? And further saith not. ISAAC M. BROWN. Sworn before me, September 7th, 1804. WILLIAM FURMAN, J. P. (No. IV.) King's County, ss. Samuel Middletons being duly sworn, testifies and says, that he has, for some time past, worked as ship-carpenter at Jackson's ship- yard, and lives there with his family; that he boards some of the workmen, and occupies a house east of where the two ships are now building, within about ten yards of one of them ; that his house is under the same roof with that occupied by Simeon Helme, but north of it; that he has two windows, one below and one above, opening eastward on the line of the navy-yard, but the lower window has been cut since the fever; and that he occupied this house before and during the time of the late yellow fever at the Wallabout. The de- ponent further saith, that he well remembers that on the 18th of June, he was in the ship-yard in the morning, when the Greyhound was pumping out her bilge-water, which smelt excessively nauseous ; he lieard both Dring and Brown complain of it; the former of whim was aken with the yellow fever on the 21st, and the latter, who boarded Vor.. II. o o 290 Miller on the Yellow Fever. in the deponent's house, was taken on the 20th ; and he also heard Mrs. Little complain of the same thing, who was also taken on the 20th, and died on the 24th or 25th. SAMUEL MIDDLETONS. S.gorh before me, September 7th, 1804. WILLIAM FURMAN, J. P. (No. V.) King's County, ss. Edward Livingston, of lawful age, being duly sworn, testifies and saith, that in June last, he was engaged as sawyer at Jackson's ship-yard; that on the 18th or 19th of June, as he was at work one morning in the saw-pit, he was struck with a most dreadful smell, which he perceived to come from the bilge-water then pumping out of the Greyhound, lying about one hundred or one hundred and fifty yards from the wharf. And the deponent further saith. that on Tues- day evening the 19th of said June, as nearly as he can recollect, he went on board the brig La Ruse, then lying at the wharf, to get her boat to bring up a log that lay in the stream, and on the 20th he was taken down, in the evening, with the yellow fever; in consequence of which he was sent to the Marine Hospital, after being sick a week, and where, after about five weeks, he recovered. And the deponent further saith, that he never experienced any inconvenience from dirt or filth lying about the yard or the houses, nor saw more than is usu- al at ship-yards; nor had he ever suffered for want of circulation of air or excessive heat, while working there. And the deponent saith, that at the time he was taken sick he boarded at Mr. Little's, at the head of the ship-yard, at which time no other workman boarded in the house with the deponent but William Arbutton, who slept in the same bed with him, and was afterwards taken sick with the fever, as he is informed, and died at the Hospital; that no other persons, at that time, lived at Mr. Little's house besides Mr. Little and his wife, Jane Johnson, who was taken sick two days after the deponent, and died, as the deponent is informed, on the 27th, and two small children ; but no person slept in the room with the deponent, excepting the said Arbutton ; further the deponent saith not. EDWARD LIVINGSTON. Sworn before me, September 7th, 18J4 WILLIAM FURMAN, J. P. (No. VI.) King's County, ss. Benjamin Rhodes, of lawful age, being duly sworn, deposeth and saith, that he now lives and has lived for seven years past at the place called the Wallabout, on Long-island, and that during the said time he has been employed at the said place as a master builder, and that till the appearance of the yellow fever in June last, he has ever found the place very healthy ; that it is so situated as always to have a cool and pleasant air whenever there is wind stirring, from whatever quar- ter it blows ; this is more particularly owing to its being surrounded on all sides but one by water, and on that side, which is the south side, there is a break in the hill, so that even when the wind is south Miller on the Yellow Fever. 291 there is always a draught draws down through the ship-yards. And the deponent saith, that for seven years pa9t the number of workmen employed at the navy-yard adjoining Jackson's yard where the ships are now building, has been greater thin the present year, and in some years five to one. And the deponent further saith, that there is not, nor was at the time of Uie appearance of the fever, or at any other time'this summer, any animal or vegetable filth overspreading the ground at the ship-yard or round the boarding houses near it, but that it is, and has been as clean as ship-yards usually are in New- York. And the deponent further saith, that he has never heard any inhabitants at the Wallabout, nor any of the workmen employed there, complain of the want of a free circulation of air, or say that they thought the place an unfavourable situation, but on the contra- ry he has frequently heard the workmen speak of it as being far pre- ferable on that account, to the other side of the river in New-York. And the deponent further saith, that he lives about an eighth of a mile west of Mr. Helme and Mr Middletons, where the first cases. happened, but that he visited the sick every day till the 29th of June, when he was attacked with the fever himself, but after several days illness recovered. And the deponent further saith, that he keeps a boarding house for workmen, but has never been obliged to put more persons into one bed-room than could be well accommodated, and on examination the deponent is fully convinced that in no instance any of the boarders have been before the sickness or since, crowded at the houses at Jackson's-yard. BENJAMIN RHODES. Sworn before me, September 7th, 1804. WILLIAM FURMAN, J. P. (No. VII.) King'h County, ss. Asa Randel, of lawful age, being duly sworn, saith, that he has been employed as master ship-joiner at Jackson's yard, at the Walla- bout, since the first of May last, and that he has formerly been em- ployed at the adjoining navy-yard ■- that during the time he has been so employed the present season, the ground of the ship-yard, and the grounds about the houses, have been, and are, as clean as is custo- mary, as clean as other ship-yards are, and as theibrmer ship-yard used to be ; that all the time the deponent has been s* occupied be- fore and during the late fever, and since, he has never observed any thing of so filthy a nature as to cause the least inconvenience to the persons residing there ; nor has he ever heard any complaint of the want of a free circulation of air, but, on the contrary, when there has been any air stirring any where, the W;illabout has its full proportion. The deponent further saith, that he never has heard any complaint by any of the workmen of being crowded in the boarding houses by night or day, nor does he believe, from inquiry, any cause of such Complaint ever existed And the deponent further saith, that he heard captain Chammings savi that when he opened the hatches, and went down the hold of the brig La Ruse, there was a very disagreeable smell, but that he con- ceived it to be no more than what had been caused by the confined 292 Miller on the 1ellow Fever. air of the hold, and therefore did not mind it. And the deponent fur- ther saith, that he heard Benjamin Brown, the boatman employed in taking out the ballast of the brie La Ruse, say, that the ballast, when he first began to take it out, smelt very bad, but he thought it was- owing to the closeness of the hatches, and was not at all afraid. And the deponent saith, that by observation, and die best inquiries he can make, not more than seven or eight hands were ever employed on board the La Ruse to caulk her deck ; and the deponent further saith, that he was informed by captain Chammings, that this brig was an old captured vessel, and was bought in the West-Indies by said Chammings, and sent to New-York under the command of captain Story. ASA RAN DEL. Sworn before me, September 7th, 1804. ~ WILLIAM FURMAN, J. P. (VIII.) King's County, ss. Jonathan S. Wakeman, being duly sworn, saith, that he resided at the Wallabout for some years past, during which time he has done the work for the ship-yard, as the master blacksmith, and in that time a greater number of workmen have generally been employed than in the present year; in 1799, the deponent boarded nineteen hands in his house, and the present year he has boarded, before the fever, two, and since that time, five; the deponent further saith, that he was at work with Philip Dring, on the stern of the new ship, when the smell of the bilge water was so nauseous and offensive to them all, and when Dring spoke to the deponent and asked him what was the cause of such a dreadful smelK' The deponent looked toward the schooner Greyhound, and saw her pumping out her bilge-water, and he saw the water come out so very black as to turn the water black at her side. And the deponent further saith, that the ship. yard, with which he has been acquainted for seven years, has always been in a clean and healthy state, and as clean the present year, since it was removed to Jackson's wharf, both before and at the time of the fever, as it ever was, when it was kept at the navy-yard, on the other side of the fence. The deponent further saith, that whenever any wind is stirring, from whatever quarter it blows, the yard is as well supplied with fresh and cool breezes as any place whatever; and that when tlie*wind blows from the south-east any way hard he is obliged to shut his shop-window ; nor has he ever heard of any com- plaint of a want of circulation of air by any of the people. And the deponent further saith, that his sister, Sally Wakeman, who died with the yellow fever, boarded at his house, and before she was taken ill she frequently visited Messrs. Dring's, Helme's and Little's, and was greater part of her time with the sick. JONATHAN S. WAKEMAN. Sworn before me, September 7th, 1804. WILLIAM FURMAN, J. P. Miller on the Yellow Fever. 293 (No. IX.) . King's County, ss. • Thomas Wright, of lawful age, being duly sworn, saith, that he has for some time worked at Jackson's ship-yard, at the Wallabout, as a ship-joiner, and was there on the 26th of June last, at which time he saw Dr. Bailey at the yard, and he heard him order two barrels, one full, the other part full, of spoilt beef, to be thrown overboard from on board the brig La Ruse, which then lay at the wharf. And the depo- nent further saith, that he never observed that the ship-yard, or any of the ground about it, was ever in a more dirty or filthy state than is customary at other ship-yards, and such as is caused by the quantity. of dry chips that lie loose about the vessels ; nor did he ever hear any person complain, or perceive himself, that the ship-yard at the Wallabout was so situated as not to have a free circulation of air THOMAS WRIGHT. Sworn before me, September 7th, 1804. WILLIAM FURMAN, J. P. (No. X.) King's County, ss. William Sherlock deposeth and saith, that he has lived three years at the Wallabout; said place was as healthy as arty place, during the time, as he ever knew, until the shipping came there in June last. On the 20th June the*yellow fever made its appearance ; on the 22d his wife was violently attacked, and on the 28th died with the black vomit. She frequently went to the dook of the navy-yard, where the brig La Ruse lay, to pick up chips ; the roems where his wife and three children and self resided, were large, on the second story, had the benefit of a free and pure air from all quarters, being nearly sur- rounded with running salt water. A few days after the families moved away from Jackson's yard, the fever disappeared ; the place has been healthy since, although there has been nearly twice the num- ber of men at work at Jackson's yard as there were before the sick- ness, all whom have been healthv ; and further saith not. WILLIAM SHERLOCK. Sworn before me, September 7th, 1805. WILLIAM FURMAN, J. P. " Before I go farther I owe it to truth and candour to correct an error, which I have just discovered in the pre- ceding number. " It has been said that the crew of La Ruse abandon- ed her at the quarantine ground, and that she was brought to the Wallabout, by persons hired from Long-Island. This is a mistake, she was brought up by her own crew. " Previous to proceeding with the depositions it may not be amiss to state, that captain Siory, who commanded La • 294 Miller on the Yellow Fever. Ruse, has. very politely given me all the information I asked for, and even permitted me to examine his log- book and to transcribe what I chose. The history of the brig in relation to this affair is as follows : " The brig La Ruse was taken as a merchant vessel, returning from Demerara to Guernsey, by a French pri- vateer, and carried into Point-Petre,* where she was pur- chased by Captain Chammings about ten days after her arrival, and in about three weeks more was fitted out for this port; the whole time she lay at Point-Petre was, as I am informed, about six weeks. Before captain Story sailed he understood some cases of fever had oc- curred at the place, but not that the disease was preva- lent so that it could be called a sickly port, and thus be brought within our Act. On the J,5th of May she set sail. The following is an extract from the log-book : * 23d. Cook complained. 24th. Jack (a boy about nineteen years of age) and cook complaining. 25th. Cook worse. 26th. half past one, Larch Norgrave fthe cook] departed this life, after a short ill- ness, and was committed to the deep. Jack much better.' " The cook's bedding and all his clothes were thrown overboard with him. The brig arrived at the quarantine June 5th, and on the 8th the captain left her, and she was brought up to the Wallabout by the crew." " The above account has been read by me, and the circumstances are correctly stated. WM. W. STORY." September 13, 1804. * We understand that our board of health perceiving that persons in many vessels from Point-Petre were affected with yellow fever, have, during the last two months, subjected all shipping from thence to a rigid quarantine, and we now deem it our duty, for the sake of the health of the other ports of the United States, to declare from authority that the Board yesterday received official information of the prevalence of the yellow fever both on shore and in the port of Point- Petre.—Aurora. Miller an the Yellow Fever. 295 " I now proceed with the remainder of the testi- mony. (No. XI.) King's County, ss. James Cassils, of lawful age, being duly sworn, deposeth and saith, that he was one of the labourers who worked at the Wallabout as ship-carpenter, and was in the yard on the 18th of June, when he perceived a very disagreeable smell to come from the vessels, and looking towards the schooner Greyhound, saw she was pumping out her bilge-water, which seemed to be the cause of it. And the deponent further saith, that on the 20th of June he was taken with the yellow fever ; and on the 27th of June, the deponent was sent to the Marine Hospital, where, after some days illness, he recovered ; and further saith not. JAMES CASSILS. Sworn before me, September 14, 1804. WILLIAM FURMAN, J. P. (No. XII.) King's County, ss. Samuel White, of lawful age, being duly sworn, deposeth and saith, that he was one of the ship-carpenters who worked at the Wallabout, and was in the yard on the 18th of June, when he perceived a very disagreeable smell to come from the vessels, and looking towards the schooner Greyhound, saw she was pumping out her bilge-water, which seemed to be the cause of it; and the deponent further saith, that on the 20th of June he was taken with the yellow fever, and re- covered in about twelve days ; and further saith not. SAMUEL WHITE. Sicovn before me, September 7, 1804. WILLIAM FURMAN, J. P. LETTERS. (No. XIII.) JYew-fork, September 12, 1804. To Mr. Simeon Helme.—Sir, •*" I perceive that Dr. Walter, in his letter to the health officer, has, among other things, undertaken to state the dimensions of your house, and the number of persons in your family. Suspecting from what I have seen and been informed of, that the Doctor is wide of the truth, I enclose you that part of his letter containing the above, and should I be right in my conjecture as to its inaccuracy, I will thank you to inform me of it, and to send me the exact dimensions of your rooms, and number of persons living with you at the time the fever appeared. 1 will not trouble you to put it in the form of an affidavit: a letter will answer. Yours, WILLIAM COLEMAN 296 Miller on the Yellow Fever. (No. XIV.) Wallabout, September 12,1804. To Mr. Coleman.—Sir, The following is the information I suppose you want: The house I now occupy is two stories high, containing two large rooms sixteen by eighteen feet, one in each story, and two small rooms, ten by twelve ; besides this, there is a kitchen in a separate building, fourteen by fourteen. At the time of the fever, there slept in the lower part of the house, myself and wife, Mr. Dring and wife and his four children, and my two daughters. In the upper rooms slept Mr. Leeds and wife and two children, in one room, and two men, boarder^, in the other room ; and four boarders, workmen, slept in die kitchen, making in the whole, twenty persons which then com- posed the family. Yours, (No. XV.) SIMEON HELME. September '2, 1804. To Mr. Coleman.—Sir, As the most satisfactory answer to your letter I can give, respecting the Wallabout, I here transcribe, by permission of his honour the Mayor, that passage in my report, as secretary of the Health Committee, which relates to your questions. " My first object w.as to examine the state of the houses, with respect to the cleanliness, and I had the satisfaction of perceiving that the inhabitants had not been negligent in regard to this important article. The rooms which had been occupied by the sick, had been thoroughly cleansed, and the houses whitewashed ; nor did I see any diing offensive in the vicinity." To the above 1 may add, that from the view I had of the situation of the place, the information I received from different individuals on the spot, and an unbiased reflection upon the whole in iny own mind, the result is, that I perceive no cause existing there, which, in my opinion, could have produced malignant fever. Though formerly an advocate for the domestic origin of that disorder, but always believing, that it might likewise be imported, I am induced to suppose that the late disorder at the Wallabout must have been brought there by some one or more of the vessels, which then lay at the Wallabout. I am Sir, your most obedient servant, JAMES HARDIE. (No. XVI.) Brooklyn, September 12, 1804. Mr. Coleman.—Sir, Your letteris just received, nor is the least apology neces saw for having addressed it to me. My answer shall be marked by sincerity, and with all the perspicuity in my power. In reply to your first question I have to say, that the ground at the Wallabout is a fine gravel; with wells of good water. There are now ut this place eight dwelling houses and two or three outhouses ; the distance between the two extreme houses are about one third of a Miller on the Yellow Fever. 297 mile. These houses are sufficiently separated for every purpose of cleanliness or convenience. Middletons and Helme both live under one roof; these two houses only are situated with their rears on the navy-yard to the eastward, but they both have upper and lower win- dows on that side, and are well ventilated. On the south is a bank of about fifty feet in height, but in this bank there is such a valley that wheri^er a south wind blows the place below enjoys its share of it. Beirig surrounded on every other side by running salt water, for there are no fresh marshes near, it almost constantly enjoys cool and re- freshing breezes equal to any other place. I lately, on a very hot day, and when the wind was south, made the experiment of placing the thermometer in the open air in the middle of the day in the shade below, and afterwards placed it in the open air under a tree in the orchard above, when 1 found the mercury to rise in a short time near- ly two degrees. In a word, I regard it, and have always regarded it, as being as healthy a place as I ever knew ; and the present yard is, in my opinion, better ventilated and more accommodated with fresh air and cool breezes than the former ship-yard, now the navy vard was ; which is owing to our having dug away the bank since. 1 can- not express my surprise to you, sir, at lately observing it asserted in an account taken from the Medical Repository, that the place was un- favourable to a free circulation of air, and that the inhabitants suf- fered from the hot and stagnant air they were compelled to breathe. 1 find it also stated in the same account, that the two ships now on the stocks prevented the approach of the air from the west and north- west ; but, at the time of the fever those ships had very few planks on, so that the air could meet with little or no obstruction ; though since, thev have been planked, but the fever has not made a second appearance. For several years I have carried on ship-building, and employed more men at the navy-yard, which joins it; and last year I employed a greater number of men at this same ship-yard, than I did prior to the sickness this year, but so far from being unhealthy, I have been accustomed to postpone engaging my hands till the latter part of summer, when I had no difficulty in procuring workmen a shilling a day cheaper than they would do the same work in New-York; nor have I been able to discover, or have heard of any thing that should make it more unhealthy this year than in former seasons, and since the sickness I have had twice the number of hands at work I had be- fore. I have been at the yard almost every day, but I have never dis- covered that the ground of the ship-yard was dirty, more than what was caused by dry chips lying about, nor have I seen any more filth of any sort than is usual round houses in such country places. You ask me if there are privies, because, as I presume, the Medical Re- pository account asserts, " the workmen did not possess the con- venience of a privy, the want of which, they say, must have added exceedingly to the other sources of the accumulation of filth1" There is a large privy at Helme's house, close by the ship-yard, but the truth is, the workmen do not use it, because the wharf extends so low as always to have more or less water, and during both rising and falling water, has a strong current running by it, and the men go Vol.. II. v p 298 Miller on the Yellow Fever. down there. You can judge, sir, whether this " can add exceedingly to the other sources of filth." But it is also said that the boarding houses allotted to the workmen were excessively crowded. The number of houses at the Wallabout, situated within about one third of a mile of ground, is eight; of these seven are two-story houses, and five are double houses, all of them sufficiently roomy fgr the families that occupy them. The whole number of workmen at, the yard, at the time the fever appeared there, was about twenty ; of these, one lodged at Mr. Middletons'; seven at Mr. Helme's, three in the house with himself, and four in an out-house ; two at Mr. Little's ; from four to five at Mr. Rhodes' ; at Mr. Titus's two ; at Mr. Goodridge's one, and at Mr. Martin's one. As to the number of workmen stowed in single rooms, I have not been able to discover that it was in any instance inconvenient; the greatest number that have slept in a room has been four, all of whom have remained in health. Your second question relates to the characters of the workmen, and the tenants who occupy the houses. As to this I can only say, that so far as my acquaintance extends, I have uniformly found the workmen to be decent and industrious, and persons of veracity. If your object is to know whether the persons who have made affidavits respecting the fever at the Wallabout, are people to be credited, I have no difficulty in saying, that they are all decent men, and entitled to full credit; and, having read tlitir affidavits, I have no doubt of the facts to which they have testified, as most of them fell under my own observation. As to the tenants, they are as cleanly, well behaved, industrious people as I wish to have in my houses. In answer to your third question, I well remember the brig and schooner both coming to the Wallabout. The schooner lay off, as I should judge, about one hundred, or one hundred and fifty yards, but the brig lay alongside the wharf, at first at the navy-yard, for some days, and then she hauled her length forward to the ship-yard ; where she lay till she was moved down to the quarantine ground. On the 26th of June, after the brig had been ordered back to the quarantine ground by Dr. Bailey, and after the death of Mrs. Little and Mr. Dring, Dr. Rodgers. the health officer, came up to the ship- yard, and seeing him standing there, 1 asked him what he thought of the disorder that prevailed at the place, and whether he did not think it was the malignant fever; and told him I wanted information on which I could rely for my guide as to my workmen, who looked up to me for advice whether to stay at the yard or not. He said he had not discovered any thing to induce him to be of that opinion j at Uiis time Dr. Waters came out of Mr. Little's and said one or two more were going; I then asked Dr. Rodgers to go in and see the persons sick there, Jane Johnson and Edward Livingston, and he did so. I then requested him to go over to the mills at the navy-yard and see Mrs. Sherlock, he did so ; when he came out of the house, I asked him what he thought ? he said Mrs. Sherlock had the intermittent fever, and I need not be alarmed. The next day Jane Johnson died, and the day after, word came to me that Mrs. Sherlock was dying ; both she and Jane Johnson died with the black vomit I then wa« Miller on the Yellow Fever. 299 fully convinced that it was the yellow fever, and advised the people to remove from the place as fast as possible. Most of them did so, and soon after the disease disappeared. This, sir, is all the information that I presume you want, and all that occurs to me as being material to the question to which it re- lates. I am, Sec. JOHN JACKSON. (No. XVII) J\Tcw-York, September 12, 1804. To Da. Daniel Lord.—Sir, Being engaged in the investigation of facts, in order to enable the public to form a correct opinion of the origin of the yellow fever, which appeared at the Wallabout, in June last, I conceive that the very interesting nature of this inquiry to the community, is such, as to form my apology for applying to any person who, I may suppose, can give me information on the subject. I therefore, sir, do not hesi- tate to address myself to you, although I have not the pleasure of a personal acquaintance with you, as I understand you were the first physician called on to visit the sick on that occasion, and can proba- bly furnish me with some important particulars. In order that you may perceive at once the design of my inquiries, and shape your an- swer to the precise point, I take djp liberty to submit the following questions to you: First—When you saw your patient or patients, did you, at once, judge the disease to be the yellow fever ? Second—-Did you discover any thing in the ship-yard, or in the houses, or about them, to induce you to believe the disease originated there ? Third—Did you see one or more vessels lying, at that time, at the Wallabout, to which you thought, and still think, the origin of the disease justly attributable I Your answer, sir, in as concise a form as you please, will render a service to the cause of truth, and particularly oblige Your humble servant, WILLIAM COLEMAN. (No. XVIII) New-York, September 12, 1804 Ma. Coleman.—Sir, In answer to your letter, just received, I with sincerity de- clare, that 1 would very gladly have been excused from seeming to take any side in the controversy. A great aversion to having my name appear in the papers, and still more, a personal friendship for the Health Physician, create a strong reluctance against complying with your request; on the other hand, a sense of duty to the commu- nity, and of what is owing to truth, operate forcibly to induce me not to withhold from the public such information relative to the late epi- demic at the Wallabout, as is in my possession. I proceed, therefore, briefly to answer your question. To the first 1 have to say, that on the 24th day of June I was called to visit Philip Dring, who, I was told, was very sick, witii vomiting, &c. 300 Miller on the Yellow Fever. As soon as I saw him I had no hesitation in deciding, in my own mind, that it was a case of unequivocal yellow fever, having seen a great deal of that disease since 1797, when I first removed to this city. At the same time, in an adjoining room, lay another person by the name of Cassils, not so ill, but who was then attacked with the disease. In answer to repeated inquiries of what I thought of their illness, I told Mr. and Mrs. Helme, Dring's father and mother-in-law, that it was the yellow fever. I then saw Jane Johnson and a man by the name of Livingston, at Mr. Little's, a house within a few yards of Helme's, whose cases I likewise pronounced to be yellow fever. In answer to your second question I have to say, that being one of those who firmly and steadily believed the yellow fever was a disease of local origin, I inquired of Mr Helme first, if there were no fresh stagnant water or dead animals in his neighbourhood ? but was answered in the negative, aud told the water which covered the sur- face every where near them, was salt water, and rose and fell with the tide. I next inquired of him where their sink and necessary were > after being told, and viewing them, I walked over the ship-yard and down to the wharf, and about it, and could perceive nothing that could give the least cause of suspicion, nor did the situation of the houses, or of the adjoining grounds, furnish to my mind any cause for the appearance of the disease. In answer to your third question, I did see two schooners and a brig : one schooner and the brig lying at the wharf. I went on board the schooner at the wharf, which was the Union; on examination she appeared to have been well cleansed and white-washed, both in the hold and forecastle, and I thought her perfectly clean. I did not go on board the brig, for I was informed her cabin and hold, Sec. were all locked up, so that I could not examine her. Young Mr. Helme at this time observed, that it must have been the ballast of this brig that caused the mischief, and on inquiry, I found she had unloaded some part of it. If I am asked my opinion on this question, I feel myself, as a man loving truth and candour, obliged to declare, that there was such a total want of local causes, (the wind then being from the north- east and east, and for about a fortnight previous, and the weather quite cool,) that I felt myself entirely overpowered and compelled to relin- quish an opinion that had been unshaken for years. It was my de- cided opinion then, it remained so after two more visits, (and the last for the express purpose of examining into facts,) and I now am neces- sitated to be of opinion, that the yellow fever was introduced into that place by one or both of the vessels that I saw there. I am, Sir, your humble servant, DANIEL LORD." " I now proceed to sum up* the cause, which I shall endeavour to do with brevity, candour and precision. Fortunately, the grounds of the controversy are narrowed by its being, at length, admitted, (with what inexpressible Miller on the Yellow Fever. 801 reluctance the public has seen,) that the disease in ques- tion was decided yellow fever. " The health-officer, after two deaths had occurred, and while three lay sick before him, pronounced the disease not malignant [or yellow] fever; and after the exami- nation of a third, he deliberately and formally declared it was only an intermittent, and that there was no cause of alarm. While the resident physician, equally acute and dis- cerning, gave it officially as his opinion to the Common Coun- cil, in the case of Arbutton, even three days after his at- tack, and but forty-eight hours before his death of black vo- mit, that there were no symptoms sufficiently marked to warrant an opinion ; and, at the same time informed them that Patrick Profay, another labourer, who had been suf- fered to come into the heart of the city, and pass through all the stages of the disease without a word's being commu- nicated' to the public, or even to the Common Council, " was better." Thus our city was exposed for several days to all the horrors of an epidemic yellow fever, because those to whom the care of ic had been particularly com- mitted held a theoretical opinion that the yellow fever was not a cont agious disease. Who will say we have not had a narrow escape ? But cases multiplied so fast, and deaths so frequently followed, marked by such peculiar and dreadful symptoms, that at length they admitted that the yellow fever did prevail at the Wallabout. The only question then remaining is, in what way was this pesti- lence introduced there ? Two only are suggested : one that it originated in the place from bad u air, soil, weather," and other local causes ; the other, that it was imported in the brig La Ruse, from Point-Petre, or the schooner Greyhound, from Cape-Francois, and commu- nicated to the inhabitants. 302 Miller on the Yellow Fever. " The Health Commissioners are the advocates of the former opinion; other physicians, of equal standing in the profession, (to say the least) embrace the latter. Thus were they at issue. " The first particular information that the public had of the epidemic, was communicated by three physicians of this city, Drs. Hamersley, Stringham, and Gamage, in a letter addressed to his honour the Mayor, and published on the 3d of July, thirteen days after the disease had made its appearance. After stating a number of facts, they observed, that they should forbear making any com- ments, and that their only wish was to present to the first magistrate, such a statement of facts, as should enable him to take the most proper method for the preservation of the city. What could be more modest, more inoffensive, than this highly praiseworthy conduct ? Who could have supposed it could have created animosity in any one ? But the facts they stated, though unaccompanied with re- mark, spoke a louder language than any comments ; they went direcdy to the destruction of a dangerous and darling theory, to which certain medical gentlemen are wedded, and which they seem determined to part with but with life, and to them it gave the highest offence. This offence vented itself in aspersions the most extraordi- nary the public had ever witnessed in an address by gen- demen of a learned profession to brothers of the same profession. The Medical Repository went the whole length of charging them with fabricating reports grossly unfounded, for the purpose of abusing the public credulity, " which would answer no other purpose than to prop a declining doctrine, and to injure the reputation and com- merce of New-York." But we were not to be the dupes of this imposing language. We shall soon see who it was that fabricated reports; we shall soon see who it was Miller on the Yellow Fever. 303 that abused public credulity for the purpose of propping a declining doctrine; and lastly, we shall see whose doc- trine it is, that is indeed injurious to the reputation and commerce of New-York, and a libel on our climate and our country. " The answers have appeared; the first from Dr. John R. B. Rodgers, supported by an accompanying let- ter of Dr. Walter ; the second from Drs. Mitchill and Miller, editors of the Medical Repository, and the latter the resident physician. These are now to be examined. " Method would seem to require me to begin with a recapitulation of the facts stated by the three physicians, but it will be seen that that is not necessary to a full un- derstanding of the subject. As the editors of the Medi- cal Repository have given us, at large, and with much learning and ingenuity, a particular account of the " local circumstances of the ship-yard, together with the condi- tion of the inhabitants," for the express purpose of satis- fying all reasonable inquirers that the mischief generated there, I will begin with them. That they may not com- plain of any " malignant misrepresentations" from me, I shall, whenever practicable, quote their own words ; and I shall give the refutation in the words of the witnesses. " To show the unfavourable situation of the Wallabout, they say: " A very high and steep bank, beginning a few feet from the house in- habited by the sick, effectually deprives persons residing there of the benefit of all refreshing breezes from the south and south-west."—Medical Re- pository. Take the following in answer— " It r_the Wallabout] is so situated as always to have a cool and pleasant air whenever there is wind stirring, from whatever quarter it blows ; this is more particularly owing to its being surrounded on all sides but one by water, and on that side, which is the south side, there is a break in the hill, so that even when the wind is south, there is always a draught draws down through the ship-yard."—Rhodes' Deposition 304 Miller on the Yelloxv Fever. Same point—" On the south, is a bank of about fifty feet in height, but in this bank there is a valley, that whenever a south wind blows the place below enjoys its share of it."—Jackson's Letter. Once more—" The principal houses are so situated with their rears to the eastward on the line of the navy-yard, that for want of doors and windows on that side, they almost entirely exclude the north-east, east and south-east winds."—Medical Repository. E. contra.—" Samuel Middletons, being duly sworn, testifies and says, that his house is under the same roof with that occupied by Simeon Helme, but north of it; that he has two windows, one below and one above, opening eastward on the line of the navy-yard, but the lower window was cut since the fever." Same point.—" And the deponent further saith, that this large room had a window that opened into the navy-yard."—Helme's Depo- sition. Same point.—" Middletons and Helme both live under one roof; these two houses only are situated with their rears on the navy-yard to the eastward, but they both have upper and lower windows on that side, and are all ventilated."—Jackson's Letter. Once more.—" Two ships on the stocks, surrounded by their scaffolding, together with large quantities of timber deposited in different situations, prevented, in a great degree, the approach of currents of air from the west and north-west."—Medical Repository. E. contra—" Isaac M. Brown, being duly sworn, deposeth and saith, that being at work on the stern of a new ship on the stocks, which was then only in frame, with not three streaks of plank on her bottom." Same point.—" I find it also stated in the same account, that the two ships on the stocks prevented the approach of the air from the west and north-west, but at the time of the fever, those ships had very few planks on, so that the air could meet with little or no ob- struction • though since, they have been planked, but the fever has not made a second appearance."—Jackson's Letter. Once more.—" From these circumstances, it results, that the only wind which had free access to the ship-yard, or could ventilate it with any effect was a north wind, which seldom blows during the hot season. The effect of these circumstances was strongly felt and acknowledged by the inhabitants of the place, who described, in striking terms, the unfavour- ableness of it to a free circulation of air, and their sufferings in conse- quence of the very hot and stagnant air they were obliged to breathe." Medical Repository. E. contra.—" And the deponent further saith, that he views the Wallabout to be a healthy situation, well accommodated as to a free circulation of air."—Helme's, jun. Deposition. Same point.—" Nor has the deponent ever heard of any complaint by any person at the yard, of the want of a free circulation of air."—Brown's Deposition. Same point.—" Nor had he ever suffered for want of circulation of air, or excessive heat while working there."—Livingston's Deposi- tion." Miller on the Yellow Fever. 305 Same point.—" And the deponent further saith, that he has never heard any inhabitants at the Wallabout, nor any of the workmen employed there, complain of the want of a free circulation of air, or say that they thought the place an unfavourable situation, but on the contrary he has frequently heard the workmen speak of it as being far preferable on that account, to the other side of the river in New- York".—Rhode's Deposition. Same point.—" Nor has he ever heard any complaint of the want of a free circulation of air, but on the contrary, when there has been any air stirring any where, the Wallabout has its full proportion." RandeVs Deposition. Same point.—" The deponent further saith, that whenever any wind is stirring, from whatever quarter it blows, the yard is as well supplied with fresh and cool breezes as any place whatever; and when the wind blows from the south east any way hard he is obliged to shut his shop window ; nor has he ever heard any complaint of a want of circulation of air by any of the people."—Wakeman's Deposi- tion. Same point.—" Nor did he ever hear any person complain, or per- ceive himself, that the ship-yard at the Wallabout was so situated as not to have a free circulation of air."—Wright's Deposition. Same point.—" Being surrounded on every other side by running salt water, for there are no fresh marshes near, it almost constantly enjoys cool and refreshing breezes equal to any other place. I lately, on a very hot day, and when the wind was south, made the experi- ment of placing a thermometer in the open air in the middle of the day, in the shade below, and afterwards placed it in the open air un- der a tree in the orchard above, when I found the mercury to rise in a short time nearly two degrees. In a word I regard it, and have al- ways regarded it as being as healthy a place as I ever knew ; and the present yard is, in my opinion, better ventilated and more accommo- dated with fresh air and cool breezes than the former ship-yard, now the navy-yard, ever was ; which is owing to our having dug away the bank since. I cannot express my surprise to you, sir, at lately observing it asserted in an account taken from the Medical Repository, that the place was unfavourable to a free circulation of air, and that the inha- bitants suffered from the hot and stagnant air they were compelled to breadie."—Jackson's Letter. " I have been the more particular in multiplying tes- timony as to this single fact, because it is one that seems to depend on the experience and feelings of numbers. We now return to our two physicians. " The boarding houses allotted to the numerous workmen at this ship- yard were excessively crowded. Tlie number of lodgers stowed in single rooms was, in several instances, so large that great danger must have re- sulted from this source, in a situation ever so favourable on other accounts. In one instance, it is asserted that nine labouring men, with tlieir bed- ding, &c. were obliged to pass their nights in a room about ten or twelve Vol.. II. Q. q 300 Miller on the Yellow Fever. feet square, with only one window and door. In several other eases which have been distinctly related, the degree of crowding was nearly at great."—Medical itepository. E. contra.—" On examination the deponent is fully convinced, that in no instance, any of the boarders have been, before the sickness or since, crowded at the houses at Jackson's yard."—Rhodes' Deposition. Same point.—" The deponent further sath, that he never has heard any complaint by any of the workmen of bei tg crowded in the board- ing houses by night or day, nor does he believe, from inquiry, any cause of such complaint ever existed."—Rondel's Deposition. Same point.—" For several years I have carried on ship-building, and employed more men at the navy-yard than now at the ship-yard which joins it; and last year I employed a greater number of men at this same ship-yard, than I did prior to the sickness this year, but so far from being unhealthy, I have been accustomed to postpone en- gaging my hands till the latter part of the summer, when I had no difficulty in procuring workmen a shilling a day cheaper than they would do the same work in New-York ; nor have I been able to disco- ver, or have heard of any thing that should make it more unhealthy this year than in former seasons; and since the sickness I have had twice the number of hands at work I had before."—Tackson's Letter. Same side.—" But it is also said that the boarding houses allotted to the workmen were excessively crowded. The number of houses at the Wallabout, situated within about one third of a mile of ground, is eight; of these, seven are two story houses, and five are double houses, all of them sufficiently roomy for the families that occupy them. The whole number of workmen at the yard, at the time the fever appeared there, was about twenty ; of these one lodged at Mr. Middletons'; seven at Mr. Helme's, three in the house with himself, and four in an out house ; two at Mr. Little's ; from four to five at Mr. Rhodes'; at Mr. Titus's two ; at Mr. Goodridge's one, and at Mr. Martin's one. As to the number of workmen stowed in single rooms, I have not been able to discover that it was in any instance inconve- nient ; the greatest number that have slept in one room has been four, all of whom have remained in health."—Same Letter. " To show the manner in which these unhappy work- men were stived up, so that the poor fellows engendered, and indeed could not but engender yellow fever, Dr. Daniel D. Walter is brought forward. This diffident young gentleman tells us that he does not want to hear any discussion of the question of importation ; to show however, that it was not imported, but originated in the house of Mr. Helme, he has undertaken to give us the precise dimensions of Helme's house, every way, to a single foot, and as his ill-stars will have it, he is not Miller on the Yellow Fever. 307 right in any one particular: he has also undertaken to give us the number of lodgers, in which the same bad luck attends him, for he has not stated the number right in any one room, excepting the outer kitchen. He says, in a letter to Dr. Rodgers, " You wish to be informed of the number of inmates dwelling in each house. In Mr. Helme's house, which consists of two rooms, each fifteen feet square, and two, each eleven feet square, and a very small kitchen, in all five rooms, there lived twenty-four or more persons, twelve of whom or more have constantly slept in the two lower rooms, eight or more in the two upper, and four or more in the kitchen."—Walter's Letter. " Suspecting, from what had fallen under my own ob- servation, that the doctor was a little mistaken, I wrote to the occupant for information. The following is an ex- tract from his answer. " The house I now occupy is two stories high, containing two large rooms sixteen by eighteen feet, one in each story, and two small rooms ten by twelve ; besides this, there is a kitchen in a separate building fourteen by fourteen. At the time of the fever there slept ill the lower part of the house, myself and wife, Mr. Dring and wife and his four children, and my two daughters. In the upper rooms slept Mr. Leeds and wife and two children in one room, and two men, boarders, in the other room ; and four boarders, workmen, slept in the kitchen, making in the whole, twenty persons, which then com- posed the family- Yours, SIMEON HELME" " Our unfortunate doctor happens not to be exactly right in any single item ; and this may be all a very innocent mistake ; I doubt not it is ; though, it also hap. pens that every error is on the side of exaggeration. But we will let that pass. " There was but one instance of a family at this ship-yard enjoying the comfort of apartments sufficiently spacious and commodious in proportion to their number, and these all preserving good health, while the neigh ■ tours around them were sickening and dying." 308 Miller on the Yellow Fever. " In support of the same curious and instructive fact, is the following extract from Doctor Daniel T. Wal- ter— " .ft ought to be observed before quittitig this subject, that Samuel Mid- dletons' family, consisting of six persons, have lived during the whole sickly season at the Wallabout, in the north-east end of Mr. Helme's house, next the water, and of course nearest the vessels, and have enjoy- ed an uninterrupted state of health ; but Mr. Middletons' family occupies exactly half the house, whichgives six persons, in one instance, as much room as nearly thirty enjoys in the other. If, however, the fever was de- rived from the vessels solely, this circumstance ought to be of no avail, and Mr. Middletons' family ought to have been the first to have taken ^.''—Walter's Letter. E. contra.—" The deponent saith, that' he has two windows, one below and one above, opening eastward, on the line of the navy-yard, but the lower window has been cut since the fever."—Middletons' Deposition. " As Helme had a lower window before the fever, open- ing east on the navy-yard where the brig La Ruse lay be- fore she was moved, and Middletons had not, this might account for Helme's family taking the disease and Mid- dletons' escaping. If, however, this should not be thought satisfactory, then take the following extracts, in answer to the statement of the Repository, that " Middletons* fa- mily all preseryed good health," or, as Dr. Walter says, " uninterrupted health." " The former of whom [Brown] was taken with-the yellow fever on the 21st, and the latter, who boarded in the deponent's house, was taken on the 26th."—Middletons' Deposition. Same point.—" On the Wednesday following, to wit, on the 20th, the deponent found himself attacked with pain in the head, back and limbs, on which he told Mr. Middletons that he hoped for the best, but he felt just as he formerly did when he had the yellow fever; soon after he was attacked with it, and was sick about three weeks, when he recovered. And the deponent further saith, that he boarded in the house of Mr. Middletons, adjoining the house of Mr. Helme north-east, and under the same room."—Brown's Deposition. " The quantity of animal and vegetable filth overspreading the ground, and lying about the boarding houses, taken in connexion wilh the other circumstances of the place, was sufficient to generate great mischief. J\'o Miller on the Yellow Fever. 309 plan of properly cleansing the yard seems ever to have been adopted,• of course this filth has been progressively accumulating, and becoming more dangerous ever since the establishment of this place was first underta- ken."—Medical Repository. E. contra.—" The ship-yard is as clean as ship-yards usually are, any where, nor is there any animal filth or vegetable filth lying about or near it, so as to cause any kind of inconvenience to any person in the place ; and further saith not."—Helme's, Jun. Deposition. Same point.—" Nor has he ever perceived that the yard was less clean, or the ground about it, than other ship-yards in New-York." Brown's Deposition- Same point—" And the deponent further saith, that he never ex- perienced any inconvenience from dirt or filth lying about the yard or the houses, nor saw more than is usual at ship-yards."—Livingston's Deposition. Sarne point.—" And the deponent further saith, that there is not nor was at the time of the appearance of the fever, or at any other time this summer, any animal or vegetable filth overspreading the ground at the ship-yard or round the boarding houses near it, but that it is and has been as clean as the ship-yards usually are in New- York."—Rhodes' Deposition. Same point.—" During the present season, the ground of the ship- yard, and the grounds about the houses, have been, and are as clean as is customary, as clean as other ship-yards are, and as the former ship-yard used to be ; that all the time the deponent has been so oc- cupied before and during the late fever, and since, he has never ob- served any thing of so filthy a nature as to cause the least incon- venience to the persons residing there."—Handel's Deposition. Same point.—" And the deponent further saith, that the ship-yard, with which he has been acquainted for seven years, has always been in a clean and healthy state, and as clean the present year, since it was removed to Jackson's wharf, both before and at the time of the fever, as it ever was when it was kept at the navy-yard on the other side of the fence."—Wakeman's Deposition. Same point.—" And the deponent further saith, that he never ob- served that the ship-yard, or any of the ground about it, was in a more dirty or filthy state than is customary at other ship-yards, and such as is caused by the quantity of dry chips that lie loose about the vessels."—Wright's Deposition. Same point.—" I have been at the yard almost every day, but I have never discovered that the ground of the ship-yard was "dirty, more than what was caused by dry chips lying about, nor have I seen any more filth of any sort than is usual about houses in such country places."—Jackson's Letter. Same point.—" My first object was to examine the state of the houses, with respect to cleanliness, and I had the satisfaction of per- ceiving that the inhabitants had not been negligent in regard to this important article. The rooms, which had been occupied by the sick, had been thoroughly cleansed, and the houses whitewashed; nor did I see any thing offensive in the vicinity."—JWrf. 310 Miller on the Yellow Fever. " To the above I may add, that from the view I had of the situation of the place, the information I received from different individuals on the spot, and an unbiased reflection upon the whole in my own mind, the result is, that I perceived no cause existing there, which, in my opinion, could have produced malignant fever."—Letter from the Se- cretary of tlie Health Committee. Same point.—" I walked over to the ship-yard and down to the wharf and about it, and could perceive nothing that could give the least cause of suspicion, nor did the situation of the houses, or of the adjoining grounds, furnish to my mind any cause for the appearance of the disease."—Dr. Lord's Letter. " The number of persons at this place was sufficient to carry on the work of building two large ships, and of occasionally repairing others. Yet these workmen did not possess the convenience of a privy, the want of which must have added exceedingly to the accumulation of filth. When all these facts are considered in connexion with the local circumstances of the spot, which rendered ordinary ventilation impossible, it will not appear strange that a malignant disease should have been generated at this place."—Medical Repository. E. contra.—" You ask me if there are privies, because, as I presume, the Medical Repository account asserts, " the workmen did not possess the'eonvenience of a privy, the want of which, they say, must have added exceedingly to the other sources of the accumulation of filth." There is a large privy at Helme's house, close by the ship-yard, but the truth is, the workmen do not use it, because the wharf extends so low as always to have more or less water, and during both rising and falling water, has a strong current running by it, and the men go down there. You can judge, sir, whether this "can add exceedingly to the other sources of filth."—Tackson's Letter. " One would suppose from this that the situation, in respect to privies, had the advantage over almost am* other, and must be remarkably inoffensive in this par- ticular. " But this affair of the privies is not the least curious in our curious medical account. To understand it, I must remind the reader, that it is now some years since the ad- vocates for domestic origin, in their search after causes of yellow fever in the United States, added to their list, privies and new made grounds. The moment the yellow fever appears in any of pur cities, these zealous gendemen run about the neighbourhood inquiring after privies and new made grounds ; and, as the epidemic has, heretofore, al- ways appeared on some of the wharves of the East river* Miller on the Yellow Fever. 311 there has never been any difficulty to discover at once both privies and new made grounds. As soon as the fact is put beyond question, they go their way rejoicing at the dis- covery of another piece of testimony in favour of domes- tic origin. Thus, after it had been well ascertained that the fever actually existed at the Wallabout, they went over in pursuit of privies and new made grounds ; those two never failing sources of septic acid vapour. As soon as they got there, they saw it was in vain to look for new made grounds, and, they next inquire after sinks and pri- vies ! when behold there are none ! What*s to be done now ? One gentleman, more candid than the rest, ac- knowledges, that finding the absence of this, and every thing else that could be justly considered as a local cause, he felt himself compelled to relinquish an opinion that had been unshaken for years. Such conduct is honourable- Not so with the editors of the Medical Repository; these great champions of domestic origin, meeting with neither new made ground nor privies, wheel right about, and declare that the disease was caused by the xvant of privies. " The want of a privy, quoth the Medical Re- pository, must have added exceedingly to the other sources of the accumulation of filth," and " it will not appear strange that a malignant disease should have been gene- rated at the place." " Dr. Miller, the Resident Physician, to whom Dr. Rodgers, the Health Officer, referred his Honour the Mayor, for more particular information respecting the Wallabout than he could give, because Dr. M. had been on the spot, (though, by the way, so had the Health Officer, as appears from Mr. Jackson's letter) chose, it seems, to make his communication in form of an article for the 312 Miller on the Yellow Fever. Medical Repository and Review. This Medical Repo- sitory and Review is an octavo volume, respectable for its size, and imposing in its appearance, and it circulates not only throughout the United States, but several copies go annually to Europe, where it is read by the faculty there, as the work of the most eminent medical men in this country. In such a work, professedly undertaken for the purpose of exposing the ignorance, correcting the mistakes, and detecting the misrepresentations of others, surely the public have some right to expect at least a little more than usual attention to accuracy in itself. What then will be their surprise, and how must it affect the reputation of the work, that the only article, (and that on a favourite subject too, where more than customary care would be expected,) which has been subjected to a rigid criticism, is found to be, not merely, very often wrong, but never once right ! But we have not room for multiplying ob- servations of this sort ; we hope, indeed we feel very con- fident, that the editors of the Medical Repository have some way of accounting for this, beyond vfhat we know of; especially, since they are so loud and so frequent in charging other gentlemen with fabricating " gross and glaring mistatemerits." But, at any rate, this detection of their errors should teach them a little more caution in future, inspire them with a little more modesty, and ren- der them a little less presumptuous in their attacks upon gendemen whose characters, private and professional, stand as fair and as exalted as their own. " As Dr. Rodgers has thought proper to mention the weather as one of the causes of yellow fever at the Wal- labout, I here present the reader with a transcript from a table of meteorological observations, beginning eight Miller on the Yellow Fever. 313 days before the disease appeared, and continuing till the day on which the last "new case" occurred. THERMOMETER. 9 | 12 | 3 June 12 13 14 15 16 17 18 19 20 21 1 65 60 k 71 70 .71 >6 72 70 76 72 76 77 80 74 76 67 67 1 68 68 | 59 74 72 77 76 80 83 74 67 68 9 | 12 | 3. 'June July 22 23 24 %5 26 27 28 29 30 1 68 68 70 72 72 76 69 69 69 72 75 "79 78 80 70 76 71 72 64 68 69 74 78 71 76 81 83 78 75 68 " By inspection of this table it will be seen, th^t except- ing four days, the weather was even below " summer' heat," and in no instance was the heat excessive. " Having shown that the origin of the epidemic is not to be accounted for from any of the causes assigned by the Health Commissioners, neither from the " air, soil, or weather ; local situation of the Wallabout; the position of the houses, or the materials surrounding them ;" all of which are pointed out by the Health Offi- cer : Having proved that, in all these respects, whatever has been advanced, has been, throughout, * gross misrepre- sentations,' we are necessarily driven to seek for the origin of the disease in the other, of the only two assign- ed causes ; namely, vessels rccendy arrived from the West-Indies. As there are but two causes, foreign and domestic, to which the disease can be attributed, if it appears that there was a total absence of one, sound logic would warrant me in leaving it here, and saying, that as it is not of domestic, it must necessarily be of Vol. II. R r 314 Miller on the Yellow Fever. foreign origiri; at any rate, a very slight degree of proof ought, in this case, to be admitted as competent and con- clusive. To the vessels, then, let us now turn our atten- tion. " I begin with the schooner Greyhound. She arrived, as appears by the newspapers, on the fourth of June, Dr. Rodgers says the second, (this is not very material,) after a passage of sixteen days. What day she was suffered to come up to the Wallabout is no where stated. On the 18th, it appears, her bilge-water was pumped out on the south side oi her, she then lying to the windward &T the W«Habout, at the distance of one hundred, or one hundred and fifty yards. The Health Officer says, that while she was at the quarantine ground, "her bilge-water was comphtelf pumped out, and the water from the pump clear and free from smell." It may be so ; had the Health Officer said he saw this with his own eyes, it would not have been decorous to have doubted it ; and though „this schooner, as I am informed by the owner, is so re- markably tight, that she is said not to leak at all, yet as we know that all vessels leak more or less, I shall admit that she was pumped out at the quarantine, and that the water which came from her so black and with such an intolera- ble stench after lying some days at the Wallabout, was what she took in while she lay there. And I desire no other concession than this in favour of my argument. But before I proceed to the inference, I must go on a lit- tle further with the Health Officer's letter. " All the ports, (says the Health Officer,) from which the vessels now in the / Wallabout, or which have been there since the first of June, sailed from, were, at the time of their respective departures, in great health." " Guadaloupe too (says he) Miller on the Yellow Fever. 315 was very healthy when La Ruse sailed, and had been so for a long time before." " I acknowledge it is extremely difficult to obtain from captains of vessels, or any of the crews, the truth as to the health of the port they sailed from. They all think they are perfecdy justified to make use of any sort of misrepresentation, nay, if it is absolutely necessary, some of them think they may back it with an oath, to evade the irksome operation of quarantine laws. Hence, in some parts of Europe it has been found, by experience, necessary to punish such misrepresentations with death ; nothmg^lse being found adequate to restrain them. All this, however, is as well known to the Health Officer as to me, and his experience should have taught him to speak with some sort of diffidence. Yet he not only in- forms us that all the ports were in health, but "great health." To make it still stronger, the editor of the Re- pository undertakes to say, that " it appears from incon- testible evidence, laid before the public by the Health Officer, that the vessels in question came from ports which were in a very healthy state." Now I say no " evidence" at all has been laid before the public by the Health Officer. He has said, indeed, that the ports were healthy ; but this we know is only information derived from others ; derived too, untier strong temptation to de- viate from the truth, and, after all, it does not appear what his information is, from whom derived, or how au- thenticated. He has " laid nothing" of this sort before the public. I say, Messieurs Editors of the Repository, in direct contradiction of you, that he has not laid incon- testible evidence before the public, and to call it so, is a palpable perversion of language, calculated to make an 316 Miller on the Yellow Fever. impression, wherever your book is read, materially wide of the truth. " I suppose I am not expected to send to the West* Indies and get depositions there ; though I am sorry it has not been in my power to do so. I shall however give the best evidence the nature of the case admits of. First then, an extract from a southern newspaper. " Died at Cape Francois, on the 16th of June, of the yellow fevei*, Mr. Edward Mou lson, late Merchant of this place." " Making proper allowance for the time Mr. Moulson was sick, and supposing that the fever had bee$ so long in the place as to have been prevalent before he sickened, the Cape, at the time of the departure of the Greyhound, could not have been in great health. As to the case of La Ruse from Point-Petre, I have been fortunate enough to meet with the captain, who was so candid as to give me some important information. He informs me, and has signed his name to the information, that " Before Cap- tain Storey sailed, he understood some cases of the fever had occurred at the place.1"1* 'Tis true, he adds, that the disease was not so ' prevalent,' as that it could be called a '■sickly port!1 but this I must beg permission to say, is only setting up_ opinion against fact. What is a * sickly port1 is the most vague of all things. How many cases of sickness, or how many deaths, or how wide spread must be the fever before the place can be called a sickly port? The fact is stated, clearly and undeniably, that the disease had made its appearance before the brig sailed, after having lain there about six weeks. The next important fact is, that, on the eighth day after her departure, one of * Vide page 294=. Miller on the Yellow Fever. 317 the crew sickened, and the next day, another ; one reco- vered and the other died, after three days illness. " His bedding and all his clothes were thrown overboard with him.' This is alwavs the case when the deceased is supposed to die of a contagious disease. The bedding and clothes of Jack, however, (the other person who was sick,) were not thrown overboard ; but preserved and brought into port. The following paragraph appeared in the Aurora of the 10th inst.— " We understand that our Board of Health, perceiving that persons in many vessels from Point-Petre were affected with yellow fever, have^during the last two months, subjected all shipping from thence to dPngid quarantine, and we now deem it our duty, for the sake of the health of the other ports of the United States, to declare from authority that the Board yesterday received official information of the prevalence of the yellow fever both on shore and in the port of Point- Petre.' " This, I think, shows pretty conclusively what sort of fever had begun to prevail there before the departure of La Ruse; indeed, the captain did not deny to me but it was the yellow fever; and the short time the cook lay sick, with the circumstances of destroying all his clothes and bedding prove, in a manner equally satisfactory, that he died of the prevailing epidemic. " After this I shall submit it to the Health Officer, whether he ought not to have expressed himself with a little more caution as to the healthiness of the ports of Cape Francois and Point-Petre ; and 1 shall ask the editors of the Medical Repository, what are their real notions about attempts to abuse public credulity, or whether they think a man may do it without any offence against propriety or morals, provided only he does it on the right side—that is to say, in behalf of domestic origin ? But to pro- ceed— 31 a Miller on the Yellow Fever. " I now come to the situation of the vessels after then arrival. The Health Officer says the brig was clean, free between decks, nothing in the hold but stone ballast, aad this free from smell j and that this ballast was tho- roughly washed and cleansed. Dr. Bayley, he says, found all the vessels at the Wallabout in such a situation as to warrant him in saying " no evil could possibly have arisen from them." He, however, saw one barrel of tainted beef, which he ordered to be thrown overboard. It is also added, that none of the crew or passengers of the brig have been sick since her arrival. This opinion of Dr. Bayley, I hope, by the way, is not to be considered as incontestible evidence ; and therefore, for the present, I will lay it out of the case. "• We have now the circumstances of these two vessels pretty well before us. They, both, were from ports where the yellow fever prevailed ; and had the Health Officer been as well satisfied of this at the time he permitted them to come up from the quarantine, as I have no doubt he is now, I venture to say, he would not have permitted it. He was, unquestionably, in the first instance, deceived, and I am sorry that he or his friends should think it necessary to persist in circulating a statement to justify him on a supposition that he was not. The vessels, then, were from ports where a malignant fever prevailed at the time of their departure. But at the quarantine ground they were as well cleansed as washing could cleanse them. And will washing cleanse a vessel ou board of which con- tagious diseases have prevailed ? That it will not, I shall produce their ©w» authority, I mean the authority of the Medical Repository. u On the 27th of June, 1800, the United States ship General Greene, sailed from the Havanna for America. Miller on the Yellow Fever. 319 On the 31st of July she was moored in Newport har- bour. On this occasion the Repository says: " Every customary method of preserving purity of air, and the health of seamen had been assiduously observed. The ship was free- ly ventilated, scoured, white-washed, sprinkled with vinegar, and the nitrous fumigation particularly recommended by Doctors Smith and Patterson, was frequendy excited between decks. But notwith- standing all these precautions, and the still more favourable circum- stance of her arrival in a more northern latitude, there was one man attacked on the day of her leaving the Chesapeake. (July llth) with a highly malignant fever, which terminated on the fifth day ; and on the day after his attack, another was seized similarly, and died in eighteen hours."—Medical Repository, v. 4. p. 235. " In short, it was the case where a ship's crew after being healthy at sea, are attacked as soon as they get into port with decided yellow fever. It was proposed first to send her down to quarantine, but a temporary abatement of the disease induced the inhabitants to give up this rigid proceeding ; the vessel was therefore suffered to remain, but was hauled from the wharf into the stream, and the sick were sent off as fast as they were taken ill, to a distant hospital. I need hardly add, that the consequences were, that, in a little time, the yellow fever was introduced into the town of Newport. Yet does the correspondent of the Medical Repository, as to that case, say, " It is impos- sible to reduce to satisfaction the opinion that all the cases were derived from the ship, since some occurred wherein the patients had no communication either with the ship or any who had the disease." It is added, that u soon after the offensive filth, which collected between the ship's ballast, was, with it, removed, and the ship properly cleansed, no instance of fever occurred on board her." I belive it must be admitted that this ship had been more, much more thoroughly cleansed than the brig La Ruse, yet was it all insufficient until after the ballast had been removed. 320 Miller on the Yellow Fever. " There is one circumstance in this Report which ar- rests attention, as it is precisely in point with the very case before us, in reference to the Greyhound at the Wallabout. And as one fact is always worth a volume of the best arguments on earth, it will save us a world of controversy with Dr. Mitchill about the nature of in- fectious poison chemically dissolved in caloric; or the qualities of pestilential air, formed from septic materials, by a septic process, thereby creating a septic gas; which may diffuse and spread itself through the atmosphere, after the manner of hydrogen gas, or carbonic acid gas ; I say all this chemical learning must vanish before a well attested fact. In the same account of the fever at Newport from this correspondent, I find the following re- corded. ** Notwithstanding these prudential cautions, other inhabitants who had worked on board the ship, and in particular, one young man and two boys who had bathed near her at the time her bilge-water was pumped out, were attacked with the disease and died."—Id. p. 236. " Now it is in evidence, that in the first six cases that occurred at the Wallabout, every person taken sick, com- plained of the shocking smell of the bilge-water of the Greyhound, or the Greyhound and La Ruse, for both wrere pumping at the same time, and that it was so very offensive as in some to cause qualms. Well, but, says one, this is evidence not of foreign but domestic origin ; for the water was made while she lay at the wharf. I shall ask then, why the filthy bilge-water, which is every day made by the hundreds of vessels lying at our wharves, and near them, does not produce the same ef- fect ? Can it be believed that the vessels in question, after being so thoroughly cleansed as they were, would cause an epidemic fever, if they had not some peculiar Miller on the Yellow Fever. 321 quality existing in their holds, among their ballast, or ad- hering to their timbers ? But, says the Health Physician, the crews and passengers were all healthy. In answer to this I must once more take the liberty of opposing the au- thority of the Medical Repository itself. " It [sickness] may affect only the crew and disappear; or the crew may sustain it, uninjured, by a habit gradually formed, and the first effects be felt by healthy, unhabituatedpersons in the first port she visits."—Medical Repository, v. 2. p. 86. " Supposing it may be more satisfactory to the reader to have the precise fact laid before him as to the effects of the bilge-xvater, mentioned in my last, I here extract from the several depositions what the witnesses have, each, said. " And the deponent further saith, that the evening before Philip Drin^ was taken, he told this deponent that he never in his life smelt any thing so very bad as the smell from the vessels; meaning the br'ig La Ruse and the schooner Greyhound, which lay at a little distance from the wharf, but which had been pumping out their bilge-water, and that he heard Mrs. Little make a similar obser- vation.—Helme's Deposition. Same fact.—The deponent further saith, that when the brig La Ruse lay at the naw-vard, the schooner Grevhound lay at about one htm dred or one hundred" and fiftv yards distant from the wharf, and while there, on the morning of the 18th or 1 ,th of June, a* the deponent was at work in the ship-yard, he perceived a most shocking smell to come from the water, the wind then being about north, and looking up he observed the schooner was pumping out her bilge-water, which was the cause of the smell. At this time Philip Dring and Isaac Brown both com- plained to the deponent verv much of this offensive smell, and the latter was obliged to leave his work in consequence, and go and get a drink of brandy and water ; in a day or two afterwards they were both taken with the fever."— Helme's Jr. Deposition. Same fact__" The deponent on either Saturday the 16th, or Monday the 18th of June, was addressed by Philip Dring, who was at work on the stern of an adjoining ship, and asked what was that nauseous and disagreeable smell, to which the depo- nent said it was the bilge-water then pumping out of the schooner Greyhound, which lay, as near as the deponent can judge, about one hundred and fifty yards to the windward, or that it came from the brig La Ruse, which was also then pumping out her biltre-water, and which lav within about thirty yards of where the de- ponent was at work. The effect was so disagreeable that the depo- VOL. II. SS 322 Miller on the Yellow Fever. nent got off the stage and went and got a glass of brandy and water. And the deponent further saith, that he heard Mrs. Little complain of the bad smell of the bilge-water, and that she asked him what it was that smelt so bad at the time he went up and got the brandy and water."—Brown's Deposition. Same fact.—" The deponent further saith, that he well remembers that on the 18th of June, he was in the ship-yard in the morning, when the Greyhound was pumping out her bilge-water, which smelt ex- cessively nauseous ; he heard both Dring and Brown complain of it." Middletons' Deposition. Same fact.—" On the 18th or 19th of June, as he was at work one morning in the saw-pit, he was struck with a most dreadful smell, which he perceived to come from the bilge-water then pumping out of the Greyhound, lying about one hundred, or one hundred and fifty yards from the wharf."—Livingston's Deposition. Same fact.—" The deponent further saith, that he was at work with Philip Dring, on the stern of the new ship, when the smell of the bilge-water was so nauseous and offensive to them all, and when Dring spoke to the deponent and asked him what was the cause of such a dreadful smell ? The deponent looked toward the schooner Greyhound, and saw her pumping out her bilge-water, and he saw the water come out so very black as to turn the water black at her side."—WakemujCs Deposition. Same fact.—" James Cassils, of lawful age, being duly sworn, depo- seth and saith, that he was one of the labourers who worked at the Wallabout as ship-carpenter, and was in the yard on the 18th of June, when he perceived a very disagreeable smell to come from the vessels, and looking towards the schooner Greyhound, saw she was pumping out her bilge-water, which seemed to be the cause of it. " And the deponent further saith, that on the 20th of June he was taken with the yellow fever." Same fact.—" Samuel White, of lawful age, being duly sworn, de- poseth and saith, that he was one of the shipcarpenters who worked at the Wallabout, and was in the yard on the 18th of June, when he perceived a very disagreeable smell to come from die vessels, and looking towards the schooner Greyhound, saw she was pumping out her bilge-water, which seemed to be the cause of it; and the depo- nent further saith, that on the 20th of June he was taken with the yellow fever." " There have been two other causes of disease found in those vessels, or at least one of them ; namely, the spoiled beef, and the foul ballast of the brig La Ruse. " It is admitted by the Health Officer, that Dr. Bay ley- saw " one barrel of beef on board the brig which was in an unsound and tainted state, which he immediately ordered overboard." Yet it is said that- Dr. Bayley found the vessels in such a state, as to " warrant him in saying Miller on the Yellow Fever. 323 that no evil could possibly have arisen from them." Af- ter what these domestic gentlemen have so repeatedly told us of tainted beef's producing disease, I must be permitted to express a little surprise at the positive man- ner in which Dr. Bayley is stated to have given this opi- nion. Let us turn to what the Medical Repository has said of the effects of tainted or spoiled beef. In the same article, entitled, " State of the weather and dis- eases " in 1799, we find them thus expressing them- selves— " Yet, notwithstanding the duration and intenseness of the win- ter, there were instances of disease, now and then to be met with in the city of New-Vork, caused by septic effluvia. A number of these could be traced directly to the remains of the spoiled or tainted bee£ of the preceding season, sold at auction during the cold weatneii, and " used for food in its semi-putrid state."—Med. Rep. vol. 3. p. Oi. " Again, in the same volume is an article entitled, " Septic acid vapour, extricated from corrupting beef.'* The article is too long to transcribe ; but the intention of it is to prove that " the acid quality of the putrifying flesh, and of the gas flowing from it," was the cause of a number of deaths at Burling-slip, in 1798. Lastly, to prove demonstratively that the septic acid vapour of a single barrel of spoiled beef, even when standing in the open air, will give the yellow fever itself, they have pub- lished a long letter from Tunis Wortman, Esq. showing that while the epidemic raged in New-York, with a de- gree of violence and mortality never before or since wit- nessed, Mr. Roorbach caught the same disease by fre- quenting a foot-path every day, within six or eight yards of which stood a barrel of spoiled beef. See Med. Rep. v. 3. p. 402. I confess I do not believe that spoiled beef will ever communicate the yellow fever, unless it comes from a place where that disease exits ; but with the cor- rectness of these gentlemen's notions on this subject I do * 324 Miller on the Yellow Fever. not here meddle : yet, methinks, after labouring to prove that spoiled beef has produced, and will produce yellow fever, it is not very like consistency, for them now, be- cause this beef is found on board a vessel that has some- how been permitted to come from the quarantine ground, to insist that no evil could possibly arise from it. Nor is it calculated to give us a very favourable impres- sion of the candour of the editors of the Medical Repo- sitory, that in the whole of their elaborate article, they have never once mentioned the fact of the tainted beef: heretofore, according to them, the primary cause of pesti- lence and death. But I suppose tainted beef brought from the West-Indies is not so unhealthy as that which spoils in our unfortunate climate ; nor possesses any of that deadly septic acid vapour which the pestilential air of New-York produces. " It only remains to consider the foul ballast of the brig La Ruse; which, of course, must make foul bilge-water, and which is, in itself, and has always been considered one method of communicating pestilence. " To guard against the frequent source of yellow fever from the noxious air in the holds of vessels, we recommend the unloading such vessels as contain cargoes liable to putrefaction, and the discharging tlie ballast of all vessels at ad stance from the city.".—Letter from the Phi- ladelphia Academy of Medicine. " This I give the more cheerfully, because the Acade- my are great sticklers for domestic origin; and because I am able to support it by another authority, which in the opinion of the editors of the Repository will be thought I presume, equally respectable; I mean their own. In their review of Caldwell's oration, on the origin of pesti- lential diseases, having observed that he ascribed much mischief to the foul air emitted from the putrid ballast and damaged cargoes of vessels, they add; * Miller on the Yellow Fever. 325 " We are not disposed to controvert; on the contrary, "we admit the frequent production of cases of pestilence from this source."— Med Rep. r. 3. p. 60. " But the Health-Officer says, the ballast of the brig was washed " till the water came from her as pure, as clean, and as free from smell, as the water of the ocean.'' To this, admitting the fact to be precisely as stated, the answer is furnished by the case of the General Greene, as quoted yesterday from the Medical Repository. In that instance, every'possible method of cleansing was resorted to ; the ship was " freely ventilated, scoured, white-wash- ed, sprinkled with vinegar, and fumigated," yet, until the ballast was removed out of her, it answered no purpose. But in this case the Health Officer tells us, that neither Capt. Wadsworth nor Capt. Chammings could perceive any disagreeable smell on board her ; and that he himself went up on the 26th June, and " attentively examined the vessel and ballast, and could perceive no evil, or de- tect any disagreeable smell or effluvia in her ;" and that the ballast, which was brought to quarantine and unload- ed, he has u passed over again and again," nay, that he had even " handled and smelt to it,*' but could detect no evil. As his learned friend, Dr. Mitchell, has demon- strated in an ingenious pamphlet, published some years ago, that u though pestilence may be accompanied, evi- dently, with ste nch ; yet its most formidable effects are felt when neither the sight nor the smell give any evidence of its presence," I cannot for my life see why Dr. Rod- gers should n-ake such a point of smelling to this ballast, especially af er it had been removed from the brig, landed at Staten-Island, and had lain exposed to the weather I dont know how long. But let us see how our evidence stands as to this— 326 Miller on the Yellow Fever. " And the deponent further saith, that he heard Capt. Chammings say, that when he opened the hatches and went down the hold of the brig La Ruse, there was a very disagreeable smell, but that he con- ceived it to be no more than what had been caused by the confined air of the hold, and therefore did not mind it. And the deponent further saith, that he heard Benjamin Brown, the boatman employed in tak- ing out the ballast of the brig La Ruse, say, that the ballast, when he first began to take it out, smelt verj bad, but he thought it was owing to the closeness of the hatches, and was not at all afraid."— RandePs Deposition. " Same fact— " The deponent saith, he heard some of the pefsons employed in unloading this ballast say, that it was so very offensive, they could not throw out but a few stones at a time, without being obliged to put their heads up the hatchway, to obtain a breath of fresh air."—Helme Jun'r's Deposition. " But here two other difficulties present themselves. First, That some of the worst cases commenced before her ballast was started. Second, That the brig lay at such a distance from the house where the first case hap- pened, as to render it morally impossible that any conta- gion could have been communicated, supposing her to be really embued with contagion : But let us give the objec- tions in their own words. " La Ruse hauled first to the navy-yard, where she lay till the 23d of June, when she moved to the wharf where the Generous friends and the Union lay, and opposite to the house where a woman sickened on the 20th, and died on the 24th or 25th. She lay there without dis- charging her ballast, or even touching it, till the 25th."—Rodgers* Letter. " Same side— " It was asserted, in particular, that the disease appeared after die discharging of the ballast from the brig La Ruse, which was just men- tioned j but it is ascertained that three or four of the worst cases commenced before this ballast was removed."—Medical Repository. " Same side— " The statement in question [of the three physicians] appears to be incorrect in the following parts : * an idea is meant to be held forth that no one sickened before the ballast was discharged, which was not the fact"— Walter's Letter. Miller an the Yellow Fever. 327 " Pretty formidable, certainly ! but as it has so hap- pened, that not one fact hitherto asserted has turned out as was stated, it naturally inclines us to hesitate through- out. Let us then go once more to our evidence ; by which I mean, not the loose sayings of individuals or of officers, but thevdeliberate declarations of persons under the solemnity of an oath. " Simeon Helme, of lawful age, being duly sworn, deposeth and saith, that he has lived with his family at the Wallabout since March last, as master builder of the large ship now on the stocks at Jack- son's wharf; that he well remembers when the brig La Ruse came up from the quarantine ground, and hauled along side of the wharf at the navy-yard, where she discharged part of her ballast before the sick- ness broke out; that some days after discharging the first load of bal- last, Mr. Philip Dring, son-in-law to the deponent, was taken with the yellow fever." " Same fact— " Simeon Helme, Jun. of lawful age, being duly sworn, saith, that he, the deponent, remembers when the brig La Ruse first came up from the quarantine ground, and hauled along side the wharf at the navy-yard, which was, according to the best of his recollection, about the twelfth of June; that a few days afterwards, and before the sick- ness appeared, this brig began to unload her ballast at the navy-yard." " But, it is asserted, she lay at a great distance from the house where the first case occurred, meaning Mr. Helme's— " It was farther asserted, that the brig in question lay close to the house of Mr. Helme, in which one of the most malignant cases com- menced on the 20th of June : whereas there is the best evidence that this vessel lay at the navy-yard of the United States, a distance of more than 150 yards from the spot referred to, until the 23d of the month, when she moved to the wharf near Mr. Helme's house, a day or two after some of the malignant cases had commenced."—Medical Repository. " Let us now see how much this hundred and fifty yards of the Medical Repository* amounts to, by a ac- tual admeasurement." " And the deponent further saith, the said Philip Dring lived in the same family with himself, and slept in an adjoining room with 328 Miller on the Yelloxv Fever. his wife and child," " but thatthe door of the room adjoining, which was a large room of 18 by 16 feet square, was always kept open. And the deponent further saith, that this large room had a window that opened into the navy-yard, at the wharf of which the brig La Ruse lay when his son-in-law was taken sick, and within thirty yards of this window by admeasurement."—Helme's Deposition. " But, from the following extract, it will appear that Dring constantly worked in a place still nearer the brig— " And the deponent further saith, that Dring worked every day on the stern of a ship on the stocks within abouttwenty-five yards of where the La Ruse lay at the navy-yard, and used to go repeatedly to a blacksmith's shop to e^et iron-work, within eight, or, at most, ten yards of the brig."—Helme's Deposition. " Any one, from reading the statement of the Medical Repository, or that in the Health Officer's letter, would suppose that the navy-yard and the ship-yard were dis- tant from each other, whereas, only a fence is the line o* separation ; separation as to boundaries, but an air-line as to atmosphere. " And the deponent saith, that after unloading one sloop load, for some cause, she [La Ruse] desisted, and on the 23d she moved about her length westward to Jackson's wharf, which is only separated from the navy-yard by a fence."—Helme Jun'r's Deposition. " It is also ass rted, that no person of those taken sick was on board either of the suspected vessels. " It does not appear that a single person of those attacked with this malignant fever had been on board either of the vessels charged with the importation of it, or held any communication with them, or any thing belonging to them."—Medical Repository. " Neither of them [Livingston and Arbutton, who both had the fe- ▼er] had ever been on board La Ruse; Livingston had once been on board the Union, and no other vessel."—Rodgers' Letter. " Edward Livingston, of lawful age, being duly sworn, deposeth and saith, that on Tuesday evening, the nineteenth of June, as nearly as he can recollect, he went on board the brig La Ruse, then ly- ing at the wharf, to get her boat to bring up a log that lay in the stream, and on the twentieth he was taken down, in the evening, with the yeliow fever; in consequence of which, he was sent to the Marine Hospital, after being sick a week, and where, after about five weeks, he recovered." Miller on the Yellow Fever. 329 " Lastly, it is stated— " It deserves also to be mentioned, that a large proportion of all the victims to this disease, and some of the earliest, were women, whose occupations did not lead them to the wharves, who were employed within doors."—Medical Repository. " It will be seen by turning to the list of those who were attacked by the disease, the whole number was seven- teen, of whom, eight only were women ; of these, four died, viz. Mrs. Little, Mrs. Sherlock, Jane Johnson, and Sally Wakeman. " But in answer to the attempt to show that the women had no communication with the brig that could account for their taking the disease, I shall now show that not onlv these, but all the cases that occurred, are traceable directly to one or both the vessels. " The first set of cases were Brown, White, Livingston, Castles, Mrs. Little and Dring ; of these six, all com- plained of the offensive smell of the bilge-water the eighteenth of June, and five were taken with the fever on the 20th, within forty-eight hours afterwards ; the sixth, Dring, was seized the day alter. Besides this, Simeon Helme, jun. swears that— He " frequently saw Mrs. Little, the woman who was first taken ill and died, down upon the wharf near where the brig La Ruse lay, and near the brig, looking for her child, which used to play about the wharf." " On the twenty-second, Mis. Sherlock was seized, and besides the probability that she visited the sick, (for 1 give it only as such, since it is only mentioned to me and is not in evidence) her husband has deposed that— " She frequently went to the dock of the navy-yard, where the brig La Ruse lay, to pick up chips ; die rooms where his wife, three chil- dren and self resided, were large, on the second story, had the benefit of a free and pure air from all quarters, being nearly surrounded with running salt water." Vol. II. t t 330 Miller on the Yellow Fever. "Jane Johnson,who was t.^ken on the twenty-third, lived in the house with Mrs. Little, and nursed her. William Arbutton, who sickened on the twenty-eighth, slept in the same bed with Livingston after he was taken ill. Sally Wakeman who sickened on the twenty-ninth or thirtieth, visited the sick at both Helme's and Little's, as appears from her brother's deposition. Benjamin Rhodes, who sickened on the twenty -ninth, has deposed that " he visit- ed the sick every day" till he was taken ill himself. George Little, Mrs. Dring, and Patty Helme, all sick- ened on the thirtieth ; the lormer had attended on his sick wife, the two latter on Mr. Dring; and Hannah Helme, attacked July first, was the last person taken, and had been exposed in a similar manner. These three last, it is wor- thy of remark, were attacked after their removal to a place called Vinegar Hill, more than a quarter of a mile distant, s. E. and their disease is stated by the father to be yellow fever, and not dysentery, as asserted by Dr. Walter. Pa- trick Prosay is the only person unaccounted for. All in- quiries after this man have been fruitless j all we know is, that on the twenty-eighth of June, at a meeting of the Health Committee, in answer to their inquiries about his situation, which they had by some accident just been in- formed of, the Resident Physician said that Patrick Prcsay « was better ;" and in the Medical Repository article, he is said to be a labourer who " had quitted the ship-yard and made his way into the city."' Thus the public have a history of every case, and of the circumstances attending the occurrence of each ; all traced up to one source. Three causes are proved to have existed, all of which, pro- bably, operated, but either of them, if I mistake not, has appeared sufficient to account for the introduction of the Miller on the Yellow Fever. 331 epidemic, viz. the bilge-water, the spoiled beef, and the foul ballast. " I have now finished my promised investigation ; and in the course of it have presented a series of facts, which to me appear interesting, important, and conclusive." Such was the case ol the Wallabout, and such the evi- dence respecting it. More than seven years have elapsed since this evidence has been laid before the public, whol- ly and completely disproving every material fact stated in the account which first appeared in the Medical Reposi- tory ; yet have not the editors of that work ever had the candour, we will say, the integrity, to correct that ac- count, or even so much as to mention to their readers that a different one had appeared. How such behaviour, in the conductors of such a work, can be reconciled with fair- dealing towards the public, we must confess ourselves at a loss to comprehend. It was in reference to this case of the Wallabout, that we seriously asked, and now repeat the question, ** What must the public think, what ought it to think of a literary work, which, in the guise of openness and truth, pubUshes important mistatements of material facts, and when it is afterwards convicted be- yond all doubt, of having done so, continues, notwithstand- ing, to circulate these mistatements, and to propagate a doctrine founded upon them, most momentous in its con- sequences upon society ?" To return once more to the Essay under review: " The occurrence of similar diseases in other parts of the world, under similar circumstances, where contagion introduced from abroad cannot possibly be suspected, is also adverse to the doctrine of importa- tion. In making the circuit of the globe, on the parallels of latitude nearly or exactly corresponding with>our's, we pass over countries, which, from the earliest records of history, have been frequently vi- sited with the ravages of disease. Spain and Italy afford striking examples." oJ2 Miller on the Yellow Fever. The observation here made respecting the parallels of latitude, is anticipated, and completely answered, in a let- ter to the editors, in the first number of volume first, en- titled, " Conjectures concerning the Native Climate of Pestilence, by an Observer." Dr. Miller introduces Spain and Italy as examples to show, that when the yellow fever prevailed there, *' conta- gion introduced from abroad could not possibly be suspect- ed." Has Dr. Miller then wholly forgotten what he has himself recorded in several volumes of his own Reposi- tory ? Has he forgotten the Spanish work of Dr. D. Roque Jose de Oyarvide, which he has so ingenuously re- viewed, beginning thus : " Dr. Oyarvide professedly and zealously maintains the contagious nature of yellow fe- ver, and, like other persons who advocate the same side of the question, either mistates facts, or reasons badly upon them." Or has he forgotten the Report on the subject of quarantines, made to Congress by his coadjutor, Dr. Mitchill, as preserved in the same 6th vol. where Dr. Mitchill utters the following complaint ?—" The recent accounts of the severe quarantine of an hundred days, and more, imposed upon American vessels in some of the principal ports of Spain, must fill every friend of our commerce with regret." And yet Dr. Miller has the courage to declare, that in Spain, " contagion introduced from abroad could not possibly be even suspected." Has the Doctor forgot the article in his 4th vol. facetiously entitled, " Retaliation on the importers of yellow fever," in which he informs us, that " for fear of suffering from conta- gion, imported from the United States, our ships are sub- jected to quarantine and their consequences in all the ports of Europe ?" In fine, can Dr. Miller have to- tally forgotten the great and valuable work, entitled, Miller on the Yellow Fever. 3453 u Precis Histcrique de la Maladie qui a regnS dans I'An- dulousie en 1800," and reviewed in his 8th vol. ? It con- tains no less than 800 octavo pages on the yellow fever which prevailed in Cadiz and the Spanish province of Andalusia in the year 1800, and is the result of the per- sonal investigations of three of the most eminent French physicians of the day, who were appointed as commis- sioners by the French government for this express pur- pose. In 1802 they published their discoveries, which were examined and sanctioned by the faculty, approved of by the governments of both France and Spain, and have, ever since, served as a guide to the proper authori- ties in the precautionary measures taken to guard against the introduction of this pestilence. " In this investiga- tion, (says a much esteemed medical correspondent) made at a time when the disease was scarcely extinguished* and with the greatest industry, caution, and discernment, lhe commissioners have established the three following points : " 1. That the disease was of foreign origin, having no affinity with any of the known indigenous diseases; such as the putrid marsh or malignant bilious fevers, of the summer and autumnal seasons, so common to all the south of Europe. " 2- That it was evidently contagious : not, like an atmospherical epidemic, displaying its influence by a sudden and rapid extension, striking its objects in different and distant directions, at the same time ; but attacking, in regular order and succession, individuals, fa- milies, the inhabitants of the same or adjacent streets, towns, and vil- lages ; not, like an endemic which attacks those only who have been exposed for some length of time, to some local, insalubrious, noxious source, and which vanishes with the removal or destruction of that source; but like those diseases universally known to be contagious, attacking only those who have intercourse with the infected, directly or indirectly, sparing but few in its progress, except where precau- tionary measures were observed against it. " 3. That, in all its symptoms and circumstances, the disease was the same as the pestilential yellow fever of the West-Indies, and a theUnited States." 334 Miller on the Yellow Fever. " The commissioners, also, traced its origin distinctly and satisfactorily to an American vessel that had arrived at Cadiz from Havanna, in the preceding July, which had lost some of her crew by the fever at sea. From this vessel the infection was communicated, first, to some of the waiters and officers of the customs, who had been placed on board, who carried the disease into the city? from whence it gradually spread in almost every direc- tion. Into what weakness, (observes the editor of the above French work) especially on medical subjects, have not men been betrayed by theoretical enthusiasm ? Pre- judice, passion, or the weak ambition of acquiring a name distinguished above their professional brethren, or com- petitors, make men, sometimes, embrace strange and extravagant opinions without due examination, which their pride or self-love forbids them ever after to re- nounce." Dr. Miller, in order to lessen the credit of the above work, with an air of importance, observes upon it— " Now, the reader of this publication ought to understand that the three professors arrived so late in the season at the sicklv region, that the distemper had disappeared with the cool weather of autumn be- fore their arrival, and that they did not see a single case of it." That it was necessary to see the disease, in order to judge whether it was yellow fever or not, might possibly be asserted with some, but not much plausibility ; but that fact not being in question here, why a case of it should be actually seen, in order to enable the inquirer after its origin to judge of the applicability and the force of evidence we have never heard, nor can we conceive : Certain it is, that many of those non-contagion lay writers quoted by the Me- dical Repository, with the highest applause, such as Noah Webster, Esq. and others, never saw a case of the dis- Miller on the Yellow Fever. 335 ease ; and we have heard it questioned whether Dr. Mil- ler's learned colleague himself ever saw a case of it. Dr. Miller, however, we observe, hopes the reader will not yield too much credit to the three physicians, because, as th ;y oifly arrived just after the extinction of the dis- ease, their statement of facts ought to be received with distrust. It is, however, fully expected that we should believe the Doctor himself, who was this side the Atlan- tic, and neither saw a case, nor ever had an opportunity to acquire any personal knowledge of the facts whatever. Who can sufficiently admire the modesty and consistency of this gentleman ? So much for Spain. As to Italy, where, he also as- serts, no contagion from abroad could possibly be sus- pected, we will go no further for proof to the contrary than to the Med. Rep. in the 8th vol. of which, p. 429, we find " An extract of a letter in Leghorn, beginning thus: " The late fever with which we have been visited, I am persuaded, is the same as the American yellow fever. It has been proved, be- yond the shadow of doubt, that it was imported from South,America, in a ship laden with hides, which touched at Cadiz to recruit its hands, having lost several on the passage. The captain died of the fever in a short time after his arrival." It is true, the Repository contains also other extracts of other letters, expressing a different opinion. But the above is produced here, in answer to Dr. Miller's assertion, that contagion in Spain and Italy has not even been sus- pected. We now see in his own pages, a direct contra- diction to this assertion staring him in the face : we here find, that it has not only been suspected, but, if the wri- ter deserves belief, proved. We must now travel with him to Rome, ancient Rome, and combat him in the arena there. 336 Miller on the Yellorv Fever. As another example that, " in making the circuit of the globe, on the parallels of latitude nearly or exactly corresponding with our's, we find countries, which, from the earliest records of history, have been frequently vi- sited with the yellow fever," the city of Rome 1s adduced. " Rome, in particular, though its elevated situation is generally sa- lubrious, is annoyed by a marshy spot at the feet of two of its hills, along the margin of die Tiber, which has been sickly and pestilential from the origin of the city. While the streets on the hills, like Broadway and other high grounds in the city of New-York, enjoy a salubrious air, the spot of marsh just mentioned, togedier with a small extent of made-ground (for the noxiousness of made ground has been felt at Rome, as well as at New-York) corresponding with the marshy spots, and vastly more extended space of made-ground, along the margin of the Last river, has produced, from time immemorial, malignant and mortal epidemics." In support of this statement, Dr. Miller quotes Baglivi and Lancisi, two celebrated physicians and medical histo- rians of the 16th century, and he also quotes Ovid, al- ways much admired as a poet, but now, for the first time adduced as historical authority. The following lines are given to prove that the u noxiousness of made-ground was felt at Rome :"— " Hoc, ubi nunc fora sunt, udae tenuere paludes, Amne reduntatis fossa madebat aquis. Curtius ille lacus, siccas qui sustinet aras, Nunc solida est tellus, sed lacus ante fuit. Qua Velabra solent in Circum ducere pompas, Nil prster salices, cassaque canna fuit." On looking into the original, we find the poet intro- duces a decrepid old woman, who undertakes to narrate the important changes in the face of the country, that have taken place in her day ; which brings us to the quotation before us: she recollected, she says, the time when, in the spot before them, where the courts of justice stood, there was once a large ditch or canal filled with water, which flowed into it from the Tiber; when the Curtius Lacust Miller on the Yellow Fever. which then was solid earth, and supports a temple for worship, was once a common lake ; when the temporary artificial lanes, through which it was customary to lead solemn processions to the circus, presented nothing to the eye but willows and useless reeds. If more'than this is to be found in the passage, or the context, it has escaped our research ; if there is any thing that, in the most re- mote degree, can be supposed to relate to the " noxious- ness of made-ground" or to made-ground at all, we have not been able to discover it. Dr. Miller and his fellow-labourers on the same side have, forever, been harping on " marsh miasmata" as the cause of a vitiated atmosphere, and they persist in charging the yellow fever of our cities on this " marsh miasmata." Well, the city authority take them at their word, and they order all these marshes (which, by the way, are situated in places where no yellow fever has ever yet appeared ; the Collect and Lispenard's Mea- dows) to be filled up ; and for three years they have been filling accordingly, until, as Ovid says, " Nunc solida est tellus, sed lacus ante fuit.'"' And now the same complaint is heard against the new made-ground, as was heard against the former marshes ; they now declai-e that it is the new made-ground which causes the yellow fever. There is also much made-ground on the East and North ri- vers. The filthy slips have been filled up with sound and solid earth ; the mud of the bordering shore, which used to be left bare at low water, is left so no longer, but is co- vered by new made-ground, and neat, cleanly wharves. Against this the non-contagionists clamour louder still. It is this nexv made-ground, say they, which breeds yel- low fever. In vain we point to o\\x eastern shore, and re- mind them that, in 1741, that shore was mowed for Vol. II. 'T u 338 Miller on the Yellow Fever. sedge, in the recollection of some of our oldest inhabitants, and that, at that very time, long before made-ground was thought of, the yellow fever male its fatal appearance, and became dreadfully epidemical. Equally in vain we re- mind them that it is more than six years since the disease showed itself among us, although, during all that period made grounds have been constantly going on, until there are acres now to feet then ; in vain we point across the East river, to the Wallabout, and tell them there are no made- grounds there ; to Brooklyn, and tell them there is but a very small portion there ; across the bay to Amboy, and tell them there is none at all there ; still our ears are stun- ned with the cry against made-grounds and marsh exha- lations. " Here is an incongruity, say we : If marsh ex- halations cause pestilence, the way to meet it, and preven* those exhalations, is, surely, to cover over these marshes with a hard, dry, solid, and deep gravelly soil, is it not ?'' " No, says Dr. Miller, that will be made-ground, and Rome suffered much from the noxiousness of made- ground ; vide Ovid." " But you non-contagionists, we rejoin, will not contend that the same effects are produced by two opposite causes, wet ground and dry ground ?" " Certainly we do ; have I not told you already, that, ** We live in a latitude of pestilence, and our climate is on- ly beginning its tendency to produce this terrible scourge ?" Baglivi and Lancisi are also quoted by Dr. Miller for the same purpose. We have carefully examined both these authors in the original Latin, and now are compel- led to contradict Dr. Miller on the fact: we do deny* first, that either of them contain the most remote allusion to made-ground; and, secondly, that either of them de- scribe any disease that can be identified with our yellow fever. They mention, indeed, fevers, which, however, they Miller on the Yellow Fever. 539 ascribe, not to dry made-ground, but to causes directly the contrary. " Quaecunque loca (says the former) cre- bris aedificiis ambiuntur> atque editiora sunt, in septentri- onem atque orientem spectant, et multum a Tiberi dis- tant, salubriora: Contra, quae sejuncta sunt, et remota a frequentibus tectis, situque sunt humili, ac maxime in convallibus, turn propriora Tiberi, in meridiem atque occasum spectantia, minus salubriora judicantur." Is there even an allusion here to made-ground? So too Lancisi: u Nemo sane luctuosa Itinera per id temporis Roma? conspiciens, fcet'>remque in vicis illis persentiens, dubius hassit, quin causa malignarum, perniciosarumque febrium, quae publice vagabantur, fuerit multitudo stag- nantium et corruptarum aquarum, turn in scrobibus pra- torum, turn in magna cloaca, atque in fossa potissimum Hadrian* arcis.'' Will any one, who can read the Latin tongue, say that made-ground is here once mentioned or alluded to, in any manner whatever ? Certainly not. But, we would ask Dr. Miller, on which authority it is, that he asserts that our yellow fever ever appeared at Rome ? In the first place, no pathognomonic symptoms of the yellow fever are mentioned, and, if it were other- wise, Dr. Miller has effectually precluded himself from saying that they are the same with those which character- ize the yellow fever ; for he has expressly declared in the Essay before us, that the yellow fever has no pathognomo- nic symptoms. If he will turn, however, to Baglivi's chap- ter " De febribus in genere," he will find the author, in section the first, expressing himself thus: " Ante septi- mum diem in acutis, et inflammitoriis, nee purgato,nec dia- phoretica vehementia dato." But before the seventh day of the yellow fever arrives,, the time for exhibiting medi- cine, or affording relief of any sort, is for ever past. As 340 Miller on the Yellow Fever. it is hardly to be supposed that Dr. Miller has totally forgotten his Latin, what, in the name of charity, can we say for him ? Great, indeed, must be his assurance in thus venturing to quote authors in a dead language, unknown to the majority of his readers, in support of a theory which those authors never dreampt of. If Dr. Miller can re- concile his conduct with his notions of strict integrity, he must have formed his ethics in a very different school from any that we ever knew or heard of, ancient or mo- dern. We finish what we have to say on the subject of made- ground, by asking Dr. Miller how it is, that neither that part of the city known by the name of The Collect, sur- rounded as it is, and partly covered by houses, nor that known as Lispenard's Meadows, much of which is alreadv built upon, and the rest in a train of being occupied with houses, although both consist entirely of made-ground, the former once covering a deep pond, the latter an ex- tensive marsh, how is it, we ask, that the yellow fever has never first made its appearance in either of these places, nor even in their vicinity ? Till Doctor Miller can better reconcile theory with fact, he may certainly spare himself the trouble to caution the people of this city against the noxiousness of made-ground, as a cause of yellow fever. " The source of mistake (he says) on the subject of importation, seems to consist in not distinguishing a febrile poison generated by heat and filth in a vessel, from contagion taken up in a foreign port, and successively communicated from one person to another." " The construction of vessels disposes them to the collection and retention of filth, and renders cleansing and ventilation extremely difficult. The qualities of cargoes and provisions, the inattention of seamen to cleanliness, the crowded manner in which they live, &c. &c. render shipping the most dangerous of human habitations. It is no wonder, therefore, they should become unhealthy, when they pass into warm latitudes, or lie in our harbours in the hot season." Miller on the Yellow Fever. 341 Unquestionably the market-boats, which fill our slips during the summer, are the filthiest of all sailing "' hu- man habitations ;" yet, if the resident physician should go aboard, and assure the proprietors that they bred the yellow fever in them, we suspect he would scarcely escape being heartily laughed at. But, pray what became of these filthy vessels during the fifty years preceding 1795 ? But to make the answer short, we call upon Dr. Miller, or his colleague, to mention a single instance, a single one, where the yellow fever has ever shown itself on board of any vessel lying in any harbour of the United States, and not recently from a port within the tropics. We confidently defy him to point out a case. When he does so, and substantiates what he says, then shall we feel compelled to abandon all that we have ever contended for. " The inefficacy of all the various modifications of quarantine laws hitherto devised in the United States, confirms our disbelief of conta- gion. In the port of New-York, as well as that of Philadelphia, a ri- gid system of quarantine has been in operation for many years; and there is no doubt of its having been vigilantly and faithfully executed." Is it indeed so ? Have the quarantine laws been hitherto inefficacious ? Have they always been vigilantly and faith- fully executed ? This Review, then, has been written to very little purpose. We are egregiously mistaken, how- ever, if it has not appeared, in the course of our researches, that the exemption of this city, for several years past, has been solely owing to a better modification of our quaran- tine law, which was amended in 1804, and a better exe- cution of it. We are mistaken, too, if it has not been equally made to appear, that the misfortunes of the Wal- labout, and of Brooklyn were wholly owing to a want of " a vigilant and faithful execution" of the quarantine laws. But what, we ask, could be expected from the vi- gilance and faithfulness of a Health Officer who does not 342 Miller on the Yellow Fever. believe the yellow fever is either an importable or a con- tagious disease ? Would it be reasonable to expect a man to be active and vigilant in preventing the spreading of a fire who did not believe that a fire existed, or could communicate itself? Ought it rationally to be expected that a physician, though exalted into a Health Officer, could vigilantly execute a law, providing against the in- troduction of a pestilential yellow fever, who does not know the disease when he sees it, from an intermittent ?* Or that another was capable of executing satisfactorily the duties of Resident Physician, for the purpose of ordering out of the city, the first case of yellow fever that makes its appearance, who holds the same theories as the Health Officer, and who, also, does not know the disease from a common cold ?+ We say, boldly and fearlessly, say, because we feel it to be our duty to do so, that to commit the execution of our health laws to gen- tlemen thus professing a theory directly at variance with that which constitutes the basis on which those laws are founded, is a gross absurdity, and no better than a mockery of the community. Political considerations may- be allowed weight in appointments to office on ordinary occasions, but when they are permitted to outweigh every other, in cases where the lives of thousands, and almost the existence of our commercial cities, are at stake, it is an evil most deeply to be deplored, and its authors deserve the bitterest reproaches. " Under the influence of this phantom of contagion, (says Dr. Miller; we have instructed the Europeans to enact laws and regula- tions, sanctioned by the highest penalties, which retard and oppress our commerce, and subject our shipping in their ports to the most grievous detention." • Vide page 298. t Vide page 280. 301. Miller on the Yellow Fever. 343 If Dr. Miller could show that those Europeans stand ready to relinquish their quarantine laws and regula- tions, as soon as he convinces us that " contagion is but a phantom," and the yellow fever " a misfortune limited to ourselves, and cannot endanger their safety;'' if, we repeat, he could satisfy us that they will, in complaisance to us, repeal their quarantine laws, the moment they hear of our repealing our quarantine laws, there would be something in his argument. Or, at least, there might be something, were it not for the appearance of the following passage in the same Essay : " In rejecting the doctrine of importation the benefits of quaran- tine are, by no means, intended to be undervalued. The generation of pestilential diseases in foul vessels is undeniable." " There ought undoubtedly to be some mode of ascertaining whether a vessel may be safely approached by people in business, or whether she may be likely to diffuse pestilential vapours among all who come within their reach. Quarantine is, also, one of the most humane regulations in favour of seamen. It interposes between them and the careless- ness or cruelty of their commander, and make it his interest to pre- serve their lives and health." If the doctor is sincere in this, quarantine laws are highly valuable in themselves, and in all parts of the worldi without reference to contagion, or to yellow fever, or to the United States. " The generation of pestilential disease in foul vessels (he declares) is undeniable ; they are a frequent source of malignant sickness," and " quarantine is one of the most humane regulations as to seamen," &c. Now then, we should be glad to know what the Doctor really means ? He charges the ad- vocates of importation and contagion with being the cause of quarantine regulations in foreign countries, " which re- tard and oppress commerce, and subject our shipping to grievous detention," in one page, while in the next he declares, that quarantine regulations are, by no means, in- tended to be undervalued ; and gives several reasons 344 Miller on the Yellow Fever. why they are not to be dispensed with. As we have al- ways thought that the main design of Dr. Miller's Essay was to persuade the public that quarantine regulations were highly injurious to commerce, and ought to be for ever abandoned, we were somewhat at a loss to find him thus a strenuous advocate for their continuance. Nor could we have acquitted him of a palpable inconsistency, had we not fortunately recollected there was still one power- ful reason more, which Dr. Miller's modesty has kept back, viz. " because my brother R • ■> ■ is Health Officer, and------Resident Physician.'"' Having reluctantly laid so heavy a claim on the reader's patience in this attempt to expose the errors of fact, and the false reasonings connected with them, that so eminently distinguish an Essay, which we have always considered one of the most mischievous tendency, our Review, at length, approaches its close. Thinking we cannot do better than to finish by reminding the reader of those leading opinions on the subject that has so long occupied our attention, we beg permis- sion to repeat what we have once said in an early number, by way of explaining what we mean by the contagiousness of yellow fever. Byr the contagiousness of the yellow fever then, we mean the communication of it, under certain peculiar circumstances, from one person to another, or from things to persons. By communication, however, we do not mean, first, that it is to be conveyed only by touch, like the itch or syphilis ; nor, secondly, by touch and through the medium of a pure atmosphere, like the small pox and measles; but, thirdly, we mean that it is conveyed from a diseased person to those in health, or from infected materials to persons in health, under circumstances of an atmosphere of peculiar impu- Miller on the Yellow Fever. 345 rity, and under such circumstances only. " The yellow fever, like typhus, jail, ship, hospital or lake fever, and dysentery, is a disease only communicable through the medium of an impure atmosphere ; in a pure air, in large and well ventilated apartments, when the dress of the patient is frequently changed, all excrementitious dis- charges immediately removed, and attention paid to cleanliness in general, these diseases are not communi- cated,-or very rarely so, from one to another. But in an impure air, rendered so by the (presence of a foul or in- fected ship) decomposition of animal and vegetable sub- stances, such as takes place in low marshy countries, or by concentrated human effluvia, as in camps, jails, hospi- tals, or on ship-board, they are rendered not only extreme- ly malignant and mortal in themselves, but become com- municable to others who approach the sick, or breathe the same atmosphere which has become assimilated to the poison introduced, insomuch that the same specific dis- ease is communicated, whether it be the plague, yellow fever, typhus, or dysentery."* But neither is it every kind of impure atmosphere that will form a medium for conveying this disease; but it is that kind of impurity which has become " assimilated to the poison introduced by the disease." Hence, therefore, a single person may be ill of the yellow fever in even an uncleanly lodging, but of which the air has not become assimilated to the poison of the disease, and if care is taken to change the f-«tient's dress, remove excrementitious discharges, and in case of death to destroy the bedding and purify the apartments, the disease may not be communicated to any * Hosack on Contagion. Vide Edinburgh Medical and Surgical Journal, for October, 1809. Vol. II. x x 346 Miller on the 2'ellow Fever. others in the house. With these explanations and quali- fications we adhere to the opinions we have long since formed, which we have more than once published, and which we have never re-examined without increased confidence in their soundness. Should we be correct in those opinions, it follows, that instead of looking for the origin of the yellow fever in our gutters, or made grounds, or in a peculiar constitution of our atmosphere, or in our "latitude of pestilence," or in the " septic acid engendered by us, [unhappy Americans !] within our own alimentary canals,"* is a contagious disease, brought hither in ves- sels from infected places abroad, and that, in order to pre- vent this terrible scourge from ever again appearing here, and desolating our city, nothing is wanting but a system of good and wholesome quarantine laws, faithfully and vigilantly executed. Give us this, and we have no hesita- tion in saying that the city of New-York will be as secure from yellow fever, as the city of Albany or the village of Utica. To conclude. It is probable that some of those who have done us the honour to peruse this Review, may have thought we have not always restrained our feelings of in- dignation as much as we might have done, without any deduction from the weight of the argument. To such, if such there are, we offer in answer, the following pas- sage from a controversial work of a celebrated English divine. " Perhaps I have used a quickness of language by which my more gentle reader may be hurt in his feelings. But let the gentlest of my readers reflect, that such a • Vide Med. Rep. v- 6. p. 424. Miller on the Yellow Fever. 347 manner is unavoidable, from the nature and circumstances of controversy. All controversy is, in the literary world, what all war is in the political, an evil necessarily incident to the wretchedness of our present state. In war such acts are lawful, as would be criminal out of it. Blows and wounds then become licensed outrages. Just so it is in controversy. A tartness of remark, a harshness of reprehension, and a provoking pointedness of triumph, are all as lawful as blows and wounds in war. War can- not subsist without these. Controversy cannot without those. And to fight fairly without wounding, or to con- trovert fairly without hurting, are equally impossible." An apology may, possibly, be expected of us for this Review, after the very able Letter of Dr. Chisholm to Dr. Haygarth, on the same subject, " in order to cor- rect the pernicious doctrine promulgated by Dr. Edward Miller" &c. It was not that we had the vanity to think that we could add to the arguments of Dr. Chisholm ; never for a moment did we suppose that this great man and vigorous controversialist, needed such assistance as our feeble pen could afford—" non tali auxilio"—but the superior advantage we possess in residing amidst the principal scenes of action, enabling us to controvert many important statements in point of fact, which he was com- pelled to take for granted, or combat upon conjecture, we felt impelled to glean after him, proud of such a leader in this great cause of truth and humanity, though too conscious of the haud passibus tequisw'ith which we must follow him. Far from being insensible to the distinguish- ed merits of this celebrated man, we see the master's hand conspicuous in every thing he touches. An erudi- tion the most profound, a logic correct and luminous, con- veyed in a style elegant, nervous and classical, signalize and 846 > MUler on the Yellow Fever. adorn the pages of this eminent physician, this fine scholar and accomplished gentleman ; and if such qualifications, under the constant guidance of a nice sense of honour, which, while it renders its possessor sensibly alive to every indignity-, preserves him from the smallest tres- pass on decorum, can insure lasting fame, the name of Chisholm shall not only wear the honours of the age in which he lives, but his laurels shall bloom perennial. Without meaning to be understood as uttering the lan- guage of triumph, we now seriously call upon Dr. Miller to come forth and defend his elaborate Essay against the foregoing Review; or if the doctor himself has neither leisure nor inclination for such an undertaking, we trust that the reviewers,* who say in their last number of the " New-York Medical and Philosophical Review," they " are so perfectly satisfied with Dr. Miller's Essay, that nothing, as they apprehend, more satisfactory can be offered in the present state of our knowledge," will step forth in their own defence. We should be happy to meet either or all of these gentlemen in the field of fair controversy. The gauntlet is thrown for any who choose to take it up. * Drs. M'Nevin and Smith. 203 Account of the Malignant Fever that prevailed in the United States and West Indies during part of the year 1819. In the last number of the Recorder, a brief notice of the malignant fever that prevailed in several cities and towns in the United States was given; and a promise was made to furnish more ample details of it, in this number. This promise shall now be performed. Of the fever, in Boston, that prevailed partially in September, we have no official documents except as to the number ol deaths by it. These are stated in the annual bill of mortality, to be 82. The term used is '■'•malignant fever:" one hundred and eight are said to have died of typhus, and ten of bilious fever. It.is highly probable that several of the cases thus named, ought to be included under the first head. Eighteen died in the hospi- tal at Rainsford's island, including those who were sent from Boston, and who arrived sick in vessels which were under quarantine. The disease appeared in New York in (he latter end of August, at the Old Slip and vicinity, East River, near to the same spot in which the yellow fever commenced in 1798. The tirsi publica- tion on the subject by the Board of Health, was on the 7ih Sep- tember, when they wisely recommended to the inhabitants ol the infected district specified by them, to remove; and to purify the yards of their houses, their gutters, and privies, by a tree use of lime. The assistants of the Board of Health, together with the city inspector and assistants were also required to examine every house and lot, wi.mu the limits described, and to cause every place capable of adding to the contamination of the air to be puri- fied by a free use of that excellent article, just named. Vessels also were required to be removed from the wharves of the in- fected district, viz. in luded between Pearl street, the East River, Coenties Slip, and Wall street.* This decisive conduct of* the * it appeared from publications in the newspapers of the day, that the vicinity of tlie Old Slip abounded with the materials of putrefaction • that it Vol. III.—D d 204 Fever in the United Stales, in 1819. Board called forth much censure, as is common on such occa- sions, from the inconsiderate or selfish. The alarm was consi- dered u premature," and certificates of attending physicians were published to show that the diseases of which the people that caused the alarm had died, was merely the common bilious re- mittent fever of the season. The destruction of the commerce of the city was predicted from the terror which the official declara- tion of the existence of the fever would cause; some persons re- fused to evacuate the infected spot; one man, (Boggs,) with con- sistent obstinacy, after being removed by order of the mayor, re- turned, and shut himself up in the house with his family, where he remained unknown, until discovered dead on the 19th Sep- tember. One or two melancholy cases occurred of highly worthy and valuable citizens losing their lives in consequence of reso- lutely frequenting their counting-houses every day in the vicinity of the Old Slip; they also publicly denied the existence of any danger, and freely censured the Board for their publications. On the 8th, a detailed statement of Jthe deaths that had been re- ported to them was published by the Board of Health: and it is to be regretted that some of the reports of the medical men, were of a nature to distract, and mislead the Boa'rd by their ambiguity and want of precision, had not the Board been composed of men of a decisive character, and not disposed to be led away by fine spun distinctions between " highly suspicious diseases," " of diseases having the appearance of yellow fever, but that exhibit- ed symptoms of bilious remittent fever, and that were attended with an unusual degree of malignancy." The Board of Health made this very sensible remark on the subject of their preven- tive regulations. " Measures of precaution, when attended with present inconvenience, are always unpalatable, (unpopular,) and they usually become most so, when completely successful. It w as the abode of a condensed population, and the resort of a vast number of sailors; and that the houses were destitute of yards and other conve- niences necessary to receive excrementitious deposits. The Slip was de- scribed as the receptacle of dead carcasses, and of every variety of animal and vegetable offal. Fever in the United States, in 1819. 20j frequently happens that their failure is received as their best justi- fication." They continued to make daily reports to the j ublic of the progress of the fever, and on the 10th ot September, called upon the physicians to attend to the law which requires their reporting in writing to some one of the health commis- sioners, all patients under their care, labouring under malignant fevers. Dr. Dewitt, the health officer of the port, died on the llth of September, at the quarantine ground, of a stroke of the sun. On the 18th of September, the Grand Jury of the city and county of New York, presented as nuisances several places, and remarked, " that while such prolific sources of fevers are suf- fered to exist, no precautionary measures for the health of the city can be efficacious in preventing disease, or in arresting its progress." They particularly specifyed the bottom of several streets, and a lot in the north of the city; the Old Slip and vici- nity; the Fly Market; Peck Slip, " and the last, yet not least," " Rosevelt Slip," which was stated to be " in a most shocking and filthy state." The Fly Market, they remarked, is built over a common sewer, which has no covering under tlie meal market, ex- cept the market-house floor, which is loosely laid, and on the sides of the market are a number of apertures into the sewer, which are receptacles of filth and garbage from the adjacent taverns, fruit stands, and cook shops, creating offensive and pestilential effluvia, and infecting the atmosphere. On the 18th, much alarm prevailed, and great numbers moved from the vicinity of the Old Slip. On the 20th, the Board recommended proper measures to be adopted to ventilate, cleanse, and purify the houses which had been vacated. They judiciously specified the good old-fashioned remedies of scrubbing and whitewashing; and advised the free use of lime in cellars and privies; the removal of all substances liable to putrefaction. The acid fumigations they very properly left to those who chose to use them. On the 21st, the Board stated, that with the exception of three sailors, there has not been any one who has taken the dis- order out of the district designated by the Board in their resolu- 206 Fever in the United States, in 1819. tion of the 6th of September; and those who have taken the disorder there, and have sickened and died in other parts of the city, have in no instance communicated it to their nurses or at- tendants, or to any one else. Two of the sailors alluded to be- longed to the ship La Florentine from Martinique, the particulars of which it will be useful to record. From the publication of the Board of Health, of the 25th October, it appeared this ship La Florentine arrived in July after a passage of 20 days from St. Pierre, Martinique. The yellow fever prevailed at that place at the time of her leaving it, and one of the passengers died with it there. She performed a quaran- tine of 30 days, underwent all the ordinary purifications, and on the 24th August, the Health officer reported that she was free from infection, and might be allowed to come to the wharves. The Board, however, ordered her to be anchored In the stream. In the beginning of September, two of the seamen were taken ill wi h the yellow fever, and she was sent back to the quarantine ground. From thence she went to sea; but having met with a storm, she put back in distress, on the 25th of that month, when it was found, that since her departure her captain had died of the same disorder.* Another seaman came from the quarantine during the last illness of the health officer, and died on board a sloop at the wharf. The infected district was now announced to be entirely evacu- ated. The poorer inhabitants were removed to Staten Island, and the sick sent to the vicinity of Hurl-Gate up the East river. The entrances of the streets leading through the infected district were fenced up, and the vessels at the adjacent wharves anchored in the stream. The most active measures were also taken to correct nui- * The case of another vessel deserves to be mentioned, as shewing the permanence of infection, under certain circumstances, and the caution neces- sary to be used in pronouncing a vessel safe. " The brig Eliza arrived on the 13th August, after a passage of six days from Charlestown, S. Carolina, hav- ing on board a sick passenger, who died the same day with yellow fever. She performed a quarantine of 30 days, and was three times whitewashed and otherwise purified, and on the 6lh September, she was allowed to anchor in the stream, yet on the 6th October her captain died of the yellow fever, and on the 17th one of her seamen sickened with the same disease.'" Fever in the United States, tn 1819. 201 sances, to purify such places as seemed likely to generate or exas- perate disease, and generally to do whatever might tend to preserve the health of the city. The watch was doubled round the deserted houses; and the citizens were earnestly cautioned not to enter the infected district, " an imprudence which had proved fatal to several."* The good effects of the judicious and decisive conduct of the Board, who acknowledge the able assistance derived from the mayor, Mr. Colden, were soon apparent in the speedy diminution of the number of cases report- ed daily by the physicians; and on the 25th of October they an- nounced that" the danger which had lately threatened the city had disappeared." It ceased to appear after the 13th October. Their pre- cautionary measures, ihey said, would have been complete " but * for the imprudence of individuals. The incredulity of some, and the interest or folly of others, prompted them to visit the forbidden district. Several took the infection, and thus kept alive the dis- ease, which would otherwise have ceased for want of subjects on which to prey." Of sixty-three cases reported, forty-three per- sons died of itf in the city, and at Richmond on Staten Island; a mortality, small when compared with that of other seasons in which this malady has prevailed. On the 23d Sept. a severe gale took'place, and the water of the river penetrated the cellars of many houses in the infected district: had the inhabitants remain- ed, the mortality would have been from that cause greatly increas- ed. The Board were warmly urged to use the vile acid fumigations which were some years since cried up by the chemist Morveau of France, and Dr. Carmicheal Smith of London, as grand in fallible destroyers of contagion; but they declined, and for the fol- lowing sensible and substantial reasons. " They had seen in the instance of the vessels before alluded to, the difficulty of destroy- ing infection; and admitting that the fumigations possessed all the efficacy ascribed to them, and that they might be successfully employed lo purify a chamber or a house, yet it was at least doubtful whether more than 200 houses and stores, (many of the » Cases of infection from a short visit to the Old Slip were mentioned in the last number of the Recorder. f The whole number of deaths in the year 1*1°- (Viz. M76) \v.t> SO less than in 1818. 208 Fever in the United Stales, in 1819. latter filled with goods) could be so effectually purified as to ren- der all of them safe. It was known that frost would destroy the disease; if the district remained without inhabitants til] after a frost, no other purifier woold be requisite, and to invite the in- habitants to return sooner, and to depend for security upon a process which in the case of so many buildings could scarcely fail through accident or unskilfulness to be unsuccessful in some of them, was an experiment which appeared too perilous to be sanctioned by prudence." The details respecting the fever in New York are designedly minute, because it is considered important to show the local origin of the disease, and because the conduct of the Board of Health will serve as a rule for the guidance of public authorities in the event of a malignant disease breaking out in other places. • In Philadelphia the first report of a disease of a " suspicious na- ture" was made to the Board of Health on the 2d July. Three cases were stated to exist in the family of Mr. Reeves, who kept a tavern on the north side of Market or High-street wharf. Ac- cording to the account of Mrs. Reeves, her husband was taken ill on the 28th of June, and died on the 5th of July. He had been complaining for several days before his illness; on the 28th of June, after being much heated by working on board the steam ferry boat which plyed between the wharf at his door and New Jersey, he came into the house and layed down on the floor in a draught of air. Being soon warned of the imprudent act by his wife, he re- tired to bed. Mrs. Reeves was taken ill the same afternoon: their daughter had been indisposed the preceding evening: all of them were removed by order of the Board of Health on the following Saturday, 3d of July, across the river to New Jersey, where Reeves died on the 5th; his wife and daughter were confined to their beds several days, but both recovered. .1 Isaac Geyhan, who was employed in a store on the wharf, and next door north of Reeves', had cut his ancle severely with a glass bottle, the latter end of June, and on the 1st of July he leaped into the water about two o'clock to save the life of a boy who had fallen off the wharf: after swimming about 30 feet he came nut, and went into a damp alley adjoining the store, and while a Fever in the United States, in 1819. 209 strong draught of air was blowing on him, stripped off his clothes, wrung them out, and then put them on again. He remained at the stoic until after sundown, when he went to his home mi Brown street, Northern Liberties, and that night he was taken ill. He died the 6th of July. - Thomas, son of William Wray, who lived west of and adjoining Reeves' house, was taken ill on the 6th of July; on the 5th, which was a warm day,he had paraded with a volunteer corps to which he belonged, and dined with it at Kaighn's Point, New Jersey. He was removed by order of the Board of Health to the Schuylkill up- per ferry on the 8th, and died on the 11th. A lad, James Hammon, in the same house, sickened on the 7th and died on the 9th. The re- mote causes of these cases of malignant fever maybe rationally trac- ed to the pestilential exhalations to which the subjects of them had been for some time exposed; derived from a collection of animal and vegetable matters* which Reeves had been accumulating for several months before his door, to manure some land he owned in New Jersey; and from a quantity of decayed vegetables which he had under his house, and had been left there by the country people, who came to market; and from a similar mass in the cellar of William Wray, and a narrow alley running parallel with his house, and to the north of it. The exciting causes of the disease in Reeves, Wray, and Geyhan, will be obvious from the facts stated above. A few days before the illness of Reeves he had superintended the removal of the mass of manure before his door on board a horse boat; the stench of which was so great as to annoy the whole neighbourhood, and among others, a member of the Board of Health, whose counting-house was to the north of Reeves. Prompt measures were taken by the Board of Health to purify the houses. More than a cart-load of an offensive collec- tion was taken from Wray's cellar, and of putrid vegetables from under Reeves' house; and every part of both houses was well whitewashed, the families were removed and kept away several * This consisted of oyster-shells, with a portion of the oyster left in them; garbage from the cleanings of fish in the adjoining market; decayed vegeta bles, and to these were added the sediments of the gutter that rarr'rd uV- water down Market-street, and settled on the heap. 210 Fever in the United States, in 1819. weeks. The offensive alley north of their houses was washed by a fire engine. A committee of the Board of Health, in their reply of 10th of July to the inquiries of Dr. Dyckman, who was sent by the Board of Health of New York to ascertain facts respecting the reports of malignant fever in Philadelphia, observe in reference to the cases on Market-street wharf, " All the sick mentioned were resi- dent in the city, and the disease has not been traced to any vessel or any stranger arriving from abroad in the place." The fever now ceased on Market-street wharf, but several cases afterwards occured in different parts of the city, and Southern Liberties, some of which, as being evidently produced from local causes, deserve notice. Three were reported on the 13th of July, at 51 South Wa- ter street: upon examination of the house and yard, they were found to be extremely filthy: three or four cart-loads of putrefactive substances were removed. On the 2d of August another case was reported in Jones's or pewter-platter alley; the cellar was found to be extremely filthy; two cart-loads of putrefactive sub- stances were removed therefrom. Four persons were taken ill in Swanson-street, Southwark, whose diseases were evidently oc- casioned by the stench of three privies in the rear of the houses; three of these died. Others in Mead and HuddelPs alley were reported by the attending physicians, who also informed of the nuisances existing in the vicinity of the sick. The most unceasing attention was paid by the Board of Health to the evacuation of some of the houses in which persons had died; the removal and washing of their bedding and clothes, and the purification of all the infected houses, and the removal of every source of pestilential exhalation in the city and liberties, together with a strict vigilance, as to the introduction of sick persons or of putrefactive substances from abroad. The whole number of deaths by " malignant fever," in the , city and liberties, recorded in the bill of mortality for 1819, amount only to 13:—126 are said to have died of typhus, 49 of bilious fever, 6 of intermittent fever, and 43 of remittent fever. Some of the four last forms may fairly be included under the first head, together with some of 33 said to have died of " fever,*' Fever in the United States, in 1819. 211 simply, for all who have been familiar in the American pestilence know the proteus forms it puts on. The disease appeared at Fell's Point, Baltimore, in the month of August, where, with the exception of Smith's wharf, and a few scattering cases, it was confined. That it originated from local causes, is the unanimous opinion of the district medical society, who in answer to an application from the joint committee of the councils of Baltimore, appointed to take into consideration that part of the mayor's communication recommending an inquiry into the causes of the late epidemic, say, " The malignant fever which prevailed at Smith's wharf, and at Fells Point in the sum- mer of 1819, in the opinion of this society, is to be ascribed to the decomposition of vegetable matters. This opinion is supported by the following facts: The alley back of Smith's wharf has been filled up with dock-mud, shavings, and other putrescent materials. The same remarks will apply to the construction of Smith's wharf generally, and also to those parts of the Point where the fever first appeared. The immense mass of materials just adverted to, have been accumulating for many years: while the heat of the summer remained moderate, the destructive prin- ciple was only partially evolved: but the intense heat of the last summer reached the mass of perishable materials, and gave origin to the disease." The number of deaths reported in the bill of mor- tality by " malignant fever," is 350. But it is probable that of 73 called " bilious" and of 84 called " typhus" several might be included under the first head. When the decided character of the disease was ascertained, viz. on the 28th of August, the poor were removed from the infected district to the eastern extremity of the city and there encamped, under the direction of a committee of citizens. In Charleston, South Carolina, the disease prevailed to a much greater extent than in the year 1817; in which year 270 died of it. The official statement of deaths, during the year begin- ning 1st of October 1818, and ending 1st Oct. 1819, return only 176 cases of deaths by yellow fever, but it is remarked that as the disease had not ceased at the time of closing the account. Vol. III.—E e 212 Fever in the Uniled Stales, in 1819. those who fell victims to it on or after the first of October 1819 are omitted. The absurdity of making up a bill of mortality like a custom-house report from October to October, is so obvious, and leads to such inaccurate opinions as to the actual disease prevalent, and the number of cases of any particular disease in a given year, that the arrangement ought to be altered in future reports, and commence with January and close with the last of December. The number of deaths by bilious fever are reported to have been 19. It is probable that some of these should be added to the account of yellow fever. At Savannah, in Georgia, it also prevailed, but almost entirely among foreigners recently arrived from Europe, among whom the mortality was great. At Mobile the disease was highly malignant and fatal. After it had ceased, a committee was appointed by the comparatively few citizens, which the destructive fever had left, " to investigate the causes and extent of the sickness and mortality" at that place, who have published a report,* in which they prove incontestably, the local origin of the disease from the numerous and powerful sources of pestilential exhalation, that existed in the town. They particu- larly notice the wharves, which were filled up with rotten logs, bushes, shavings, and other vegetable matters, and covered lightly with swamp mud: Water-street filled up with the same kind of materials,—docks clogged with timber, old boats, sea-weed and other filthy substances in a state of decay, particularly under the stores standing over the water. They add, that the prevalent north wind in September and October, left the docks, and a large extent of marsh mud about them, exposed to the heat of the sun, and the water, variously obstructed, became itself stag- nant and offensive. They further notice several lots covered with stagnant water, and filled with offal substances; extreme neglect of cleanliness in the town; collections of dead animal and vegetable matter, increased by the hurricane on the 28th and 29th July; incessant rain from the 28th July to llth September, succeeded by a hot sun for 66 days, and drought. For a while the disease seemed to * 12 pages 12mo. S. Potter, & Co. Philadelphia. Fever in the United States, in 1819. 213 be confined to those employed about the river and wharves,, but in a few days after the 10th Sept. it spread rapidly through the whole town, and affected Creoles, inhabitants, and people of colour. About 274 persons died of it. The suburbs of the town were healthy; and no instance is known of the disease being communi- cated to persons out of the town by the removal and attendance upon the sick. The facts detailed in the report referred to, while they prove to demonstration the local origin of the disease, furnish a severe but useful lesson to all emigrants in newly settled places, to remove the local causes of disease, and to prevent the occurrence'of them, by attention to the mode in which their temporary accommoda- tions are provided for. The Mobile report also states, that at Baton-Rouge, Natchez, and perhaps generally upon the Mississippi, as high as the latter place, the same species of fever seems to have prevailed, as at Mobile, with great mortality; in the interior of the country, upon the waters of the Tombecbe and Alabama, the sickness and mortality was greater than was ever known before. At Natchez, it was evidently caused, according to the informa- tion of a resident there, by the exhalation from numerous ponds formed in the course of the new regulations of the streets. About 250 persons died of it. At New Orleans, upwards of three thousand are reported to have died of yellow fever during the past summer and autumn, and it was not until after the first of December, that a return to it or to tfle town of Natchez was deemed prudent. In the West Indies, the fever prevailed wilh great mortality. The pestilential exhalations arising from the want of attention to cleanliness in the city of Havanna, aided by the uninterrupted heat of the climate, naturally account for it at that place, where late in January it still continued to prevail. But it is more diffi- cult to assign a cause for it in the healthy island of St. Thomas, and the rocky town of St. George, Bermuda, in both of which places it was very mortal among strangers. In the vicinity of Cadiz in Spain, it is said to have been very fatal: but the parti culars are not known. 214 Jbi Account of the Fever which prevailed in certain parts of Bal- timore, during the Summer and Autumn of 1819, with some remarks on its Origin and Treatment. By John Revere, M. D. One cannot help feeling surprise on observing the very oppo- site opinions at which men arrive on examining the same objects, and reasoning from, apparently, the same premises. Perhaps there is no pursuit in which this remark is more frequently ex- emplified than in medicine. This is no doubt in a great measure attributable to the nature of the subject, which does not admit of demonstration, but depends on the collective observation of many individuals, whose judgment is apt to be influenced by accidental circumstances, and preconceived opinions. When once we have adopted any set of doctrines we are too often disposed to adhere to them with pertinacity, and to abandon them with reluctance. We are too apt to feel as if our honour was concerned in defend- ing them, and,rather to seek for arguments to confirm our present impressions, than to make honest and disinterested exertions for the developement of truth. The contradictory opinions which are held concerning some of the most important, and, one would suppose, obvious characters of yellow fever, a disease of such frequent occurrence in our country that almost every practitioner has opportunities of studying it, are striking instances of the bad effects 'of this disposition of mind. Perhaps there is nothin more effectual in correcting such erroneous impressions tha faithful reports of diseases, and of those circumstances attending them which may be supposed to modify their character. It is under the impression, that an accurate statement of the circum- stances which took place during the prevalence of yellow fever in Baltimore, in the course of the last summer and autumn, will go far towards establishing some of these controverted points, in the minds of those who are sincerely desirous of discovering the truth, that I have undertaken to give the following account. 1 shall depend for my success chiefly on the fidelity of my narrative. The ground on which Baltimore is placed is peculiarly favour- Fever in Baltimore, in 1819. 215 able to an investigation of the origin of this disease; it will be proper therefore to give a concise topographical description of it, to enable those who have not visited this city justly to appreciate the inferences which may be drawn, from the facts which will be detailed. Baltimore is situated about 10 miles from the head of the Chesapeake Bay, on the north side of a creek, or inlet of the river Patapsco. The land in this vicinity is alluvial, consisting of a coarse sand or gravel on a stratum of clay. Through the centre of the city runs a small stream called Jones's Falls, flow- ing in a direction from north to south, which empties into the Inlet or Basin as it is commonly called. The part east of Jones's Falls is called Old Town and Fell's Point. The north and western part of Old Town is dry, gravelly, and considerably ele- vated; but as you go in a south and easterly direction the land becomes low and flat, and seems to have been recently formed by the wash of the river. The extremity of the land in this direc- tion projects for a considerable distance into the harbour, and is that part called Fell's Point. This portion of the city is not only low and flat, but was originally intersected by creeks, which are now artificially filled up; so that many places which are now occupied by dwelling houses quite remote from the water, have within the memory of many persons now living, been landing places for boats. Nearly all the cellars are .occasionally wet. The whole margin of the city bordering on the water is indented wilh wharves and docks artificially constructed. The wharves are generally faced with timber, and then filled in with logs and the various offals of a large city} with a thin stratum of gravel on the surface. In some instances chips, and shavings of wood constitute the principal material. There are many reasons for be- lieving that these substances have for some time been in a slate of putrefactive decomposition. About two years since a person was employed to drive piles for the purpose of erecting a store on Wigman's wharf. In order to do this it was necessary to re- move a quantity of logs, of which he found the wharf to be prin- cipally composed; in doing this there arose such an offensive odour, that it was almost impossible for the workmen to proceed, although ~I6 Fever in Baltimore, in 1819. it was then in the midst of winter. The exciting cause of yellow fever, whatever it may be, was found during the summer of 1819, to exist in this spot, as will be seen hereafter, in its most concentrat- ed form. Fell's Point is the place where all ships of considerable burthen lie, the depth of water not permitting vessels of this de- scription to go farther. This is the principal place of residence for the sailors. It should be mentioned, that the water has insinuated itself into the body of many of the wharves, and washed out the looser parts, thus excavating some of them to considerable extent; in consequence of which large surfaces are alternately wet, and laid bare by the rise and fall of the tide. Some persons were inclined to attribute very considerable agency to this circumstance in producing the disease. West of Jones's Falls the land is generally gravelly, dry, and elevated, excepting a strip bordering on the basin, and another, adjoining this stream, called the Meadow. This last, until within a few years was a mere marsh, frequently overflowed. It is now however rendered solid by being covered with a stratum of gravel several feet thick, and in many parts is quite thickly inhabited. The water in the basin is slightly brackish, and in a calm day the tide rises and falls about one foot, and when the wind blows fresh from the south or east, it rises much higher, and vice versa. The country bordering on the Potomac and Patapsco rivers, is generally visited, during the warm season, with sudden and- vio- lent showers of rain, attended with thunder and lightning, every few days. The following remarks on the weather are taken from a meteorological journal, kept by Mr. Lewis Brantz, and published monthly in the Federal Gazette. From the known character.of this gentleman, their accuracy may be depended on. The summer of 1819 was unusually dry and sultry. The heat was extremely oppressive not only from its intensity, but its duration. The pre- vailing winds, from the 1st of June to the last of September, were from the south and east. During the month of June there was no steady rain, and but five showers, three of which were very light. The mean temperature of Fahrenheit's thermometer dur- ing this month was 72° 2. 38. The mean temperature during Fever in Baltimore, in 1819. 211 ihe month of July vyas 75°. The general range during the day was from 78* to 96°. There were but two days in the course of this month when it stood below 78° at 2 P. M. The weather during the month of August was still more oppressive; it was for the most part clear and hot, being seldom cloudy. There were but two thunder-gusts and four light showers during this month. The mean temperature of twenty-three successive days, from the 24th of July to the 15th of August inclusive, was 80° 1.88, and on the 14th between 2 and 3 o'clock P. M. the thermometer rose to the extraordinary height of 98°, at which it remained one hour. The mean temperature of the first nine days in September was 79°, of the nine days from the 10th to the 18th, 65:>°. From the 1st to the 22d of this month there was but one slight shower, but this day began cloudy with a strong breeze from the north east, which increased to a heavy gale, attended with rain. The ther- mometer immediately fell to 60°, and never afterwards rose above 73°, but gradually declined after this time, the nights becoming quite cold. The weather remained cloudy and rainy for the re- mainder of the month. . The city remained healthy until quite late in July. Even, after the yellow fever had made its appearance, the physicians in the more elevated districts remarked that the summer was more healthy than usual. Contrary to what would be anticipated by most persons, this disease did not begin in the city, but prevail- ed, to a very considerable extent, in the heighbourhood for several weeks before a single case occurred in town. It was first discover- ed on the margin of the harbour, for an extent of between two and three miles without the city. The spots where it was more particu- larly noticed, are known by the names of Canton, Harris's creek, Cedar Point, and the Sugar-House. In the course of the-month of July one physician had no less than 30 cases on these estates. These persons were affected with all the intermediate degrees of fever from a slight intermittent to well marked yellow fever, at- tended with bilious stools, black vomit, and haemorrhages. The greater number were of this latter description. These persons were generally farmers. It is worthy of notice that several of them who suffered most severely had not been in the city for a 218 Fever in Batimore, in 1819. month. As this occurred in a remote district, and the attending physician thought proper to be silent on the subject lest it should excite unnecessary alarm, this remained, comparatively speaking, unknown. The latter part of July the public attention was first roused by several cases which happened about the same time, exhibiting all the distinctive characters of bilious, remitting, or yellow fever, in its most malignant form. They could all be satisfactorily traced to Smith's dock, which is west of Jones's Falls, and one of the most central -and busy spots in the whole city. The persons attacked were not exclusively of any particu- lar profession. They were merchants, whose counting-rooms were on this wharf, crews of vessels lying in this dock, &c. Within a short time ten persons were seized, who were in the habit of frequenting this wharf, nearly all of whom died with black vomit, haemorrhages, &c. From the number and violence of the cases, and from the high rank which several of these indivi- duals held in society, great excitement was produced among the citizens. Several of the most intelligent and experienced mem- bers of the faculty likewise expressed serious apprehensions lest this should prove the harbinger of greater trouble. It was not alone because a few cases of yellow fever had been observed, as there is seldom a summer when some scattered, but well marked cases of this disease do not appear. It was the unusual heat and dryness of the season, and the early period at which they took place, which excited the unfavourable prognostics of these gentle- men. They now occurred in July, whereas they are seldom noticed until the latter part of August. Smith's dock is very long, but has never been noticed as being particularly filthy, nor is it ever left bare to any considerable extent by the tide. The wharf is constructed in the manner before mentioned. Some of the stores have wet cellars, others planked over, with an interval of from one to two feet between the plank and the mud. This was the state of several of the stores, the tenants of which died. We think this circumstance especially worthy of being noted, be- cause Bowley's wharf, which was placed apparently under similar circumstances, and from which many persons died in the epidemic of 1800, was now healthy. This mortality, at that time, wa? Fever in Baltimore, in 1819. 219 attributed to the bad state of the cellars, in consequence of which in most of the stores, they were filled up with fresh earth, and paved wilh bricks. There was but one case which occurred on this wharf during the summer of 1819, and that seems to counte- nance the belief that considerable importance should be attached to this circumstance. This patient was a clerk in a store, the cellar of which was in a bad state, and has since been filled up. It is right, however, to say that this gentleman had remained for several hours, during the middle of the day, delivering wheat, in one of the most filthy docks of the city, in an open boat. Im- mediately after he exposed himself to a stream of cool air in an open entry, with but'little clothing. Soon after this he was seiz- ed with a violent chill, which was succeeded by a fever exhibiting symptoms of yellow fever, which shortly proved mortal. The situation of the adjoining (Price and Watson's) wharf, was sup- posed to have considerable agency in producing the disease in this spot. This wharf is faced with timber, and for a distance of 10 or 15 feet along its whole length it is filled with mud dug from the neighbouring dock. The remainder of the wharf, which is large, is filled with shavings, dirt collected from the streets, &c. &c. The margin of the wharf next to the water being filled with dock mud, is of course more dense, and it is likewise the highest part, so that the waste water runs off towards Smith's wharf. There is a twenty feet alley between these two wharves, on which the back doors and windows of the stores on Smith's wharf open. This alley was in a very bad state. V.u-ious nuisances were com- plained of about this spot, and the police took such means as were deemed necessary to prevent the further extension of the dis- ease. The principal means employed for this purpose were, scat- tering lime over the alley and burning tobacco before the stores. The spot, however, was now nearly deserted, which was probably the principal reason that the progress of the malady was suddenly and completely suspended. There was evidently something in the structure of the wharf itself, and not the dock, to which we must impute the production of the exciting cause of this disease, because Spear's wharf, which is directly opposite, and which is only separated by the dock, was never invaded. Vol. Ill-—F f 120 Fever in Baltimore, in 1819. An interval now of nearly a fortnight elapsed, during which no new cases were publicly noticed. The fears of the citizens were in a great measure dispelled, and there seemed a well grounded hope that the progress of this dreadful malady was effectually stopped for the season. At the end of this time it again shewed itself in a spot remote indeed from the scene of its former ravages, but with a virulence in no degree mitigated. A public report made by the Health Office at this time (17th of August) assured the inhabitants that no serious or alarming increase of the fever had taken place, and still cherished the hope that it would not prevail to any very considerable extent. The total number of deaths for the past week was, however, rather alarming, and the prevailing diseases indicated that constitution of atmosphere from which every thing was to be feared. The total number of deaths for this week was 79, of which 18 were reported to die of cholera morbus, and the same number of bilious fever It was likewise at this time formally announced by the Board that some well marked cases of the disease had been seen at the extremity of Fell's Point, in Wolfe street. This street runs parallel to the water, and is artificially constructed. That part where the disease first discovered itself is unpaved; in fact it seems to have been almost exclusively formed of shavings without even a stratum of earth upon them. The exciting cause of yellow fever would seem to have been evolved on this spot in its most concentrated form. This is shewn by the following circumstance: Soon after the epidemic had begun to spread in this part of the town, in conse- quence of a very disagreeable odour arising from this mass of putrefying shavings, it was complained of as a nuisance, when the police ordered it to be covered with fresh earth. Three labourers, all of whom lived in a healthy part of the town, were employed with their carts for this purpose. In the course of a few days all these men were seized with the prevailing disease, and they all died. A gentleman who attended two of these men assured me, that in his whole life he had never witnessed two more deplorable cases of disease. It confined its ravages for a few days to the wharves situated on the extremity of Fell's Point, and the adjoining streets, Pitt and Wolfe streets. But it remained stationary for a verv short period. The fever Fever in Baltimore, in 1819. 221 was first observed on this spot on the 17th of August, and by the 27th it had spread to such an extent, that every reflecting person became convinced that all hope of its being extinguished before the approach of cold weather was now utterly futile. There were several circumstances which conspired to excite the most gloomy anticipations about this time, (latter part of August and beginning of September.) The weather continued dry and sultry in the extreme. The situation of the spot which it had now in- vaded was most favourable to the extension of the disease; which, with the loose and improvident habits of the sailors, and persons connected with them, who form a considerable class of the po- pulation of this part of the city, led to an anticipation of the most deplorable consequences. It was remarked thatthe disease begun about the wharves, and gradually spread itself into the interior. The crews of all the vessels lying at the extremity of the Point became more or less sickly. At Wirgman's wharf one physician attended the crews of three ships, nearly all of whom were down at the same time. The police now very properly ordered all the vessels to be hauled off into the stream. By the 9th of Sept. the disease was spreading rapidly over that part of the city which is properly called the Point, and seemed every day to become more ungovernable and fatal in its character. Every one who had it in their power to find a comfortable home elsewhere, now abandon- ed this part of the city; and every effort which'humanity could dictate, and circumstances admit, was made by that portion of the citizens who were exempted from this dreadful malady, for the comfortable accomodation of the poor, in healthy situations. The weekly bill of mortality ending Monday, Sept. the 6th, re- ports the total number of deaths to be 91, of which 29 were malignant; yet at a very full meeting of the faculty three days afterwards, Sept. 9th, it was solemnly and unanimously declared by that body, that excepting the cases already mentioned at Smith's wharf, they do not believe a single case had originated west of Jones's Falls. They likewise declared without a dis- senting voice, that four fifths of the city was at that time more healthy than it had been at the same season for several years. From this period during the remainder of the month this horri- 222 Fever in Baltimore, in 1819. ble pestilence stalked abroad in all the plenitude of its power, spreading death in its most loathsome and appalling form, in every direction. From its dreadful attacks there was no safety but in flight. No courage, no strength, no age could withstand this resistless, though invisible enemy. The most robust frame and vigorous health, equally with the more delicate form and feeble constitution of body sunk before its deadly approach. It is scarcely possible to conceive a more melancholy or affecting spectacle than this part of Baltimore exhibited. During the night it was com- pletely illuminated by numerous bonfires, made in every street by the inhabitants, under an impression that this was an effectual mode of purifying the atmosphere. In the day the view was still more painful. Those places which were generally the most throng- ed and busy were now nearly depopulated. No noise of carriages was heard. Nothing was seen to interrupt this gloom, but per- haps a miserable negro lounging about for want of employment, a physician going his irksome round of duty, or the hearse with scarcely a follower. In that part of the town to which the dis- ease extended last, and where it was rather less universal, one could not pass the street without noticing through the open win- dows persons standing about the bed of, their sick and dying friends; while perhaps a little further, the attention would be at- tracted by objects exhibiting a strong and shocking contrast, persons in whom the most heedless self-abandonment and open debauchery were displayed. Almost every individual who re- mained in this part of the city was affected by the disease. From the 1st to the 30th of Sept. inclusive, besides other diseases, there were 640 cases of yellow fever reported to the Board of Health, of whom 242 died.* The following facts, which are selected from a great number possessing nearly the same common character, will shew to what an extent the atmosphere of this part of the city was at one time impregnated with the specific cause of yel- low fever:—The ship Ceres sailed for Liverpool on the 25th bf September. Among the passengers were a gentleman, his wife and daughter; the latter, a very interesting young lady about 20 * This is not, however, near the whole number of cases which took place, as the physicians only reported those which were the most strongly marked, test they should excite unnecessary alarm. The number of deaths is accurate. Fever in Baltimore, in 1819. 223 years of age, who had lived in a very healthy spot, in the wes- terly part of the city, rode to Wirgman's wharf for the purpose of embarking. The ship was already under way, and the boat wait- ing expressly for her. She only waited to get from the carriage to the boat, and was then rowed off. This was the only time she had been at the Point during the prevalence of the fever. The third day after she sailed she was seized with the usual symptoms of yellow fever, and died with black vomit, hemorrhage, &c. There were several others who died in this ship, but they had been frequently in the unhealthy part of the town. I shall only stop now to relate one more instance, which illustrates the same principle, while it delineates in a very forcible manner, one of the most remarkable and characteristic features of ihe disease. A woman employed as a housekeeper in Wilk street, which was at that time considered healthy, had made a short visit in the part of the city where the epidemic prevailed in its worst form. The third morning after she complained of a slight head-ach, and as at that lime every complaint excited alarm, the gentleman with whom she lived insisted on sending for a physician, which she considered entirely unnecessary, and consented to wiih great reluc- tance. When the medical gemleman arrived he found her sweep- ing the house, and she had been during the whole morning en- gaged in making beds and attending to other domestic duties. He observed that the expression of the countenance was bad, and was still more shocked to find on examination that no pulsation could be distinguished in either wrist. He immediately called the gentleman aside, and assured him the woman was dying. This appearing incredible, another physician was called in. The wo- men died in less than three hours afterwards!! On the 22d instant, as has been already related, a very decided change too place in the weather. There was a long and violent storm from the north east, and the weather, particularly at night, became quite cool. The first effects of this change were very un- favourable. The number of new cases and deaths suddenly in- creased in a very alarming degree. This continued until the 29th, when the number of new cases, &c. again declined. About this time three new cases were announced at Smith's dock, but 224 Fever in Baltimore, in 1819. the disease did not extend itself again in this quarter. It was not considered safe for the inhabitants to return to their dwellings until after the 25th of October, yet a favourable change may be dated from the first of the mouth, as far as regarded the number of new cases; but the severity of the disease was in no degree miti- gated towards its termination, but on the contrary its virulence was increased. The symptoms by which this disease was characterized varied very essentially in different individuals; nor could this be satis- factorily accounted for from the constitution of the patient, or the circumstances under which he was placed. Sometimes the first signs were pain in the head, back, and limbs, and an inflamed ap- pearance of the eye. At others the disease was ushered in by a severe cold fit, which would continue for several hours; this would be succeeded by a violent fever, in which the head-ach and pains in the back and limbs would be excessive, the skin hot and burn- ing, the countenance deeply suffused with blood, and the pulse hard and bounding. The fever would often continue without any intermission, and sometimes without any perceptible remission until the fifth or seventh day,when the pulse would sink,the surface become cold, deadly nausea would take place, followed by coffee- ground vomiting, hemorrhage and death. The yellowness of the skin often came on in this stage of the disease, and was sometimes of so deep a hue as to approach a black. In other instances nearly the reverse of this would take place. In the early stages of the disease there would be slight head-ach and pain in the back, attended with great prostration of muscular strength, preternatural coldness and clamminess of the surface, and sunken pulse. In some instances, these symptoms proceeded to such an extent that the powers of life were completely prostrated, and the patient died in a fqw hours. In one case a sailor was walking the deck with- out any complaint; he suddenly fell down. When the physician, who was immediately sent for, arrived, the senses remained, and the respiration continued, but the pulsation had ceased at the wrists, the face was hippocratic, and the man died almost imme- diately. If the patient did not die in this stage, which was often the case, on the 2d or 3d day reaction would take place, and the Fever in Baltimore, in 1819. 225 state of the system would be completely reversed. The pulse would rise, the skin became hot, and repeated venesection be- came necessary. In some instances there would be neither, in the complaints of the patient, or other symptoms, any thing which would lead one to suppose that any alarming morbid affection existed,, yet the patient would tell with astonishing precision the hour, and almost minute when he was siezed, and such cases frequently terminated fatally. In one instance the patient wag apparently in a quiet refreshing sleep, the skin cool and the pulse not seem- ing to indicate danger. The patient being roused and questioned, answered rationally, that he had been seized at a certain hour two days before with head-ach and slight indisposition, but that he was now free from any complaint, excepting he was rather sleepy. Yet this man was passing his faeces and urine involuntarily, and died comatose within twelve hours. Inothercases a train of symp- toms so entirely opposite would ensue, that one could hardly re- cognize the most remote resemblance in a single feature of the disease; e. g. a' man walked out to the hospital, a distance of more than a mile, and after he was left there by his friends, insisted that he had not a complaint. But he was delirious when he arrived, and soon became so troublesome that it was necessary to apply the strait waist-coat, which it was not found prudent to remove until within a short ti me before his death, which happened within 36 hours after he was admitted. The bowels were generally sluggish, but by no means insensible to-the operation of cathartic medicine. There were no distinct remissions and exacerbations of fever. After the first attack there was generally an uninterrupted febrile state until a complete intermission took place. This was sometimes the case at the end of 24 hours, put at others it continued for four or five days. In many instances the sensations of the patient were in a very remarkable degree disordered. The skin would feel cold to a bystander, while the patient complained of a distress- ing sensation of heat, and vice versa. In almost every case the pa- tient complained of heat and pain about the scrobiculus cordis, attended with such extreme sensibility, ihat the slightest pressure occasioned acute pain. This preternatural sensibility sometimes extended over the whole surface of the body, so th.it in one in- 226 Fever in Baltimore, in 1819. stance the patient, a man, complained seriously of the pain caused by the pressure of the finger of the physician on the wrist, in feeling the pulse. In those pans which had undergone the process of vesication the soreness and pain was most exquisite. I saw a sailor on whom the common pains of the body would have made no impression, absolutely weep from the pain he endured in dressing his blister. Hemorrhages were most frequently from the mouth. The blood did not seem to be poured out from any spot, but to ooze from the whole internal surface of the mouth and gums. Bleeding sometimes took place from the nose, ears, sto- mach and bowels, and in one case, from the eyes. The blood was sometimes discharged in large quantities, particularly from the bowels, attended with tenesmus. Hemorrhage was always an alarming symptom, but not necessarily fatal. In one instance there was hemorrhage from the nose, ears, and stomach, preceded by black vomit, yet the patient, a boy, recovered. Black vomit took place generally on the 5th or 7th day, and was a most dan- gerous symptom. It was sometimes however the first symptom of the disease, as in the following case: A boy had fallen into the bold of a ship, by which both ihe thigh bones were fractured. The bones had united, and the boy was comparatively well. Soon after eating his breakfast, in apparent health, he was seized with ■ deadly nausea, which terminated in black vomit; and he died on the fourth day. After the beginning of October, as has been already stated, the number of new cases and deaths essentially diminished; yet in those who were seized after this time, the disease was still more malignant and fatal than at its commencement. One gentle- man assured me that of the 23 last cases which were under his care, 19 died in the following manner; after two or three days of smart fever, a complete intermission would take place, the patient would seem convalescent, his appetite would return, and every thing appear most flattering; when suddenly, and without any apparent reason, he would be seized with nausea, or rather a most distressing sensation of weight about the pit of the stomach, soon after which black vomit, or hemorrhage would ensue, which were the harbingers of death. Enough has been said of the symytoms, I presume, to eslablisl Fever in Baltimore, in 1819. 227 beyond a doubt the identity of the disease, and as we are already acquainted with the situation of the spots where it prevailed, with the principal facts relating to the weather which preceded and accompanied it, and the whole progress of the disease, we are now in possession of all the circumstances on which we are to form our judgment respecting its nature and origin. In entering upon this inquiry I am sensible that I approach a delicate subject, and one that has been contested with a sharpness and personality which ought never to be allowed to enter within the pale of scien- tific inquiry. In my investigation of it I shall endeavour to be candid and dispassionate, and to draw only those inferences which the above facts and the known laws of the animal economy will fairly bear me out in. To resort to all the authorities which might be produced to illustrate the origin of yellow fever, is plainly be- yond the scope of this paper. Indeed the necessity of such an at- tempt is entirely superseded by Dr. Bancroft's " Essay on the Yellow Fever." I know of no book in the profession in which any point in pathology is more satisfactorily established. His authorities are so numerous, and unquestionable, his facts so apposite and happily arranged, and his arguments so manly, yet conclusive, that I can hardly conceive how any one can peruse the book without conviction. I have undertaken to give an ac- count of the disease as it appeared in Baltimore in the summer and autumn of 1819, and I shall confine myself to this alone. It has been, I believe, universally agreed among physicians, that the origin of yellow fever should be imputed to some one, or all of the following causes, viz. specific contagion, the effluvia arising from the decomposition of animal substances, and marsh miasmata. Let us now inquire if the phenomena which were observed during the progress of this disease, were such as to lead us fairly to infer, that it arose from any or all of these causes. 1st, Specific contagion. Ancient medical authors were not in the habit of marking with sufficient accuracy the distinction be- tween the origin of contagions, epidemics, and endemic diseases. This is particularly evident in the writings of Sydenham, and the early English physicians. Even Dr. Cleghorn, in his account Vol. IU.—Gg 228 Fever in Baltimore, in 1819. of the diseases of Minorca, considers intermittents as contagious as small-pox.* This arose no doubt from the peculiar circumstances under which they were placed, particularly from the total neglect of police regulations. But the evils arising from these inaccuracies, have not yet ceased. In the care which has since been taken to prevent the introduction of foreign diseases, by quarantine laws, the same want of precision has been continued. All the violent diseases of warm climates have been considered contagious, and restrictions imposed on all intercourse with such places, to the manifest injury of commerce, and frequently to the ruin of indi- viduals. To prevent the inconvenience of using terms without a precise meaning, I will endeavour to define the epithets, endemic, epidemic, and contagious, when applied to disease. I am sensible that ob- jections may be made to these definitions. In answer to such objections, I can only say, that I have looked in vain to find these terms distinguished from each other with more philosophical pre- cision. At any rate they will serve to mark with sufficient accu- racy my meaning, when I employ them. I have taken as my guide what seems to have been Mr. Adams's general meaning in his u Observations on morbid Poisons,"! though I consider his definitions very imperfect and unsatisfactory. By epidemic dis- ease, then, I understand the effects produced by a certain unknown state or constitution of the atmosphere, in consequence of which, many persons residing in certain districts, or countries, become affected about the same time, by a disease having a common cha- racter. Thus, the influenza is sometimes epidemic, affecting about the same time many countries. Dysentery and pleurisy, having certain peculiar characters, are sometimes known to pre- vail as epidemics; certain fevers are sometimes epidemic, as the spotted fever, which has been so fatal in some parts of this coun- try, puerperal fever, &c. It has been remarked, that during an epidemic, other diseases are apt to approximate, or affect the same character. An endemic disease may be defined the morbid effects produced Vide p. 121. Chap. 2d. p. 6 & 7- Fever in Baltimore, in 1819. 229 by certain exhalations, or effluvia, or miasmata, arising from the peculiar properties of some soils when applied, under certain cir- cumstances, to the body, and which are confined to certain districts, which may be defined with considerable precision. The most striking examples of endemic diseases, are intermittent and remittent fevers. As these diseases, particularly the first, arc only known to prevail in low marshy situations, or where the soil has considerable vegetable matter and argil combined with it, or is placed on a stratum of this earth, while persons residing in the immediate neighbourhood, on dry, gravelly and elevated situations, remain healthy; we must suppose, that these noxious effects are derived from the earth. The goitre of Switzerland, the leprosy of Syria, and the Barbadoes swelled leg, may perhaps be considered endemic, although they are generally im- puted to other causes. Contagion may be defined a product, or secretion of a diseased body, which, when applied to a healthy body, is capable of pro- ducing a disease similar to itself. Small-pox, measles, pertussis, and syphilis, are familiar examples of this. From the above defi- nitions it will be seen that a contagious disease may be epidemic: that is to say, that in certain states of the atmosphere, these dis- eases may be propagated with more facility, than in others. But a contagious disease cannot be endemic; for although there be no absolute absurdity in supposing, a priori, that a disease produced by certain exhalations or miasmata, should become contagious, yet, after it has once acquired that quality, it may be communicated indefinitely. There can be no doubt that the readiness with which a contagious disease may be communicated, is very essentially modified by the degree of concentration of the contagion, the sus- ceptibility of the individual, and the peculiar constitution of the atmosphere; yet it is contrary to all our knowledge of pathology to suppose, that a disease can at one time be contagious, and at another, absolutely destitute of that quality. It will be readily admitted that a person labouring under a contagious disease, in a narrow a|ley,and in a small, jll ventilated apartment, would com- municate it with much more certainty than in a spacious room, in an open, airy situation. But it seems highly incredible that a 230 Fever in Baltimore, in 1819. tlisease can at one time be so contagious, that it is capable of being transported hundreds, or thousands of miles, concealed in a package of goods, a trunk of clothes, or even about the person of an individual in perfect health, while at others, it shall prevail for months, in the midst of a populous city, and be confined to a narrow circle, and not be communicated in a single instance out of that circle, though no care be taken to restrict it. In investi- gating the contagious quality of disease, we are apt to be misled by finding that families, and persons in the habit of frequent inter- course, are seized with the disease, and we are often inclined to impute its origin to this intercourse rather than to their having been exposed to the same exciting cause; the same impure atmos- phere. On this subject, if has very properly been remarked by Dr. Haygarth, that* " observation or experiment can determine with much greater certainty what does not, than what does give infection." But let us proceed in our proposed inquiry. If this disease arose from a specific contagion, then it was most probably of foreign origin, and we should expect to find it first in those spots were there is the most frequent intercourse with foreign countries. But from the history which has already been given, it will be seen that it was first discovered in the country, at least two miles from'the city. Nevertheless, as this is on the margin of the harbour, and in sight of which all ships entering must pass, it is possible thafsome intercourse might have taken place without its being generally known. But, from the known laws of contagious diseases, we should suppose after it had been once excited, that it would extend itself from this spot, as from a center, and that the new cases might, by a little care, be traced to some intercourse with this spot. But, excepting in the low marshy situation^, and clayey soils, where intermittent and re- mittent fevers annually prevail,-the disease did not extend in this neighbourhood. It next manifested itself at Smith's wharf, a dis- tance of between two and three miles off, and between which little or no intercourse existed. Again, several of the persons who were supposed to have received their disease at Smith's wharf, resided in elevated situations in the westerly part of the town, where they * Vide Bancroft, p. 94. Fever in Baltimore, in 1819. 231 remained during their whole sickness; and the intercourse between these persons and their families and friends was at no time in- terrupted. Yet none of these families became affected, nor has any one pretended that this was the case. On the contrary, the disease, instead of radiating from these different points, en- tirely ceased after the death or recovery of these individuals, The spot where it again shewed itself was at least a mile in a right line from where these persons resided, where it spread itself, as has already been remarked, wilh dreadful rapidity; but none of the inhabitants of this part of the city have ever supposed that they derived it from any other part. Fell's Point may with propriety be considered the Port of Balti- more; and although the operations of commeree were weakened yet they were never entirely suspended. Vessels were constantly arriving and discharging their cargoes at this part of the town from which the goods were conveyed into the healthy districts without any inconvenience. There were likewise numerous in- stances of persons labouring under the worst forms of the disease being removed into the healthy parts of the town, without it being pretended that they communicated the disease in a solitary in- stance. The Hospital is situated about one mile from the city, on a very elevated delightful spot, and, in the extent and arrange- ment of the building, is inferior to no institution of the kind in the United States. It generally contains from 130 to 150 pa- tients, lunatics, and sick of the United States navy. During the whole of the disease there were from 30 to 50 patients, in every stage of yellow fever from its mildest to its most malignant form. The wards where these persons were placed communicated by entries wilh the rest of the house, and there was an uninterrupt- ed intercourse kept up. There were nurses constantly in at- tendance employed in removing the excretions, and yet there was not a single circumstance which could lead one to suppose that the disease was contagious. Such was the conviction of its non-contagious nature, not only in the minds of the faculty, but the other citizens, that the Hospital was thronged, particu- larly on Sundays, by people, some of whom came to visit their 232 Fever in Baltimore, in 1819. friends, and many who came merely to witness the effects of a disease which had excited so much horror. When to these facts is superadded the solemn and unanimous declaration of the fa- culty on the 9th of Sept. that they had not seen a single circum- stance which could lead them to suppose it was contagious, I am irresistibly led to the conclusion that the disease neither originated from, nor was afterwards propagated by contagion. Such is the disgust and horror we naturally feel on witnessing the putrefaction of animal substances, particularly human bodies, that it is not surprising that this should have been early assigned as one of the causes of pestilential diseases. A more careful examination of this subject by modern physicians, however, does not confirm this opinion.* I have never heard that any one at- tributed the disease of which we are now treating to this cause; * The following quotation from Dr. Bancroft, will go very far to shew thai the effluvia arising from the putrefaction of animal bodies, is not capable of producing yellow fever, or other pestilential disease. " The church yard of the Saints Innocens, at Paris, situated in one of the most populous quarters of the city, had been the depository of so many bodies, that although its area enclosed nearly two acres, yet the soil had been raised, by them, eight or ten feet higher than the level of the adjoining street, and, upon the most moderate calculation, considerably more than six hundred thousand bodies had been buried in it during the last six centuries ; previous to which date it was a very ancient burial ground. In less than thirty years the last grave- digger had deposited more than ninety thousand corpses. The earth itself had become so supersaturated with human putrefaction, as to have no longer any action, or decomposing influence, upon the bodies buried therein. The public mind became at last so much alarmed by the offensive smells, that it was determined to forbid all future burials, and to remove so much of the super- stratum as would reduce it to a level with tlie street. This work was under- taken in 1786, under the superintendence of M. Thouret, a physician of eminence in Paris, and in two years he accomplished the removal of that superstratum. The exhumation, says this gentleman, (Journal de Physique, for 1791,) were principally executed during the winter, but a considerable part of them was also carried on during the greatest heats of summer. They were begun with every possible care, and with every known precaution; but they were afterwards continued, almost for the whole period, without employing any precaution whatever. Yet no danger manifested itself in the whole course of our labours,—no accident occurred to disturb the public tranquillity. It does not appear from the fullest inquiry, that any febrile disorder Mas ever produced by this immense mass of corruption." Fever in Baltimore, in 1819. 233 nevertheless it will be proper to say something on this point. The only considerable sources, that I know of, from which these effects could be expected, are the grave-yards and slaughter-houses. The first are all without the city, and it so happens that nearly all of the last are very remote from where the fever prevailed, and I have not been able to find an instance where the disease was supposed to have been taken in this way. These houses are generally placed in the precincts, but for the most part in situa- tions which are quite populous. If the stench arising from them was alone sufficient to produce yellow fever, then we should sup- pose that the neighbouring inhabitants could seldom be free from it from April to December. A physician, who had a very exten- sive practice among these people for many years assured me, that he had always considered them particularly healthy. The only supposed cause of yellow fever which it remains for us to examine, is the exhalation commonly called marsh mias- mata. The deleterious effects of this agent upon the human constitution are so palpable, that although it is entirely destitute of any sensible qualities, it has been mentioned as a cause of pes- tilential disease from the earliest records of medicine. Though the opinion, that contagion and animal putrefaction are among the number of the exciting causes of yellow fever, has been strongly contested, yet I believe all have admitted, that marsh miasmata is one of these causes. There is the strongest evidence of the existence, and certain properties of marsh effluvia, though they have never been obtained in a seperate form, or submitted to chemical analysis. The only known test of their existence is, their effects on the human body. They necessarily require for their evolution the three following agents, viz. decaying vegeta- bles, or a soil consisting of vegetable remains, humidity, and a temperature above 45° of Fahrenheit's thermometer. The pre- cise proportion of these substances, and the degree and duration of heat most favourable to this process, is not known; but it is plain that a temperature above 45° for a considerable time is ne- cessary, and that the evolution is increased, by increasing the temperature, until you arrive at 100°. An excess or deficiency 234 Fever in Baltimore, in 1819. of humidity tends to retard the process. In a living animal or plant the particles of which it is composed are not combined ac- cording to their chemical affinity, but are placed under the in- fluence of that unknown principle, life. The laws of chemical affinity, so far as regards them, are suspended, and they are con- trolled by what has been aptly called* " vital affinity." . But when dissolution has taken place, the laws of chemical affinity again resume their full force, which is shewn in the process of putrefaction. The form becomes changed, new.combinations are formed, different gases are extricated; and this process con- tinues until these bodies return to the elements of which they are composed, constituting, what has been called, a caput mortuum; and in this form they become the proper pabulum for other plants. As the circumstances above mentioned, favourable to the produc- tion of marsh miasmata, are precisely those most favourable to putrefaction, there seems to be good reason to believe that this exhalation is in fact one of the gaseous products of this process. The effects arising from this exhalation or gas are found in low, marshy situations, excepting in what are called peat boggs,f and are generally proportioned to the temperature of the cli- mate, the season of the year, and the susceptibility of the indivi- dual exposed to it. In the spring and early part of the summer, when perhaps it is extricated in less abundance, it causes inter- miltents; during the latter part of summer, and through the autumn, when perhaps it exists in a more concentrated form, the common autumnal, or the malignant bilious remitting fever, and usually ends in intermittents;| these effects being modified by the temperature and humidity of the season, &c. &c. Persons accustomed to a cold dry atmosphere are most susceptible of its in- fluence, especially by sleeping on the ground during the night.§ There seem to be good reasons for believing that this exhalation is specifically heavier than atmospheric air, and that it does not * Vide J. Jackson's Inaugural Thesis on the Brunonian System. j Vide Bancroft, Appendix, No. VI. Pringle on Diseases-of the Army. § Bancroft. Fever in Baltimore, in 1819. 235 rise to any considerable height.* It seems likewise to be solu- ble in water, at least it seems to lose its deleterious effects in passing over its surface, or through it.f It does not affect other animals in any thing like the degree that it does man. Indeed I know of but one authority (Dr. Rush) for supposing that it affects them at all. I cannot find any one who observed this to be the case, during the prevalence of the disease concern- ing which we are now speaking. I inquired of Mr. H.islam, a very intelligent veterinary surgeon, whu is consulted in most of the diseases of domestic animals which occur in the city, whether he had observed any thing of the kind; but he assured me that he had remarked that the season was unusually healthy. Carbonic acid gas, and other noxious factitious airs, particu- larly those which sometimes escape from animal bodies in an early stage of putrefaction, manifest their injurious effects by their sud- den and direct action on the organs of respiration, producing syncope or asphyxia, &c. But marsh miasmata differ essentially in their effects from all these: they are destitute of all taste and odour. It often happens that while the unsuspecting individual is gay and happy, this invidious poison insinuates itself into the inmost recesses of the body, and lays dormant for weeks without producing a disagreeable sensation. " No visible signs," says Cha- teauvieux, a French traveller in I aly," marks the existence, or the approach of this pestiferous air. The sky is as pure, the verdure as fresh, the air as tranquil as in the most healthy region. The aspect of the elements is such as should inspire the most perfect confidence; and it is impossible to express the horror which one experiences on discovering that all this is deception; that he is in the midst of dangers ol which no indication exists; and that with the soft air that he is breathing he may be fnhaliug a poison destructive to life." But this noxious exhalation is not entirely confined to low marshy grounds; it is sometimes generated in spots which are considerably elevated. Those soils which contain a considerable * Dr. Hunter on the Diseases of the Army. Pringle, Blane, &c. f Ui Blane's report respecting the Walcheren Fever, Medico Transac- tions, &c. Vol. HI—H h io6 I'ever in Baltimore, hi 1819. portion of clay, or rest on a stratum of this earth, which is uearlj impenetrable to fluids, are sometimes found to produce this exha- lation, even when they are considerably elevated. So frequently is argil found to abound in those situations where these mias- mata are produced, that Linnaeus endeavoured to prove in his Inaugural Thesis, for the degree of M. D. that intermittent fevers were always caused by this earth. This effluvia is known in Italy by the name of mal. fria. It chiefly prevails in a large tract known by the name Maremma, " which spreads along the shores of the Mediterranean Sea, from Leghorn to Terracina, and reaches inland as far as the first chain of Appenines. Its length is 192 geographical miles, and its breadth in the Agro Romano, where it is greatest, between 30 and 40." The Pontine Marshes constitute a part of this tract, but a greater part of it cannot be considered by any means marshy. The surface is waving and in some places quite high, but there are several cir- cumstances which render the soil peculiarly favourable to the retention of humidity. The basis of the soil, we are informed, •' consists principally of pure argil," or " of substances thrown out from volcanoes in a detatched state, and afterwards consolidated into stone."* On this basis is a rich mould, in which all the vegetable productions of this delightful country grow in the greatest luxuriance. As these regions have become almost de- populated in consequence of the noxious state of the atmosphere, this extensive, district is almost exclusively devoted to pasturage. This, during the existence of the Roman empire, was one of the most populous parts of Italy, where stood the villas of the wealthy and luxurious inhabitants of the neighbouring city. As it was then in a high state of cultivation, it was not considered unhealthy, excepting about a few spots, viz. Andea, Antium, and Terracina. But as the political importance of the country has declined, the number, industry, and enterprise of the inhabitants have declined with it. The large quantities of decaying ve- getable matter which has been allowed to accumulate on a moist soil in a warm climate, has probably caused this pestilential state ' See a very interesting paper in the Edin. Review, vol. 23. Fever in Baltimore, in 1819. 23*. of the atmosphere, which is constantly extending the sphere of its influence. " It has already passed the gates of Rome, and lodged itself within the walls of the ' eternal city.' The sanc- tity of the papal residence has not exempted the Quirinal from this pestilence, any more than the departed majesty of the Caesars has protected the Palatine from its influence. Yet the Quirinal is 207 feet above the level of the Tiber, and the Palatine 181/ Such is the origin, and such the most essential properties of that exhalation commonly known among physicians by the name of marsh miasmata. However they may differ on other subjects, yet, I believe, they universally acknowledge, that this exhalation is, at least sometimes, an exciting cause of yellow fever. As specific contagion, and animal putrefaction, seem entirely inade- quate to account for the prevalence of this disease in Baltimore during the summer and autumn of 1819; let us next inquire if the known properties of this agent will more satisfactorily ex- plain it. The soil about that spot where the disease first appeared, viz. Canton, Cedar Point, and Harris's creek, is precisely that most favourable to the production of marsh miasmata. These places have always been considered sickly, and found subject to those diseases which have been described as the result of this exhala- tion, viz. intermittent, remittent and yellow fevers. I have been informed by the physician, who has attended the greater number of families in this neighbourhood/that every summer the two first prevail, and that a season seldom passes when he does not meet with some cases of the last. If vegetable substances in a state, of putrefaction, humidity, and heat, are ever capable of causing yellow fever, we can scarcely imagine circumstances more favourable to its production than whatexisted at Smith's, and Price and Watson's wharfs, which arc essentially the same, being only divided by an imaginary line. Such a mass of materials as I have described this wharf to be composed of, lying entirely open to the south and east, during such a season, we should suppose could not fail of exhaling this noxious effluvium. \t Fell's Point, particularly in that district where the disease 238 Fever in Baltimore, in 1819. raged with the greatest fury, all these causes existed to a still greater extent. Not only warehouses were erected on new made land filled up vvith these noxious materials, but whole streets of dwelling houses. This spot is annually subject to intermittent and remittent fevers. The very moment I am writing this (last of Feb. 1820), the weather having been uncommohly warm for a few days, intermittents begin to prevail. This cause then (marsh miasmata) seems entirely sufficient to explain all the phenomena which have been described, and to assign any more would be " to suppose more causes of things, than are necessary fo explain their appearances." The following conclusions, therefore, seem not only ligitimate, but unavoidable. 1st, That ihe disease which prevailed in Baltimore, during the summer and autumn of 1819, was that known and designated by physicians, by the name of yellow fever. 2d, That it was, strictly speaking, endemic, that it neither originated in, nor was afterwards propagated by, any specific contagion, but was of domestic origin. • When I began this paper, it was my intention to have entered pretty fully, into a consideration of the treatment; because, from the testimony of those who had the best opportunity of examining the subject, and my own observation, I have been induced to, believe, that what are considered the received and established doctrines on the subject, are far from being infallible. But it has insensibly been drawn out to such an extent, that this must at least be deferred for the present. It is proper for me to say, that I am under obligations to seve- ral physicians, for many of the facts which have been stated. I would acknowledge particular obligation in this respect, to Drs. Clendenin and Murphy, who reside in the part of the town where the disease prevailed. MEDICAL REPOSITORY; * THE PLAGUE OF ATHENS. SECTION I IN the third year of the 87th Olympiad, anfw'ering to the 430th preceding the chriftian sera, a plague broke out in the city of Athens, which, for its feverity, duration, and the mortality it occafioned, exceeded all which, before that time, had been known to the Greeks: for it infli&ed the moft dread- ful pains on all who experienced it; fpared neither age nor fex; deftroyed near five thoufand of the flower of the Athenian ar- mies, with an immenfe multitude of the poor; and did not difappear till after it had exercifed the moft unexampled cruel- ties, for a period of little lefs than five years, and reduced the powerful republic of Athens to the very verge of ruin and tle- Ipair. Attica, of which Athens is the capital, is a fmall ftate, fitu- ated between the 37 and 39th degrees of north latitude, and comprehending a territory, the extent of which, though vari- oufly eflimated, is on no computation very confiderable.* Its figure is a triangle, having its two fides wafhed by the fea, and its bafe united to the continent. The face of the country is exceedingly broken and diverlified by high, rugged, and irre- gular mountains, contrafled with deep, winding, aud pent up vallies. The frreams by which it is divided are remarkably rapid; fwelled in the fpring, by the diAblution of the fnows which crown the mountains; but fhrunk up, by the exceflive heat of the fummer: refembling, in this refpect, the Lehi and other rivers of Pennfylvania and the fouthein ftates. The lower extremity of the Attic peninlula was, and con- tinues, remarkably barren; being chiefly compofed either of bare rocks or defert fands. Towards Athens it affumed a move lively appearance; where the afliduous hand of cultivation in- termingled the olive, the vine, and a variety of plants, with the firs and other evergreens that naturally ornamented the fummits of the hills. But of other woods they were nearly deftitute; fo that, at the period of which we are fpeaking, fuel was both fcanty and dear. * The Abbe Barthelemi makes it 66 fquare leagues. Voy. du J. Anachar. chap. vi. M. de Pauw computes it to equal 250 fquare miles. Philof. Diflcrt. on the Greeks, vol. i. p. 3. Tranflation. Edit. London. 4. MEDICAL REPOSITORY. The foil of Attica, light and poor, produced no other grain than an indifferent barky; and the country was unfitted, no * lefs on this account, than from its fmall extent, tor pafturage. Eubea, and the neighbouring parts of Greece, furnifhed the Athenians with thejr meats; while their fliips fupplied them, v/ith wheat from diftant countries, but chiefly from the borders of the Euxine. The conftant demand for grain at Athens, gave rife to a multiplicity of municipal regulations, frequently evaded by a fpirit of fpeculation not unworthy, either for in- genuity or eagernefs, of the prefent times; while the imper- fect fupply of better meats, conferred a value on many kinds of flefh, birds, and infefls, at which modern delicacy would ficken.* Even at the prefent time, if we may credit the af- fertion of a late traveller, f no other flefh but that of goats, is to be found in the Athenian markets. This defect of animals proper for food, created in the people of Attica an habitual preference of vegetables; and, confpiring with the meagernefs of the foil, produced a ftate of cultivation unequalled in any country now known, if, parhaps, in deference to the tefti- mony of Kasmpfer and Thunberg, we except Japan. The olive and the vine which flourifh in a thin foil, were natural- ized ; earth was carried from the vales and depofited upon the hills; walls were conftrudled to fupport it there, and prevent its being wafhed down by the rains; and by contrivances not different in effect from our hot-beds and green-houfes, the markets of Athens were regularly and daily fupplied with frefh vegetables, even during the feverity of winter. Nor was the induftry of the people reftrained to the fecuring of a fteady fufficiency of the neceffaries of life. Luxury ancLtafte, wliich found little to gratify them in the meal, prefided over the de- fert; not efculent plants alone, bu^ the myrtle,' the rofe, and other flowering fhrubs, were affiduouily reared; and a winter entertainment in Athens, regaled the fmell with fragrance, the eye with bloffoms, and the tafte with fruits of delicious flavor. But, though induftry and art could remedy the defects of foil, nature had been equally pariimonious, in another refpeft, where they could not prevail againft her. Athens and Attica were poorly fupplied with water. Their ftreams were brack- ifh, impregnated with minerals or with fait; and the people were obliged to have recourfe to pits and cifterns, to preferve * De Pauw, fed. xi. chap. 3. f Travels through Switzerland, Italy, and part of Greece, &c. in 1787, 1788, and 1789, by Thomas Watkins.—London, Cadell, 8vo. 2 vols. MEDICAL REPOSITORY. ' < that water with which they were f< antily fupplied by infre- quent rains. For, befide that the air of Attica was, in general, exceedingly dry, plentiful rains were only known to happen when the hellefpontias, or north-call wind, prevailed.* The climate of Attica bears a finking lefcmblance to that of many of the United States. Its latitude being nearly the fame, vari- ations could only depend on local circumftances. From the broken face of the country, we Ihould naturally expert to find the feafons tempeftuous; and from its nearnefs to the tea, the weather changeable. Both of thefe were true; but the fnowy heights of the numerous furrounding hills, and the long chain of mountains which reached quite acrofs and ahnoft buried the adjoining kingdom of Thrace, preferved a more fteady and fevere cold in winter than on the fea-coaft; and a more uni- form and fuffocative heat in fummer. The north-weft winds, which came from the icv fummUs in tlie cold feafon, were piercing; and the fultry and confined vales, when agitated by any bieeze in the warmer months, feemed to have borrowed their gales from the deferts of Africa.—So exceflive was the cold of the neighbouring ftates bf Bceotia and Phocis, though both in a latitude lower than Norfolk in Virginia, that the Bacchantes nearly perifhed in a fnow-ftorm, in the former; and an army, from the confines of Germany, were unable to fuftain the rigors of a winter campaign in the latter.f * De Pauw, chap. 10. vol. i. part i.—It may be proper once for all, to inform the reader, that the chapters of De Pauw, which have been particu- larly confulted, are the 2d, 3d, 8th, 10th of fedion i. and the 6th of fc&ion 14.—Other parts of the work are occafionally referred to. f De Pauw, chap. 16, fe&ion i. The following paflages, from the " Works and Days" of HefioJ, a poet yyho rcfided at Afcra, a village in the neighbouring country of Bceotia, and but a few leagues fron* Athens, ferve to confirm this account of the climate pf Attica. " The month, all hurtful to the lab'ring kiue, lit part devoted to the god of wine, Demands your utmoft care ;* when raging forth, O'er the wide feas, the tyrant of the north, Bellowing through Thrace, tears up the lofty woods, Hardens the earth, and binds the rapid floods. The mountain oak, high tow'ring to the flues, Torn from his root, acrofs the valley lies; Wide fpreading ruin threatens all the fliore, Loud groans the earth, and all the forefts roar: And now the beaft amazed, from him that reigns Lord of the woods, to thofe which graze the plains, * This anfwers to the month Nivofe of the new French calender. 6, MEDICAL REPOSITORY. Sometimes a fudden and fevere froft deftroycd even the roots of the vines and the trees.* The winter fat in very early in Attica. The cold winds be^an to prevail about the autumnal equinox; when the north- weft, in particular, feemed to defcend, fraught with chills, perpendicularly, on the city of Athens. Its greatefr. height was about the firft of February—nor has the climate under- gone any change fince the time of Pericles, in thofe partictr- lars, as appears from the publications of Riedefel and Whee- lerf—the laft of whom was prevented from vifiting the top of Shiv'ring the piercing blaft, affrighted, flies, And guards his tender'tail betwixt his thighs. Now nought avails the roughnefs of the bear, The ox's hide, nor the goat's length of hair, Rich in their fleece, alone the well-cloth'd fold, Dread not the bluft'ring wind, nor fear the cold. The man who could ereft fupport his age, Now bends reludtant to the north-wind's rage." * * • • • " Now does the bonelcfs polypus, in rage, Feed on his feet, his hunger to afiuagc; The fun no more, bright fhining in the day, Directs him in the flood to find his prey; O'er fwarthy nations, while he fiercely gleams, Greece feels the power but of his fainter beams. Now all things have a different face below; The beafts now fliiver at the falling fnow; Thro' woods, and thro* the fhady vale, they run To various haunts, the pinching cold to fhun: Some to the thicket of the foreft flock, And fome, for flicker, feek the hollow rock." Cook's Hefiod, verfe 175. " When with their domes the flow-paced fnails retreat, Beneath fome foliage, from the burning heat," «c. Cooke—vcrfc 256. " The feafon when the dog refumes his reign, Weakens the nerves of man, and burns the brain. Then in the fhade avoid the mid-day fun," &c. Verfe 370. The defcription of winter would well apply to the northern boundary of the United States; and the dire&ion in the laft line of the laft quotation is well adapted to the climate of Georgia and the Carolinas. * Theophraftus—DeCausis Plant arum, lib. v. quoted by M. d e Pauw. —Inftances of this kind are frequent in our own country. I have known fuch a froft, near the city of New-York, in June; and a fnow-ftorm happened in the May of 1760, after the apple-trees were in bloflbm; and another in May, 1774. f Obferv. fur le Levant, par M. Reidefel. Wheeler's Travels in Greece, vol. ii. both cited by De Pauw, but neither to be found in the New-York and Philadelphia libraries.—The accounts of thefe gentlemen do not feem MEDICAL REPOSITORY. 7 Mount Hymettus, by the fnows in February, and found his woollen clothes fcarce fufficient to protect him againft the cold of the vallies. The narrow and rapid ftreams of Attica and Peloponnefus were feldom fattened by ice, notwithftanding this rigorous winter; but the broader rivers of Thrace, a coun- try fituated in a much warmer latitude than New-York, were frozen over like the Conne&icut and the Hudfon. It refulted, neceffarily, from this variety of feafons, that a great difference exifted between the fummer and winter drefs of the people. In the cold feafon, it was difficult to clothe too warm ; in the warm feafon, to go too thinly clad. The Atheni- ans, in fummer, rambled about, and performed their exercifes, nearly naked, in their extenfive porticoes and public groves. In the winter, they wrapped themfelvesup in woollens, and fhrunk into their clofe, confined, and heated rooms.* Even their nice fenfe of the graceful in attire, yielded to the imperious mandates of the feafon; and the actors of their theatres, as well as the fpecvtators, covered themfelves with a fleecy mantle. The women, alone, with that pertinacious regard to external appearance, which has been little weakened by time, were remarkable for a light drefs, ill-fuited to protect them from the terrors of the winter. But their reclufe and fedentary lives did not fo much expofe them to its influence, as the active habits perfectly to accord with that of Mr. Watkins, unlefswe are to fuppofethe winter in which he was at Athens unufually moderate. He wa9 there in December, 1788—when he fays, " the feafon which is particularly fcvere at Conftantinople, is here open." Perhaps the grcateft cold happens after De- cember, at Athens, as appears to have been the cafe at New-York, for fome years paft. * Hefiod, in the Poem before cited, gives the following directions for » winter drefs. " A winter garment now demands your care, To guard the body from the inclement air ; Soft be the inward veft, the outward ftrong, And large to wrap you warm, down reaching long: Thin lay your warp, when you the loom prepare, And clofe to weave the woof no labour fpare. The rigour of the day a man defies, Thus cloth'd, nor fees his hairs like briftles rife. Next for your feet the well-hair'd fhoes provide, Hairy withki, of a found ox's hide. A kid's foft fkin over your moulders throw, Unhurt to keep you from the rain or fnow; And for your head a well-made covering get, ^ To keep yi.i"- cars fafe from the cold and wet." ri Works and Days, v. 215. 8 MEDICAL REPOSITORY. of the men, who monopolized, at the fame time, bufinefs arid divcrfions.* To caufes already enumerated it may doubtlefs be attributed that the principal part of the food of the Athenians eonfifted of vegetables.! Even at the tables of the rich, their fcanty and minute difhes of mears, which formed the firft courfe, or the meal, were foon removed, to make way for fruits of every flavour, the rich olive, the delicious grape, and the honey of Mymettus.J To the poor this flender fupply of flefh was denied, as beyond their means to procure; and, except at their public feafts, we may prefume, they rarely tailed it. On thefe occafions, indeed, they indulged in gluttony and drunk- ennefs without reftraint.§ Nor were the private entertain- ments of the Athenians always more becomingly conducted,§ Women, as well as men, at certain feafts gave way to the moft djfgufting intemperance and diforder; as if refolyed, at fuch times, to avenge themfelves, by the extent and violence of their debaucheries, for that general ftate of dependant infig- nificance to-which they werefubje6r.ed.§ But fuch opportu- nities occurred, neither for them nor for the people at large, fo often as to have any permanent influence on their health. Their vegetable diet was moftly perfifted in. Roots and fruits abounded in the winter; honey they always had; and the dried grape was then fubftituted for thefrefh. Thus a ftcady fuc- ceflion of garden vegetables, of fruits, and even of flowers, became effential to the Athenians; and a failure in quantity, or a defect in quality, tended to excite commotions and infur- re£lions in Athens, as certainly as like citcumftances in re- fpedt to bread in Paris. But frugal as they were in time of peace, in war they were obliged to fubmit to ftill greater f'ru- * To this reclufe life of the Athenian women, Hefiod alludes in the fol- lowing lines—" Works and Days, v. 195. " —----------------the tender maid, Free and fecure, of ftorms nor winds afraid, Lives, nurtur'd chafte beneath her mother's eye, Unhurt, unfully'd, by the winter's flcy." In addition to De Pauw, confult Voy. du J. Anachar. chap. xx. and Pot- ter's Grecian Antiquities, B. iv. chap. 13. f Potter's Antiquities, B. iv. chap. 18. i Watkins, in 1778, enumerates" rice, dried figs, olives, honey of Hy- mettus, and rich milk"—among the delicacies which Athens afforded, to compenfate him for goat's flefh, few roots, and bad bread." § See Voy. du J. Anaehar. chap. 25. Pe Pauw, fed. iii. chap. a. Pot-* ter, B. iv. chap. 20. MEDICAL REPOSITORY. 9 gality, and a lefs agreeable fare. The fubfiftence of the Athe- nian armies confifted of faked meat, particularly fifh, dried fruits, checfe, olives, onions, and an inferior fpecies of bar- ley* Nor were the poorer citizens of Attica better provided £at. "l\euher ,n thclr boroughs, or in the capital, they were reftridted, at once, from dieir accuftomed fupplies, which the rich only could draw from their extenfive gardens: for the Athenians held a feeble face on the land fide; and their terri- tory was frequently left, undefended, to the ravages of a mer- cilefs invader. Nothing could exhibit a more ftriking and immediate change in the ordinary food of the people, than the preparations for war. Yet, how great foever were their fuf- ferings, and though commotions fucceeded commotions, their vanity and ambition, their numerous fpedtacles at home, and their fplcndid victories abroad, deceived them of their forrows, and elevated them above their misfortunes. Domeftic flavery exifted, in full force, throughout Greece. In Attica the generous temper of the people mitigated its fe- verity; and, if we except the wretches who were doomed to labour in the mines, the flaves were treated with mildnefs and indulgence. This might be the more necefTary, as they greatly exceeded their mafters in number, and were employed on all public works, and fometimes in the armies. The number of flaves in Attica is eftimated at 400,000; and it is not probable that the cicizens of the Republic, together with ftrangcrs refi- dent in the Athenian territory, exceeded 100,000, including women and children. The permanent houfes of Athens and its fuburbs are computed by Xenophon, to amount to 10,000; and when we confider that moft of them were mere cabins, we ihall not think the refidents of that city more numerous than 50,000: which is the eftimation of De Pauw. The remainder were inhabitants of the neighbouring boroughs; employed in the mines; and fcattered over the face of the couutry. Fifty thoufand people, therefore, may be fuppofed to have fteaciily rcfided in Athens, in time of peace. And it is the more material to obtain correal ideas on this point, as very important deductions will be found, irreliftibly, to flow from its eftablifhment. The extremity of the Attic peninfula feems to have been little fufceptible of tillage. Its chief population confifted of the flaves employed in tlie filver mines of Laurium, and the * Potter's Antiquities, B. iii. chap. 4. De P»uw, fc#. ii. chip. 3. Vol. J. C MEDICAL REPOSITORY. perfons concerned in their fuperintendence. Northward, and to the north of Athens, the whole country was covered with orchards and vineyards. It was in the country that the wealthy and luxurious Athenians moft delighted to dwell: for while the private buildings of the city exhibited an appear- ance of meannefs and wretchednefs below that of our moft miferable frontier towns, every decoration that architecture, fculpture, painting, gardening, and planting would beftow, was expended on the villas of the rich. As in European coun- tries, their plantations oftentimes extended feveral miles in cir- cumference, while the poor pofTeffed not a foot of earth. Yet the fuperior wretchednefs of the city poor attached the coun- try people to their habitations, where they were univerfally more comfortably fettled, and led more tranquil, healthy, and independent lives. Such was the general condition of Attica, and the Athenian people: but the city of Athens, the feat of the fevere calami- ties which were brought upon the nation by the Plague, de- mands a more particular confederation. The city of Athens, fituated on the left fide of the penin- fula of Attica, and built almoft on the border of the Saronic gulf, lies in north latitude 38 deg. 5 m. or nearly that of Nor- folk in Virginia. This place, afterwards fo celebrated, at firft confifted only of a few miferable cabins, eredted on the top of a rock, in the midft of an extenfive plain. As the number of inhabitants increafed, the furrounding plain became fettled: the original city was devoted to the gods, and was called Acropolis, or the Citadel; while the reft of the fettle- ment was denominated the Lower City. The Citadel was inclofed in a proper wall; and a wall, common to that and to the lower city, furrounded the whole. The population and commerce of Athens extending, the city extended with them; and by means of the Long Walls, which reached to the fea, was made to comprehend three harbours—the Piraeus, Muny- chia, and Phalerum. The Citadel, if perhaps we except the minifters and fer- vants of the temples, contained no inhabitants. Nor does it appear to have been vifited by the plague. The Lower City, like moft of the cities of Modern Eu- rope, and. many of our own, was fettled without regard to any plan. Each perfon regulated the pofition of his houfc by his own particular notions of convenience; and thus, while in fome quarters the buildings were huddled together, in others MEDICAL REPOSITORY. II large places were left unlocated.—The circumference of the 'city, or the fpace comprehended within the wall, was about feven miles. This extent of territory, though much more confiderable than was neceflary for the accommodation of the proper inhabitants, afforded them little advantage; for fcarcely a third was built upon. A large portion of it, the M irfhes, was unfit for ufe. Some parts were rocky; others covered with groves, and devoted to particular exercifes; and many places, the beft adapted for building, were left defolate. For, when any citizen was convicted of treafon, the laws directed his houfe to be razed, his grounds to be laid wafte ; and for- bade the erection of other buildings, and the profecution of further improvements, on the places. This fentcnce, it is true, was fometimes reverfed by particular rulers; but, at the time now treated of, many fuch vacant fpots were left. Of thefe, the Pelafgic was one, and probably the moft extenfive; and its fettlement was fpecially prohibited by the Oracle.—But a further reafon for leaving fo much ground unoccupied, was for the accommodation of the country people, who, in time of war, were obliged to take refuge within the walls of the capi- tal. Here they erected, without any order, their temporary and wretched huts ; leaving their fields to be defojated by their furious adverfaries. Marfhes and ftagnant water were, by no means, confined to the city. Much of the road to the harbours was marfhy; and the Ilyffus and Cephifus wandered through the extenfive marfh of Phalerus, which lay directly fouth of and near the lower wall, leading to the harbour of that name. The northern and eaftern environs of Athens partook of the fame misfortune. The Academy, where the celebrated fchool of Plato was kept, fuffered feverely in copfequence. That philofopher himfelf, many years after the plague, and when much labour and money had been expended to render the fituation healthy, was made fick by the dampnefs of the air, and obliged to remove to the higher country or Colonna. Nor was the Academy more falubrious from the vicinity of an extenfive burying-ground on one fide, numbers ot tile-kilns on the other, and the rows of thick planted trees (a common fault in Athens), which excluded the fun, and prevented a free circulation of the air. Within the city this was not the only obftacle to due ventilation. The numerous ftreets of the inhabited quarters were narrow, irregular, unpaved, and worfe built than any of the towns in the United States. The pubT j 2 MEDICAL REPOSITORY. * lie buildings alone excelled thofe of other countries for elegant magnificence', rendered more ftriking by contraft with the uni- form meannefs bf thofe by which they were furrounded : for it was the policy of the government to difcountenance private expenfe in building; and the Areopagus fat the example of 'this- rigid and baneful fimplrcity, by holding their own affem- blies in a houfe whofe cieling was of clay. The wealthy fled into the country, where they rioted in luxury at their fuperb villas; but the regular citizens were obliged to fubmit; while the poor were confoled by conftant employment in conftrudt- ing and beautifying the national edifices, whofe fplendor, equally fhared by rich and poor, gratified their vanity and elevated their pride. Their own dwellings, indeed, were little better than the wigwams of our favages; few of the rich had houfes of more than a tingle1 ftorv; and where upper apartments were added, the fecond ftory projected into the ftreet, and was afcended to bv flairs on the outlide.* The number of houfes in Athens has been already ftated at 70,ooo, exclufive of temples, other public edifices, and ma- nufactories. Thefe laft were numerous and extenfive. A wnole fquare was devoted to the cabinet-makers; another to fculptors; and feveral to the workers in metals. The following facts may ferve to convey fome idea of the ordinary cleanlinefs of Athens. The people, it has been noticed already, ate but fparingly of meat. Moft of their cattle were offered up as facrifices to the gods. Sometimes the victims were portioned out among the affiftants; fometimes a feaft fucceeded, when the limbs, half confumed, were wantonly thrown about the ftreets; fometimes the blood and entrails were burnt, and thrown in- to a ditch ; but oftener they were left undifturbed, or unburi- ed, at the places of facrifice; and this was fo common, that fome parts of the town muft have borne a near refemblance to a flaughter-houfe.—To thefe circumftances, De Pauw, wiih great probability,f afcribes it that Athens was perpetually in- * In many European towns, and even in London fo late as the year 1784, and probably later, the fame fad has been obferved. In the narrow ftreets where this manner of building prevails, the tenants of the lower ftairs never feel the fun, or fee him fliine. Thofe who live in the upper rooms can fhakc hands acrofs the ftreet, and from their front windows.—Is it furpriiing that thefe places are rarely free from low fevers ? The prefent town of Athens is as badly built as ever, according to Mr. Watkins; and its population reduced to about 5000 people; others fav 10,000. ' f Compare this with Mr. Bruce's account of the city of Gondii-, in Abvf- MEDICAL REPOSITORY. 13 fefted with wolves.* The rewards offered for the deftrudtion of thefe anitnals were infufficient while the caufe remained; nor are they extinct, if we may believe a modern traveller,f at this day, in the vicinity of Athens. From the fouth-wefterh gate of Athens, two walls took their rife; the fouthei nmoft of which extended, about 3! miles, to Phalcrum; the northernmoft, about 4 miles, to the Piraeus. Between thefe two ports, but neareft Phalcrum, lies Munychia; which, by means of a third wall, near feven miles in length, conformable to the windings of the margin or beach, was in- cluded with them. Thus thefe three walls, the two former of which were called the Long Walls, formed a triangle, whofe irregular bafe was on the fea, and its narrow apex at the wall of the city. The extent of Athens, if determined by the walls which inclofed as well the town as the ports, is eftimated at 22 Attic, or about 17 of our miles. At the time of the plague, the Piraus was the principal port; though all three were in conftant ufe. Here the vef- lels and fhips of war were built, victualled, refitted, and fta- tiohed. Here all commodities were fhipped and received from abroad. Thefe, and the borough of Piraus, which was fitu- ated between that port and Munychia, were the receptacles of their fearnen, of refidentiary and trading ftrangers, of manu- facturers and artifans, of all employed in traffic and the labours of the ports, and of the many wretches which commerce and navigation never fail to create. The harbour and town of Piraeus were very populous. Three docks diftinguifhed the former; and an extenfive portico, compofed by the union of five inferior porticoes; two forums, one near the lea, and another towards the city; 3 fpaeious mart, the relort of all the trading nations; and a prodigious arfenal; ornamented the latter. From hence to Athens was about four miles, over a marfhy road; the width of which, between the walls, was near \ a mile at Piraeus, and about 50 rods at Athens. So iinia. The hyjenas enter Gondar, in the night, to prey on the remains of Slaughtered animals, which lie in the ftreets. * " She (Greece) breeds the ravenous wolf, the bear, the boar, Pernicious monfters!" Fawkes' Theocritus, idyl. xxv. 1. 201. " Any one who brings in an he-wolf, fliall have five drachms, and for a flie-wolf, one." Law of Solon. Potter's Grecian Antiquities, vol. i. page 167.—In the time of Xenophon, the hunters alone were allowed to pais the line of defence, in time of war, in order to deftroy bears and wolves, which would otherwife dcfolate the country. De Pauw, fecit, ii. chap. 6. | Spon. Voyage de la Greece. MEDICAL REPOSITORY. fmall and confined was this ancient emporium of commerce; and when we recollect the inferior fize of veflels at the time of which we are fpeaking; when wc bear in mind the affer- tions of late travellers, who maintain that this port would not afford anchorage for fifty modern fhips;* when, too, we re- member the immenfe crowd bf people who actually reforted there in times of peace, and the navies fitted out by the Athe- nians in the Peloponnefian war, we fhall have fome idea of the confulion, mixture, and miferable accommodations which the refidents of that quarter fubmitted to, in its ordinary ftate of population. The Athenians, in general, if we except the regular inha- bitants of the town, were remarkably attached to a country life. Neither the fplendid ceremonies, nor the enchanting fpedtacles of the city, poffefled fufficient allurements to entice them from places where they acted without reftraint, and in- dulged in exercifes equally conducive to health and pleafure. The rich were more luxurious, and the poor better provided for. This tranquillity and enjoyment had been interrupted by the Perfian invafion; but, after the liberties of Greece had been afferted and fecured, the Athenians re-fettled their terri- tory; beautified it with new groves and villas; covered it with their wooden huts; and fpread an ample and luxuriant vege- tation over all its fields. Such was their fituation at the com- mencement of the Peloponnefian war. Differences had fubfifted between the Spartan and Athenian republics, for a long time. Negociation had been ineffectu- ally reforted to, for their accommodation, till at length, Athens, by the perfuafive and irrefiftible eloquence of Pericles, was led to a declaration of hoftilities. The Spartans and their con- federates were powerful by land; the Athenians by fea. The former trufted to their armies; the latter, to their fleets. It was their ufual practice to leave their frontiers unguarded, and, at the alarm of war, retreat within the city and the walled * " Defcription of the gulph of Venice and the coafts of the Morea," by M. Bellin—referred to by De Pauw, feet. ii. chap. 6. Watkins, vol. ii. p. 279. fays, that Phalerum is " fo fliallow, that a large, barge could not float in it"—and Munychia is in the fame condition. If ano- ther remark of this writer be accurate, vol. ii. p. 293. " that the foil of Athens is from 12 to 18 feet higher than it originally was," it will appear that fome confiderable change has taken place in the capacity of thefe ports. That an alteration has been effected is evident by the circumftance of the channel both of the Ilyffus and Cephyfus being dry. See p. 304 and 310 of the fame Work. MEDICAL REPOSITORY. 15 boroughs. A fimilar conduct was recommended to them, by Pericles, on the breaking out of the prefent war, in the year 431 preceding the chriftian era. But, though they followed his advice, from a conviction of its propriety, yet never was a removal attended with circumftances more melancholy, and regrets more poignant. The people had juft become comfort- ably fettled, and the country beginning to refpire, after the de- feat of the Perfian invaders. Thefe pleafant accommodations, and thefe rural fcenes, paflionately beloved, they were forced to relinquifh, unprovided with fhelter in the city, from which, in times of the greateft profperity, they flattened to depart, and where they were now to feek their fad and reluctant refuge. They were obliged, with their own hands, to pull down their new-built houfes, and to abandon the fields, tilled by them- felves, to a mercilefs and defolating enemy. Nay more, to forlakr " their temples, which, from long antiquity, it had " been their forefathers' and their own religious care to fre- " quent;" " to quite alter their fcene of life, and each aban- " don as it were his native home. When they were come " into the city, fome few had houfes ready for their reception, " or fheltered themfelves with their relations. The greater " part were forced to fettle in the lefs frequented parts of the " city, in all the buildings facred to the Gods and Heroes, ex- " cept thofe in the citadel, the Eleufinian, and any other from " whence they were excluded by religious awe."* So urgent was the neceffity, that, contrary to the exprefs prohibition, as it was fuppofed, of the Pythian oracle, they feized upon the interdicted ground of the Pelafgic, and erected there their miferable huts. Set up wherever fpace was found, in the ut- moft diforder, and preft together, they experienced no free cir- culation of the air; while their diminutive fize provoked the fallies of a farcaftic poet,f who compares them to butts or cafks. When the Pelafgic was fully' occupied, there was not yet fufficient room for the new-comers. " The city," fays Thucydides, " was not able to receive fo large a conflux of " people." " Many were forced to lodge in the turrets of " the walls, or wherever they could find a vacant corner." " Afterwards the Long Walls, and a great part of the Piraeus, J " were portioned out to them, for little dwellings." '• Some," • Thucydides, B. ii. Smith's Translation. f Ariftophanes. f i. e. The ftreets, market-places, porticoes, ckc. of this borough, were partitioned off, into little rooms, for the families from the country. i6 MEDICAL REPOSITORY. he remarks in another place, " had no houfes, but dwelled in " booths, where there was fcarce room to breathe." " At the " fame time, they (the Athenians) were bufied in the military " preparations, and fitting out (at this very Piraeus) a fleet of " one hundred (hips, to infeft Peloponnefus." This was in the fpringof the year 431; die flocks and labouring catde had been previoufly fent over into Eubea, and the neighbouring iflands; and the harveft was left ftanding. By this removal, the population of Athens was augmented from 50 to more than 400,000; all fupplies of frefh meats were at an end; the city was in a ftate of blockade, dependent for its vegetable nutri- ment on the importations and hoards of the preceding year, and the fcanty product of the fields in its immediate vicinity. Such was the fituation of Attica and the capital, when, " in " the height of fummer, and when the harveft was ripe," the Spartans and their confederates broke into the Athenian territory, and laid it wafte even to the walls of Acharna ;* which they clofely befieged. But the fouthern extremity, and moft barren part of the Attic peninfula, protected by the fleet, efcaped this year. Thus were the principal fupplies of Athens, for the en- fuing year, totally deftroyed. Nor were the people fhut up within its walls infenfible to this calamity. A feene like this they had never witneffed before; and its horrors were magni- fied by their apprehenfions of famine; by their grief on quitting their fields and dwellings; by their refentment againft the ac- tors in it; and all were heightened by the earneft entreaties of the Acharnians, to fally out, and repulfe the enemy. Commo- tions and infurredtions followed; the courage and conduct of Pericles were loudly arraigned ; and it required the utmoft ef- forts of his addrefs and eloquence, and the full weight of his popularity, to reftrain the difaffected. When the Peloponnefians had withdrawn from Attica, the Athenians, as if k were to leave no poflibility of fupplies, for themfelves or others, on the north of Athens, inarched into the adjacent country of Megara, and fubjected it to fimilar devaluations. Thofe who remember the defolation effected under the or- ders of the celebrated Mai fhall Turenne, or the more recent horrors of the Vendee, will have fome fuitable notion of the * Acharna was about fix of our miles from Athens; and contained, at this time/ 3000 fighting men. Eefide this, there were feveral fmaller towns, alio garrifoned, and in the fame condition as Athens and Acharna, in refpe& to fupplies. MEDICAL REPOSITORY. i; condition ifi which Attica was left by the Peloponnefian,^ Neither fire nor fword was left unemployed in this terrible war againft the harmlefs earth; vines and fruit-trees were wholly deftroyed; the government of Sparta encouraged its rapacious foldiery; and " nothing was left to the vanquifhed but their temples and their tombs."* The Atheriiaus paft the firft winter of the war, pent up within their city, difcontented and unhappy ; in part fupported by their naval ftfength, and cherifhing the vain hope that their enemies would not renew their depredations; or, at leaft, not to the fame degree. Early in the cnfuing fpring (of 430, A. C.) the Pelopon- nefians made a frefh incurfion. Whatever had efcaped before, or had fince grown up, on the north and weft of Athens, was now utterly laid wafte. They were bufied in this work when the Plague, about the laft of April, or beginning of May, fuddenly appeared in the Pirzeus ; and, afterwards, during the fame fummer, extended over the whole city.—The Pelopon- nefians, having completed their ravages in all the Attic terri- tory above Athens, fell upon the fouthern parts of the pen- infula, and rendered them equally defolate. Thus, to ufe the words of Thucydides, " they made the whole country one continued devaftation."—If the Athenians who had removed into the city were before afflicted, all their forrows were now redoubled. Nor could the talents of Pericles, which prevailed upon them to continue, and which directed the efforts of the war, re-animate their fpirits amid fuch unexpected calamities. " The poor citizens who had but little, could not bear, with patience, the lofs of that little. The rich and the great re- gretted the lofs of their eftates, with their country-feats, and fplendid furniture."f Meantime the plague continued to extend; and prevailed, with grfeat mortality, the whole of the years 430 and 429. However, in the laft of thefe years the country refpired a little. The enemy made no ravages, and Athens had op- portunity to gather in her vegetable harveft. This was fol- lowed by an abatement of the plague, duiing the following year, 428.—In the fummer of that year, and " when the corn was full-grown," the Peloponnefians entered Attica: but * Scholiaft of Demofthenes, on the " Difcourfe againft Timocrates," quotsd by De Pauw, feet. i. chap. 8. f Thucydides, B. ii. Vol. I. D r8 IV1EDICAL REPOSITORY. the Athenian horfe and light troops kept them off; arid; bf means of repeated fkirmilhes, defended and protected " the parts adjacent to the city." This allowed the people to ga- ther a fecond, but more fcanty harveft; and they paft the fuc- ceeding fummer, with a further exemption from the plague; which, however, had at no time deferted them.* But, in the autumn of 427, and about the equinox,* it broke out afrefh, and with augmented violence. As a precurfor to this fevere calamity, their enemies, the preceding fummer, had renewed their depredations, with fuch fuccefs as to be necef- fitated to retire from the Athenian territory, for want of forage for their horfes.—The year enfuing (426) the plague raged with unexampled fury and mortality. But this was the limit pf its power. Caufes, hereafter to be inveftigated, operated to deliver them from its dominion; and the incurfions of their hoftile neighbours now ceafing, health was reftored to Athens. The relation apparently fubfifting between the plague of Athens and the ftate of the citizens, in refpedt of vegetable fupplies, is too curious and important to be lightly paffed over; and will be belt exhibited by the following table, for the introduction of which it feems unneceffary to offer an apology. Attica ravaged, and the vegetable fupplies cut off, in the fummer of- 431, A. C. The plague breaks out in the fpring of 430 The ravages renewed and extended in the fummer of 430 The plague at its height in 429 No devaftations in 429 No plague, or but very little, in 428 Depredations in the latter part of the fummer, but not fo extenfive as formerly, in 428 The plague holds off all fummer, but recurs in autumn 427 The ravages more extenfive than ever, in 427 The plague worfe than ever, in 426 * The New-York fever of 1795, though it commenced the laft of July that year, was nearly extinct on the fourth of September; but revived about the Ijth, and increafed in mortality till the middle of October. The great- eft mortality of the fe-ver of Philadelphia, in 1793, was in Q&ober; nor did the winter entirely banilb all fymptoms of the difeafe. MEDICAL REPOSITORY. i9 Tempeftuous feafon, &c. obliges the Peloponne- fians to retire, without committing any depre- dations, in 426 No recurrence of the plague either in 425 or after.—The Peloponnefians were in Attica but fifteen days this year (425), in which time they had opportunity to inflict very little injury on the country. SECTION Tf. THE preceding narration of facts has prepared the way for the difcuffion of a queftion in relation to the difeafe under con- fideration, which has always given rife to great variety of opinion, and been deemed of much importance, in the hiftory of Epidemics—Whether the Plague was imported, or of local origin ? As no certain evidence is left to us by the ancients, on this interefting point, we are neceffitated to have recourfe to the exercife ot our own judgments, on a comparifon of all the circumftances connected with this memorable calamity. It, indeed, appears, from Thucydides, that a report prevailed in his time, that the Plague originated in Africa, and was im- ported into Athens. But, from the manner in which this report is noticed by the hiftorian, it may be inferred that he thought it entitled to very little credit; for he declares that the diforder fell fuddenly on the people of the Piraus, fo that it " occafioned a report that the Peloponnefians had caufed poi- fon to be thrown into the wells;" and he calls upon " every one, phyfician, or not, freely to declare his own fentiments about it, and to affign any credible account of its rife, &c."* Great ftrefs, it is true, is not to be laid on an argument like this; it is fufficient, however* to counteract the abfurd dog- matifm of later writers, who have not hefitated to reprefent the difeafe as propagated from imported contagion.—Medicine, at this period, had fcarcely difencumbered herfelf of her fwad- dling clothes; and though no peifon will venture to queftion the fagacity of the Athenians, and the peculiar talents of Thu- cydides for obfervation, neither his countrymen, nor hiinfelf, can fairly be fuppofed to have examined this fubject with phi- Jofophical precifion. The method leaft liable to rational ob- jection will be, carefully to enumerate ail the circumjlances * Smith'6 Thucydides, B. ii, aQ MEDICAL REPOSITORY. connected with this memorable calamity.—To this enumer ration, therefore, we fhall immediately attend. i. The condition of the city of Athens, in. its ordinary ftate, was favourable to the generation and continuance of febrile difeafes, in their feafon. 2. The people of the town, as well as of the country, were accuftomed to a vegetable diet, and to much and free exercife. 3. The population of Athens, in common, was fmall in proportion to its extent. 4. Its population, during the firft years of the Pelopon- nefian war, was increafed beyond all capacity of the place for accommodation. 5. The country people, efpecially, underwent a remarka- ble change of air, lodging, diet, and mode of life. 6. Exercife was, in great meafure, denied to all; few were provided, in any confiderable degree, with frefh provi- fions; all, probably, had fait meats; all were difheartened; moft of them were without employment, and idle. 7. The plague firft appeared in that part of the city where there was the leaft cleanlinefs; the leaft ventilation; the worft accommodations of all forts ; and where the people were the pooreft of the country poor. 8. In this part of the town it broke out all at once, or " fell fuddenly," to ufe the words of Thucydides; and thence, gra- dually extended to the better fettled, and more healthy parts of the city. It was longeft in reaching or appearing in the neighbouring country towns of Attica, which were, like Athens, in a ftate of fiege or blockade. 9. It: commenced in the fultry feafon of the year ; after peo- ple had paffed a year in this new and wretched fituation, op- preft in mind, and harraffed in body; and as foon as the fummer fun came to operate on the collected filth of winter. 10. Thofe who came into the town, from the country, fuffered moft; and the poor more than the rich; and this in proportion as they were badly lodged and provided for. 11. Like other epidemical difeafes, the plague of Athens converted every other complaint into itfelf, or banifhed it, dur- ing its own continuance. 12. It was fatal to domeftic animals, as well as to men; and birds, and all wild animals, fliunned the city during its prevalence. ; 13. It affected the Athenians only, when carried by their MEDICAL REPOSITORY. 21 troops into other countries; and was never propagated into any other ftate than theirs—not even the conriguous towns of Peloponnefus and Boeotia— notwithftandingthe numeious en- counters between the hoftile nations. In the fummer of the year 430, A. C. when the plague firft arofe, the Athenians were fitting out a fleet, to commit de- predations on the coaft of Peloponnefus. This armament landed at Epidaurus, and expected to take the city; but the plague raged among the troops, deftroyed numbers of them, and they were obliged to return without having effected their purpofe. Plutarch* fays that they communicated the difeafe to all who had intercourfe with them. By this he may mean to all their allies.—The total iilence of Thucydides, a cotem- porary writer, on this point, would be a fufficient reafon tor believing this ftatement to be inaccurate, even if he had not, clfewhere,f expreflly mentioned that the plague was never propagated to Peloponnefus. The fame fummer the Athenians fent a reinforcement to their army which was carrying on the liege of Potidea, a town of Chalcidica, lying on the gulf of Therma. The reinforce- ment amounted to 4000 men; and they found the troops be- fore Potidea healthy. This did not long continue. They fell fick themfelves; communicated the peftilence to the others; and returned, after a flay of forty days, having, in that time, loft 1050 of their number. Yet the old troops continued the fiege, and afterwards took the place; and the Potideans were never affected bv the difeafe.X 14. The condition of the fkin, mouth, &c. (hereafter to he more particularly noticed,) bore a ftriking refemblance to that ftate of the fame parts which occurs in frurvy; a difeafe um- verfally attributed to confinement, bad air, and want ot trcfh provifions.§ * Article—Pericles. f Smith's Thucydides, B. ii. J Neither the Philadelphia fever of 1793. n°r *e New-Wk fever of I7QC, were communicated to other places. The citizens of both places were, in numerous inftances, feized with the fever after leaving thofe "ties; but their country attendants efcaped.-The Philadelphia fever appears to have been contagiou s-i. e. communicable by one to another, from contact, &c. The New-York fever, on the contrary, was rarely, or never, fo commum- "^ft is worthy an attentive inveftigation, whether the peculiar ulcers, buboes, carbuncles, &c. of the plague, which render it worfe than our yel- low fever, do not depend on failed meats, other defeds in diet, and fuch cir- cumftances, generally, as are known to occafion icurvy. 22 MEDICAL REPOSITORY. 15. There was always a decline of the plague, when the harveft of the preceding year was fpared; and the plague re- turned, when the harveft of the preceding year was deftroyed. The fecond great prevalence of the plague did not com- mence till after the middle of September; when the ordinary caufes of fever are moft accumulated; when the fcanty fup- plies of the preceding year may be fuppofed to have been con- fumed; and when thofe for the year fucceeding, which fhould then have been gathered in, were cut off.* 16. The plague did not ceafe till after the incurfions of the Peloponnefians were given over. But the confideration of the caufes of its difappearance will be deferred for the conclu- fion of this fection. 17. The Athenians, themfelves, accufed Pericles of having caufed the plague, by bringing fo vaft a number of people into the city, who were ill-provided with lodgings, and lived in idlenefs, infecting the air, and poifoning one another, f 18. A further indication of the fentiments of the Atheni- ans, concerning the fource of their peftilence, may be per- ceived in the following fadt. After the war, they conftituted five diftindt places, in feparate Cantons, afylums for the country people, in times of invafion; nor have we any cer- tain account of any future plague infefting their city. J A due confideration of the facts juft enumerated can hardly fail to imprefs the mind of the reader with entire conviction of the domeftic origin of the Athenian plague. Nor fhould we want medical authority to countenance us in the belief, if opi- nions could be admitted as confirmation. Yet, to pafs by thofe of many living phyficians of deferved reputation, who might be fuppofed improperly biaffed in their decifion on this quef- tion, and not to inlift on the pointed declaration of the illuftri- ous Haller, who confiders the plague of Athens as an ordi- * How far may habit be confidered as influential in thi9 cafe? The plague originally broke out in the firft of fummer: could the people have become fo habituated to their fituation as to require the accumulation of all the ordinary, as well as the extraordinary caufes of fever, to the renewal of the difeafe ? f See Plutarch—Life of Pericles, near the end. i London has never been affliaa«£* (whence our syllable,) was then stuck on the outside. The whole volume might be about three feet wide, and forty or fifty feet long. The books found at Herculane- um and Pompaei, according to the late report of the Rev. Mr. J. Hayter, whom the Prince of Wales employed, about ten years ago, to examine and unroll them, are of papyrus upon wooden rollers: the leaves are from one to three feet broad, and when un- rolled extend from thirty to forty feet. He says, the ink con- tains much gum, and no acid. Hence it should seem, that they were written on by means of a reed (calamus) dipt in the atramen- tum librarium of Pliny, which was fine size and lamp black. It was common to insert a piece of parchment between every four or five leaves of papyrus, to support them. Much pains was taken by the paper makers and bookbinder: thus Horace ad librum suura, epist. 20. " Vertumnum, janumque liber^pectare videris. (That is, you will be sent to the Forum, where these statues were erected.) " Scilicet ut prostes, Sosiorum pumice mundus. (Polished with the pumice, and for sale at the bookstore of the Sosii.) " Sometimes the leaves before writing were first polished with a tooth, 13 PI. 12. For more od the subject of papyrus, see 5 Herod. Coopers Introductory Lecture. 481 58. 4 Theoph. 9. 13 PI. 11, 13. Drummond and Walpole's Herculanensia, Dissertation 8th, aud Brace's travels, who has given a good plate of the papyrus. " Job xxxi. 35. talks of writing a book. I think, with many divines, this is a sacred drama of eastern origin. If so, this book implies the use of papyrus at an early date. See 1 Gog. i 87. " Phylyra, 13 PI. 11, is not only the name for the finer interior filament of the papyrus, but of the maple, the sycamore, the beech, the mulberry and the linden tree, all which were occasionally con- verted into paper, when sized, beaten, dried, and rolled. The com- mon paper in the time of the emperors was from nine to twelve inches square. " The papyrus paper was succeeded by paper made of cotton, or at first perhaps of silk; for although the cotlou paper acquired the name of charta bombycina, yet it is highly probable, that the refuse silk was first applied to this purpose, as in China. The Indian, or finer silk, was sericum, (inter sericos jacet pulvillos,) the inferior, or Syrian silk, was the bombycinum. By and by, the frauds of the paper-makers, substituted the byssus, or cotton, but still it was sold as silk paper: till coming into common use, all the cotton paper retained the name of charta bombycina. The papyrus continued in use at Rome from about two hundred years before Christ to the end of die eleventh century, when many of the papal bulls, according to Father Mabillon, were written on papyrus. Montfaucon mentions a manuscript on this paper in the king's library at Paris, of the date 1050. Parchment was also still in use at the same period."--p. 163.—168, In the course of our labours we have frequently, and with great pleasure, borne testimony to the rapid improvements in American typography. On the present occasion, however, we are compelled to remark, that the mechanical execution of the present volume would disgrace the state of the arts as cultivated by our Plymouth forefathers, vol. in. 3 o . ( 482 Art. III. An Essay on the Bilious Epidemic Fever, pre- vailing in the state of New-York. To which are added, a Letter from Dr. James Mann, Surgeon General to the Army, and aDissertation by Dr. John Stearns, delivered before the State Medical Society, on the same subject. With Notes and Observations on these productions. By Christopher C. Yates. Albany. H. C. Southwick. 8vo. pp. 48. 1813. In the first volume of the Register, p. 87—96, we offered to our readers a brief analysis of Dr. Strong's Dissertation on the Petechial or Spotted Fever, as it prevailed in Con- necticut, and in some of the eastern states. In the same vo- lume, p. 226—244, a full view was taken of the able Report of the Massachusetts Medical Society, upon the same dis- ease, as it appeared in that state, accompanied with some editorial remarks upon the peculiar character of the disor- der. In our second volume, p. 440, we announced the trea- tise of Dr. North. Beside the reviews of these works, which, we believe, are all that have been given as distinct publica- tions on the spotted fever, several original communications on the same disease may be found in the pages of this jour- nal. We state this, in order to facilitate the inquiries of those who are desirous of obtaining all the information they can relative to the epidemics, which, within these few years, have caused so great mortality in the United States. The disease, which is the subject of the pamphlet before us, like the epidemic lately so prevalent in the eastern states, has, from the peculiar character which it assumes, and the fatality which accompanies it, deservedly attracted the at- tention of medical practitioners. The remarks which have Yates on the Bilious Epidemic Fever. 483 been made upon it are, as yet, confined chiefly to the ephe- meral columns of the newspapers, and indeed the pamphlet of Dr. Yates, with the exception of some few pages of it, u made up of materials from these sources. But it is matter of little moment through what channel the opinions of our me- dical brethren are communicated to the public, provided those opinions be deliberately formed, and candidly given, without prejudice or illiberality, and are the result of atten- tive observation and experience. That such, however, ii not the fact, and that the opinions which have been offered on this disease have, in a majority of instances, had their origin in a partial and erroneous view of its nature, and that they have been maintained for the purpose of supporting some pre-contrived theory, and of giving plausibility to some favourite practice, is sufficiently evident from the general complexion of most of the essays on the subject which have come within our notice. Different physicians, liv ing in the same district of country in which the disease prevails, often witnessing the same cases of the disorder, laying claims 11 equal experience in the management of it, and boasting of equal success in the result of their practice, are the abettor* of theories and modes of treatment diametrically opposed to each other. The disease, says one, is purely inflammatory, and depends upon a sthenic diathesis of the whole system, copious depletion is indicated, and large and repeated blood- letting is had recourse to. The reverse of all this, says another, is the fact. The disease is, from its commencement, characterised by every symptom of the lowest species of typhus, and to arrest its putrid tendency, the most powerful and diffusible stimulants are requisite, and brandy and lau- danum, spiced wine and asther, are poured down without mea- sure. We will not insult the understanding of the reader, with facts of this kind in his recollection, by introducing any arguments to prove, that the great mortality of the epidemic, 484 Yates on the Bilious Epidemic Fever. now prevalent in this state, like that of the spotted fever of Connecticut, has been caused by such extraordinary and un< justifiable methods of treatment. Our opinion of the nature of the present epidemic, (if strict- ly speaking, it may be called an epidemic,) and of the method of cure, which we believe will be found most successful, and which, indeed, as far as our experience goes, and from all that we can learn, has actually proved the most beneficial, may be found in a preceding article in this number.* The name, Peripneumonia Typhodes, under which this disease is there described, appears to us to convey the most ac- curate idea of its nature, and our subsequent opportuni- ties of observation, since that article was penned, give ua additional reason to adhere to the opinion there advanced. That the present epidemic is a " new calamity," and " unknown" before in this country, we can no more admit, than that it is the yellow fever of the West Indies ; and we regret that any writer of respectability should so far have committed himself as to have pronounced such an opinion. The powerful agency of climate, season, temperature, the local circumstances of country, variety of situation and of constitution in the origin and modification of diseases, are well known to all who are conversant with the history of epi- demical disorders; and to this agency, we have the high- est probable evidence, we may attribute whatever peculiari- ty of character this disease has assumed. But we return to the Essay of Dr. Yates. The fever here described under the name of bilious epi- demic fever, made its appearance, according to Dr. Yates in the city of Albany, in October, 1812. The few cases * See Dr. Hosack's observations on the Peripneumonia Typhodei. See al»* Dr. Williamson's observations on the Malignant Pleurisy. Yates on the Bilious Epidemic Fever. 485 which then occurred not being characterized by any pecu- liarity in its symptoms, excited no suspicion. About the middle of December many were attacked with it in a severer degree, but still there was no particular cause of alarm until the beginning of the following month, when a few cases as- sumed the deceptive appearance of violent pneumonic inflam- mation, and in which the ordinary treatment, instead of re- moving the disease only hastened it to a fatal termination. During the month of January, many patients who were at- tacked with the disorder died, and the " clashing practice" adopted by different practitioners, increased the mortality. From the success of the method of treatment pursued by Dr. Yates, he was induced to publish his observations on the disease, which he did on the 20th of the same month, in the newspapers of that city. His subsequent practice, after this period, afforded him opportunities of becoming more familiarly acquainted with the nature of the disease, aud en- abled him to enter more fully into a description of its symp- toms, nature, and treatment. We shall make an extract or two from this part of his work. " The remote cause of this fever appears to be general, being confined to no particular district, town, city, or village. From this circumstance we are induced to consider it as existing in the air : how or from what cause we cannot tell. " The exciting causes may be various ; intemperance in eat- ing, or drinking spirituous liquors, fear, anxiety, exposure to exces- bive heat or cold; in short, all the causes which generally bring ou common colds. " The proximate cause appears to be a secretion of morbid, acrid matter, or vitiated bile ; this secretion taking place in so large and important a gland as the liver, on whose healthy action the division and assimilation of our food depends, and the conse- quent purity of the blood, has a tendency to excite, create, and ac- 486 Yates on the Bilious Epidemic Fevet. cumulate the sudden, distressing, and alarming symptoms, which, as it were in a few minutes, usher in this disease."—p. 18. " This disease is confined to no particular stage of life. Children and old people were less liable to it than the middle aged aud young. Men were much more subject to it than women. " Premonitory symptoms were not always discoverable. Sometimes a lassitude and indisposition to action, and eratic pains through the chest and sides, preceded the attack for a day or two, aud sometimes the pain in the head and back were bo light for two or three days, that the patient felt no disposition to make serious complaint. " The general symptoms of an attack of this fever are, " 1st. Cold chills, which last but few hours, and are succeed- ed by, " 2d. A degree of heat on the surface, little above natural. " 3d. Pain in the head, arms, small of the back, and]lower extre- mities. " 4th. The blood vessels of the eyes preternaturally distended. " 3th. Tongue pale and moist, with little fur. " 6th. An uncommon degree of languor and debility pervading the whole system. " 7th. More or less nausea, and sometimes vomiting. " 8th. Pulse weak, soft, and a little quicker than in health. " Au increase or severity of these symptoms, premonish an at- tack which forms the most serious state of this disease, iu which case " The chills assume a degree of oppressive anguish to the suffer- ing patient, which to some has been more intolerable than any other symptoms, and recur frequently during the first twelve hours; many, however, do not suffer these chills to this excessive degree: " The pain in the head becomes more excruciating, and is not confined to one part; the forehead, back and sides are alternately affected : " The eyes feel heavy and painful, and their vessels become more turgid with blood, which gives them a dull red appearance : Yates on the Bilious Epidemic Freer. 487 " The face exhibits a universal flush in those who in health were not marked with distiuct red cheeks, those who were, now have their cheeks more of a livid than red colour: " A pain more or less severe in the right side, in the region of the gall bladder, passing up towards the neck, and settling between the shoulder blades: " Faintness, delirium, a suffocating sensation across the breast, with little or much difficulty of breathing, catching at half inspira- tions, as if the lungs could not be filled with air, not from a painful sensation, as in pneumonic affections, but an apparent repugnance in that organ to inhale, as if the air were noxious or impure. " Tongue continues pale in most cases during the continuance of the fever, though in some few instances dry, (and then only for a few hours at a time) and of a yellowish or light brown cast, fur trifling. " Pain in the back and extremities much increased. "A cough and difficult expectoration usually attend. The phlegm is in many cases accompanied with a little blood, but mostly only tinged with it, evidently owing to the violent exertion of coughing, or it probably issues from small ruptured blood vessels about the throat. " The state of the stomach appears the same as iu common bi- lious fever, being more or less affected with nausea at the com- mencement. Some vomit, others incline to vomit, or feel but the slightest degree of nausea. When the vomiting is spontaneous, the matter thrown up is invariably yellow or green coloured. " The bowels exhibit nothing peculiar until acted on by me- dicine. " The skin easily disposes to moisture after the stomach and bowels have been well evacuated. I have found it unnecessary, in most cases, to encourage perspiration by warm drink; an addi- tional blanket or two will suffice, if the patient does not readily sweat under the usual covering. " The approach of death is indicated by a cessation, for many hours, of all distressing symptoms, respiration, instead of laborious, now becomes less difficult, though short and hurried, and seems to 488 Yates on Uie Bilious Epidemic Fever. excite little uneasiness: the countenance and surface of the body become livid, or of a lead colour, resembling the body of a drown- ed person; the patient, and attendants, unaccustomed to these ap- pearances, are flattered with the hope of a recovery."—p. 20—23. In some further remarks on the nature of this disorder, the author remarks, " That the affection of the lungs in this disease is not primary, but sympathetic, appears to me as clear as the sun at noon day," p. 27. In support of this opinion, he states the powerful efficacy of emetics and ca- thartics in unlocking the biliary vessels by which the op- pression on the lungs " immediately yields or vanishes." We are not disposed to controvert the theory Dr. Y. wishes to establish, provided a successful mode of practice be the re- sult. But for ourselves we cannot admit the position attempt- ed to be maintained, that the prominent characteristic of the disease evinces its bilious nature ; and the facts which have come to view from the dissections which have been made of those who have died of this epidemic, instead of proving the liver to be the "reservoir," whence the nox- ious matter of the disease is diffused through the system, clearly establish the fact that we must look to a very diffe- rent part as the principal seat of the mischief. We there- fore cannot but object to the name by which Dr. Y. has dis- tinguished this disorder. His method of cure is thus briefly stated. " The method of cure which I have pursued in this disease, I shall state in a few words. When called to a patient labouring under the symptoms of this fever, my first prescription is, in all cases, an " emetic of tartarized antimony, sometimes combined with ipe» eacuanha, and sometimes with calomel. If this operates, the dis- charge from the stomach is in every case yellow or green bile in Yates on the Bilious Epidemic Fever. 489 great quantities, sometimes mixed with or followed by a whitish, slimy, compact substance ; if it operates on the bowels, their dis- charges are dark coloured, mixed with green bile; and are gene- rally veryfatid. If the emetic does not operate as freely as I wish, I repeat the dose. I follow this prescription, notwithstanding it may have operated on the bowels, with a cathartic of jalap and calomel. I hardly recollect a case in which a cathartic did not operate on its first exhibition. I have in no disease found the bowels more susceptible of being moved by a single dose. The cathartic always produced copious evacuations of bilious matter, sometimes assuming the appearance of strong lie. An additional dose on the third day of the disease, often cured my patient in the milder attack. " In the severer attack, I commence in the same manner, with first an emetic, and then a cathartic; if the symptoms become stronger or more violent, my exertions are proportion ably so to evacuate the contents of the stomach and intestines. " If the patient grows weaker, and the symptoms do not abate, I repeat the emetic; this throws up in some cases greater quanti- ties of bilious matter than the first I administered. Relief invaria- bly succeeds this last evacuation. I now continue cathartics in smaller doses, but often repeated; for this purpose I have chosen of jalap and soluble tartar equal parts ; of th's compound I gave twenty grains every two or three hours, so as to keep Uie bowels in motion until the pain in the side and distress of breathing yield; after which I continue it in a limited degree until the evacuations change to a more natural colour, which is generally not till the 6th or 7th day. It is very common for the patient, while in a state of apparent convalescence, to have suddenly a return ofpaiu in the head, or side, and distress in breathing. I now again have recourse to a powerful emetic, and this relieves the patient imme- diately after its operation; the discharges are as copious, and to appearance, as bad as they were4iu the first stage. These pains al- ways indicate a collection of morbid matter. «I have not, since the 26th of January, given any other medi- cine in this disease than emetics and cathartics. My whole atten- vol. in. 3 p 490 Yates on the Bilious Epidemic Fever. tion is confined to a removal of the morbid bilious secretions which are unquestionably collected, and continue pouring into the gall bladder: probably giving rise, by distending that viscus, to the pain in the right side. " I have not found it requisite in any case to use medicinal to- nics to restore my debilitated patients; whenever the bowels and liver resume their natural and healthy action, the appetite returns, and food becomes the best and most natural tonic, beginning with weak soups, and gradually proceeding to more solid substances."— p. 23—25. We have nothing to remark upon the treatment adopted by Dr. Y.; it doubtless proved very successful in his hands, as he has mentioned. The letter of Dr. Mann, and the dis- sertation of Dr. Stearns, appear next in order in the Essay. They are inserted at length in the present number of the Register, and are left to the judgment of the reader. Of the notes which our author has annexed to them, we are con- strained to say, that they are not written in the temper we could wish, and which, indeed, the respectability of his oppo- nents and ihe nature of the subject required. After all, the theory which Dr. Yates has advanced of the nature, seat,, and proximate cause of this disease, is, in our opinion, in- sufficient and unsatisfactory; and the attempt to explain the phenomena of general disorder which pervades the system^ in this epidemic, by referring them to the liver as their source, is indeed taking a limited and local view of the subject* The best part of Dr. Yates' performance is that which con- tains his animadversions upon the unjustifiable and destructive stimulant practice of treating the epidemic, and for his early and salutary remarks we present him our warmest thanks. Present State of Medical Science. 93 Regents of the University, the Trustees, and other officers of that institution, &c. &c. The degree of Doctor in Medicine was granted to the following twenty gentlemen, eleven of whom were regular students of the College, had un- dergone the requisite examinations prescribed by its laws, and defended the 'respective inaugural dissertations annexed to their names. Robert M. Barclay, A. B. of Orange county, N. Y.—" On Marsh Miasmata." Charles Drake, of the city of New-York—" On the Proxi- mate Cause of Inflammation." Gideon C. Forsyth, of the city of New-York—"On the Blood." James Fountain, of Westchester county, N. Y.—" On Ty- phus Fever." Jabez W. Husted, of Westchester county, N. Y.—" On Teta- nus." Frederick J. Hill, of North-Carolina—" On Gout" Richard I. Ludlow, of New-Jersey—" On Respiration." Samuel Maxwell, of Montgomery county, N. Y—" On the Transfusion of Blood." Isaac Roosevelt, A. B. of the city of New-York—" Ok An- gina Pectoris." Dirk G. Salomons, of St. Eustatia, W. I.—" On Human In testinal Worms." Delos White, A. R. of Otsego county, N. Y.—" On Ut. ccrs." The honorary degree of Doctor in Medicine was conferred on the following gentlemen: Alexander Shelden, of the county of Montgomery. John Stearns, of the city of Albany. Westel Willoughby, Jun. of Herkinier county. Oliver C. Comstock, of Schenectady county. William Kirkpatrick, of Onondaga county. Joseph White, of Cherry Valley, Otsego county 94 History of the Yellow Fever David Baillie Warden, American Consul at Paris. Andrew Morton, of the city of New-York. John Augustine Smith, Professor of Anatomy and Surgery iu the College of Physicians and Surgeons. History of Uie Yellow Fever, which prevailed at Perth Amboy, (N. J.) in the summer of 1811, and of the evi- dences of its importation into that place. We at length give place to the following report on the yellow fever, and the official proceedings of the Board of Health relative to the same. Our only apology for having so long delayed the publication of these interesting papers, is, that we have not had room for them before, the pages of the Register having been occupied with the favours of our numerous and highly respectable correspondents. In the publication of this statement, we shall only remark, that if the facts now given relative to the introduction of the yellow fever into the city of Amboy, do not carry conviction to the minds of all who peruse it, we may truly say, neither will they be persuaded, though one rose from the dead. ed. Board of Health of New-York, September 16, 1811. The Honourable De Witt Clinton, President. Information having been given to the board that a dange- rous, malignant, and infectious fever now prevails at the city of Amboy, in New-Jersey; it was resolved, that it be re- commended to his honour the Mayor to issue his proclama- tion interdicting all communication between the said city of Amboy and this city. Resolved also, that a committee be appointed to confer with the health officer at the quarantine ground, and obtain from him, and from such other sources as theyr shall judge ad- visable, information of the existence of the said disease, and which prevailed at Amboy in 1811. 9j other facts deemed necessary by them, and report with all convenient speed to this board. Resolved, that the committee appointed, be Dr. Joseph Bayley, Dr. John H. Douglass, of this board, and Dr. David Hosack, of this city, and that the health officer, Dr. Rodgers, be associated with them. September 19, 1811. The committee appointed to confer with the health officer, and to ascertain the facts respecting the disease prevailing at Amboy, presented the following report, which was approved, and ordered to be entered on the minutes. Report of the Committee appointed by the Board of Health to investigate the nature and origin of the disease now pre- vailing at Perth-Amboy, New-Jersey; addressed to the President and Members of the Board:— Gentlemen, Agreeably to the instructions conveyed by the resolution of the Board of Health, we yesterday proceeded to Perth- Amboy, for the purpose of obtaining information relative to the nature and origin of the disease, at present prevailing in that city. The health officer, Dr. Rodgers, having been ap- pointed, with us, a member of the committee, we waited on him, at Staten-Island, with the hope that as he had been at Amboy, and had seen some of those persons who had died of the disease, he would have had it in his power to furnish the information required, and perhaps rendered our visit at Am- boy unnecessary ; and in case he should not be in possession of the facts which would be expected by the Board of Health, to request him, as a member of the committee, to accompany us, for the purpose of making the necessary inquiries. Upon our arrival at the quarantine ground, we accordingly stated to the health officer, that information had been received by the Board of Health of the prevalence of an infectious disease at 96 History of the Yelloiv Fever Pertli-Amboy, which had excited considerable alarm among the citizens of New-York. That in consequence of this in- formation, the mayor had thought it necessary to issue his proclamation, interdicting the communication between the two places ; and that the Board of Health had appointed a com- mittee, for the purpose of inquiring into the facts upon this subject: that Dr. Miller, the resident physician, had been re- quested by the board to be a member of the committee, but owing to unavoidable engagements, he had declined the ap- pointment : that thereupon they considered it expedient to request, the health officer to perform that duly, and under- standing that he had already been at Amboy, and had express- ed an opinion of the nature of the disease, they had been in expectation of receiving from him an official statement of the facts that were now sought for. Dr. Rodgers replied, " that he did not consider the Board as having any right to expect a communication from him relative to a fever at Amboy." We then observed, that as a constant communication existed be- tween Amboy and New-York, and that as the disease might be conveyed to the latter city, they expected from him, as the sentinel at the out-post, every information in his power to communicate ; and that by a resolution of the Board, they cer- tainly did expect that he would also communicate to us the facts that had come to his knowledge. Dr. Rodgers then stated, " that when this disease might come under his pur- view at the quarantine ground, he should consider it his duty to make such communication, but not till then;" and added, " You had better, gentlemen, proceed to Amboy to seek in- formation for yourselves;" that his duties did not permit him to accompany us; that he should probably go again to Amboy to-morrow, and pay a visit of friendship, as his two former visits had been, but should not go in an official capacity. We then expressed the hope, that if he did not think it proper to accompany us, that he would favour us with his opinion of the which prevailed at Amboy in 1811. 97 nature of the disease, and the facts relative to its origin. This also he declined, observing, "that he was delicately situated, and did not wish to express to us an opinion on this subject." We then asked him if he had any objection to give us a statement in writing for the information of the board, and that we would call for it on our return from Amboy. This he also begged leave to decline, adding, however, that if the Board of Health would do him the honour to address him a letter, stating the points on which they wished information, he would answer their questions. We then read to him the resolution of the Board, requesting us to obtain from the health officer such information as he possessed on this subject, and added, that we considered the application conveyed by the present resolution as sufficiently respectful, and expressive of the wishes of the Board for him to communicate the infor- mation requested: he however persisted in declining to ex- press to us, as a committee from the Board, either verbally or in writing, any opinion on this subject; repeating, " that his situation was a very delicate one." We then observed, that we had understood he had publicly expressed his opinion, at Amboy, of the nature of the fever prevailing there ; he ac- knowledged he had visited Mr. Kearney at Amboy; that he had also seen Mr. Compton, and that he did express to the two physicians of that place, and in presence of a third per- son, that Mr. Kearney's case was that of malignant fever of the highest grade. As the term malignant fever appeared to us of ambiguous import, we next inquired if he considered the fever referred to as the yellow fever: to this question he an- swered, he disliked the term yellow fever, considering it an improper one, but admitted that the disease was such as would by many persons be denominated yellow fever, and particularly mentioned, that the patient had the glassy eye and yellow skin. We next asked him, if Mr. Kearney had had the black vomit; to this he replied in the affirmative, but vol. in'. N 98 History of the Yellow Fever that in the other case the stomach was not so much affected: he also stated that Mr. Kearney had been subject to attacks of bilious fever, and that upon this late occasion, had been very much fatigued, and prior to his attack had been exposed to the sun without an umbrella. We repeated our request, that he would accompany us on our visit, but he again declining to comply with our wishes, we considered our conference at an end. We immediately proceeded to Amboy, and called upon Mr. Daniel Perrein, the collector of the port, and Dr. Nathaniel Manning, the physician who had attended on all those who had been attacked with the disease. The other physician being out of town, we had no opportunity of con- versing with him. Dr. Manning informed us, that he had lost four patients with a fever, which, from its peculiar symp- toms, and great mortality, he considered to be the yellow fever; that although he had been two years and a half a prac- titioner in Perth Amboy, and his partner, Dr. Freeman, had practised medicine in the same place many years before him, and both had been familiarly conversant with the fevers which ordinarily prevail in that city and its vicinity, particularly the bilious remittent, yet that they had never, before the present season, met with any fever attended with the symptoms of that of which their late patients had died, and with which others at that time were affected; and as further evidence, Dr. Manning remarked, that at that very time he had patients ill of both diseases, each exhibiting its characteristic symp- toms, and invited us to see them. He also stated, that our health officer, Dr. Rodgers, had visited, with him, two of the first cases, and had pronounced them as decided cases of the yellow fever as he had ever seen. Dr. Manning then gave us an account of those persons who, in his opinion, had died of the yellow fever, namely, James Compton, who was attacked on the 7th, and died on the 10th instant; James Kearney, attacked on the 9tb> and died on the which prevailed at Amboy in 1811. 99 14th; Joseph Compton, attacked on the llth, and died on the 15th; and Mrs. Crowell, also attacked on the llth and died on the 15th. He observed, that a Mrs. Marsh, an el- derly lady, died yesterday morning, the 17 th, after a week's illness; but her disease did not appear to be characterized by the same symptoms that had distinguished the cases of the first persons that have been mentioned* The first four, he remarked, were all seized with severe pain in the head, back, and limbs, attended with a highly inflamed state of the eyes. On the second or third day, the skin, especially about the neck and breast, became yellow, which colour gradually ex- tended over the greater part of their bodies ; and in all, the stomach was very much affected with a sense of heat or burn- ing, and rejected almost every thing received into it; which symptoms he had never found associated in the ordinary autumnal, or any other fevers in that place or neighbourhood. We asked him particularly if he had seen Mr. Kearney in any of his former attacks of fever, to which he had been subject in the autumn, as before related to us by Dr. Rodgers. He replied, he had been his physician in two such attacks, and that his disease exhibited the ordinary characters of our com- mon autumnal remittent fever, and was totally different from the inflammatory symptoms with which he was attacked in his last illness. He particularly remarked, that Mr. Kearney threw off a great quantity of black matter, resembling coffee with the grounds, and mixed with other portions in the form of flakes. We next asked Dr. Manning for his opinion rela- tive to the origin of this extraordinary disease. He replied, that there was. but one opinion, either with the inhabitants or physicians, namely, that it was derived from some of the West India vessels, which had been lying at the wharves ; observing, however, that the brig Ocean, from St. Bartholomews, was the vessel which the inhabitants in general supposed to have introduced it. The town we observed to be remarkably cle- 100 History of the Yellow Fever vated; the soil chiefly composed of sand; free from all lodge- ments of water; the streets wide, and the houses for the most part spacious, and at a considerable distance from each other; and the whole town exhibiting an uncommon degree of clean- liness. Dr. Manning also informed us, that there were no local causes to which this calamity could possibly be referred, and that it could only*be accounted for as arising from inter- course with the vessels at the wharves; and that the citizens were so perfectly convinced of this fact, that they had order- ed them to be removed to the stream. He further staled, that Mr. Kearney and the two Mr. Comptons had all been frequently on board the brig Ocean, and another vessel lying along side of her, the ship Favourite from the Havanna, both of which vessels had come consigned to 31 r. Kearney. He also observed, that Mr. Joseph Compton had not only been on board of the vessels at the wharves, but that he had set up with his brother James during his illness. Mrs. Crowell, the fourth person mentioned, was the wife of a ship carpenter, who resides at the head of the wharf, within fifty yards of the said vessels. Dr. Manning also stated, that Mrs-. Crowell was so near to the vessels, that upon one of them (the Ocean) having her bilge water pumped out, she was made very sick by the smell of it, the wind blowing directly towards the house, and into her apartments, and that she herself, during her illness frequently declared to her physician and friends, that in her opinion she had thus taken the disease. It will be readily observed, that the same wind which blew the effluvia of the bilge water, would also convey the poisonous vapour from the adjoining vessel. Having received this information from Dr. Manning, we accompanied him in his visit to five of his patients whom he considered to be the most danger- ously ill. We united with him in opinion, in pronouncing three of those, viz. Miss Ann Taylor, Captain James Bay- ntfn, and Mr. Voorhees, to be decided cases of yellow fever. which prevailed at Amboy in 1811. 101 The diseases of the two others, Mr. Semplc and Mr. Kane, were readily distinguished as the common bilious remittent of autumn. The alarming situation of Miss Taylor par- ticularly arrested our attention, although this was the second day of her illness; her symptoms (so peculiar are the fea- tures of this disease) were of a character, that declared her to be in the most imminent danger, and with all the kind as- sistance she receives from her amiable sisters, and the skill of an attentive physician, we have too much reason to fear that she must sooa be numbered among the victims of this dead- ly disease. Miss Taylor resides some distance from the source of infection, bu'. on inquiry, we found she had been unfortunately in the neighbourhood of the vessels, by fre- quently visiting a friend in the house adjoining to that in which Mrs. Crowell lay ill and died, and that too, at the very time of Mrs. Crowell's illness. We learned also, that the olher persons taken ill, had been exposed either directly by being on board the vessels, or by visiting those who were ill of the disease. Many other persons, Dr. Manning informed us, had been just seized with fever, but so recently, that he would not yet undertake to pronounce on the character of the disease. Our attention was also directed to the vessels sup- posed to have introduced the fever. For this purpose, we applied to the collector of the port, who furnished i:s with the following facts. That twelve vessels had arrived at that port from the West-Indies, since the first day of June. That many others had arrived from Ireland, full of passen- gers, in a most filthy condition, but remarkable healthy. He then informed us, that the brig Ocean, the vessel at first sus- pected, arrived at the wharf on the 4th September, from Bartholomews, that she was laden with mm, sugar, molasses, and coffee, that four or five days after her arrival, she began to discharge her cargo. The master, Captain Sutton, being in New-York, we had no opportunity of obtaining any infer- 102 History of the Yellow Fever mation from him. The collector staled, that Mr. Kearney, as the consignee, was frequently in the hold of the vessel. Captain Little, a passenger in the Ocean, informed us, that her crew had been healthy, but admitted that her bilge water was in a very offensive state, and that in this respect, she was a filthy vessel, but not more so than West-India traders in general. Mr. Perrein next stated, that the ship Favourite, James Stuart, master, the other suspected vessel, arrived from the Havanna, and came to the dock on the 30th August, and was also consigned to the late Mr. Kearney, and that she, with the other vessels, was removed to the stream on Sunday bst; he added, that 3Ir. Kearney, the consignee, and the two Mr. Comptons, had been also frequently on board of this vessel. Captain Stuart being in Amboy, we availed our- selves of the opportunity of conversing with him, relative to the state of his vessel. He, with great frankness, gave us every information we requested; he stated, that he first went to North Carolina from Perth Amboy, that he next proceed- ed to Falmouth, (Jamaica,) and from thence to the Havanna, and that he had brought the crew all back with him in a state of health; that they had all been several voyages to the Havanna, some three, four, and five voyages, and were all well seasoned to the West India climate : he also acknow- ledged that it was very sickly at the Havanna when he was there. Upon questioning him relative to his vessel, he also very candidly stated, that his ballast had not been shifted from the time he left Amboy to this day. Such are the facts we have been enabled to obtain on this subject, and which we beg leave to present to the board without delay. As it •has been made our duty to express an opinion of the nature and origin of the disease in question, we feel no hesitation in saying, first, that the disease, in our opinion, is that common- ly known and described as the yellow fever ; and secondly, that it has been satisfactorily traced to one of the two las>t which prevailed at Amboy in 1811. 103 mentioned vessels, arriving from the West Indies, and that it has most probably been derived from the ship Favourite, from the Havanna, which is by all acknowledged to have been a sickly port at the lime of her sailing. Nor do we conceive it to be an objection to the correctness of this opi- nion, that the crew remained healthy throughout the voyage, as it is also stated, that by the several voyages they had made to the Havanna, they had become seasoned to that climate. It will be readily recollected by the board, that a similar in- stance occurred in July, 1809, at which time two persons from this city worked on board the brig Mary, a vessel from the Havanna, then detained at the quarantine ground, and were seized with the yellow fever, of which they died in this city, although the crew of the same vessel had been in per- fect health during the whole of her voyage. We cannot conclude this communication without remark- ing, that Mr. Perrein, the collector at Amboy, and Dr. Man- ning, a physician of the same city, are entitled to our ac- knowledgments, for the very unreserved and candid manner in which they communicated to us the information they possessed relative to the subject of our inquiries. VVe are, gentlemen, very respectfully, Your humble servants, DAVID HOSACK. JOS. BAYLEY. JOHN H. DOUGLASS New-York, September ISth, 1811. To the President and 31embers of the Board of Health Extract from the minutes, J. MORTON, Sec'ry The Board of Health of Philadelphia have issued a> pro- clamation, prohibiting all intercourse and communication be- tween the city of Amboy and the city andconnty of Phila 104 History of Uie Yellow Fever delphia, on account of a pestilential disease prevailing in the former city. Persons, after leaving Amboy, must perform fourteen days quarantine before they can be admitted into Philadelphia.—Public paper of September 20. Board of Health, September 24, 1811. A report of Jacob Lewis, Esq. Recorder of the city of Amboy, dated 21st instant, was read, which stated, that there had been four deaths of the yellow fever in the said city, that no new cases had occurred since the 16th, and that all the sick were now convalescent. September 27, 1811. A letter from the Mayor of Amboy, to the Honourable De Witt Clinton, President of the Board of Health, together wilh an affidavit of James Seguine, were read, and directed to be entered on the minutes. They were as follows: To De Witt Clinton, Mayor of the City of New-York, Sir, I have observed in the newspapers, your proclamation, prohibiting all intercourse between the cities of New-York and Perth Amboy; also the report of the Committee appoint- ed by the Board of Health, to investigate the nature and ori- gin of the disease prevailing in this city. I had not the honour of seeing Doctors Bayley, Douglass, and Hosack, but approve very much of their report respecting the fever originating in one of the two mentioned vessels : more fully to prove this, I send you the affidavit of Captain James Se- guine, who piloted the brig Ocean out of this port, on the 24th instant. Also, as it may be satisfactory to the citizens ©f New-York, I inform you, that the Resident Physician, which prevailed at Amboy in 1811. 105 Nathaniel Manning, has reported to me, that there has been no new cases for two days past. I am sir, your obedient humble servant, JOHN ANGUS, Mayor. Perth Amboy, September 26, 1811. deposition. James Seguine personally appeared before me, John An- gus, Mayor of the city of Amboy, and deposed and said, that he was employed as Pilot on board the brig Ocean, Sut- ton, commander; that on the 24th of the present month, he piloted the said brig out of the port. Previous to leaving her, Captain Sutton, or the mate, gave permission to him (Seguine) to collect the coffee which was scattered in the bottom of the vessel, for which purpose he went below, when he im- mediately heard violent groaning by some sick person or persons: being alarmed, immediately repaired on deck to in- quire into the cause, or whence came the groans, when he was answered by the crew, that it was the boy, who then lay sick in the steerage, and very far gone, upon which the de- ponent left the vessel without collecting the coffee. JAMES SEGUINE. Perth Amboy, September 25, 1811. Amboy—Report of the intendant Physician of that city, to the Corporation. September 29, 1811. No new cases of yellow fever have occurred since last Monday week; one death yesterday; all others are entirely recovered, or are convalescent. We have had five deaths of decided cases of yellow fever; one doubtful; viz. James Compton, James Kearney, Joseph Compton, Miss Ann Tay- lor, and William Craig ; Mrs. Crowel a doubtful case. We have no instance of any person taking the fever from those vol. iu. o 106 History of the Yellow Fever, &c. they attended, except in that part of the town which became infected by the vessel that introduced the malady. The above vessel having sailed, and all others ordered off, no more cases are apprehended. (Signed) J. LEWIS, Recorder. General Morton, C. C. October 10, 1811. The President laid before the Board a letter from the Mayor of the city of Perth Amboy, in the following words, "Perth Amboy, October 7, 1811. " Sir, " 1 have the pleasure to inform you, that the fever which has been prevalent here, has subsided ; no new case having occurred for fifteen days past, and no person being now sick with that complaint. The last report of the Phy- sician is enclosed. " I am respectfully, your's, &c. " JOHN ANGUS." The report enclosed wasK • " Report for Saturday, October 5, 1811'': Of the cases of malignant fever, every case subsided, and not necessary to report hereafter. " NATHANIEL MANNING. " Mr. John Angus, Mayor of the city of Perth Amboy." Whereupon resolved, that it be recommended to his honour the Mayor, to issue his proclamation, restoring the intercourse between the two cities. The Mayor accordingly issued a proclamation to that ef- fect, on the Nrtl* of October, 1812. / t xk^O-fSfk^JA » A' * \ jfm^KM^h •■> ,'tU. AA V' , » **' •< A a . A*. . r . . A . i ft* » ■*Av T ;- £\A wa*/awWa. . a.....v .,:*: ••'."W A * A'. ; 'N \ A * * *■ * L