The Doctor divides this disease into three species: 1. Where “signs

of putrefaction are evident at a very early stage, which is generally

rapid in its course, and which casually terminates in black vomiting.

Yellowness seldom or never fails to make its appearance in the present

instance; and perhaps it is the only one which, strictly speaking,

can be called the yellow fever. 2. A form of fever which has either

no remissions, or remissions which are scarcely perceptible; in

which signs of nervous affection are more obvious than symptoms of

putrescency; and in which yellowness and black vomiting are rare

occurrences. 3. Another form, in which regular paroxysms and remissions

cannot be traced, but in which there are marks of violent irritation,

and appearances of inflammatory diathesis in the earlier stage,

which give way, after a short continuance, to signs of debility and

putrescency, to which yellowness frequently succeeds, or even sometimes

the so much dreaded vomiting of matter of a dark colour. The disease

in these three forms appears to be in reality one and the same. The

difference of the symptoms probably arises from very trivial or very

accidental causes. It is in some measure peculiar to strangers from

colder regions soon after their arrival in the West Indies, and may

generally be distinguished from the common endemic of the country, not

only by a total want of paroxysms and remissions, but likewise by a

certain expression of the eye and countenance, with something unusually

disagreeable in the feelings, of which words convey only an imperfect

idea.”

The symptoms enumerated by Dr. Jackson are in general the same with

those already taken notice of. He mentions likewise a degree of

confusion frequently joined with _grimness_, difficult to be described

in words, but which a person acquainted with the appearances of the

disease immediately recognises as one of its distinguishing marks. In

the second stage he says, that no sweat or moisture was now observable

on any part of the body: the state of the skin impressed the idea as if

it were not pervious to any degree of perspiration, and heat gradually

forsook the surface and extremities: the tongue became moist, and at

the same time frequently clean about the edges: the gums became redder,

more spongy, and showed a greater disposition to bleed: vomiting

was troublesome: the matter thrown up was ropy, in large quantity,

and abounding with villous or mucous flakes of a darker colour. The

circulation in the extreme vessels became gradually more languid; the

natural heat retired from the surface of the body, which was now dry

and impervious; the pulse returned nearly to its ordinary state, or

became slow, full and regular; the yellowness increased fast, so that

the whole body was frequently yellow as an orange, or of as deep a

colour as the skin of an American savage: anxiety was inexpressible;

vomiting was irrestrainable, and the vomiting of a matter like the

grounds of coffee at last made its appearance. This matter was often as

black as soot, where the progress of the disease had been rapid; while

it was not only less intensely black, but often tinged with green,

where the disease had been more slow and gradual. The number of villous

or mucous flakes, in the matter discharged by vomit, increased as the

disease advanced, and with them were joined streaks of blood, which

seemed principally to come from the throat and gums. As the disease

advanced, the vomiting became more frequent, but was seldom accompanied

with any violent retching. Quantities of liquor were discharged, so

enormous that it was often difficult to imagine whence they came; after

which the patient enjoyed some respite, till a similar collection was

made. As soon as the matter discharged by vomit acquired this dark

and sooty colour, the belly generally became loose, the stools being

black, smooth, and not unlike tar or molasses; the tongue became

clean, the gums putrid; hæmorrhages, or rather _oozings of blood_, were

sometimes observed in different parts of the body, while livid blotches

made their appearance on the belly and insides of the thighs. The

pulse, which during the latter stages of the distemper could scarcely

be distinguished from that of a person in health, became at last

irregular, quick, or intermitting; soon after which coma or convulsions

closed the scene. Sometimes the yellowness succeeded the black

vomiting. In these the vomiting began unexpectedly, or without much

previous affection of the stomach: the colour was commonly intensely

black; the patient turned yellow almost in an instant, and died in a

very short time. When any one recovered from this deplorable situation,

of which there were some few instances, the termination was not by any

regular crisis. The black vomiting ceased, sometimes apparently in

consequence of treatment, sometimes evidently of its own accord: but a

vomiting of a ropy, glutinous matter continued for a great length of

time, together with an extreme irritability of the stomach, and a very

peculiar state of the skin; which sometimes did not recover its natural

smoothness and unctuosity for several weeks.

The disposition to faint, so common in the yellow fever, is supposed

by Dr. Jackson to arise from a kind of torpor in the nervous system,

rather than the usual causes of fainting. For this opinion he assigns

as a reason, that “the patient was often able to stand upright for

some time, and even to walk to a considerable distance; and, when at

last overcome, was observed to fall down in a torpid, rather than a

fainting, state.”

In dissections our author observed that the omentum and all its

appendages were in a dry and parched state, and of an uncommon dark

grey colour. But, along with this dark grey colour, and want of

unctuosity and moisture, usually met with in the abdomen, the stomach

and intestines had a dirty yellow appearance, were highly putrefied,

and much distended with wind. The liver and spleen were generally

enlarged in size; the former of a deeper yellow than any of the other

abdominal viscera; while the texture of the spleen was often less

firm than natural. The bile was usually black and thick, like tar or

molasses; the blood-vessels of the liver bearing marks of uncommon

distension. A quantity of black fluid, similar to that ejected by

vomit, was found in the stomach, which fluid our author says positively

derived its blackness from the bile, the flakes observed to float in

it being parts of the villous coat of the stomach abraded. He denies

that the black colour of the matter vomited is owing to blood, as many

authors have supposed. He says that the passage of the bile might be

easily traced from the gall-duct into the pylorus.

This being in the Doctor’s opinion the only true kind of yellow

fever, we shall not follow him through the description of the other

two species, but proceed to consider that remarkable and excessively

fatal distemper which appeared in the year 1793, first in the West

India islands, and then on the American continent. Dr. Chisholm, who

has described the distemper very particularly, derives it from the

coast of Africa, and gives the following account of its origin on the

authority of a Mr. J. Paiba, “one of the adventurers in the Boullam

scheme; and who, despairing of success, left the coast of Africa in

a vessel called the _Hankey_. This vessel sailed from England in

April 1792 with stores and adventurers for the intended colony at

Boullam. The people were all in good health: that part of the coast

of Africa on which they touched is remarkable for its healthiness;

only it is destitute of water except what can be procured by digging

temporary wells on the beach, and which is brackish, and consequently

unwholesome. The ferocity of the negroes who inhabit that part of the

continent prevented them from being accommodated on shore, so that they

found themselves obliged to remain on board the Hankey for nine months.

As the rainy season came on almost immediately after their arrival on

the African coast, they attempted to shelter themselves by raising the

sides of the vessel several feet, and covering it with a wooden roof.”

Thus were upwards of two hundred persons, among whom were many women

and children, confined in such a manner as must be supposed capable

of producing fevers of a bad kind, if they could be produced by such

causes. Accordingly a malignant fever did break out; the vessel was not

ventilated, nor were the bed-clothes, &c. of the sick destroyed; from

whence Dr. Chisholm concludes that the infection remained on board the

vessel. The Doctor then proceeds to give the following account of the

vessel after her departure from Boullam:[148] “Capt. Coxe, finding the

water at Boullam unwholesome, proceeded with his ship to Bissao, where

there is a Portuguese settlement, for a supply. The ship was navigated

by about twelve seamen, most of whom had not experienced sickness, and

had probably been procured from Sierra Leone: at any rate they were

then taken on board for the first time. Of these, before the return of

the Hankey to Boullam, nine died; and the remainder, with the captain,

were reduced to a deplorable state. The time for which the Hankey was

chartered being expired, Mr. Paiba, with his family, intended to return

to England in her; but as no seamen could be procured they put to sea,

having on board the captain, sick, and only the mate, Mr. Paiba and

two seamen to navigate the ship. With much difficulty they arrived at

St. Jago, where they fortunately found the Charon and Scorpion ships

of war. Capt. Dodd of the former, humanely rendered them every service

in his power, and on leaving them put two men of each ship on board

the Hankey. With this aid they proceeded to the West Indies; a voyage

to England being impracticable in their wretched state. On the third

day after leaving St. Jago, the men they procured from the ships of

war were seized with the fever, which had carried off three fourths

of those on board the Hankey at Boullam; and, having no assistance,

two of the four died: the remaining two were put on board here in the

most wretched state possible. Capt. Dodd, on his arrival at Barbadoes

from the coast of Africa, was ordered to convoy the homeward-bound

fleet of merchantmen. In the execution of his orders he came to Grenada

on the 27th of May, and, hearing of the mischief which the Hankey

had been the cause of, mentioned that several of the Charon’s and

Scorpion’s people were sent on board the Hankey at St. Jago, to repair

her rigging, &c. that from this circumstance, and the communication

which his barge’s crew had with that ship, the pestilence was brought

on board both ships; and that of the Charon’s crew thirty died, and of

the Scorpion’s, about fifteen. The Hankey arrived at the port of St.

George’s (in Grenada) on the 19th of February, in the most distressed

situation, and for a few days lay in the bay, but was afterwards

brought into the careenage. From this period are we to date the

commencement of a disease before, I believe, unknown in this country,

and certainly unequalled in its destructive nature.”

[148] Chisholm’s Essay on the Malignant Pestilential Fever, p. 86.

This account of the introduction of the fever (which however is

by Dr. Chisholm accounted very different from the yellow fever

above described) is so clear and distinct, that, at first reading,

it commands our belief. It hath not, however, met with universal

approbation; and even the _facts_, for which both parties appeal to Mr.

Paiba and capt. Dodd, vary from one another in a surprising manner. Dr.

Trotter, in his Medicina Nautica, p. 328, gives the following account:

“Dr. Chisholm tells us, that the ships of war on the African station,

having sent men to assist the Hankey, after numbers had perished from

the fever, received the infection by means of this communication,

and that in the Charon thirty died, and fifteen in the Scorpion.

Capt. Dodd, who at that time had his broad pendant in the Charon, now

commands the Atlas of 98 guns in the fleet; Mr. Smithers, the surgeon,

is at present in the Formidable, a second rate, also in the fleet;

_from them_ I have copied the following narrative of their transactions

with the Hankey:

“When the squadron under commodore Dodd came to St. Jago in 1793, the

Hankey lay there in great distress for want of hands; having buried

above one hundred persons, men, women and children, from the time she

had been at Bulam. _The fever was now overcome_: Mr. Smithers saw two

men that had lately recovered. He left a quantity of bark. The Charon

and Scorpion sent two men each to assist in navigating her to the West

Indies. The Hankey at this port was cleaned, washed with vinegar,

and fumigated. _No fever appeared in either of the men of war_, in

consequence of this communication; they arrived at Grenada in perfect

health, but did not go into the same part of the island to which the

Hankey went. The Charon, at this harbour received some seamen from the

merchant ships then taking in cargoes for England; she had afterwards

_fourteen_ cases of yellow fever, of which one died; but it is

remarkable that the Scorpion did not bury a single man during the whole

voyage.[149] It is probable from these facts, that the Hankey _did not_

import the infection that produced the Grenada fever; for, _after the

disease was worn out_, she had a passage to make to the West indies of

many hundred leagues. It is also doubtful how the effects left in the

Hankey could produce the fever, for the _bedding was thrown away_, and

what clothing remained had been aired, and probably had scarcely been

in contact with the body after being sick.”

[149] To this is subjoined the attestation of Mr. Smithers with

respect to the Charon.

The discordance between this and the foregoing account is abundantly

evident. Dr. Chisholm’s account of the bedding, &c. is also very

different. “Our lieutenant governor, Ninian Home, esq. some time after

the disease became epidemic, informed me, that, in consequence of the

information he had received of the clothes, &c. of the victims of the

fever at Boullam being still on board the Hankey, he ordered Capt. Coxe

to be brought before him and some gentlemen of the council. He then

acknowledged, that _all the effects_ of those who had died were then

on board his ship, and said that he _would not_ destroy them, unless

he was indemnified for the loss he might sustain, should the heirs of

the deceased call on him for those effects. Every argument was used to

induce him to destroy the articles, but the only one which influences

a man of this description, _indemnification_; and he of course carried

the seminium of the disease to England.” It was this consideration

which induced the governor to write to the secretary of state, and in

consequence of his representation the vessel was obliged to perform

quarantine in England, a circumstance which Dr. Trotter mentions

without approbation.

Thus far the matter of _fact_ seems to be very much obscured; and

the more we investigate, the more we are involved in darkness. In

the Medical Repository, vol. i, p. 484, we find the following severe

censure passed upon Dr. Chisholm by the late Dr. Smith of New York: “It

belongs to another part of this paper to assign the probable motives of

Dr. Chisholm for maintaining that the fever was imported into Grenada:

certain it is that he avowed a different opinion to Mr. Paiba, to whom

he freely declared, that he could by no means trace the disease to the

_Hankey_; and that he believed it to be of local origin, owing to the

unhealthy condition of the careenage, and the particular prevailing

winds: and, to confirm this notion, he informed Mr. Paiba that a

similar disease, from the same cause, though in a less degree, had

existed in St. George’s some years before.”

This was plainly giving Dr. Chisholm _the lie_; which, whatever

might have been the consequence between the two parties, absolutely

supersedes, to any impartial and unconcerned person, the evidence of

_both_, at least as far as regards the origin of this disease. It

is not, however, to be supposed that Dr. Chisholm would pass such a

censure unnoticed. He did accordingly reply in a letter to Dr. Smith,

who had sent him a copy of the Repository, with a letter inviting

him to defend what he had said. Dr. Smith died before this letter

reached him, but the principal part has appeared in the Medical

Repository, vol. ii, p. 285. In this Dr. Chisholm retracts what he

had said concerning the mortality on board the Charon and Scorpion

ships of war. “I have lately received (says he) from a gentleman of

the navy here, a log-book of the Charon, kept by one of her officers

during the voyage in question. In this I find, that no sickness took

place in either of these ships in consequence of this interview. A

log-book is unquestionable evidence, and I therefore admit it.” As

to the more serious part of the charge, viz. that Dr. Chisholm had

wilfully misrepresented matters, the Doctor replies, that the narrative

published by him was in general such as he had from Mr. Paiba; not

indeed in manuscript, as Dr. Smith stated his to have been, but in

conversation; and that this conversation took place expressly with

a view to elucidate the cause of the fever, which he (Dr. Chisholm)

could not account for by any reasoning from local causes, but heard it

very generally ascribed to infection from the Hankey. Mr. Paiba was

introduced to Dr. Chisholm at the request of the latter by the Hon.

Samuel Mitchill _now_ (the letter is dated Sept. 6th 1768 probably

1798) the senior member of the council of Grenada. “Mr. Mitchill (says

the Doctor) brought Mr. Paiba to my house, and was present during the

greatest part of the time the conversation continued. I found Mr. Paiba

very willing to give me every information in his power relative to the

state of the Bulama or Boulam colony, and of the ship Hankey; but I

found him strongly disinclined to fall in with the universally received

opinion, that that ship introduced the disease. The particulars I have

given, are those Mr. Paiba related to me in this conversation; and, in

order to be correct, I immediately, after Mr. Paiba left me, committed

them to paper. Mr. Paiba promised to favour me with a written account;

and in order to direct that gentleman’s attention to the points I

considered as of most importance, I drew up a set of queries, and Mr.

Mitchill charged himself with the delivery of it. A copy of these I

have now in my possession, and a slight attention will exhibit my

view in framing them, and show the doubts respecting the nature of

the epidemic which suggested them. Although I repeatedly, through Mr.

Mitchill and Mr. Palmer, the gentlemen with whom Mr. Paiba resided

in the country, renewed my request to have this promise fulfilled,

Mr. Paiba left the Island without gratifying it. If no other strong

proof existed of something peculiar in the fever which at that time

prevailed, the circumstance of my formally applying to Mr. Paiba for

information relative to the state of the Hankey, and of taking the

trouble to obtain an interview with him, presents an evidence as

conclusive as can well be required by reasonable men. But the belief

of the infection of the Hankey was _universal_, nor was it by any

means confined to those whose interest might have been affected by the

prosperity of an infant colony on the coast of Africa.”

Another charge against Dr. Chisholm is, that he falsifies the date

of the Hankey’s arrival at Grenada; and which in Dr. Smith’s paper

is brought forward in the following words: “In p. 91 the Doctor

remarks, that, ‘in the short space of time from the beginning of March

to the end of May, 200 of about 500 sailors, who manned the ships

in the regular trade, died of this fever.’ By this it appears that

the fever in question broke out as early as the beginning of March.

The disingenuousness of this author is particularly evident from

this quotation, if the period of the commencement of the disease be

correctly assigned: and that it is so is probable from the difficulty

of concealing the fact; as there must have been thousands of witnesses

to the progress of the fever. When therefore it was thought proper to

fix the odium of introducing the disease upon the Hankey (a project

of which Dr. Chisholm seems originally to have had no idea) it became

necessary for him to fix an earlier date to her arrival. Now, that the

Hankey did not arrive till towards the latter end of March, is verified

by the concurring testimony of Mr. and Mrs. Paiba, and of Mr. Bell, of

this city (New York) who happened to be in Grenada about that time,

and was personally acquainted with Mr. and Mrs. Paiba in that island.”

In answer to this Dr. Chisholm repeats his declaration that the Hankey

arrived at Grenada on the 18th of _February_, and not on the 19th

of March, as Dr. Smith (supposed on the authority of Mr. Paiba) had

stated. In proof of this he produces an incontestible evidence, viz.

an extract from the St. George’s Gazette in Grenada, of date 19th of

February, which begins thus: “By the ship Hankey of London, arrived

here _yesterday_ from the island of Boulam on the coast of Africa, we

are informed,” &c. The remainder of the extract contains an account of

the excessive mortality on board the ships; which, as it may perhaps be

exaggerated, it is needless to transcribe.

The next thing of consequence is the destruction of the bed-clothes

and effects of the deceased; of which Dr. Smith says, “Before the

Hankey put to sea, all the bedding of the sick was thrown overboard

or destroyed; the ship was washed from stem to stern, both above

and below, with salt water; and the purification was completed by

fumigating her with tar, pitch and gun-powder. In this clean condition

they bade farewel to Bulama on the 22d of November, 1792; but, in

attempting to pass through the channel near to the entrance into the

open sea, in a dark and foggy night, they got aground on a sand-bank,

upon the north side of the island of Formosa or Warang, belonging to

the Bijugas, who are represented as cannibals. The extreme terror

excited by this accident was not calculated to improve the health of

the people on board the Hankey; so that, when it became necessary to

take measures for their security and deliverance, only four men were

found in a condition to do duty, and all of these had intermittents.

With them, however, and his lady, Mr. Paiba set off, in an open boat,

for Bissao, to obtain assistance from the Portuguese settlement.

Thither he arrived, rowing through rains and fogs, in a leaky boat,

after being out two nights and a day; and having obtained such help

as he could, returned to the Hankey, got her off, and carried her to

Bissao. On the passage there _eight_ persons died who belonged to

this ship. At Bissao they refitted, and the Hankey _was a second time

purified as completely as she had been before leaving Bulama_.”

In answer to all this Dr. Chisholm _again declares_, “that the bedding

and effects of the deceased _were preserved_ on board the Hankey, and

constituted the seminium of the infection. Capt. William Liddle, of the

ship General Mathew, saw them on board; and it was in consequence of

that gentleman’s representation that the lieutenant governor, Mr. Home,

entered into a strict investigation of the matter; the general result

of which I have given; and the authenticity of it may be depended on.

Capt. Liddle is now resident in London, and Mr. Byles, the governor’s

secretary, is now resident commissary at Grenada; and these gentlemen

will readily testify to the truth of my statement. The destructive

articles I have mentioned _were not thrown overboard_ till the Hankey

arrived in Grenville Bay, when they were destroyed at the request of

Mr. Prendfoot, the gentleman who chartered the ship for England.”

Dr. Chisholm is likewise charged with having mis-stated the case of

a Capt. Remington, said to be the first who suffered by the fever in

Grenada. The words in Dr. Chisholm’s Essay are, “A Capt. Remington, an

intimate acquaintance of Capt. Coxe’s, was the first person who visited

the Hankey after her arrival in St. George’s bay. This person went on

board of her in the evening after she anchored, and remained three

days; at the end of which time he left St. George’s, and proceeded in

a drogher (a coasting vessel) to Grenville bay, where his ship, the

Adventure lay. He was seized with the malignant pestilential fever on

the passage; and the violence of the symptoms increased so rapidly, as,

on the third day, to put an end to his existence.” In opposition to

this Dr. Smith gives the following statement from Mr. Paiba: “He (Capt.

Remington) had been all day and all night coming from Grenville bay,

and had been wet through. He slept on board in his clothes; and went in

an open boat _the next day_ back to his ship: enough to kill any one

in that climate.” Dr. Chisholm replies “that the above statement is

not correct, nor founded on fact; Dr. Chisholm’s evidence for what he

said was founded on the information of captains of vessels, who knew

all the circumstances of his visit to the Hankey; and of Dr. Stewart,

an eminent practitioner, who attended him at Grenville bay, when he

landed there. Lastly, that the idea of his having returned to Grenville

bay in an open boat, is absurd; nothing of the kind having been ever

attempted.”

From this tedious account it is plain that the evidence relative to

the importation of the fever into Grenada by the Hankey is quite

contradictory, and subversive of itself, because we are unable to judge

between the two disputants. A further consideration of it would lead

us entirely from the subject of this treatise, into an endless dispute

about which of the two parties had spoken the truth. Setting aside

therefore _the whole_ of the evidence on both sides as insufficient, we

shall now proceed to give an account of the symptoms of the distemper

as described by Dr. Chisholm, and to which description there has never

been any objection made.

In the most violent kind of this fever, according to our author, “the

patient, without any previous complaint, suddenly becomes giddy;

he loses his eye-sight; every thing seems to move round him with

inconceivable velocity; he falls down almost insensible, and in that

state remains near half an hour, or upwards. During this paroxysm the

body feels cold, and is over-spread with cold sweat, which issues from

every pore in astonishing abundance. On his recovery the cold goes

off, and is instantly succeeded by intense heat, and quick, small,

hard pulse; the head achs dreadfully, particularly the fore part;

generally accompanied with pain in the right side and at the præcordia.

The last, however, has never been acute, and may rather be called

oppression than pain. The eyes are much inflamed, watery, protruded,

and wildly rolling; the face much flushed; much heat is felt at the

pit of the stomach, and that organ seems to be considerably affected

by the frequent retching and vomiting which then come on. The patient

soon after complains of intolerable pains in the small of his back and

in the calves of his legs; but the latter appears to be most violent.

During twelve, eighteen, twenty-four or thirty-six hours, these

symptoms continue increasing, except the quickness and hardness of the

pulse, which does not change materially during that time; and are then

succeeded by general coldness, cold sweat, a greater or less degree

of coma and delirium, or a state very much resembling intoxication.

Life in this state is lengthened out to sixty or ninety hours from

the first attack. A short interval of reason then takes place; the

patient considers himself better, and is, for a moment, flattered with

the prospect of recovery: but a fit as sudden and unexpected as the

first comes on, during which he foams at the mouth, rolls his eyes

dreadfully, and throws out and pulls back his extremities in quick

succession. In general the patient expires in this fit; but some have

recovered from it, and continued rational for a few hours longer, when

a second fit has carried them off.”

This, without much deviation, was the general progress of the worst

kind of the fever. In some, however, a comatose disposition showed

itself from the very first; in others the disease began with short

convulsive fits in frequent succession, followed by constant delirium

and cold clammy sweat, without any intervening heat. In a few cases the

first symptoms were coldness and shivering, as in other fevers.

The distinguishing symptoms were the uncommonly sudden attack, the

remarkably acute pain in the loins and calves of the legs, the watery,

inflamed and rolling eye, flushing of the face, tendency to coma, the

pain generally confined to the forehead, and the peculiar cast of the

delirium, during which the looks and actions of the patient very much

resembled those of a person intoxicated. It was never furious in any

other way than by making efforts to get out of bed; and these in a few

instances rose so high that the patients got up, dressed themselves,

and walked out a considerable way before they could be overpowered.

“The strength during the delirium is to appearance surprisingly great,

for it is frequently necessary to use the united efforts of two or

three men to keep the patient in bed. This is, however, no more than a

spasmodic affection of the muscles; for in reality the powers of the

sick in this disease are reduced to the extreme of debility, as is seen

in the convalescent state.”

The most unequivocal characteristic of this disease, however, according

to our author, is the appearance of a kind of petechiæ, but which look

rather like red or livid patches than what is commonly understood by

that word. They were _always_ the forerunners of death. In a few very

violent cases the body was almost of a livid or black colour, but they

were generally seated on the neck, shoulders and breast. _Vibices_

also, like those in the plague, described p. 258, sometimes made their

appearance, and were also a fatal presage.

Hæmorrhage occurred much more frequent and profuse in this than in any

other acute distemper our author had met with. “In several instances,

the immensity of blood discharged has evidently been the more immediate

cause of death. The robust, plethoric and gross habits have been the

most subject to it. It has taken place from the nostrils, mouth, anus,

and urethra; sometimes from the canthi (corners) of the eyes; but

never, I believe, from the ears or pores of the skin. The most profuse

discharge has been from the nostrils and anus, and has frequently,

amounted to three or four pounds at a time; the stools having been on

those occasions entirely composed of pure blood. Towards the close of

life, the blood thus discharged has appeared granulous, or like ichor,

with a sediment of a black gritty substance, and has been so extremely

offensive as to oblige all the attendants to keep at a considerable

distance till the hæmorrhage ceased. Hæmorrhage, however, has never

been critical, nor has it in any instance permanently relieved the

head-ach or pain in the breast or side.... Nearly about the period that

these profuse discharges came on, a rawness was felt on the whole of

the interior surface of the nose, and on several parts of it little

ulcers formed; on others, small eschars, which were remarkably itchy,

but on being touched, or an attempt made to detach them from the

membrane of the nose, were very painful, and bled. These disappeared

in proportion to the patient’s recovery; and I have reason to suspect,

that, when the issue of the disease was fatal, these little eschars

became gangrenous.”

In this distemper there was always a tendency to coma after the first

two days; and after the third, it certainly came on. On examining

the heads of two who died convulsed after having been comatose for

some time, a great quantity of serum was found in the brain; and, on

narrowly inspecting the eyes of those who were afterwards seized with

coma, the pupil was found manifestly dilated.

A remarkable symptom unnoticed in any other fever is taken notice of

by our author; viz. an affection of the testicles. “About the end of

the second day the patient began to complain of a violent pain in these

parts, accompanied with a contraction of the spermatic cord, and a

drawing up of the testicles towards the abdominal ring. On examination

they appear very much lessened in size, are drawn up considerably

towards the abdomen, and the scrotum appears at the same time

remarkably flaccid and empty. The surface of the scrotum becomes soon

after very painful, and an excoriation takes place, chiefly at the most

descending part, from which a considerable quantity of very offensive

purulent matter issues: at the same time a similar discharge from the

urethra takes place, which ceases with the disease when the event is

favourable, or becomes ichorous and bloody, and insufferably fœtid

when death is the consequence. In cases which terminate favourably,

the whole of the scrotum, in a few days, is covered with a crust of

hardened pus, which in the convalescent state, comes away very easily

by means of a warm bath. The thickness of this coat may be about the

fourth of a line; and, when separated, it much resembles moistened

parchment. In fatal cases, this affection of the scrotum always

terminates in gangrene a few hours before death.”

Another remarkable symptom is the change of voice to a shrill, soft

and low sound when compared with the natural tone, at the same time

that the syllables are more distinguished, and the words are strangely

lengthened out in a drawling and whining manner. This change of voice

affords a pretty certain prognostic; every alteration towards the

natural tone being an almost certain sign of a favourable change, and

the contrary if the voice becomes farther removed from it.

The pains felt in this fever were in a great measure peculiar to it,

and seem to have been of a spasmodic nature. In the head the pain shot

from the forehead, to which it was confined, invariably towards the

bottom of the orbits, where it was generally exquisite. Sometimes it

extended to the temples, where there was always a throbbing; but in

no case did it extend to the back part, or over the whole head. This

pain extended also to the balls of the eyes, which were protruded,

and seemed ready to start from their orbits, with an inflammation

externally, and a sensation of pain internally, rendering the admission

of light intolerable. In the legs the pain had its seat at the top of

the great tendon, immediately below the calf, and in the point where it

was seated a gnawing sensation was felt, occasioning exquisite torture,

with an involuntary contraction of the limb; so that, on the whole, our

author concludes that this pain much resembles the cramp, differing

only in being more permanent.

With regard to the pulse, our author observes, that in this disease “it

never intermits. Even at the approach of death it has not intermitted,

but has generally been remarkably tremulous, and so slow as to beat no

more than thirty times in a minute. On the whole, it has not been found

quicker than 130, or slower than 30, in a minute.” In violent cases the

pulse was hard, quick and small, but sometimes full; and when it was

so it was a good sign. It was however subject to excessive variations;

and it frequently happened, “especially in the robust, that, after the

first stage, flushing and chillness have often alternated in less than

a minute; and that, although the skin felt considerably warm, the pulse

has been no more than 52; but that, even when the low state came on,

in which there was always a disagreeable coldness of the surface, it

has been as quick, and nearly as full, as during the preceding febrile

stage, although unaccompanied with thirst, or any other evident symptom

of the existence of fever.”

In the state of delirium, Dr. Chisholm observes, that, whatever was

the subject of the patient’s raving thoughts, he was always strongly

under the impression of fear; and a word from the physician always

reduced him to implicit obedience, however restless he might have been

before. During this state he complained of no pain, even from blisters,

nor was he sensible of the operation of laxative medicines. On being

asked about his situation, he always answered that he was very well,

and sensible of no pain, as in the yellow fever already described. It

is observable, however, that the yellow colour, so remarkable in the

former, seldom took place in the Boulam fever; but indeed this symptom,

as has formerly been noticed, is by no means a characteristic either of

the one disease or the other; but Dr. Chisholm observes “that in some

protracted cases on shore, and in some among the sailors, which might

have been a combination of the pestilential and yellow fevers, this

symptom appeared about the 5th, 7th or 9th day.”

Besides the petechiæ and vibices, already mentioned, Dr. Chisholm takes

notice of two other sorts of eruptions, which appeared about the lips:

the one was such as frequently appears at the termination of the common

remittents, and was favourable; the other resembling spots made by the

fine black pencil of a painter, all round the mouth, but especially the

upper lip, and certainly affording a fatal prognostic.

This disease was attended with a suppression of urine, a violent pain

above the os pubis, a scalding in the urethra, a sense of fulness,

without any visible swelling, a contraction and distortion of the

penis; the urine generally of a deep red, sometimes brownish, green,

very often bloody, and in a few cases much inclining to black, and of

an oily consistence. Its smell was generally very offensive. All the

excretions were exceedingly offensive, but the fæces most remarkably

so towards the latter end of the disease; for in the beginning they

had no remarkable fœtor. The sick were almost universally costive,

which our author supposes to have arisen from a suspension of tone

in the intestinal canal; for by exciting action in the fibres a

large evacuation generally ensued. The colour of the fæces varied

from yellow, or a yellowish white, to black; and from a considerable

degree of thickness, to the exact appearance of coffee-grounds. The

matter discharged by vomit also varied from porraceous to black, and

resembling coffee badly boiled.

In this disease, as in the plague described by Thucydides, most other

diseases degenerated into it, or partook of its nature. Dysenteries

suddenly stopped, and were immediately succeeded by the symptoms

of pestilential fever. A remarkable instance of this is given in

twenty-seven recruits, who had been seized with dysentery, in

consequence of being exposed to rain, receiving the infection in the

hospital to which they were carried. The medicines exhibited with

a view to cure the dysentery seemed to be attended with surprising

effect; but in a short time symptoms of pestilential fever came

on, even in a few hours after those of dysentery had disappeared.

In like manner catarrhal complaints soon changed their nature.

Convalescents from other diseases, such as laboured under chronical

complaints, particularly rheumatism and inflammation of the liver, were

particularly subject to it. “The puerperal fever became malignant,

and of course fatal; and even among pregnant negro women, who might

otherwise have had it in the usual mild degree peculiar to that

description of people, many were reduced to a very dangerous situation

by it. In short, every disease in which the patient was liable to

infection, sooner or later assumed the appearance, and acquired the

danger, of the pestilential fever.”

This fever was said to be propagated from Grenada to others of the

West India islands, and to the United States, where in the same year,

1793, it raged with great violence in Philadelphia. Without entering

into any inquiry at present concerning the truth of this report, or

the origin of the fever itself, let us see whether from the symptoms

enumerated by Dr. Rush, who hath written a very lengthy dissertation

upon the disease, it was the same with the Boulam fever already

described. According to him the fever in 1793 was frequently preceded

by “costiveness, a dull pain in the right side, defect of appetite,

flatulence, perverted taste, heat in the stomach, giddiness or pain

in the head, a dull, watery, brilliant, yellow or red eye, dim and

imperfect vision, hoarseness, or slight sore throat, low spirits, or

unusual vivacity, a moisture on the hands, a disposition to sweat at

nights, or after moderate exercise, or a sudden suppression of night

sweats.... On entering a sick room the physician was first struck by

the _countenance_ of the patient. It was as much unlike that which is

exhibited in the common bilious fever, as the face of a wild animal

is unlike that of a domestic one. The eyes were sad, watery, and so

inflamed in some cases as to resemble two balls of fire. Sometimes they

had a most brilliant or ferocious appearance. The face was suffused

with blood, or of a dusky colour, and the whole countenance was dusky

and clouded. After the 10th of September, when the determination

of blood to the brain became universal, there was a preternatural

dilation of the pupil. Sighing attended in almost every case. The

skin was dry, and frequently of its natural temperature.... The pulse

at the beginning of the attack was sometimes full, tense and quick,

but frequently weak; sometimes so low that it could not be perceived

without pressing the wrists; and sometimes it had no preternatural

quickness. In many it intermitted after the fourth or fifth, and

sometimes after the fourteenth stroke. In some it was extremely slow;

even as low as thirty strokes in a minute. The pulse was also _tense_

and _chorded_. The slow intermitting pulse was observed more frequently

in children than adults, and supposed to proceed from a collection of

water in the brain. Impressed with this idea, I requested Mr. Coxe, one

of my pupils, to assist me in examining the state of the eye. For two

days we discovered no change in it; but on the third day after we began

to inspect the eyes, we both perceived a preternatural dilatation of

the pupils in different patients; and we seldom afterwards saw an eye

in which it was wanting. In Dr. Say it was attended with squinting, a

symptom which marks a high degree of a morbid affection of the brain.

Had this slowness or intermission of the pulse occurred only after

signs of inflammation or congestion had appeared in the brain, I should

have supposed that it had been derived wholly from that cause; but I

well recollect having felt it several days before I could discover

the least change in the pupil of the eye. I am forced therefore to

call in the operation of another cause, to assist in accounting for

this state of the pulse, and this I take to be a spasmodic affection,

accompanied with preternatural dilatation or contraction of the heart.

Lieutaud mentions this species of pulse in several places, as occurring

with an undue enlargement of this muscle. Dr. Ferriar describes a

case, in which a low, irregular, intermitting and hardly perceptible

pulse attended a morbid dilatation of the heart.... After the 10th of

September this undescribable or _sulky_ pulse became less observable,

and, in proportion as the weather cooled, it disappeared. It was

gradually succeeded by a pulse full, tense, quick, and as frequent

as in pleurisy or rheumatism. It differed, however, from a pleuritic

or rheumatic pulse, in imparting a very different sensation to the

fingers. No two strokes seemed to be exactly alike. Its action was of

a hobbling nature.... It was an alarming symptom.... The pulse most

frequently lessened in its fulness, and became gradually weak, frequent

and imperceptible before death; but I met with several cases in which

it was full, active, and even tense, in the last hours of life.

“Hæmorrhages occurred in the beginning of the disorder, chiefly from

the nose and uterus. Sometimes only a few drops of blood distilled

from the nose. As the disease advanced, the discharges of blood became

universal. They occurred from the gums, ears, stomach, bowels, and

urinary passages. Drops of blood issued from the inner canthus of the

left eye of Mr. Josiah Coates. Dr. Woodhouse attended a lady who bled

from the holes of her ears which had been made for ear-rings. Many

bled from the orifices which had been made in performing venesection,

several days after they appeared to have been healed; and some from

wounds in veins made in unsuccessful attempts to draw blood. These last

were very troublesome, and in some cases precipitated death....

“I was surprised to find so few marks of hepatic affection. I met with

but two cases in which the patient could lie only on the right side.

Many complained of a dull pain in the region of the liver, but very few

complained of that soreness to the touch, about the pit of the stomach,

which is taken notice of by authors, and which was universal in the

yellow fever of 1762. In proportion as the cool weather advanced, a

preternatural determination of the blood took place to the brain and

lungs. Many were affected with pneumonic symptoms, and some appeared

to die of sudden effusions of blood or serum in the lungs.... The

disease seldom appeared without nausea or vomiting. In some cases

they both occured for several days, or a week, before any fever took

place. This was more frequently the case where the disease _was taken

by exhalation from the putrid coffee, than by contagion_. The stomach

was so extremely irritable as to reject drinks of every kind. Sometimes

green or yellow bile was rejected on the first day of the disorder; but

I much oftener saw it continue for two days without discharging any

thing from the stomach, but the drinks which the patient had taken.

If the fever in any case came on without vomiting, or if it had been

checked by remedies that were ineffectual to remove it altogether, it

generally appeared or returned on the 4th or 5th day of the disorder.

I dreaded this symptom on those days; for, though it was not always

the forerunner of death, yet it generally rendered the recovery more

difficult and tedious. In some cases the vomiting was more or less

constant from the beginning to the end of the disorder, whether it

terminated in life or death. The vomiting which came on about the 4th

or 5th day was accompanied with a burning pain in the region of the

stomach. It produced great anxiety and tossing of the body from one

part of the bed to another. In some cases this painful burning occured

before any vomiting took place. Drinks were now rejected so suddenly

as often to be discharged over the hand that lifted them to the head

of the patient. The contents of the stomach were sometimes thrown up

with a convulsive motion which propelled them in a stream to a great

distance, and in some cases all over the clothes of the by-standers....

On the first and second days many puked from half a pint to nearly a

quart of yellow or green bile. In four (three of whom recovered) the

bile, even at this time, was black. On the 4th or 5th day a matter

resembling coffee-grounds was discharged.... Many recovered in whom

this symptom appeared. Towards the close of the disease there was

a discharge of a deep or pale-coloured black matter, with flakey

substances frequently swimming on the top of it.”

A quantity of grumous blood, dark coloured on the outside, was

frequently discharged by vomit towards the end of the disease; and,

along with all the discharges from the stomach, there was occasionally

a large worm, and frequently large quantities of mucus and tough

phlegm. Our author supposes the black blood and coffee-coloured matter

to be different from that which constitutes the true _black vomit_.

This last he supposes to arise in some cases from matter formed in

consequence of a mortification of the stomach.

The bowels were generally costive, sometimes with extreme pain,

tenesmus, and mucous and bloody discharges. Sometimes the disease came

on with diarrhœa, principally in those who had weak bowels. Sometimes

there was a tension of the abdomen, with pain in the lower part of

it. Flatulency, chiefly in the stomach, was almost universal in the

disorder throughout all its stages.

The colour and consistence of the fæces was various according to

the mode of treatment the patient had undergone. Where they were

spontaneous, or brought away only by gentle purgatives, their

appearance was natural; but when the patient was strongly purged,

they were dark-coloured, fœtid, and in large quantity. The colour was

sometimes green, sometimes olive. Their fœtor was proportioned to the

time they had been detained in the bowels. In one case, where tonics

had been used, and the patient had no stool for several days, a purge

produced such an excessively fœtid discharge, that the smell produced

fainting in an old woman who attended. Their acrimony was so great that

the rectum was excoriated, and an extensive inflammation sometimes

produced round its extremity. In some cases the stools were as white as

in the jaundice. Large round worms were frequently discharged with them.

The urine in this disease was sometimes plentiful and high-coloured,

sometimes clear, and sometimes turbid; sometimes discharged with a

burning pain, as in a gonorrhœa; sometimes it was suppressed; and in

one case the patient voided several quarts of limpid urine just before

he died.

Many were relieved on the first day by sweats, sometimes spontaneous,

and sometimes produced by diluting drinks, or strong purges; sometimes

of a yellow colour, and offensive smell. Sometimes they were cold,

though the pulse was full at the same time. In general, however,

the skin was dry, and there were but few instances of the disease

terminating by sweat after the third day. In some there was a great

discharge of mucus from the throat, occasioning an almost constant

hawking and spitting; and those always recovered.

In this fever, as in that of Boullam, and in the true plague, people

sometimes fell down suddenly in apoplexy, syncope or universal

convulsions. Some had numbness and immobility of their limbs. Some had

a coma (a continual sleepiness) or an obstinate wakefulness; the latter

chiefly attended a state of convalescence. In some the distemper began

with a violent cramp in the legs or arms. The last stage was attended

with a strong hiccup, which was a very dangerous symptom, as indeed it

is in all fevers. In some cases there was a deficiency of sensibility,

in others too much, so that the mere motion of the limbs was attended

with pain.

In this, as in the Boullam fever, the patient often manifested a

considerable degree of strength, even without any delirium. One of Dr.

Rush’s patients stood up before a looking-glass, and shaved himself,

the day on which he died. A delirium, however, was common, alternating

in some cases with the _exacerbations and remissions_ of the fever, but

in some continuing without intermission to a few hours before death.

Some had maniacal symptoms, without any appearance of fever; but in

many the understanding was not impaired throughout the whole course of

the disease.

In this disease the pains in almost every part of the body were very

distressing. In those cases, however, “where the system sunk under the

violent impression of the contagion, there was little or no pain.” In

other cases the patients were distressed with pains in their head,

particularly affecting the eyeballs. Sometimes it extended from the

back down the neck. A pain was felt in the ears, as if they were drawn

together by strings. The sides, stomach, liver and bowels were all

affected. A burning pain in the stomach was sometimes so excessive

that the patient shrieked out violently. The back was often the seat

of violent pain, which sometimes extended from the back to the thighs;

and the arms and legs were sometimes affected in such a manner that one

patient said his limbs felt as if scraped with a sharp instrument.

The thirst was generally moderate, but sometimes otherwise; and, when

excessive thirst came on in the last stage of the disorder, it was

a dangerous symptom. Water was preferred to all other drinks. The

appetite for food returned much sooner in this than in other fevers,

and was excessively keen. Coffee was relished in the remissions, in

every stage of the disorder. Wine was disliked, but malt-liquors

were agreeable. In some cases the recovery was attended with a great

propensity to venery, as in the true plague, but in an inferior degree.

In some cases the disease was attended with buboes and glandular

swellings. “I met with three cases (says our author) of swellings in

the inguinal, two in the parotid, and one in the cervical glands:

all these patients recovered without any suppuration of their

swellings. They were extremely painful in one case, in which no

redness or inflammation appeared. In the others there was considerable

inflammation, and but little pain.

“Several cases of carbuncles, such as occur in the plague, came under

my notice. They were large, hard swellings on the limbs, with a black

apex, which, upon being opened, discharged a thin, dark-coloured,

bloody matter. From one of these malignant sores an hæmorrhage took

place, which precipitated the death of an amiable lady. A large and

painful anthrax on the back succeeded a favourable issue of the fever

in another patient. I met with a woman who showed me the marks of a

number of small boils on her face and neck, which accompanied her

fever.... Notwithstanding the disposition to cutaneous eruptions in

this disorder, it was remarkable that blisters were much less disposed

to mortify than in the common nervous fever. Such was the insensibility

of the skin in some people, that blisters made no impression upon

it.... In every case of this disorder which came under my notice,

there were evident remissions or intermissions of the fever, or such

symptoms as were substituted for fever.”

The yellow colour rarely appeared before the third day, and generally

about the fifth or seventh day. The eyes were not always affected with

this colour. Sometimes it appeared first on the neck and breast; and

in one case it appeared behind the ears and on the crown of the head,

which had been bald for some years. It varied in the deepness of the

tint, and sometimes disappeared altogether; but, though some cases of

great malignity and danger appeared without any yellowness, it was

always a dangerous symptom when it appeared early. The cause of this

yellowness is by our author supposed to be an absorption and mixture of

the bile with the blood.

After death the body appeared of a deep yellow colour, sometimes a

few minutes after death; sometimes it was purple or black; and in one

case yellow above, and black below, the middle. In some it was pale,

as in common diseases, and many died with a placid countenance as in

natural sleep. In some the body grew cold soon after death, in others

not till six hours afterwards, and in like manner stiffness occurred

sometimes in one hour, in others not till six. Where evacuations had

been procured, symptoms of putrescence were longer in making their

appearance than in those who had used no medicines for that purpose.

Many discharged large quantities of black matter from the bowels,

others, of blood from the nose, mouth and bowels.

“The morbid appearances of the internal parts of the body (says the

Doctor) as they appear by dissection after death, from the yellow

fever, are different in different countries and in different years.”

Dr. Mitchill, in his history of the yellow fever in Virginia, in

1737 and 1741, informs us, that, in a female slave of forty, the

gall-bladder was outwardly of a deep yellow, but within, full of a

black, ropy, coagulated _atrabilis_ (black bile) obstructing the

biliary ducts. It was so thick, that it retained its figure when the

gall-bladder was opened. It more resembled bruised and mortified

blood than bile, though it would stain a knife or probe of a yellow

colour. Two thirds of the liver on its concave surface were of a deep

black colour, and round the gall-bladder it seemed to be mortified

and corrupted. A viscid bile, like that just described, was found in

the duodenum near the gall-bladder. The villous coat being taken off,

the other parts were found red and inflamed. The whole was lined with

a thick fur or slime. The omentum was so much wasted, that nothing

but its blood-vessels could be perceived. The stomach appeared to be

distended or swelled, lined like the duodenum, containing a quantity

of bile even blacker than that in the bladder. It was inflamed both on

the outside and inside. The lungs were inflated and all full of black

or livid spots; and on these spots were small blisters like those of an

erysipelas or gangrene, containing a yellow humour. The blood-vessels

in general were empty; only the vena portarum seemed full and distended

as usual. On cutting the sound part of the liver, the lungs or the

spleen, blood issued freely.

Dr. Mackittrick found the liver sphacelated, the gall-bladder full of

black bile, and the veins tinged with a black _fluid_ blood. In all

cases the stomach, duodenum and ilium were remarkably inflamed. The

pericardium contained a viscid yellow serum, and in larger quantity

than usual. The urinary bladder a little inflamed; the lungs sound.

Dr. Hume, of Jamaica, found the liver enlarged and turgid with bile,

and of a pale yellow colour; the stomach and duodenum sometimes

inflamed; and, in one case, the former had black spots of the size of a

crown-piece. He had seen some bodies in which there was no appearance

of inflammation of the stomach, though the patients had been afflicted

with excessive vomiting.

Dr. Lind’s account is given on p. 394.

Drs. Physic and Carthrall, of Philadelphia, found the brain in a

natural state; the viscera of the thorax perfectly sound; the blood in

the heart and veins fluid, similar in its consistence to the blood of

persons who have been hanged, or destroyed by electricity. “The stomach

and beginning of the duodenum are the parts that are most diseased.

In two persons, who died of the disease on the 5th day, the villous

membrane of the stomach, especially about its smaller end, was found

highly inflamed; and this inflammation extended through the pylorus

into the duodenum some way. The inflammation here was extremely similar

to that induced in the stomach by acrid poisons, as by arsenic, which

we have once had an opportunity of seeing in a person destroyed by it.

The bile was of its natural colour, but very viscid.”

In others the stomach was spotted with extravasated blood; and it

contained, as well as the intestines, a black liquor like that which

had been vomited and purged before death. The gentlemen were of opinion

that this must have been a secretion from the liver, as a fluid of the

same kind was found in the gall-bladder, of such an acrid nature that

it inflamed the operator’s hands, and the inflammation lasted some

days. The liver was of its natural appearance, or nearly so. These

dissections were made early in the season; and at that time Dr. Rush

is of opinion that the disease was not attended with any congestion in

the brain, though it was so afterwards; and accordingly we are informed

that Dr. Annan attended a dissection at Bush-hill, in which the vessels

of the brain were remarkably turgid. Dr. Rush, however, is likewise

of opinion, that the morbid appearances in the brain may cease after

death, as well as the suffusion of blood in the face disappears after

the retreat of the blood from the extremities of the vessels in the

last moments of life. “It is no new thing for morbid affections of the

brain to leave either slender or no marks of disease after death. Dr.

Quin has given a dissection of a child that died with all the symptoms

of hydrocephalus internus, and yet nothing was distinguished in the

brain but a slight turgescence of the blood-vessels. Dr. Girdlestone

says, that no injury appeared in the brains of those persons who died

of the symptomatic apoplexy which occurred in a spasmodic disease

which he describes in the East Indies; and Mr. Clark informs us that

the brain was in a natural state in every case of death from puerperal

fever, notwithstanding it seemed to be affected in many cases soon

after the attack of the disorder.”

With regard to the state of the blood in this distemper, Dr. Rush

says, that when drawn from a vein, it was, “1. In the greatest number

of cases, dense, and of a scarlet colour, without any separation

into crassamentum and serum. 2. In many cases it did separate into

crassamentum and yellow serum. 3. In a few cases the serum was of a

natural colour. 4. There were many cases in which the blood was as

sizy as in pneumony and rheumatism. 5. In some instances the blood was

covered with a blue pellicle of sizy lymph, while the part which lay in

the bottom of the bowl was dissolved. In two cases the lymph was mixed

with green streaks. 6. It was in a few instances of a dark colour, and

as fluid as _molasses_. Both this and the 5th kind of blood occurred

chiefly where bleeding had been omitted altogether, or used too

sparingly, in the beginning of the disorder. 7. In some patients the

blood in the course of the disease exhibited nearly all the appearances

which have been mentioned. They were varied by the time in which the

blood was drawn, and by the nature and force of the remedies which had

been used in the disorder.”

From this account of the different appearances of the blood, it appears

to have varied at the very first attack from an healthy state, and to

have gradually deviated from that state more and more, as the disease

advanced. Dr. Rush says,[150] from Dr. Mitchill’s History of the Yellow

Fever in Virginia, in 1741, that “blood drawn from a vein was always

dissolved. The same state of the blood was observed in many persons who

had been exposed to the contagion, who discovered no other symptom of

the disease.” In p. 70 Dr. Rush gives his own opinion in the following

words: “I shall say, hereafter, that the blood was seldom dissolved in

this fever;” and p. 73, speaking particularly of the blood, he enters

into an argumentation against the putrescency of that fluid. “It” (the

blood) says he, “has been supposed to undergo a change from a healthy

to a putrid state; and many of the symptoms which have been described,

particularly the hæmorrhages and eruptions on the skin, have been

ascribed to this supposed putrefaction of the blood. It would be easy

to multiply arguments to prove that no such thing as putrefaction can

take place in the blood; and that the symptoms which have been supposed

to prove its existence are all effects of a sudden, violent and rapid

inflammatory action, or pressure upon the blood-vessels; and hence

the external and internal hæmorrhages. The petechiæ on the surface of

the skin depend on the same cause. They are nothing but effusions of

serum or red blood, from a rupture or preternatural dilatation of the

capillary vessels. The smell emitted from persons affected with this

disease was far from being of a putrid nature; and, if this had been

the case, it would not have proved the existence of putrefaction in

the blood; for a putrid smell is often discharged from the lungs, and

from the pores in sweat, which is wholly unconnected with a putrid,

or perhaps any other morbid, state of the blood. There are plants

which discharge an odour which conveys to the nose a sensation like

that of putrefaction; and yet these plants exist at the same time in a

state of most healthy vegetation: nor does the early putrid smell of

a body which perishes with this fever prove a putrid change to have

taken place in the blood before death. All animals which die suddenly,

and without loss of blood, are disposed to a speedy putrefaction.

This has long been remarked in animals that have been killed after

a chace, or by lightning. The poisonous air called _samiel_, which

is described by Chardin, produces, when it destroys life, instant

putrefaction. The bodies of men who die of violent passions, or after

strong convulsions, or even after great muscular exertion, putrefy in

a few hours after death. The healthy state of the body depends upon

a certain state of arrangement in the fluids. A derangement of these

fluids is the natural consequence of the violent and rapid motions,

or of the undue pressure upon the solids, which have been mentioned.

It occurs in every case of death from indirect debility, whether it

be induced by the excessive stimulus of contagion, by the volatile

vitriolic acid which is supposed to constitute the destructive _samiel_

wind,[151] or by violent commotions excited in the body by external

or internal causes. The practice among fishermen in some countries of

breaking the heads of their fish as soon as they are taken out of the

water, in order to retard their putrefaction, proves the truth of the

explanation I have given of its cause soon after death. The sudden

extinction of life in the fish prevents those convulsive or violent

motions which induce sudden _disorganization_ in their bodies. It was

remarkable that putrefaction took place most speedily after death from

the yellow fever, where the commotions of the system were not relieved

by evacuations. In those cases where purges and bleeding had been used

it was much slower. There is a fact mentioned by Dr. Ferriar, from

Dr. Hamilton, late professor of anatomy at Glasgow, which may seem at

first to militate against the facts I have mentioned. He says that he

had observed that bodies which were brought into the dissecting room

that had petechiæ on them were longer in putrefying than any others.

The fevers of which the poor (the common subjects of dissection) die,

are generally of the low nervous kind. Great _direct_ debility is the

characteristic of those fevers. The petechiæ which occur in them appear

in the last stage of this direct debility. They are the effect, not of

too much impetus in the blood, as in the yellow fever, but of a defect

or total absence of it in the last hours of life. The slow progress of

the body to putrefaction after death, in the instances mentioned by

Dr. Hamilton, seems to depend upon the same cause as that to which I

have ascribed it in those cases of death from the yellow fever in which

evacuations had been used, viz. direct debility. In the former cases

this slowness of putrefaction is induced by nature, in the latter by

art. The effects of debility from both causes are, notwithstanding, the

same.”

[150] Account of the Bilious Remitting Fever, &c. p. 106.

[151] See p. 126, n. where an account is given of the samiel, and

another hypothesis concerning its nature.

From this long detail, in which the author’s meaning seems rather

involved in obscurity, we may gather that in the fever of 1793 the

blood had no determinate appearance, but that, according to the action

of the vascular system, it was sizy or otherwise. This position, which

in my opinion is the meaning of the passage just now quoted, is not

supported by any facts. It is mentioned indeed that the blood in some

was sizy, in others quite fluid, but as the cases in which it was so

are not particularly related, we do not know whether the action of the

vessels was stronger in those where the blood was fluid than where it

was not. Certain it is, that the blood may be made fluid by certain

substances mixed with it, without any action of the vessels at all. The

poison of the ticunas, as well as all other animal poisons, renders the

blood fluid, yet this will kill instantaneously when injected into a

vein, before the vessels have time to act in such a manner as could be

supposed to change the texture of any of the fluids.[152] Or if this

still will not satisfy, we are assured that the poison of serpents, as

well as many other substances, which are not poisons, when mixed with

the blood taken out of the body, will prevent it from coagulating.

Granting, therefore, what hath not been proved, that the greater

the action of the vessels, the more fluid the blood will be, yet we

cannot know whether this fluidity be occasioned by the action of the

vessels, or the action of the vessels by the tendency to fluidity in

the blood. But it matters not which of the two is cause or effect: the

question is, Whether in the yellow fever does the ultimate effort of

the disease tend to produce any alteration in the texture of the blood

to fluidity, or otherwise? This can be known only from considering

the symptoms which take place in the last stage of the disorder, and

from dissections. Now, from the concurrent testimonies of all the

writers quoted in this treatise, it appears that towards the end of

the disease there is such a tendency to dissolution, that the whole

body seems ready to fall down into a putrid mass; or at least into

what is commonly called so, whether with strict propriety of language

or not, signifies little. In short, the difference between the plague

and yellow fever seems to be entirely of the same kind with that taken

notice of in this treatise, p. p. 269, 270, where the bile of a person

dying of a malignant fever was injected into the veins of a dog. Here

the blood was very fluid. In capt. Mawhood’s case (p. 385) the blood

flowed from his nose, eyes and gums, besides what he discharged by

vomit. Dr. Lining (p. 389) attests a similar tendency to dissolution in

the blood in a most remarkable manner. See also Dr. Lind’s opinion to

the same purpose, p. 393, Dr. Hillary’s, p. 395, Dr. Jackson’s account,

p. 399, Dr. Chisholm’s, p. 411; and lastly, Dr. Rush’s own testimony

concerning the hæmorrhages from all parts, lately quoted.

[152] See p. 221–223.

As we have formerly seen, that in the plague there was no such tendency

to dissolution, but rather to coagulation, in the blood, it was thence

concluded that the immediate cause of the symptoms of plague is a

tendency in the blood to throw out the latent heat it contains, by

which means the parts on which these discharges fall, are burnt up to a

kind of cinder. In the yellow fever the reverse takes place. The blood

has a tendency to absorb heat, and if it does so it must of course

become thinner, for this is the nature of all fluids, and indeed it

is abundantly manifest that fluidity in all cases is an effect of the

absorption of heat.[153] In consequence of this absorption, the body

towards the latter end feels cold, the heat seems to retire from the

extremities towards the vital parts, and the vessels contracting and

losing their power by reason of the abstraction of sensible heat, the

pulse ceases entirely some time before death. Dr. Huxham takes notice

of this excessive coldness in the limbs taking place in a lady who

died of a malignant fever, and likewise that an intolerable stench

issued from her body for some time before her death, though kept clean

with all possible care. As the plague therefore is the highest of all

inflammatory diseases, so the yellow fever seems to be the highest of

the malignant class.

[153] See p. 150.

It may be objected, however, that as hæmorrhages, petechiæ, black

vomiting, and convulsions, sometimes take place in the plague, we

cannot from the existence of similar symptoms in the yellow fever,

conclude that they are different diseases. But, with regard to the

first, it must be observed, that an hæmorrhage may ensue from a rupture

of vessels as well as from an oozing of blood in consequence of an

acrimonious thinness of blood. It is indeed to be questioned, except

in cases where blood is discharged by the pores of the skin, whether

any hæmorrhage takes place but by a rupture of vessels. In an healthy

subject, hæmorrhages very frequently take place from the nose where

the blood is of a very proper consistence; and Dr. Russel says that

he had occasion to see hæmorrhages from the nose and uterus only;

that in the advanced stages of the disease though the blood was paler

and of a _thinner_ consistence, the hæmorrhage was seldom profuse. It

was, however, of very bad omen; most of the cases in which it appeared

having terminated fatally.

That towards the end of this disease the blood should begin to absorb

the heat which it had before thrown out, is not wonderful. A tendency

to dissolution very probably does in all cases take place in a greater

or lesser degree; but we have not any reason to suppose that in the

true plague hæmorrhages ever are as frequent, violent, or attended with

such an apparent tendency to putrefaction, as in the yellow fever, and

consequently we must suppose that there is some _specific_ difference

between the state of the blood in the one disease and in the other.

Convulsions, though very frequent in the yellow fever, yet, according

to Dr. Russel, were very rare attendants on the access of the

pestilential fever. Even hiccup was seldom observed, and sneezing

not once. However, he says that convulsive motions of the limbs were

frequently observed in the course of the disease; but this is far

from what Dr. Chisholm says of the Boullam fever, where the patient

expired in a violent convulsive fit; or what Dr. Rush says of the

fever of 1793, in which the patient sometimes fell down in universal

convulsions. In short, the absence, or much less frequency, of nervous

symptoms in the plague, seems to constitute another _specific_

difference between the two.

With regard to black vomiting, it is neither peculiar to the plague

nor yellow fever. Dr. Miller[154] has shown that it may be occasioned

by almost any kind of acrid poison taken into the stomach. In proof of

this he quotes from Sauvages the case of a man who died in consequence

of taking a drachm of white arsenic instead of cream of tartar, in

whose stomach was found, on dissection, a black liquor which deposited

a sediment like powdered charcoal. The villous coat of the stomach

was likewise abraded. For other cases of the same kind he refers to

Wepfer de cicuta aquatica, Morgagni, &c. Another case of poison by

arsenic occurred in New-York hospital, in which the patient had a black

vomiting. In another case in which corrosive mercury was swallowed

by mistake, the patient, after being to appearance in a fair way of

recovery, began to vomit a dark-coloured matter, and died in a day or

two. The agaricus clypeatus, a kind of poisonous mushroom, brought

on bilious stools, locked jaw, vomiting, delirium, oppression of the

breast, sighing, anxiety, great prostration of strength, yellowness on

some parts of the skin, and death on the sixth day. On dissection the

stomach was found to be inflamed, the duodenum distended with flatus,

and the gall-bladder full of green and black bile.

[154] Med. Repository, vol. ii, p. 412.

But the principal distinctions between the plague and yellow fever

seem to be the eruptive nature of the former, and the propensity in

the latter to attack strangers newly arrived from colder climates;

also in being more easily checked by cold than the plague. It has

already been remarked from Dr. Russel, that of _two thousand seven

hundred_ patients, whose cases he noted, every one had buboes. These,

however, were not all the cases he saw; for he mentions some that had

no eruptions; but from this it is impossible to avoid drawing the

conclusion, that eruptions are the true characteristics of the plague.

Of these two thousand seven hundred, eighteen hundred and forty-one had

buboes in one or both groins; five hundred and sixty-nine had them in

the arm-pit; two hundred and thirty-one had parotids; four hundred and

ninety, carbuncles; and seventy-four, spurious buboes. Now, in all the

number of cases of fever which Dr. Rush attended in 1793, he had only

two with buboes, and one parotid; and as to the carbuncles they do not

answer the description of those in the former part of this work.[155]

It is impossible therefore that any more clear line of distinction can

be drawn between the plague and yellow fever. The following table,

however, exhibiting at one view the symptoms of the plague, the yellow

fever, fever of Boullam, and fever of 1793, will perhaps set this

matter in a still clearer light.

[155] See p. 257.

From a mere inspection of the detail of symptoms in this table, the

difference between the several distempers is obvious. It is evident

that none of them can with any kind of propriety be called higher and

lower degrees of the rest. The plague is _essentially_ different from

the other three, which seem indeed to be nearly allied; the Boullam

fever being only attended with more violent and malignant symptoms. We

ought now to enter into a particular inquiry concerning the origin and

nature of these fevers; but, as a knowledge of this is in some measure

dependent on the question, whether or not they are contagious, we shall

in the first place present the reader with the following extract from

a French treatise, in which the question seems to be handled in an

agreeable and judicious manner, and then make another attempt, by an

investigation of matter of fact, to determine whether the disease has

ever been excited by imported contagion or not:

“A very important question is--whether this disease is contagious.

The greater part of the American physicians are of opinion that it

is, and are persuaded that it is brought from the West Indies, by

the ships which arrive here in the beginning of every summer. It is

even from that opinion, and on their vigorous representations, that

quarantines have been established, which every vessel from the West

Indies is obliged to perform during 10 and sometimes 20 days at Fort

Mifflin, several miles distance from Philadelphia. This formality, so

troublesome to navigation, was observed this year (1798) with more

severity than ever it was; but without answering any good purpose for

the vessels; for very few ships’ companies appeared taken with the

_yellow_ or _putrid fever_. Nevertheless the epidemic, whatever name it

assumes, raged this year in Philadelphia with more fury than even in

1793. Besides, if the quarantine was a sure preservative, if almost all

the ships’ crews coming from the West Indies brought the _yellow fever_

with them, why should not CHARLESTON, NORFOLK, ALEXANDRIA, BALTIMORE,

BOSTON and SALEM, where no quarantines are performed, be affected with

the contagion, as well as New York and Philadelphia? The American

physicians are so convinced that the _yellow fever_ is contagious, that

they scrupulously prohibit persons in health from all communications

with those diseased; they order frequent _waterings_ in the streets and

about the houses where the fever has manifested itself, and aromatic

fumigations. They even order the clothes of those who have fallen by it

to be burned, as is practised with respect to those who die with the

plague. It must be confessed that their precautions, in this respect,

have in some sort been justified, on seeing all the individuals of one

family successively taken with it, and often at the same time, their

neighbours, and so on, to a number of people who might be authorised

to attribute their misfortunes only to their vicinage with the first

victims.

_Characters and most remarkable Symptoms_

OF THE

Plague, Yellow Fever, Fever of Boullam, and of Philadelphia in 1793.

(_In this table the mark Do. refers to the column immediately preceding._)

_General Characters._

FEVER OF FEVER OF

PLAGUE. YELLOW FEVER. BOULLAM. PHILADELPHIA

IN 1793.

Known and Not known to Supposed by Various opinions

described exist before the Dr. Chisholm concerning it.

by ancient last century. to be a kind

historians. of new disease

originating in

foul vessels on

the coast of

Africa in 1793.

Attacks Attacks Do. Attacks more

indiscriminately principally generally than

people of all those who change the common yellow

nations. their climates, fever.

especially from

cold to hot.

Not brought on Brought on Do. Do.

by intemperance. not only by

At least Dr. P. intemperance, but

Russel never saw by slight errors

an instance. in regimen.

Sometimes seems Attacks the Attacks the As in the yellow

to spare the robust much intemperate and fever.

weakly and more violently robust.

delicate, and to than those of

attack the robust. a contrary

description.

People sometimes Not observed. Those attacked by Patient sometimes

struck dead as the disease fall falls down in

by a stroke down giddy and apoplexy, syncope

of lightning. almost insensible or universal

Sometimes fall with a profuse convulsions.

down suddenly, cold sweat.

but revive,

and by proper

management regain

their health in a

short time.

Death sometimes Death sometimes Do. Do.

takes place within

without any fever twenty-four

or complaint; hours, but

preceded only not without

by momentary some previous

sickness, by complaints.

eruptions of

purple spots, or

the breaking out

of hard eschars

in different

parts of the body.

Irregular No remission, Do. Remissions and

remissions and but a cessation exacerbations.

exacerbations. of one set of

symptoms to make

way for another.

Venereal appetite Not observed. Do. Venereal appetite

monstrously increased but

increased on less than in the

recovery. plague.

_Symptoms of the Disease in various parts of the Body, or over the

whole System._

FEVER OF FEVER OF

PLAGUE. YELLOW FEVER. BOULLAM. PHILADELPHIA

IN 1793.

Infection Not commonly Do. Do.

sometimes begins observed.

with apparent

intoxication.

Sometimes is felt Not observed. Infection felt at Do.

like an electric the commencement

stroke. of the disease,

occasioning a

nausea and rigor.

Fainting very Do. Do. Do.

frequent.

Convulsions rare Not commonly Convulsions Tremors of the

at the beginning. observed. sometimes very limbs uncommon.

Convulsive violent: the

motions of patient often

the limbs not expiring in a

unfrequent fit.

throughout the

disease.

Hiccup uncommon. Hiccup extremely Do. Do.

common.

Sudden loss of Do. Excessive A surprising

strength. strength during degree of

the delirium. strength

sometimes only a

few hours before

death.

Delirium at times. Do. Do. Sometimes Do.

constant.

Loss of speech, Not observed. Do. Do.

faltering and

trembling of the

tongue.

Coma very general. Do. Do. Do.

Muddiness of the Grimness of Eyes inflamed, Eyes watery,

eyes, scarce to countenance. Eyes watery, rolling inflamed, or like

be described. red and heavy. and protruded. balls of fire.

Countenance wild

and ferocious.

A solitary A deep yellow The yellow colour Yellow colour

instance of the colour all over scarcely metvery frequent.

patient becoming the body so with.

green all over. common that the

disease has one

of its names from

it.

Eruptions of Never observed. A kind of small The carbuncles

the nature eschars in the do not answer to

of eschars, nose. Small any description

sometimes black spots on of those in the

small, and the upper lip, plague.

called tokens, but neither

pepper-corns, &c. resembling

sometimes larger, the tokens or

and called carbuncles in

carbuncles, on the plague.

many different Carbuncles

parts of the body. mentioned, but

not described.

Buboes in the Very rarely Sometimes A very few

inguinal, observed. observed, but

instances.

axillary and only in fatal

parotid glands cases.

exceedingly

common.

Pulse extremely Pulse sometimes Pulse Pulse disappeared

variable; indistinguishable disappearing on as in the plague

disappearing from that of a pressure. Did not and Boullam

entirely on healthy person, intermit even at fever; otherwise

pressure; often even a short time the approach of as in the yellow

intermitting. before death. death. fever.

Otherwise of

all possible

varieties.

Sometimes

entirely gone a

considerable time

before death.

Excessive Not observed. Do. Do.

uneasiness at the In the last

heart. One person stage the heart

died with violent palpitates

palpitation. strongly.

Violent pain at Universal in the Very frequently Disease sometimes

the pit of the yellow fever of observed. began with a pain

stomach, which 1762. in the stomach.

could not bear A burning pain

the touch. frequently

accompanied the

vomiting.

Hæmorrhages not Hæmorrhages Do. Do.

very common, and excessively

only from the common from every

nose and uterus. part of the body.

Vomiting of Vomiting of Do. Do.

yellow, green and matters of the

black matter. same kind;

also of matter

resembling coffee

grounds with

flaky substances

floating in it.

Stools less Stools Do. Immense Stools extremely

fœtid than in a excessively quantities of fœtid when

common tertian. fœtid, and in excessively fœtid strong evacuants

Dark coloured great quantity. blood discharged. had been used,

blood sometimes otherwise the

discharged. fœtor was less.

Sweats of various Not observed. Not observed. Yellow and fœtid

colours, and sweats.

fœtid.

Sweat the natural No natural Do. Seldom terminated

crisis of the crisis. by sweat after

distemper. the third day.

_Appearances on Dissection._

FEVER OF FEVER OF

PLAGUE. YELLOW FEVER. BOULLAM. PHILADELPHIA

IN 1793.

Bile of a black Bile of a black Intestines Bile very viscid.

and greenish colour, and very mortified.

colour; turning viscid. Congestion of

quite black by Effusions of blood in the

the addition Stomach affected blood and serum brain.

of spirit of by gangrenous in the brain.

nitre; a lasting spots called Blood in a fluid

grass green by carbuncles by Dr. Liver sometimes state. Stomach

adding spirit Lining. shrunk up into and intestines

of vitriol; and half its natural inflamed.

of a yellow by Blood very fluid, size.

the addition of and the vessels Liver sometimes

alkalies. of the viscera of its natural

much distended. appearance.

Heart of an

extraordinary Duodenum and

bigness; in seven other parts of

cases stuffed the intestines

with thick, black mortified.

blood; in one,

filled with a Worms from

large polypus; putrefaction

in another the found in the

contents not stomach in six

mentioned. hours.

Lungs in five Omentum and its

cases either appendages of a

purple, livid, dark grey colour,

or covered with and uncommonly

spots of these dry.

colours.

Liver and spleen

Liver greatly enlarged.

enlarged, with

mortified spots

in five cases.

Stuffed also with

thick blood.

Mortifications

in the brain,

intestines, &c.

Abscesses in

two cases; one

in the muscular

integuments of

the thorax, the

other in the

aorta.

Fever of 1798.

_Doctors_ RAND _and_ WARREN’s _Dissections_.

CASE I. Patient died CASE II. Death on the CASE III. Death on

on the 6th day. Lungs 12th day. Patient the fourth day. Lungs

filled with dark had been delirious inflamed on the fore

blood. Air vessels since the 6th. Blood part, and exceedingly

not distended. Large vessels of the brain stuffed with blood

extravasation of greatly distended. in the back parts.

firmly coagulated An effusion of serum Liver inflamed, and

blood in the thorax. between the dura of a very dense

Fluid blood in the and pia mater. A consistence. Gall

pericardium. Coronary band of coagulated bladder entirely

veins extremely lymph producing an obliterated; its coats

distended. Liver adhesion between the forming a confused

inflamed on both two coverings of the membranous substance

sides, and indurated brain, under the by coalescence with

as if boiled. Gall sagittal suture. Lungs the neighbouring

bladder contracted, adhered firmly to parts. Stomach covered

and containing only the pleura, and had in the inside with the

about a quarter of an several indurations black vomit. Colon and

ounce of a substance of the size of a part of the omentum

resembling pitch. pigeon’s egg. Left inflamed.

The secretion of lobe extremely

bile had apparently diseased, and in a * * * *

ceased for some time. state of suppuration.

Stomach and intestines Liver much enlarged In the two cases where

inflamed, and their and inflamed, the the gall bladder had

veins distended. inside of the great been diseased, and

Omentum thickened lobe near the gall the liver did not

and dark coloured bladder appearing as perform its functions,

from the swelling of if contused. Stomach the patients became

its vessels. Spleen covered on the inside yellow; but not in the

enlarged but without with the matter of other, where the bile

inflammation. the black vomit, was in due quantity.

though the patient In the second case the

had no evacuation of patient had previously

that kind. Duodenum had a pulmonary

and small intestines complaint.

much inflamed. Gall

bladder full of bile,

and ducts pervious.

Bladder contracted to

the size of a pullet’s

egg, with a quantity

of blood effused in

it.

“Nevertheless, if this distemper was as contagious as certain

physicians pretend, why should they not be the first to be taken with

it; they who see, examine and touch many patients every day? Why should

not those who nurse them day and night, who continually breathe those

putrid miasmata; why should not those who attend the hospitals, those

who daily carry 30 or 40 coffins to the grave, be taken with it? We do

not hear, however, that the physicians, surgeons, nurses and sextons

have enlarged the funeral list more than any other class of citizens.

Some doubtless have fallen, and perhaps they owed their death to their

frequent communications with the sick; but would the epidemic have

spared them in any other condition, more than a number of unfortunate

people who are neither physicians nor nurses?

“Another particular not less remarkable is, that the _yellow fever_

seems hitherto to have spared the Frenchmen who have resided in the

West India colonies, the greatest part of whom have nevertheless

staid in New York and Philadelphia during the _yellow fever_, and

have lived in the midst of the contagious air which proves so fatal

to the Americans. The result of all this is, that, notwithstanding

four years’ experience, notwithstanding the public and private

researches and discussions which took place between the physicians and

philosophers of the American continent, there is still much uncertainty

on the nature of the distemper which so rapidly depopulates New York

and Philadelphia. Every opinion, every system, presents palpable

contradictions, and is liable to objections which it is difficult, not

to say impossible, to answer in a satisfactory manner. If the disease

be contagious, why are not the physicians, the nurses, the servants

of the hospitals, taken sooner than persons who have no sort of

communication with the sick?

“If it be not contagious, how happens it that the natives of every age

and sex, many of which, the women and children especially, live in a

pretty sober manner, and seldom drink any of those liquors so liable to

inflame the blood, are taken with it, and fall, in spite of all the

efforts of medicine? How happens it that the Europeans and Frenchmen

who have never been in the colonies are attacked like the Americans,

whilst the planters in the West Indies are spared?

“On the other hand, if, as the French physicians pretend, this is

nothing else than the malignant putrid fever, often prevalent in

Hispaniola, how happens it that those medicines and that mode of

treatment which were so frequently successful in the colonies have

no sort of success when administered to Americans, and seldom with

Europeans? Why is this fever attended, in its very first stage, with

vomitings of blood, bile, black spots, _purples_ and other alarming

symptoms, which they frequently have at Hispaniola? How comes it that

the West India planters, who, while they resided in the colonies,

had frequent attacks of putrid and often inflammatory fevers,

enjoy the most blooming health ever since they have been on the

American continent? And why are they not taken with those putrid and

inflammatory fevers, at a time when those who have given them an asylum

are the daily victims of it? Finally, if we must attribute the epidemic

to no other cause than the immoderate heat of the summer, which is

really greater here for two or three months than at Hispaniola, where

a land and sea breeze tempers its violence, why does it not stop its

ravages when the heat moderates? We have observed in the epidemics

of New York and Philadelphia, that they were less destructive in the

burning dog-days than in the months of September and October, when the

mornings, evenings and nights begin to be cool, and even cold enough to

allow people to go clothed as warmly as in winter.

“We have now a recent and striking example that it is not heat only

which causes the epidemics; since there were only, in the month of

September, three or four days of great heat. The rest were very cool.

It may even be said that from the 22d it was cold, especially on the

28th and 29th, when a violent north wind obliged many people to have a

fire. The number of deaths never were, however, so numerous as they

have been since the 20th of September. The funeral list, which in July

and August amounted to 40 per day, reached on the 20th of September to

78, the 22d, 68, the 23d, 71, the 24th, 63, the 25th, 80, the 26th, 77,

the 27th, 96, the 28th, 106, the 29th, 76, and from the 29th at twelve

o’clock, to the 1st of October, same hour, the number was 170; a number

as prodigious as it is frightful: we could not therefore even flatter

ourselves that the severest frosts of the end of October would dispel

the epidemic, did not experience afford us that comforting hope.

“What then is the physical cause of this scourge, which all human

prudence and science are unable to avert? The ministers of religion

will not fail to ascribe it to celestial wrath, and to advise prayers,

fast and charity to appease it. Those pious practices cannot assuredly

do harm; but the philosophical observer, who does not conceive that

Philadelphia and New York should have excited the Heavenly wrath more

than those of other cities of the continent, will seek for more natural

causes, and will examine whether they should not be attributed to some

local and peculiar vice of those two unfortunate cities, and perhaps

to the temperament, the diet, the mode of life, of their inhabitants.

Respecting this, we do not find, in the _localities_ of New York and

Philadelphia sufficient reasons, nor in the constitutions or mode of

life of their inhabitants sufficient variations, to mark them as the

victims of the _yellow fever_, while the inhabitants [of other places]

are free from it.

“I am however inclined to think that New York and Philadelphia, more

than any other cities, contain causes of corruption or putridity,

occasioned by their size and the extent of their commerce, which, added

to the high mode of life of the Americans, may be the source of the

calamity which now affects them.

“In effect, we observe that in these two cities the epidemic has

constantly manifested itself in those parts which are not only the most

commercial, but also where the _common_ sinks of the city meet; where

the houses, inhabited by the poorer class of people, being smaller,

and more crowded together; where the stores contain most provisions

liable to fermentation and putridity; where the shipping crowded in the

_wharfs_ render the water stagnant; where immense quantities of dirt

and litter are brought from every quarter for the purpose of filling

up new wharves and other places designed to be taken from the sea, to

enlarge lands to build upon; finally, where the water used to drink

does not reach the pumps of the lower part of the city until it has

filtrated through the burying-grounds and privy-houses of the upper

parts, most of which have no walls, and are never emptied.

“Let us add to all those causes of infection the dead dogs, cats, pigs,

and rats, which are thrown into the common sinks and docks, the rotten

fish, and the privies, which in several houses, especially at New York,

are nothing but _tubs_, which are emptied weekly on the sea shore, and

we shall have less reason to wonder at the putrid exhalations which

issue on the eastern part of New York, and at Philadelphia on that part

contiguous to the Delaware, and which are capable of infecting the

whole atmosphere, and to impair the health of those who live in it. If

the people who dwell in those parts are not scrupulously sober, if they

frequently indulge in the use of spiritous liquors, if they feed on

such food as is generally known to be unhealthy, is it to be wondered

that, with such a mode of life, their blood should be more disposed to

inflammation and to be dissolved and corrupted, in the midst of an air

already corrupted and loaded with destructive miasmata?

“Now every man knows that those who live contiguous to the river at New

York, and the Delaware at Philadelphia, mostly sailors, shipwrights,

truckmen, labourers, tavernkeepers, &c. seldom trouble themselves about

the quantity of their foods and drinks, but indulge copiously in the

use of strong liquors, of which an astonishing consumption is made

in those parts. They are not in other respects more careful as to

cleanliness in their narrow and low houses. There, in a _hole_ called

a _bedroom_, and on a feather-bed half rotted, in a heap of rags half

devoured by insects still more disgusting, two and sometimes three

individuals, covered with sweat, often drunk, sleep, and still increase

the filth by their shameful and dirty mode of life. Shall we find it

strange that those infected haunts should shed forth in the morning

a mephitic air, capable of suffocating the most robust and vigorous

men? Shall we wonder that those who breathe this pestilential gaz are

suddenly seized with a fever? in itself perhaps not very dangerous,

if it were treated in a suitable manner. But what is their method of

treating it? They do not even know the name of _ptisan_, still less the

use of _anodynes_, nor that of _salt of nitre_, nor of _camphor_, so

proper to prevent putridity. Punch, made with rum; water mixed with gin

and molasses; a sort of soup made with Madeira wine; fish; raw oysters,

&c. these are their first medicines. If their wives or friends go to

consult the apothecary, he advises the _castor-oil_, or the famous

calomel pills or powders, whose virtues the quacks extol for every

disease. Finally, if the fever increases, the doctor is called, who

administers a light puke of 12 or 15 grains of tartar emetic, a plenty

of laudanum to procure sleep, and who, seeing the case desperate,

withdraws, saying that he was called too late![156]

[156] In Dr. Rush’s account of the fever of 1793, we find the

following remarks on the French mode of practice to which it seems

remarkable that our author has given no answer: “I proceed with

reluctance to inquire into the comparative success of the French

practice. It would not be difficult to decide upon it from many

facts that came under my notice in the city; but I shall rest its

merit wholly upon the returns of the number of deaths at Bush-hill.

This hospital, after the 22d of September, was put under the care

of a French physician, who was assisted by one of the physicians of

the city. The hospital was in a pleasant and airy situation; it was

provided with all the necessaries and comforts for sick people that

humanity could invent, or liberality supply. The attendants were

devoted to their duty, and cleanliness and order pervaded every room

in the house. The reputation of this hospital, and of the French

physician, drew patients to it in the early stage of the disorder.

Of this I have been assured in a letter from Dr. Annan, who was

appointed to examine and give orders of admission into the hospital

to such of the poor of the district of Southwark, as could not be

taken care of in their own houses. Mr. Olden has likewise informed

me, that most of the patients who were sent to the hospital by the

city committee (of which he was a member) were in the first stage

of the fever. With all these advantages, the deaths between the 22d

of September and the 6th of November, amounted to 448 out of 807

patients who were admitted into the hospital within that time. Three

fourths of all the blacks (nearly 20) who were patients in this

hospital died. A list of the medicines prescribed there may be seen

in the minutes of the proceedings of the city committee. Calomel and

jalap are not among them. Moderate bleeding and purging with glauber

salts, I have been informed were used in some cases by the physicians

of this hospital. The proportion of deaths to the recoveries, as it

appears in the minutes of the committee from whence the report is

taken, is truly melancholy!”

“Although the inhabitants of the other parts of the city who are in

better circumstances follow a mode of life more regular, feed on more

wholesome aliment, and are much more cleanly in their houses (except

however _feather-beds_ and _lower bedrooms_) it is nevertheless a

fact that they are much inclined, the men especially, to eat salt

meat, meat half cooked, green fruit, and still more to drink spiritous

wines. Several of them allow themselves an immoderate use of the latter

between dinner and tea-time, the strength of which, added to that of

the high-spiced food, and liquors, must necessarily increase in their

blood that fermentation already excited by the heat of the season. Now,

shall we not concede that bodies thus predisposed ought to be more

susceptible than others of the impression of the corrupted _miasmata_

which are constantly exhaled from every thing that surrounds them; from

the common sewers, the wharves or the docks; from the dirt and litter

of the alleys and lanes; from the sulphureous bilge-water of ships;

from the cellars and from the stores; in short, from those houses which

contain sick, dying and dead persons?”

Here the author, after stating objections on both sides, seems at last

to determine that the disease is produced by putrid effluvia. The

dispute on this subject, however, hath continued so long, that we can

by no means expect to settle it in this treatise. At first view one

would think that nothing could be more easy than to determine whether

the disease arose soon after the arrival of foreign vessels, or in

places which had no connexion with maritime affairs. But when we come

to particulars there is such a strange disagreement and contradiction

concerning facts, that we are in every instance driven back into the

wide field of theory and argumentation. One instance of this we have

already had in the case of the Boullam fever said to be imported by

the _Hankey_. Let us now try another. Dr. Currie of Philadelphia, in a

letter to Mr. Wynkoop of date October 10th, 1797, says that the fever

at New-York, of 1795, was proved “by unquestionable facts,” to have

been introduced from Port au Prince by the brig Zephyr; and for a proof

of this he refers to a letter of the health committee of New York to

the governor, dated September 8th of that year. From this letter it

appears that Dr. Treat visited this vessel on the 28th of July, where

he found three men ill of what he called a bilious _remitting fever_,

and the body of one who died that morning. Two days after, the Doctor

was taken ill, and died in eight days, with unequivocal symptoms of

yellow fever. On the 25th, four persons from on board the ship William,

from Liverpool, which arrived several weeks before (the crew of which

till this time had been healthy) were taken ill of fever, and died with

similar symptoms in seven days. Nothing can be more direct than this

evidence, yet it did not give satisfaction.

The fact was impugned by the late Dr. E. Smith, in a letter to Dr.

Buel,[157] who produces such evidence as, in his opinion, “establishes

it beyond a contradiction, that neither Dr. Treat nor any other person

contracted a fever, such as prevailed in New York in 1795, from any

sick or dead man, or any thing else connected with the vessel in

question.”

[157] Webster’s Collection, p. 98.

The evidence brought forward is the declaration and deposition of capt.

Bird. In a letter to Dr. Dingley, the captain “thinks it his duty to

contradict the report” that Dr. Treat “caught the disease of which he

died on board the Zephyr.” He contradicts it by a deposition, that “the

mate and one mariner had the _fever and ague_ seventeen days on shore,

and came on board with the same disease; and the captain himself had a

dysentery on his arrival in New York; and John Wheeler, aged 16 years,

died on the day of the arrival of the brig in New York, by _worms

crawling up into his throat, and choking him_. He was sewed up in a

piece of canvass, and ready to be committed to the deep, when Dr. Treat

came on board, who desired the captain to have the canvass opened, that

he might inspect the body; and he only cut the canvass over the face,

but did not make any other examination of the body.”

How far this proves captain Bird’s assertion, that Dr. Treat _did not_

catch the disease on board the Zephyr, the reader will judge. It is,

however, inconsistent with the plan of this treatise to enter into

an examination of contradictory evidence concerning matters of fact.

Accounting as _nothing_, therefore, all that has been said, _by either

party_, concerning the brig Zephyr, let us proceed to other testimonies.