The distemper in the mean time arrived at the most dreadful height

in Philadelphia, and almost all those who could take the charge and

burthen of public affairs were absent. An hospital had been established

at Bush Hill, but, for want of superintendence, had fallen into such

disorder, that the poor chose rather to deny their illness than to

be sent to it. On the 15th of September, however, Stephen Girard, a

native of France, and a wealthy merchant, together with Peter Helm,

a native of Pennsylvania, offered their services as superintendants.

By their exertions the credit of the hospital was soon retrieved, and

such numbers demanded admittance, that it became necessary for each

candidate to procure a certificate from a physician, that the patient

really laboured under a malignant fever. In a short time the affairs

of the city went on, in every respect, with as much regularity as

could be expected; but the mortality increased throughout the month

of September, and the three first weeks of October. Great hopes were

entertained from some cold and rainy weather in the end September;

but they proved illusive, and the disease became even more fatal than

before, till the 26th of October, when it suddenly ceased, as Mr. Carey

says, with hardly any rain, and a very moderate degree of cold. “That

day (adds he) was as warm as many of the most fatal ones in the early

part of the month. To account for this is perhaps above our power. In

fact, the whole of the disorder, from its first appearance to its final

close, has set human wisdom and calculation at defiance.” During the

time of this calamity Mr. Carey computes that _seventeen_ thousand left

the city, and _four_ thousand and thirty-one perished.

This city suffered another attack in 1794 but far less severe than

before. In 1795 and 1796 the disease seems scarcely to have made

its appearance; but in 1797 it revived, and, in 1798, broke out

with greater fury than even in 1793. No particular history hath

been published of this last severe attack. We know only in general,

that, though a much greater number of the inhabitants fled out of

town in 1798 than in 1793, the number of deaths was almost as great;

being estimated at three thousand eight hundred and forty-one. Great

disputes, as has been observed, have taken place concerning the

origin of these diseases; on which we shall only further remark, that

if, after such repeated and dreadful experience of the bad effects

of allowing putrid matters to accumulate, such quantities could be

collected as to produce the very fatal sickness of last year, it argues

a most unaccountable, and indeed incredible, insensibility on the

part of the people, as well as remissness on that of the magistrates;

and this perhaps may be accounted as strong an argument in favour of

contagion as can be adduced.

That such a violent distemper should cease all at once, is indeed not

to be expected; and we have already heard of its again appearing in the

city. Fear has been very justly excited, there and in other places;

but it is to be hoped that the remarkable coolness of the season will

operate favourably in preventing any very violent attack for this year.

New York has also suffered very considerably from this disease. Here it

appeared in 1791, in the autumn, and in a part of the town remarkable

for its vicinity to a collection of filth. In 1792 it made no progress;

and in 1793, though some died of it who fled from Philadelphia, it

did not spread. In 1794 it returned with considerable violence, and

with still greater in 1795. In the history of this disease by Dr.

Seaman,[189] he takes notice that in July and August an unusual number

of persons suffered from drinking cold water, and some fell down and

died in the streets; but the Doctor supposes this to have happened

rather through the excessive heat of the sun than the drinking of

water. As the disease came on, all others gave way to it, even “_the

common remitting bilious fever_;”[190] and in the month of July some

cases occurred. We have already had occasion to take notice of the

death of Dr. Treat, who was taken ill on the 22d of July; but before

that time, on the 6th of the same month, Dr. Seaman says that, in

conjunction with this gentleman, he had visited a patient “affected

with all the full-marked and decided symptoms of an highly malignant

yellow fever.”[191] The disease continued to gain ground in August,

and became extremely violent in that and the following month; but,

according to our author, the low ground in the southeast part of the

city was the “grand centre of the calamity, diffusing its effects like

diverging rays, aiding, by its most powerful influence, different

secondary centres, already smoking hot, to flame out its pestiferous

_operations_.” In this part of the town five hundred died in three

months.

[189] Med. Repos. vol. i, p. 316.

[190] Webster’s Collection.

[191] This proves that Dr. Treat _was not_ the first person who

suffered by this disease but it will not prove that the disease was

not imported by capt. Bird’s vessel; for the fever spread in the

vicinity of the vessel, not of the almshouse, where the first patient

was carried.

The attack at this time did not arouse the people to a proper sense of

their danger. As formerly, the origin of the disease in 1795 had been

attributed to the filth of the city. Next year it was attributed to

the same, and so in 1797 and 1798. This last year, particularly, it is

said to have originated partly from great quantities of putrid beef

and fish, collected for exportation, and which could not be exported.

In Mr. Hardy’s account of this fever, it is calculated that there died

in 1798 two thousand and eighty-six; but that, if it were taken into

the account how many left the town and died in the country, the number

would amount to between two thousand four hundred, and two thousand

five hundred.

It is not in Philadelphia and New York alone that this distemper

has prevailed. Boston, Newburyport, Portsmouth, Portland, and even

detached spots in the country, to which it is not possible to trace any

infection, have felt its ravages. At Salem also, where the disease was

never known before, twenty-one cases, including some doubtful ones,

appeared in 1798; and of these, eleven proved fatal. In 1796, when

it prevailed in Newburyport, it was supposed to have been introduced

by a vessel from the West Indies; and, according to Dr. Coffin, the

opinion would have been incontrovertible, had not a large quantity

of fish-garbage been collected at the place where the vessel landed;

so that, though the disease spread from that place, it could not be

known whether it proceeded from the vessel, or the fish, or both.

It seems now unfortunately to be the case, that where this disease

once gets footing it cannot easily be eradicated. If we suppose it

always to be imported, the continual intercourse with the West India

islands will account for this; but the extreme difficulty, or rather

impossibility, of procuring an account of facts or even a single fact

which cannot be controverted, renders every thing that can be said

upon the subject uncertain and precarious. In the case of New London

particularly, where 81 persons were destroyed by it last year, neither

importation nor collections of filth could be assigned as the cause;

nevertheless it began near a _wharf_; but Mr. Holt, in his account of

the disease, thinks it was most probably owing to the mere heat and

dryness of the season. On the other side of the question, however, we

must still insert Dr. Brackett’s account of the origin of the disease

at Portsmouth, in answer to a letter from Dr. Oliver of this place.

“The yellow or pestilential fever made its first appearance at

Portsmouth, about the first of August last. Eight or ten days before

that time a vessel arrived here from Martinico, and brought a French

family (four or five in number.) This vessel, before she left the West

Indies, had two sailors taken sick (as the captain informed me) one of

whom died on the passage home; the other was on the recovery when the

vessel came into this port.

“There was not, nor had not been for a long time before, any fever in

this town. Two or three days after, I heard that one or two men, who

were labourers (and probably had been on board, as they lived nigh

where the vessel lay at the wharf) died suddenly with fever, but am

uncertain whether with yellow fever, as I never saw them. The first

of August, the owner, whose house was about four or five rods distant

from the vessel, had a child of four or five years of age taken sick;

the next day I visited it, and two days after he died. The symptoms

appeared like a cholera morbus--sick stomach, and frequent puking of

black bile. The day before he died a brother of his, fifteen years

old, was taken ill, and had much the same symptoms, only greater

inflammation and distress. He was blooded freely, took calomel, bark,

&c. He died five days after sickened. Between the 8th and the 20th of

August, four or five of the other children and servants were taken with

the same symptoms, and recovered. On the sixteenth day, a daughter,

seventeen years of age, was taken down with the same disease: she was

treated in the same manner, with bleeding, mercury, warm bath, bark,

&c. and died on the 9th day. This patient had a great discharge of

blood from her mouth and gums for three days before she died. One or

two more of the family had it afterwards, and recovered. All these

patients took the infection, I believe, about the same time. Many

others in that neighbourhood had the fever during this time, about one

half of whom died: out of forty-six patients I lost fifteen. If I could

procure a soreness of the fauces, by administering calomel in small

doses, and rubbing it in the gums, or by frictions on the legs and arms

with mercurial ointment, the third or fourth day, I was sure of their

recovery.

“How many died of this disease in the whole, I have forgotten; as,

through fatigue, and debility of body and mind, I kept no notes: I

think rather more than half of those who had it. The fever agreed in

every symptom, almost, with that described by Dr. Rush and others. The

contagion did not appear to be propagated, as the largest number who

had the disease were seized in the month of August, and lived in the

streets only which communicated with the wharf where the vessel lay,

and the beach where she was graved. These streets are in the highest

part of the town, and always esteemed the most healthy, and as free of

putrid substances as any in it. In the months of September and October

the fever was followed by dysentery, and spread through almost every

part of the town and its environs. There has been no case of fever

or dysentery since last fall: this place, during the winter, and

summer thus far, has been uncommonly healthy; and it appears likely

to continue so, if the committee of health should not be remiss in

their duty. Thus, without any comments, I have endeavoured to give

you a short history of the pestilential fever, as it appeared here

last summer. The ideas, you may communicate to the author of the book

intended to be published.”

The following letter from Dr. Warren, which he obligingly sent to two

physicians in Salem, gives an accurate account of the distemper which

prevailed in Boston last year:

“I should immediately have answered your favour of last month, but for

a wish to give you as complete an account of the causes and mortality

of the late epidemic as could be collected.

“There were a number of suspected causes, which, though concealed

during the prevalence of the disease, it was hoped would be developed

after the agitation of the public mind had entirely subsided; and I

was in expectation that some regular returns would have been made of

the numbers who had passed through the disease, and of those who had

died with it, so that some estimate might be formed of its malignity

and mortality; but such returns have not yet been made, and it is

therefore impossible to obtain any satisfactory evidence on those

heads. I suppose the number of deaths to have been rather short of two

hundred; but this is only a rude guess, and should not be relied on in

forming any consequential deductions on the subject. I shall, however,

now offer such an account of the disorder as my present materials have

enabled me to prepare.

“The first unequivocal appearance of the malignant fever, in the town

of Boston, was on the 20th of July 1798 (though one family had been

attacked with a fever, attended with unusual symptoms, as early as

the middle of June; but, as no other instances occurred for so long

a time, of an alarming nature, some doubts may perhaps be justly

entertained of the identity of the affection.) Three or four cases

only, I believe, happened between this and the latter end of the month.

The two first of these were young men employed in stores directly

opposite to each other, on Green’s wharf, near the Town-dock. A few

days after, three or four persons were seized with the same complaint,

whilst following their respective occupation in Market square, on the

east and south sides of Faneuil Hall, or the Market-house. In the

beginning of the month of August several persons were taken sick in

the same neighbourhood, chiefly young men between 16 and 24 years of

age, whilst employed in stores and counting houses there situated. The

stores in Merchant’s row, extending from the Market to State-street

were more especially visited with the disease, and, in the course of

the same month, a family at the bottom of State-street, and several

persons at Oliver’s dock, were taken sick. At this place a kind of

bason is formed between a point of the town projecting from Fort hill,

and the Long wharf, which is constantly receiving the offals of fish,

and other animal substances, which from its situation could not be

washed off by the waters contained in it. This spot is remarkable for

having been the residence of most of the persons first attacked with

the bilious remittent fever of 1796. To the latter end of this month

the number of sick continued to be increasing; but the attacks were

principally confined to the above-mentioned quarters, till at length

the disease appeared on the south side of Fort hill, at some distance

to the southward of Oliver’s dock, leaping, as it were, over the summit

of the hill, without lighting upon the inhabitants on the north of

that eminence. The fatality of the disease was here probably greater

than in any part of the town of equal population; and it was nearly

the last place in which it disappeared. Very few families who remained

in their own houses upon the hill escaped its attack; and the progress

of the disease, in all the places above mentioned, seemed to have been

arrested only by means of the evacuation of the buildings by the

people who inhabited them. In the latter end of August, and through

the month of September, many persons were taken sick in Fore-street,

which runs northerly from Market of Dock square, along the heads of the

wharves, on the eastern side of the town.

“Through the whole period of the sickness scarcely a person was taken

ill who had not resided, or been in daily employment, in the vicinity

of these places. The subjects of the disease were generally natives of

the town, chiefly in the prime of life, and in the vigour of health.

I recollect no instance of any French inhabitants being assailed by

it, and have heard of only one or two instances of the blacks being

affected with it.

“That the fever was in a degree contagious, I cannot entertain a doubt;

but that it was not so in a very high degree, I am as fully persuaded,

from the number of cases in which there was reason to believe it could

not have been taken in that way. In most instances, where contagion

might have been suspected, the subjects were so situated that they

might have received it from the same source as those with whom they had

communicated. I cannot learn that any evidence has been furnished of

infection from the sick who had been removed into the country, though

there were many instances of such removals, under the most malignant

forms which it assumed.

“The fever was generally ushered in by a chill, but I think by no means

equal to that which commonly precedes fevers of the ardent kind, nor in

proportion to the violence of its subsequent periods. In a short time

the rigors were succeeded by excessive heat; the pulse, which had been

small and contracted, became hard and full; the respiration laborious

from violent oppression at the scrobiculus cordis; the tongue assumed

a whitish cast; the eyes became highly inflamed, while the pains in

the head, back, and legs, were intolerably severe. To these symptoms

succeeded nausea, and vomiting sometimes of a highly bilious matter,

seldom attended with diarrhœa, but often with a burning at the stomach,

tenderness of the abdomen, parcity of urine; and, in one instance, a

dysuria, with a great proportion of blood at each evacuation of that

fluid.

“These appearances usually continued about 48 hours, after which they

often suddenly gave place to a very different train of symptoms. The

pulse sunk astonishingly, and became intermittent; the heat and pains

entirely subsided; and the patient supposed himself to be out of

danger. From a perfect possession of all his intellectual faculties,

with a serenity of mind, which in no other disease, I believe, is

so generally observed to accompany its last stages, on or about the

5th day from the accession of the fever, he fell into a state of

insensibility, and thence sunk gently into the arms of death. In others

this change was less rapid; the pulse became gradually smaller, the

distressing symptoms slowly abated, a coldness of the extremities took

place, and continued for several days before death, accompanied with

clammy sweats, often without any perceptible pulse in the wrists, for

several hours before the fatal termination. The tongue seldom became

much coated, to the last. Delirium was by no means generally attendant;

and a yellowness of the skin was far from being universal; sometimes,

however, this appearance was observed within the three first days;

often on the fourth and fifth; and I was induced to consider it as an

accident, rather than a constituent character of the disease.

“The black vomit, as it has been usually called, though in my opinion

by no means to be considered as a pathognomic sign of the disease (as

I have frequently seen it take place in other acute fevers, especially

the puerperal) was very frequently attendant on the last stages of the

disorder; very few recovered after this circumstance had taken place;

in one person, however, who had it in the most alarming form, together

with an intermittent pulse, coldness of the extremities, singultus, and

every usual mark of immediate dissolution, a most unexpected recovery

happily disappointed the positive prognostics of his physicians. As

the cure advanced, the skin in this instance became extremely yellow,

and continued so for many weeks after the fever had subsided; the

biliary ducts having been completely obstructed, and consequently

the alvine evacuations of a clayey colour, and with much difficulty

procured. Frequent repetitions of rhubarb and calomel in large doses,

the continuance of the mercurial medicine in small doses, so as to keep

up a continual ptyalism, and a laxative diet, restored him to perfect

health.

“For the discoveries which were made on dissecting the bodies of

some of those who died with the disease, I beg leave to refer you

to a publication in the Boston Centinel, made during the prevalence

of the disorder in this place, and subscribed by Dr. Isaac Rand,

sen. President of the M. Medical Society, and myself.” (For these

discoveries see the table, facing p. 434.)

“We had heretofore treated our patients agreeably to the method

practised at Philadelphia in 1793, with bleeding in most instances, and

active purges of jalap and calomel, or Rochelle salts. The diseased

state of the liver, the known effects of mercury in hepatitis, and the

recollection of the suggestions contained in Dr. Rush’s publication

on the yellow fever, together with those of several other celebrated

writers on the same subject, induced us to enter immediately on the use

of calomel in small doses, as recommended in our paper above referred

to.

“In my own practice I _now_ usually commenced the treatment by bleeding

from ten to sixteen ounces, and followed it by a dose of between ten

and fifteen grains of calomel with between twenty and twenty-five

grains of jalap, or an ounce of Rochelle salts, or more, according to

the constitution. Immediately after the operation of these medicines

I began with the use of calomel in small doses, in pills of a grain,

every hour, and sometimes of 3 grains every two hours. Within the

first twenty-four hours, but scarcely ever after, I found occasion

frequently to repeat the bleeding, and it is worthy of remark, that in

scarcely a single instance was this operation performed without almost

instantaneous relief; although in most cases, a few hours after, there

was a recurrence of the symptoms. The blood for the most part was dark.

In three cases there was no separation of serum from the coagulated

mass at the end of forty-eight hours. In two of these (and they were

the only cases in which I observed it) a firm buff was formed on its

surface; and all three died of the disease.

“The calomel was often continued through the whole course of the

fever; and ptyalism was usually brought on within three or four days:

though sometimes upwards of 200 grains were given, at the rate of a

grain every hour, without any specific effect on the salivary glands.

In proportion as the soreness of the mouth advanced, the symptoms

universally gave way; and in every patient, two only excepted, this

effect of the remedy was a sure pledge of recovery. In this exception

were comprehended two persons of the same family, a father and

daughter, both of whom had survived the 14th day of the disease, had

copious hæmorrhages from the mouth (a circumstance which also attended

on many who recovered) and died in a state of apparent putrefaction.

“The purgative medicines were generally repeated every second day; or

an enema of water gruel was administered occasionally, if the bowels

were constipated; but if otherwise, and the calomel passed off by

those emunctories, opium was combined with it in sufficient quantities

to restrain the discharge. The evacuations which took place from the

intestines, during the use of the mercury, were almost universally of a

remarkably dark colour, generally approaching to a deep green, but by

no means remarkably fœtid. When spontaneous, they were often observed

to be of the colour and consistence of water gruel.

“In cases of very laborious respiration, which was frequently in an

extreme degree distressing, especially after the first 36 or 48 hours

had elapsed, blisters, applied either to the chest or extremities,

had a favourable effect; on the latter, they were most useful in the

advanced stages of the disease, by exciting to action the debilitated

vessels, and by restoring circulation and warmth to the parts. In the

same intention, wine, snake-root, and the bark, were sometimes used

with advantage.

“The diet was generally of the lightest and most cooling nature;

barley-water, apple-water, and spruce-beer, were generally both

grateful and salutary. The warm bath was often exhibited with apparent

success, especially in the beginning of the disease, and when a copious

sweat had been induced by it. The cold bath was also resorted to by

some respectable practitioners, and perhaps, under some circumstances,

with good effects; but I have no reason to think it was generally

advantageous.

“Upon the whole, I believe that the most efficacious remedy, and the

only one to be relied on, is mercury. It is certain that, as far as my

observation has extended, under no other method of treatment did so

many recover; and there were but few instances of a fatal termination,

when it had been administered from the commencement of the fever.

“Various have been the causes assigned to this disease. That its origin

was domestic, I have not a single doubt. No instance of the arrival

of any vessel from the warmer latitudes, with this sickness on board,

has been discovered; and it is believed that the local causes are

sufficiently numerous to account for its existence. At most of the

places, where its ravages have been made, very large quantities of

putrid substances had been for some time accumulating. The offals from

the fish market, as well as damaged fresh and salted fish to an immense

amount, had been thrown into the dock. A very great number of raw hides

had been imported, and stored in places contiguous to those in which

business was constantly going on. The influence of a continued heat

through the summer, to a degree scarcely before known in this country,

had rendered these articles highly putrid; and from the same cause

several articles of provision, such as barrelled beef, &c. which had

been prepared for exportation, but, by reason of the restraints laid

on our commerce, retained in store, had become tainted. The effects

of these were in some instances incontestibly evinced; three lads,

who had been employed in repacking beef, were at about the same time

seized with the disease in its most fatal form; and a person, who had

purchased some of the hides at a low price, immediately after their

removal fell a sacrifice to his folly.

“Two or three thousand of the inhabitants removed into the country, and

began to return about the middle of October, when the decline of the

disease justified the measure.”[192]

[192] The following facts, in confirmation of the importation of

the yellow fever, were communicated in a letter from an eminent

practitioner in New Haven to a gentleman of the same profession in

this town. They came to hand too late to be inserted otherwise than

in a note, the sheet being already prepared for press:

A child was reported to have died of worms, and the parents were

indulged in the common ceremonies of burial: but the truth was, that

the disease had been the black vomit. The consequence was, a very

extensive spread of the contagion. In less than a week six out of

eight of the bearers were taken with the fever, and these were young

persons from different parts of the town. “As to the suppositions

(says the gentleman) with respect to local causes originating the

disease, I conceive there is no occasion to seek for any other than

what was contained in the chest (p. 444) which was a blanket and

clothing taken off the corpse of one who had died of the fever in

the West Indies, and without the least formality of cleaning put

down into a close chest, and brought to New Haven, and lodged in

Austin’s store. Now it appears to me (these facts well ascertained)

as idle to inquire after other causes, as it would, suppose it were

the infection of the small pox brought in a chest, and a number

of persons who had inspected the chest to be taken down with it.

Would, in such a case, mankind have racked their inventions to have

investigated other inducing causes? Surely not.... As to local

putrefying substances, there was nothing but what has been common to

the place, where the fever made its first appearance, for many years

in dry summers.

“I might revert to the introduction of the fever by importation at

Chatham on Connecticut river; at Providence, Rhode Island; in which

the importation was as evident as at New Haven. In short, there is

scarcely a place on the continent, where this fever has made its

appearance, but what it may be traced to an imported origin. There

have been but two or three exceptions which I have heard of.”

The following particulars relative to the disease at Portsmouth

may likewise be deemed authentic, as communicated by a respectable

gentleman (though not of the medical profession) in that place;

“Most men of judgment and information on the subject suppose it

was imported last year in a ship of Mr. Sheafe, which arrived from

Martinico about the 20th of July. One man had died on board this ship

in the West Indies: all the rest arrived in health; but the disorder

made its appearance in a few days afterwards. Mr. Sheafe lost three

of his own family. He lived within a stone’s throw of the wharf where

his ship lay, and the fever spread in the neighbourhood. Mr. Plummer,

in the next house to Mr. Sheafe’s, died about the 10th of August;

Miss Parker, in the same house, four days afterwards; and Miss Smith,

who had lived nearly opposite, removed to Berwick, and was there

seized and died about the same time. It is worthy of remark, that

this was always thought the most healthy part of the town.”

As a contrast to these evidences, we subjoin the following epitome

of part of Dr. Rush’s address to the citizens of Philadelphia on the

origin of the yellow fever, &c.[193] In this address, the Doctor

considers it as indisputable that the disease is, in all countries,

the offspring of putrid vegetable and animal exhalations; but it

prevails only in hot climates and in hot seasons. In Philadelphia it

arises, 1. From the docks; and hence, in New York, it has got the

name of the _dock fever_. 2. From the foul air of ships. 3. From the

common sewers. 4. From the gutters. 5. From dirty cellars and yards.

6. Privies. 7. Putrefying masses of matter lying in the neighbouring

part of the city. 8. Impure pump water.

The disease is considered by the Doctor as an higher degree of

bilious fever. He answers the objection by Dr. Chisholm (see p. 467.)

where he speaks of the fever not being produced in 1778, “when it

was left in a more filthy state by the British army than it has been

at any time since.” To this he answers that for the production of

the disease three things are necessary. 1. Putrid exhalations. 2.

An inflammatory constitution of the atmosphere, and, 3. An exciting

cause, such as great heat, cold, fatigue, or intemperance. The

constitution of the atmosphere, however, he looks upon to be the

principal cause; as without this constitution mild diseases would

be produced, but along with it they become very malignant. “The

pestilential constitution of the air in the United States began in

1791. It prevailed in Charleston in 1792, and it has been epidemic

in one or more of the cities or country towns of the United States

every year since.... It has not been confined to the seaports. It

has prevailed since the year 1793 in many of the villages of New

England, and of the southern states. On the Genesee river it has

become so prevalent as to acquire the name of the Genesee fever.

The bilious fevers which prevailed in all the above places before

the year 1793 were of a mild nature, and seldom mortal. They have

lately disappeared, or are much diminished; and have been succeeded

by a fever which frequently terminates in death in five days, with a

yellow skin and black vomiting.” These circumstances are supported by

undeniable testimony.

In answer to the question, “Can the yellow fever be imported?”

Our author answers as follows; “I once thought it might; but the

foregoing facts authorise me to assert, that it cannot, so as

to become _epidemic_ in any city or country. There are but two

authorities on which the belief of this disease being imported

rests. These are Dr. Lining’s and Dr. Lind’s. The former says it

was imported into Charleston in 1732, 1739, 1745 and 1748. The

latter says it was conveyed into Philadelphia, where it afterwards

became epidemic, by means of the clothes of a young man who died in

Barbadoes. No circumstances of ships or names are mentioned with

these assertions to entitle them to credit, and from the facility

with which vague reports of the foreign origin of this disease have

been admitted and propagated by physicians in other countries,

there is reason to believe the assertions of those two physicians

are altogether without foundation. The College of Physicians of

Philadelphia, after two weeks investigation, were unable to discover

any ships, clothes, or sick person, that could have introduced

the disease into Philadelphia in the year 1793. The Academy of

Medicine have clearly proved, by many documents, that the disease

was not imported in the years 1797 and 1798. The origin of a few

cases, reported by Dr. Griffitts and other members of the College

of Physicians, which have lately appeared in our city, has in vain

been sought for from a prize sloop of the Ganges. Two affidavits of

Messieurs Hill and Ingersol prove that she had been healthy in the

West Indies, and that no person had been sick on board of her during

her voyage, nor after her arrival in our port. Equally unsuccessful

have been the attempts to derive those cases from beds and blankets

infected by the fever of last year. In Boston, Connecticut, New

York, Baltimore, Norfolk and Charleston, both physicians and

citizens have long ago rejected the opinion of the importation of

the fever. Some physicians suppose it possible for the contagion of

this fever to adhere to the timbers of ships that have sailed from

West India ports, and that it may be propagated from them to a whole

neighbourhood, although houses, and even streets, interpose between

them. This opinion is too absurd to stand in need of refutation.

Indeed every thing that relates to the importation of this fever is

contrary to reason and facts--It is an error, substituted in the room

of a belief that all pestilential diseases were derived from the

planets.”

[193] _Printed in 1799._

SECTION III.

_Methods of Prevention and Cure._

In the yellow fever, as in the plague, where an attack is frequently

made with such violence as to bring on death in twenty-four hours, or

even a still shorter time, it is plain that much more dependence must

be placed on prevention than the efforts of the most skilful physician

after the disease has once begun; for, in such violent attacks,

medicines, though ever so powerful, have not time to act. In countries

therefore where this terrible disease exists, the first consideration

necessary for every individual is, whether he is one of those likely to

be attacked by it. Now, from the general testimony of those who have

seen this fever, it appears that such as are newly arrived, the young,

and in other respects the healthy and strong, the laborious, and the

intemperate, are most liable to be attacked. Dr. Nassy of Philadelphia

seems _alone_ to afford an exception to the general testimony.

Speaking of the cause of epidemics, after having ascribed them to some

constitution of the atmosphere, he says, “If the air is not infected,

diseases cannot be epidemic; and this is so, _indeed_, though it only

attacks the natives. What can be the cause of that corruption of the

air? For what reason are the natives, and those inured to the climate

of Philadelphia, _alone_ infected with the prevailing disease, while

_foreigners_ escape it?” Dr. Chisholm particularly points out those

who, in 1793, were most liable to the Boullam fever. These were, “1.

Sailors; more especially the robust and young; those least accustomed

to the climate; and those most given to drink new rum. 2. Soldiers;

more especially recruits from Europe; and the most intemperate. 3.

White males in general lately arrived; more especially young men from

Europe. 4. All other white males; more especially the lower classes;

and of them the most intemperate; those debilitated by recent sickness.

5. White, females, more especially those connected with the shipping;

and those lately from Europe. 6. People of colour, from _Mustees_ to

_Cabres_. 7. Negro men; more especially sailors and porters. 8. Negro

women; more especially house wenches. 9. Children; more especially

those of colour.” It is certain, however, that, when the distemper

rages with great violence, natives as well as foreigners are liable to

be attacked. We cannot suppose that all who perished at Philadelphia

in 1793 and 1798 were foreigners. Though the latter therefore have

the greatest occasion to fear, the natives must not think themselves

absolutely secure; neither are foreigners to be terrified in such a

manner as if they could not escape. With respect to the general modes

of prevention, then, to which it is the business of every individual to

attend, the following things are to be taken into consideration:

1. Every one who comes from a cold to a warm climate may be assured

that on his arrival the temperature of his body is higher by three or

four degrees than that of the native inhabitants.

2. In this situation he must consider himself as necessarily about

to undergo a change of constitution; and such change he may likewise

be assured will best be made by the gradual operations of nature;

concerning which we know so little, that it does not seem adviseable to

use any artificial method of promoting or accelerating it.

3. As the voyage from the Eastern continent must have taken up a

considerable time, and as the mode of living on sea must have been

very different from that to which he was formerly accustomed, we must

consider the constitution as already in some degree altered from what

it was when the person first went on board.

4. This alteration will be greater or less according to circumstances.

If the vessel has been much crowded with passengers; if the weather

has been stormy, so that he has been exposed to damp; if they have had

little water, or of bad quality; if their provisions have been bad, or

if there has not been a sufficient supply of fresh air in the place

where he slept; the body must be considered as already predisposed

to disease, which the new climate will scarcely fail of bringing to

maturity.

5. Every one must consider that mode of living to which he has been

accustomed the greatest part of his life as _natural_ to him. Any

considerable deviation from it, especially if sudden, would be of

bad consequence, even in his own country; much more must it be so in

another. As much as possible therefore he ought to conform his mode of

life in the new country to what it was in the old, adhering only to the

rules of temperance.

6. It has already been observed, that we must take into account the

time that the person has been at sea, and the difference between his

mode of life during his voyage, and that to which he was formerly

accustomed. This difference consists in one particular in having lived

for some weeks entirely upon salt provisions. To these he has been in

some measure accustomed; and therefore it must be reckoned injudicious

to give up the use of salted meat at once for such as is fresh. In

fact, this mode of abandoning salt meat for fresh has been reckoned by

the best physicians one of the causes by which the disease is brought

on. Drs. Taylor and Hansforth express themselves in the following

manner on this subject: “It has been noticed by several medical

writers, that fresh meats, and particularly beef, in southern climates,

apparently generate fluxes and other malignant diseases.” Dr. Ramsay,

also, says of those who were mostly affected with the yellow fever in

Norfolk, that, “being _foreigners_, they dealt lavishly in beef, fish,

and all kinds of fresh food. Observe, this beef was driven perhaps from

one to two hundred miles before killed, then exposed in a hot market to

vend; that, by one o’clock, their dining hour, I always did, and do,

believe it must have been tainted. Observe, the fish were all dead by

break of day, and brought by land from twenty to twelve miles--hard

drinkers of spirits mostly.... One or two natural born citizens were

the whole, out of upwards of two hundred and twenty, who, in the space

of six weeks, fell victims to this disease. The natives live chiefly

on salted meats and fowls, or other kinds of poultry, which are killed

but a little time before dressing.” It is unfortunate that among the

emigrants from cold countries there is a general prejudice against

salt, as highly inflammatory; and many diseases are imputed to the use

of it where it is undoubtedly entirely innocent. In very cold climates

indeed it has with great reason been supposed to produce the scurvy;

and the Tchutski, who conducted capt. Billings through their frozen

regions, informed him that salt was poison in their climate; throwing

away, with marks of abhorrence, a quantity he had brought with him from

his frigate. We cannot indeed argue from salt being pernicious in a

cold climate that it is medicinal in a warm one, but we shall soon see

that it has been recommended in the plague, and may not improbably be

useful in the yellow fever. At any rate the practice of the natives

ought in this respect to be a rule for emigrants, rather than any

theories they may have laid down previous to their leaving their own

country.

7. In like manner those who newly arrive in a warm climate ought to

avoid as much as possible the using of violent exercise in a heat

greater than that to which they have been accustomed, and by all means

to avoid intemperance in spiritous liquors. We are not however to

imagine from this that such as have been accustomed to drink spiritous

liquors are all at once to give over the use of them, and live a life

of abstinence. On this subject Mr. Hardie, in his account of the

malignant fever of 1795, has the following judicious observation: “It

has often been said, that temperance was the best preservative against

infection. The observation, in general, is certainly just; but it may,

and during the late calamity has, been carried too far. For my part,

from what has come under my own knowledge, I have no hesitation in

asserting, that to persons who had been accustomed to live freely,

nothing could be more dangerous than to become remarkably abstemious

upon the appearance of this disorder. Persons of the above description

should, in my opinion, have continued to live in their usual manner;

by which means they would have been more likely to repel infection, or

if infected, they would have more strength to resist the attack. But,

whilst I consider abstinence in such a situation as highly improper, a

state of intemperance is certainly more so; for, were it necessary, I

could mention the names of several individuals, who whilst in a state

of intoxication were attacked with the fever, and in two days after

were tenants of the grave. The fate of such people might be pronounced

almost with certainty: they were seized with symptoms of a peculiarly

malignant nature, and their death seemed unavoidable.”

On the subject of vegetables much declamation has been used. If we give

heed to some, it might almost be supposed that all diseases incident

to human nature are owing to the use of animal food. The following

paragraphs from Webster’s Collection may serve as a specimen: “We shall

not repeat the observations which we have heretofore made, upon the

averseness the Americans feel for soup and restorative broths, on their

eating their meat running with blood, with scarcely any bread, and

plenty of heavy potatoes, the only vegetables which are seen on their

tables; whilst the French always give the preference to vegetables, and

especially to those which are light and wholesome. But we cannot help

observing, that, in the months of May, June and July, the streets and

markets were seen in the morning furnished with an immense quantity

of fruits, the most part of which are either green or unripe. In the

evening all those fruits have disappeared and have been eaten; hence

bloody fluxes, dysenteries and bad chyles, which unwholsome food must

undoubtedly produce.

“The city of Naples contains about four hundred thousand inhabitants;

of whom thirty or forty thousand are said to belong to the class of

beggars. In that climate the rains prevail, with little intermission,

for three months, from February to May. From May to September, a

drought, equally severe, and scarcely allayed in many years by a

single plentiful rain, renders the heat almost intolerable. The wages

of a labourer not exceeding eight pence this currency a day, and meat

being rarely had in their markets for less than four pence the pound,

and vinous liquors in the same proportion, the mass of population is

excluded from any share of these luxuries; of consequence they support

themselves on vegetables, roots, sallads, fruits, &c. and dilute their

food, and animate their spirits, with water and lemonade. Yet this city

has, for a great number of years, known no general disease. And for ten

years no febrile disease, of any sort, was common among them. They also

pay great attention to personal cleanliness. Facts of this sort are

very important, and form the best comment on the discordant opinions of

our physicians.”

As a contrast to these the reader may take the following quotation from

the Medical Extracts:

“One gentleman excepted, says Dr. Shebbeare, and I never saw a

gentleman or lady who wholly abstained from animal food look like

other people; nothing is so easy to distinguish as a _vegetable man_

by his physiognomy, the fittest appellation by which they can be

distinguished; he neither moves, talks nor looks like other people;

his face conveys a declaration of his whole body being out of order,

by the lifeless insipidity which is in it, as his conversation does of

his mind being disturbed, his whole time being taken up in recounting

to the world his manner of living, his feelings, his weak stomach,

his disturbed sleep, &c.... If he pretends to have spirits, it is no

more than a certain equability of a lifeless, inanimate state, like

that of the dormouse among animals, or the yew tree in winter among

vegetables,” &c. (Medical Extracts, vol. x. p. 234.)

On the subject of vegetable and animal food we find the following

observations in Willich’s Lectures on diet, &c. “In the primitive

ages, people subsisted chiefly on plants and fruits. Even to this

day many nations, the Bramins, for instance, abstain from the use of

animal food. The ancient Germans also, who were so renowned for their

bodily strength, lived upon acorns, wood-apples, sour milk, and other

productions of their then uncultivated soil. In the present mode of

life, here (in England) as well as on the continent, a great proportion

of the poorer class of country people almost entirely subsist on

vegetables. Although these people duly digest their vegetable aliment,

and become vigorous, yet it is certain that animal food would answer

these purposes much better. Hence, in countries where the labouring

class of people live principally upon animal food, they far excel in

strength and durability.”

On the subject of diet we shall take notice only of one article more,

and that is, the use of warm diluting liquors. These are commonly three

in number, viz. tea, coffee and chocolate. Abundance of declamations

have been published against the use of these, particularly the

first; but the daily experience of multitudes shows that its use, in

moderation, is perfectly innocent. Indeed when people go to excess with

this, as well as any thing else, bad effects must certainly ensue.

Zimmerman[194] mentions a Dutch physician (Bontikoe) who maintained

that tea _ought_ to be drank in the quantity of _one_ or _two

hundred_ cups a day! But such ridiculous excesses must make any thing

destructive to health; and accordingly this practice, being opposed

by Boerhaave, soon fell into disuse. Coffee has the same exhilarating

virtue as tea, but must be considerably different in its qualities, as

having in it a portion of empyreumatic oil extracted by the toasting,

and therefore a change from tea to coffee in such as come into a warm

country seems to be improper. Chocolate differs considerably from

both, possessing no exhilarating virtue, or only in a small degree,

but is more nutritive, and in South America constitutes a considerable

part of the food. On coming into warm climates it is obvious that the

increased perspiration must be supplied by a considerable quantity

of diluting liquids; and such of these as the person has been most

accustomed to ought to be preferred. For the rest, diluted malt liquors

seem preferable to spirits and water. Cyder, though very agreeable when

fresh, is apt to become vapid, and even get a putrescent taint. Perhaps

a plain infusion of malt, of late found so useful at sea, might also

prove beneficial at land, where proper fermented liquors cannot be had.

[194] This author relates the following curious anecdote concerning

tea-drinking: “We had a gentleman in Switzerland, who in every

respect knew how to assume the tone of majesty. He was told one day

that nothing elevated the dignity of a king so much as when every

thing around him had a pale look. This intimation was sufficient for

him. He directed all his servants to be blooded once a month, and

obliged each of them to swallow fifty dishes of tea every day.” Tea

is said to produce a cadaverous hue in the person who drinks it after

bloodletting.

These modes of prevention are obviously derived from the circumstances

which attend every emigrant from a cold to a warm country. The

indication must be, to keep themselves as cool as possible, without

debilitating the body. It was formerly a custom to use bleeding and

purging when people arrived in warm latitudes; but this practice fell

into disuse, perhaps without sufficient reason. Dr. Rush attests the

efficacy of these remedies as preventives when signs of the disease

appeared. “During the existence of the premonitory symptoms (says he)

and before patients were confined to their rooms, a gentle purge, or

the loss of a few ounces of blood, in many hundred instances prevented

the formation of the fever. I did not meet with a single exception to

this remark.” As mercury is found to be one of the best remedies, if

not the only one, that can be depended upon for curing the disease

after it is once formed, it is natural to think that it would act as

a preventive; and accordingly we find, in Dr. Walker’s account of the

yellow fever in Jamaica, an instance to our purpose. When the fort of

Omoa was taken from the Spaniards, a great quantity of quicksilver

was carried off by the English. One ship was loaded with it, and,

the vessels containing it being broken by the shot of the ship which

captured her, a number of men were employed in collecting it with their

hands into buckets. Not one of these men was in the least affected

with sickness, though a most malignant fever raged among the rest.

Preventives of such a powerful nature, however, could not well be

adopted without the advice of a physician; it being evidently dangerous

for any person unacquainted with medicine to tamper with himself in

this way.

When the disease happens to get into a town, it then becomes an

object for every person to avoid the danger; and for this Dr.

Chisholm has given such instructions as seem to be quite sufficient

for any individual, and may be very easily reduced to practice. His

observations may be summed up as follows: 1. To avoid going into

infected houses. 2. If this cannot be done, to avoid going into the

chamber of the sick. 3. If neither of these is practicable, to avoid a

near approach to the sick person. 4. To avoid drawing in his breath,

or that peculiar smell which issues from the bodies of the sick; and

not to touch the bed-clothes. By neglecting this the person becomes

affected with nausea: slight rigors and head-ach succeed in a few hours

by the disease. 5. Not to touch the patient’s body or his wearing

apparel, or suffer the effluvia from either to be blown upon the body.

The distance at which the contagion acts is by Dr. Chisholm supposed

not to exceed ten feet; but Dr. Lind thinks it may extend to fifty or

sixty feet; but this must depend very much upon circumstances. The

only thing that can be done in such cases is to keep at as great a

distance as possible. As to the preventives commonly recommended, such

as vinegar, camphor, garlic, &c. we have no accounts of their having

ever been efficacious in any case; and there is not the least reason to

think that they can be so.

To purify rooms or ships from the infection they have received, it

has formerly been observed that fumigations with the acid of nitre

have been recommended. According to the theory of Dr. Mitchill of

New York, however, this mode of prevention must not only be useless

but pernicious. The reason is, that according to this gentleman the

disease is produced by the very acid in question. His reasoning is

shortly this: Putrid substances evolve various sorts of air, two of

which by combination form the acid of nitre. Neither of these by

themselves are capable of producing fever, though in conjunction they

are. Their combination is the acid of nitre, which the Doctor thinks

is always that which produces putrefaction. Dr. Girtanner has related

an experiment which seems to confirm this opinion, viz. that, having

injected some nitrous air into the jugular vein of a dog, the animal

died in a short time, and upon opening him his lungs were found of a

greenish colour and partly putrid. Dr. Beddoes adds, in a note, that

the green colour is a sign of the existence of nitrous acid, not of

putridity; but, notwithstanding this, Dr. Girtanner might still have

been in the right, as we cannot say that the existence of nitrous acid

is incompatible with putridity. But there is not any occasion to enter

into a discussion of the question, as the matter seems to be determined

by facts which cannot be overthrown. Dr. Carmichael Smyth, in a

treatise on the jail fever, considers the disease as proceeding from

putrefaction, and “particularly the putrefaction of the _perspirable

matter_,[195] when there is not a renewal of the application of air

to carry it off.” With regard to _specific_ contagions he thinks they

can neither be carried off nor blunted, but by exposure to the open

air or to a stream of water; but with _putrid_ contagions he believes

that they may be destroyed by the mineral acids in a state of vapour.

The pernicious qualities of the fumes of sulphur prevented him from

making any trials with that substance; but to nitre there was no such

objection, and he therefore proceeded in the following manner; the

subjects of his trial being the prison wards at Winchester, where the

Spanish prisoners were kept, and among whom a typhus fever was making

rapid progress: Having divided the wards into four parts, he removed

the prisoners into three of them, took out of the fourth division all

the hammocks and bedding, and had them thoroughly cleaned out. The

hammock posts were well washed with diluted spirit of salt. The wards,

when dry, were closely shut up, and pots placed in them at different

distances, containing from half a pound to a pound of nitre, which was

deflagrated by an iron heater put into each pot.[196] The wards were

then shut up for some hours, and when opened were exposed to a free

ventilation. The process was repeated twice or thrice, after which the

prisoners were likewise cleaned; their old clothes, bedding, &c. taken

away, were replaced by others, and none of these were afterwards seized

with the fever.

[195] If this be chiefly composed of fixed air and azote, as has been

said in p. 146, it is difficult to see how putrefaction can take

place in it.

[196] It is not easy to understand this. Nitre cannot deflagrate or

burn, unless it be mixed with charcoal, sulphur, or some inflammable

substance. The iron heater could only expel the water, with a small

proportion of acid.

A much more decisive experiment was afterwards made at Sheerness on

board the Union hospital ship, where there were upwards of two hundred

people sick of a very malignant fever. Previous to the fumigation

all the ports and scuttles were shut up. “Sand which had been heated

in an iron pot was then scooped into earthen pipkins, into each of

which was put a small tea-cup containing about half an ounce of

vitriolic acid; to which after it had acquired a proper degree of heat

an equal quantity of nitre in powder was gradually added, and the

mixture stirred with a glass spatula, until vapour arose from it in

considerable quantity. The pipkins were then carried through the wards

by the nurses and convalescents who kept walking about with them in

their hands, occasionally putting them under the cradles of the sick,

and in every corner where any foul air was suspected to lodge. Thus the

fumigation was continued, until the whole space between decks, fore and

aft, was filled with the vapour, which appeared like a thick haze.”

The first fumigation was performed in about three hours; the vapour

subsided in about an hour, when the ports and scuttles were thrown open

for the admission of fresh air. Mr. Menzies, the operator, perceived

that even by this first fumigation the air was considerably sweetened;

and on repeating the operation next day, which (now that the people

were more expert) took up only an hour, such a change was made as the

nurses and attendants were very sensible of, and, beginning to put

confidence in the remedy, approached the cradles of the sick with less

fear. The experiment was further carried on by Mr. Bassan, to whom Mr.

Menzies resigned the office of conducting it; and from repeated trials

it appeared that the fumigation effectually counteracted the influence

of the contagion, though numbers of patients, labouring under the most

malignant fevers, were received from the Russian ships of war.

The good effects of nitrous vapour used in this way is also confirmed

by Mr. David Paterson, now surgeon in Montrose in Scotland. The trial

took place in the prison wards at Forton. The operation was performed

in the manner above related, and with such success, that a ward 57

feet long, 10 feet and an half high, and 20 feet broad, was filled

in a quarter of an hour, only by means of three pipkins. The good

effects were extremely obvious, and Mr. Paterson observed that in the

wards which had been fumigated at night there was an agreeable smell

next morning; and by this smell he was able to discover whether the

operation had been properly performed or not. The same author gives

several cases in which the good effects of the pure acid vapour of

nitre in cleansing putrid ulcers was manifest. A third testimony of

the efficacy of this vapour is given in a letter to Dr. Garthshore of

London from Mr. James McGregor, surgeon to the 88th regiment, in the

island of Jersey. The disease was a typhus fever, which had formerly

proved very destructive; but, while the acid vapour was used, only

one out of _sixty-six_ cases proved fatal. Mr. McGregor is not only

of opinion that the nitrous fume prevented the contagion from acting

fatally, but that it destroyed it altogether, so that no more cases

appeared. Mr. Paterson made trial of different acids, but had not

completed his experiments: we are informed, however, in the Medical

Extracts, that in the year 1795, near about the time that the last

experiments were made upon the Union hospital ship, Morveau in France

had employed, for the same purpose, oxygenated muriatic acid[197] in

the form of air or vapour, with which he purified the infected hospital

at Dijon; and the same method was afterwards extended to the different

military hospitals by a decree of the National Assembly.

[197] Perhaps this vapour may be as efficacious as the other in

destroying contagion, but its smell is so extremely offensive and

disagreeable to the lungs, that on this account nitrous vapour seems

much preferable.

This mode of prevention seems to be established on as sure a testimony

as any thing can be; but what can be said that will not be disputed?

Dr. Trotter has argued in the most strenuous manner that such

fumigation is not only useless, but pernicious. “The whole preservative

means (says he) are comprised in the immediate removal of the sick;

cleanliness in person and in clothing; fires to keep the people

warm in the winter season; avoiding cold and moisture, fatigue and

intoxication; and keeping the ship dry and properly ventilated.” To

these he also thinks it would be expedient to add a band of music in

order to keep up the spirits of the people; but, with regard to any

thing else, he thinks that “a physician of a fleet, though armed with a

diploma, and with the chemistry of the elements at his fingers’ ends,

will find that very little has been left for him to do; whether his

doctrine of prophylactics (preventives) be the _vinegar of the four

thieves_, or the fumigations of modern physicians, under the scientific

appellations of sulphureous gas, muriatic acid gas, or nitrous gas.”

The Doctor was so zealous against these noxious fumigations, that he

wrote to Evan Nepean, esq. at the Admiralty upon the subject. His

argument was, that every possible method was taken on board of vessels

to expel _azote_ or _mephitic air_, by opening ports, scuttles, &c.

and putting down windsails, &c. “This azote is the base of the nitrous

acid: they only differ in the degrees of combination with oxygen, or

what was formerly called dephlogisticated air: and in proportion to

the quantity it attracts of this principle it is called azote, azotic

gas, nitrous gas, nitrous acid, nitric acid. In short, Dr. Smyth’s

preventive is the very substance that every intelligent officer is

hourly employed to drive from the decks of his Majesty’s ships.”[198]

This letter was transmitted to the commissioners for the sick and

wounded for their report. The answer of the commissioners was to

the full as learned as the Doctor’s letter; but they considered the

experiments of Dr. Smyth and others as quite decisive upon the subject,

so that Dr. Trotter was obliged to submit. The matter therefore being

determined by such high authority, we must take leave of the subject,

and proceed to consider the mode of preventing the disease from getting

entrance into any town, or of eradicating it when once it has got in.

[198] Medicina Nautica, p. 229.

Among these the enacting and strictly enforcing quarantine laws

certainly hold the first place. But these belonging entirely to the

magistracy and police of the place cannot be the subject of any

discussion here. The success of these has been so great in other

countries, that Dr. Willich informs us “that some of the most ingenious

practitioners of Italy and Germany are, at this moment, employed in a

serious attempt wholly to extirpate this contagion (the small pox) from

the continent of Europe; an object which has formerly been accomplished

in the cases of the plague and leprosy.”[199] Perhaps, then, it is no

improbable supposition, that, by a strict observance of quarantine

laws, and attention to cleanliness, the yellow fever may be eradicated

at least from the northern states, whose climates are less congenial to

it than the southern.

[199] Willich, p. 13.

Dr. Chisholm informs us that the general plan of prevention made use of

in Grenada consists in the destruction of all small wooden buildings;

obliging the inhabitants to build with stone or brick; to make spacious

streets; to have the rooms of the houses as large as possible; stables,

necessaries, &c. at a distance; and certain places appointed as

receptacles for filth, to which it must be carried every morning;

slaughter-houses at a distance from the town, &c. with a number of

other particulars relative to cleanliness which it is needless to

enumerate here; not forgetting the quarantines, lazarettos, &c. without

which he does not think any activity on the part of the people can

avail.

Dr. Rush, who is an enemy to quarantines, recommends to the people

of Philadelphia the following particulars: “1. Let the docks be

immediately cleaned, and let the accumulation of filth in them be

prevented in future, by conveying water into them by a passage under

the wharves, or by paving them with large flag stones inclining in

such a manner towards the channel of the river as that the filth of

the streets shall descend from them (after it falls into the docks)

into the river. This method of paving docks has been used with

success in the city of Brest. 2. Let every ship that belongs to our

port be compelled by law to carry a ventilator. Let all such ships

as are discovered to contain foul air in their holds be compelled

to discharge their cargoes before they reach our city, and let the

ships in port be compelled to pump out their bilge water every day.

3. Let the common sewers be washed frequently with streams of water

from our pumps. Perhaps an advantage would arise from opening them,

and removing such foul matters as streams of water are unable to wash

away. 4. Let the gutters be washed every evening in warm weather. By

frequently washing the streets and pavements the heat of the city would

be lessened, and thereby one of the predisposing causes of the fever

would in some measure be obviated. 5. The utmost care should be taken

to remove the filth from the yards and cellars of every house in the

city. Hog-sties should be forbidden in yards, and the walls of cellars

should be whitewashed two or three times a year, and their floors

should be constantly covered with a thin layer of lime. Whitewashing

the outside of houses in sickly streets would probably be useful. 6.

Let the privies be emptied frequently; and let them be constructed

in such a manner as to prevent their contents from oozing through the

earth so as to contaminate the water of the pumps. 7. Let all the filth

be removed from the neighbourhood of the city, and let the brick kiln

and other ponds be filled up from time to time with the earth which is

obtained in digging cellars. 8. In the future improvements of our city,

let there be no more dwelling houses erected in alleys. They are often

the secret receptacles of every kind of filth. 9. The predisposition

of our citizens to be affected by the remote and exciting causes of

the yellow fever would be very much lessened by their living sparingly

upon fresh animal food, and chiefly upon broths and fresh vegetables,

rendered savoury by spices and a small quantity of salted meat, during

the summer and autumnal months. A constant attention should be paid at

the same time to bodily cleanliness.”

These are the modes of prevention which seem to be the most obvious

and necessary, as well as approved by the best judges. It appears,

however, that in certain cases neither human skill nor care can prevent

or cure the disorder. The number of physicians who have fallen victims

to this disease are too manifest proofs of this.[200] Indeed, when

we consider that it is the nature of the distemper first of all to

attack the vital parts, and that this attack may commence with little

or no pain, it is evident that an attack may be begun before we think

of a preventive, and may, as it were in a moment, prevail in such a

manner as to be entirely beyond the reach of medicine, before even

a medicine is thought necessary. In every case therefore, where the

yellow fever prevails, an attention to health becomes as necessary as

procuring the means of subsistence. Every precaution must be used, and

when we have done so we are not even then secure. We are ignorant of

the natural causes which produce it; they are invisible to our senses,

and incomprehensible by our understandings. Safety then can only be

expected from the protection of that Being to whom all natural causes

are known, and to whom all must yield obedience. In short, we may sum

up the whole in the well known sentence, “_He that will love life, and

see good days, let him refrain his_ TONGUE _from_ EVIL, _and his_ LIPS

_that they speak no_ GUILE. _Let him eschew_ EVIL _and do_ GOOD; _let

him seek_ PEACE, _and ensue it_.” A very strange receipt indeed, we

will say; but how often have we tried it?

[200] Dr. Rush pathetically laments the loss of Dr. Nicholas Way,

who had been his intimate friend. In a poem called the _Political

Greenhouse_ we find some account of the death of Drs. Smith, Cooper

and Scandella, who also perished; and the fates of Drs. Smith and

Scandella were connected with one another. Dr. Cooper of Philadelphia

was seized with the disease in that city. A friend who attended

him sickened during his attendance, and Dr. Cooper, before he had

thoroughly recovered, attended in his turn the friend who had taken

care of him. A relapse ensued, and the Doctor died. Dr. Smith was

intimate with Dr. Scandella of Venice, who had come from thence to

America, and was at New York during the time of the fever in 1798.

Intending to return to Europe, he waited there for the English packet

boat; but, being informed that a foreign lady in Philadelphia, for

whose daughter he had an attachment, was sick of the yellow fever, he

returned to that city; but could not save either mother or daughter

from the cruel disease. On Scandella’s coming to New York the second

time he could find no body that would receive him as a lodger. In

this forlorn situation he wrote to Dr. Smith, who instantly gave him

an invitation to his house. Here he was seized with the fever, and

was attended by Dr. Smith, until the latter also fell sick. A friend

who lived in the house attended first Dr. Scandella, and then Dr.

Smith, until both died.

The cure of the yellow fever hath been attempted in various ways,

according to the theories laid down by different physicians concerning

its nature. Dr. Cullen considers it as of the nature of _typhus_

fever,[201] and of consequence would have treated it with antimonials;

most probably with his favourite remedy, tartar emetic. Dr. Rush,

from his opinion that it is the highest degree of inflammatory fever,

recommends powerful evacuants, and large blood-letting, in 1793, and

1797, though he seems to have altered his sentiments in 1798. Dr.

Brown, who would have considered it as a disease of debility, would

of course have prescribed opium and other stimulants; and lastly, on

the theory of Dr. Mitchill, that the disease proceeds from an _acid_,

remedies of a nature directly opposite, viz. _alkalies_, ought to

be useful. It is not the design of this treatise to enter into any

consideration or comparison of the practice of different physicians,

but to point out at once, to those who are not physicians, the remedies

which have been, by general consent, accounted most efficacious; and

in this respect there is now a surprising unanimity among gentlemen of

the medical profession. Those which hold the first rank are,

[201] Typhus Icteroides.

1. _Mercury._ In the use of this medicine the physicians of the Western

world have certainly excelled those of the East. In a paper in the

Medical Repository, vol. i, p. 500, Dr. Holyoke of Salem says that

the practice of giving mercury was first introduced into New England

about 60 or 70 years ago,[202] by a physician from Scotland, a disciple

of the celebrated Pitcairn. In 1734 or 1735 it was used successfully

in a very malignant disease called the _throat distemper_, and which

he thinks was of the same genus with the _malignant ulcerous sore

throat_ treated of by Huxham. About 45 years ago it was commonly used

in pleurisies and other inflammatory disorders; and, ever since the

year 1751 or 1752, it has been used by Dr. Holyoke himself. In Europe,

however, the case was exceedingly different; mercury being there

generally reckoned pernicious in such disorders, from a notion of its

being inflammatory, or dissolving the blood. Thus, on the appearance of

the Boullam fever in Grenada, Dr. Chisholm found himself exceedingly at

a loss what to do, and he seems to have _invented_, rather than to have

been previously _instructed_ in, the mercurial practice. His success,

however, was very great, provided he could raise a salivation; but in

order to do this he was frequently obliged to give much larger doses

than he had ever done before, or had any notion of doing. In p. 159 he

mentions one patient who took 400 grains before the salivary glands

were affected. He tells us, however, p. 271, that, on the re-appearance

of the fever in 1794, he gave the medicine in much larger doses than

before; beginning with mercury without any previous evacuations which

he had used the year before, and with such success that he did not

lose a single patient; so that he professes himself almost ready to

pronounce it _infallible_ in curing the disease. The practice of

giving mercury is confirmed by Dr. Rush, and indeed by so many other

physicians, that it is superfluous to quote them. Dr. Nassy, formerly

mentioned, again stands almost singular in condemning the medicine,

because it dissolves the blood; but it is impossible that any theory,

however plausible, can stand against well attested facts. Dr. Rush is

indeed very much of opinion that it is easily practicable for people to

cure themselves of this disorder, dreadful as it is, provided they take

it in time. But by this we must understand, that the very moment the

person feels uneasiness he must apply a remedy, and not trust to nature

in any case whatever. When the yellow fever prevails, every one who

feels the slightest disorder may be assured that his disorder partakes

of its nature, and ought immediately to have recourse to a mercurial

purge. Dr. Rush says also that bleeding should be first performed. The

many disputes, however, concerning the efficacy of this last remedy,

must make any person hesitate at the application of it without medical

advice, especially as a mercurial purge may be safely taken without it.

[202] The Doctor’s letter is dated December, 1797.

2. _Blood-letting._ This was, by Dr. Rush, considered as the capital

remedy in 1793; but Dr. Chisholm, who made trial of it in the Boullam

fever, found that it could not be used with any degree of safety. Dr.

Jackson says it is frequently necessary in the Jamaica fever, but

it was seldom of use to repeat it. Dr. Walker says it increased the

debility in the same fever of 1793, 94 and 95. Dr. Moseley recommends

it in the yellow fever of the West Indies, but only in the first

stage, and says that the injudicious performance of this operation,

when the second stage has come on, has given occasion to the opinion

that a patient cannot bear two bleedings. Dr. Coffin found it useful

at Newburyport in 1796, in the beginning of the disease, and says it

may sometimes be repeated. Repeated bleedings are recommended by Dr.

Ouviere of Philadelphia, who says they are not to be omitted even in

fat and weak habits. This is confirmed by the editor of the Medical

Repository, vol. i, p. 92, who says it was used with success at the

hospital in New York in 1796, “at repeated times, to the amount of

from 24 to 175 ounces, and in some cases several times performed

after the sixth day of the disease, to the great relief of the sick.”

Dr. Bruce recommends it in the island of Barbadoes in the robust and

plethoric.[203] Dr. Hillary says that in the same island it is always

absolutely necessary, and that it may even be repeated once, but

that a third bleeding was seldom necessary. Dr, Wright, in the same

island, found the “lancet not only unnecessary but dangerous in the

extreme.” Dr. Clarke, in Dominica, found it generally very pernicious,

and assures us “that there was not a single instance of an emigrant

recovering who had been bled in this disease. In the first 24 hours

indeed it was admissible in the young and athletic seized a short time

after their arrival, but after that time, or at most after 36 hours, it

will always be found prejudicial, if not fatal.” It was not tried by

Dr. Bryce on board the Busbridge. It is recommended by Dr. Currie in

his treatise on bilious fevers.

[203] Lind on hot climates.

It is needless to take up time with a detail of more opinions. From

those already recited it is natural to conclude that the fever in some

places, and at some times, differs very much from others. This is

conformable to the opinion of Dr. Currie, who says, that the bilious

fever “is amazingly influenced in its aspect and symptoms by the

soil, situation, climate, season, and by the preceding and present

state of the atmosphere, and the customary mode of living of the

inhabitants.” The utility or even safety of blood letting then seems

to depend on circumstances which can be only known, and that perhaps

with difficulty, at the time; nor can its success in one season be a

sufficient argument for the general practice of it in another.

3. _Vomits_ have generally been found dangerous. Dr. Moseley, Dr. Rush,

and indeed almost all who have practised in this disease, say, that

they cannot be ventured upon without extreme caution. Dr. Chisholm,

in imitation of the Russian practice in the true plague, attempted

the cure of the Boullam fever by vomits; but, as one half of those to

whom they were exhibited died of the disease, he did not think there

was any encouragement to proceed. Perhaps as preventives they might be

useful, as it seems probable indeed that any thing must be which tends

to cleanse the alimentary canal.

4. _Purgatives_ are found extremely useful, both as preventives and

medicines. There are innumerable instances where an incipient attack

of the disease has been carried off by a brisk purge. Dr. Chisholm was

able to remove the slighter cases of Boullam fever by purgatives. He

used at first glauber salts with two grains of tartarised antimony,

which generally proved emetic as well as purgative; but he afterwards

used with advantage the better purging salts, rendering the solution

palatable by the addition of lime juice and sugar. But in all violent

cases he would depend on nothing but mercury.

5. _Stimulating medicines._ The stimulants commonly used on the

Brunonian plan, viz. opium, bark, &c. are universally owned to be

pernicious. In a letter from Dr. Sayres to Dr. Currie,[204] the former

says, that “bark, wine, and a number of the common stimulants, were

given on the first appearance of debility taking place; but with little

success. Finding the common round of medicine ineffectual in the

advanced state of the disease, I determined (says Dr. Sayres) to use

a different mode of treatment. In three cases of adults, two of which

had the black vomiting, and the third was in a gore of putrid blood

from the mouth and nose, I forbid medicine, and directed very cold

water and brandy mixed strong, to be given as freely as possible. It

had the happy effect of checking the vomiting in two cases, when the

stomach had rejected every kind of mild drink, &c. and, by continuing

that practice almost so as to produce high intoxication, for two or

three days, these two cases were recovered almost from a state of

death. The third was apparently much benefited for three days; but,

being in a high putrescent state when I saw him, and having lost a very

considerable quantity of blood from the mouth, nose, &c. he died oil

the ninth day.” In the Boullam fever Dr. Chisholm used the Angustura

bark in twelve cases, eight of whom recovered; but, though it was

greatly superior to the Peruvian bark, he did hot think proper to trust

to it in violent cases.

[204] Memoirs of Yellow Fever, p. 137.

6. _Alkaline remedies._ These have been recommended on the supposition

that the yellow fever is occasioned by an acid. Their efficacy

is attested by Dr. Jeremiah Barker of Portland, who says that

they afforded more relief than any others, and that all the cases

accompanied with yellowness ended favourably, but one. The alkaline

remedies “would actually alleviate the distressing pain and anguish at

the stomach, which would not yield to opiates. The morbid excitement

too was _evidently_ under the controul of alkalies; the febrile

disturbance appeared to be in a direct ratio to the degree of virulence

in the deleterious cause.”[205] We have not any particular details of

cases, nor any form of exhibition pointed out. In a dysenteric fever

indeed he says that he used a mixture of a quarter of an ounce of

salt of wormwood with a pound of lime water; the dose from one to two

ounces every hour, once in some cases every half hour, or oftner, in an

infusion of camomile.[206] Calcined oyster shells were sometimes given

from 40 to 60 grains.

[205] Medical Repof. vol. ii, p. 149.

[206] In this mixture the fixed air in the alkaline salt would

instantly destroy the virtues of the lime water by precipitating the

lime. What is sold for salt of wormwood is neither more nor less than

common pearl ash.

7. _Cooling medicines, external and internal._ The good effects of

cold water applied to the body in fevers has long been known. Dr.

Jackson observes that it was first introduced at Rome in the infancy

of the Methodic sect, and attained afterwards a high degree of

celebrity. Its reputation was highly raised by a cure performed on

the emperor Augustus; but soon after sunk by the death of Marcellus,

the presumptive heir to the empire, to whom it had been improperly

prescribed. It was soon after prescribed again, and greatly used by

Galen; and after him was in still greater favour with the Arabian

physicians; but, since the revival of literature, has been much

neglected till of late. In the fever of Jamaica, after the fatal

symptoms were removed, Dr. Jackson says, that the tone and vigour of

the system was best restored by cold bathing, “which (says he) I am

induced to consider as the most important remedy in the cure of the

fevers of the West Indies, and perhaps in the cure of the fevers of

all hot climates. Though it might not absolutely cut short the course

of the disease, yet it seldom failed to change the fatal tendency of

its nature.” Even in the last stage of the yellow fever, where the

patient seems at the utmost extremity, our author tells us that he has

alternately employed warm and cold bathing with the greatest success.

He has even wrapped the body in a blanket soaked in water in which a

large portion of salt had been dissolved, or which had been steeped

in brandy or rum, enjoining the liberal use of wine, or more powerful

cordials. Dr. Wright also mentions the cold bath with approbation; but,

as it cannot be very generally depended upon, its use ought never to

supersede that of other remedies, especially mercury; and indeed this

may be said of every thing else; for though by the use of the remedies

already mentioned the disease has sometimes been subdued, yet the

success has never been so great but that every one under an attack of

the yellow fever must be considered as in very considerable danger.

In the use of cooling medicines, taken internally, we must have a

particular regard to the state of the stomach, which is excessively

irritable; and it is surprising that this irritability is of such a

nature that, though it will certainly reject the mildest drinks or

medicines, it may yet retain others seemingly much more acrid, as

has already been observed in the case of Dr. Sayres’s patients. As

long ago as the time of Diemerbroeck a solution of common salt in

vinegar was recommended in the plague. Since that time it has been

found extremely useful in the dysentery; and, as in this disease the

bowels are likewise in an extremely irritable state, it would seem

from analogy that the same medicine might be useful also in the yellow

fever. Dr. Wright of Jamaica (who attests the efficacy of the medicine

in dysentery, belly-ach, remittent fever, and putrid sore throat) gives

the following improved method of preparing it: “Take of lime or lemon

juice three ounces; of marine salt as much as the acid can dissolve;

of any simple distilled cordial water one pint; and of loaf sugar a

sufficient quantity to sweeten it. The dose of this mixture must be

proportioned to the age and sex of the patient, and to the violence of

the disease. A wine glassful may be given to adults every two, four or

six hours.”

8. _Medicines proper for relieving the most urgent symptoms of the

disease._ The most distressing symptoms attending the yellow fever

are, head-ach, vomiting, pain in the stomach, and pains in the back,

loins and limbs. Blisters were tried by Dr. Chisholm to mitigate the

pain in the head. “I have (says he) blistered the whole head, and the

inside of each thigh, at once, in several cases, without producing the

least change in that or any other symptom. I have had recourse to this

remedy to lessen pain, to remove irritability of the stomach, and to

raise the vital powers in the low, comatose stage, but always except

in two cases without success.” In one a blister to the scrobiculus

cordis completely removed the irritability; the other case is related

in the next section. Another practitioner found a blister applied to

the forehead of remarkable use in four cases; but Dr. Chisholm supposes

them to have been of the less violent kind. Others have also found them

occasionally useful; so that, though dependence cannot be placed upon

these remedies, it seems improper to reject them entirely. But the most

effectual method of allaying the irritability of the stomach was by the

exhibition of vitriolic æther. Dr. Chisholm adopted the medicine on the

recommendation of M. Poissonier, and found it to answer the character

given of it by him. Dr. Chisholm gave about a teaspoonful in half a

glassful of cool water, after which the patient continued undisturbed

about two hours, when the dose was repeated. Sometimes, though seldom,

the stomach was thus enabled to bear the bark, but otherwise the æther

was given every three hours. If the stomach retained the bark after

the first dose, æther was then given only once in five or six hours.

Æther, says he, given in the manner I have mentioned, is extremely

grateful to the patient; it occasions an agreeable warmth along the

oesophagus, and gently stimulates the stomach. This effect, however,

does not continue long; but the frequent production of it at length

gives it permanency. It appears to act as a tonic, an antiseptic,

and an agreeable stimulant; a warm glow overspreads the surface; and

thirst, nausea and oppression, often have fled before it.

These are the remedies most approved, and which may with most reason be

expected to succeed in the cure of the disease, where it is _within the

power of medicine_. But there are certain cases in which medicines of

the ordinary kind cannot act. Sometimes, at the very beginning of the

disease, all the three stages of it seem to commence at once, or to be

mingled in such a manner that medicines have not time to exert their

force. Again, in the last stage, Dr. Jackson compares the attempts to

overcome the torpor of the system by medicine, to that of attempting

to revive a dead corpse. “I have, however (says he) seen instances of

such unexpected recoveries from the most hopeless state in fevers,

that I seldom totally despair as long as life remains.” It is evident,

however, that the remedies employed must be different, according to

the different times of the disease. In the beginning it is probable

that by bleeding to an extreme degree, so that the greater part of the

mass of blood was taken away, the disease might be subdued at once,

and the patient recover, as has been already mentioned of the plague,

p. 363. But the idea of death seems to be so firmly connected in the

human mind with the loss of a great quantity of blood, that very little

hopes can be entertained of any good being done in this way. It seems

indeed owing to this invincible association of ideas that the enemies

of Dr. Rush have found means to load him so much and so undeservedly

with reproach. Another method, less exceptionable, though probably also

less efficacious, is by injections into the veins. But what are we to

inject? Here, to the disgrace of experimenters, let it be recorded,

that such has been their innate propensity to cruelty, that though

we know a number of substances which, injected into the veins of an

animal, will _certainly_ kill it, yet we scarce know one which can

be injected with even a _probability_ of doing good. In the Medical

Extracts indeed we find it related that at Guadaloupe a physician had

cured the most inveterate diseases by injecting _certain remedies_

into the veins. But what these remedies were we know not. In the same

paragraph indeed it is said that alarming symptoms from the bite of

a viper were removed by injecting diluted _spirit of hartshorn_ into

the blood. As the bite of a viper is attended with a dissolution of

the blood, and yellowness of the skin, we may thence derive some faint

hope that such an injection might also be useful in desperate cases of

the yellow fever; but, till further experiments are made, we can say

nothing more on the subject.

Lastly, when the disease has proceeded so far that the blood flows out

from all parts of the body, and it is evident that the patient must

die were it only from the loss of that fluid, then, if ever, the once

celebrated remedy of the transfusion of blood may be of use. An account

of this remedy has been given in the former part of this work. It must

be evident that human blood ought to be preferred to that of a brute

creature; but the danger incurred by one who should lose a quantity of

blood so near to a person capable of giving the febrile infection must

certainly be very great. Nevertheless, there are cases in which the

death of a beloved object inspires more horror than the thoughts of

any personal danger, or even death itself, to the person who beholds

it. In such cases no doubt there are many that would run all risks;

and, should any case prove successful, no doubt the person who had the

courage to make the experiment would find ample recompense in saving

a person he loved from death, and in establishing a truth of such

importance to the world in general.[207]

[207] From the accounts of the most eminent practitioners it appears

that the fever of 1798 differed considerably in its nature from that

of 1793. In Philadelphia particularly there were many cases that

could not bear the stroke of a lancet. In Boston it seems to have

partaken more of the nature of the true plague than in other places

and other years. The dissections of Drs. Rand and Warren manifest a

difference between the effects of it on the body at that time, and

what they were in former years. Buboes, carbuncles, or what were

thought to be so, and petechiæ, were observed here, as well as in

New York. One remarkable case, related in the next section, shows a

disposition to induration, very uncommon in the yellow fever, though

so common in the true plague that in the former part of this treatise

it is taken for the characteristic mark of the disease. None of

those eschars called _tokens_, however, were in any case observed.

The disease here bore bleeding much better than at Philadelphia; but

mercury was always the most efficacious remedy, where a salivation

could be raised. The warm bath was used in some cases with success.

Large evacuations were useful, and some patients bore three or four

bleedings, with repeated doses of jalap and calomel. The distemper is

by one gentleman styled a novel disease, and differing essentially

from other bilious complaints. In one case the patient died of

apoplexy; and another would probably have shared the same fate,

had it not been for timely bleeding. The black vomit was almost

inevitably attended with death. The matter evacuated was thought

to be extravasated blood from vessels in some cases mortified. The

yellow colour was judged merely accidental; but Dr. Lind’s opinion

of its arising from a dissolution of the blood seems now to be

universally abandoned, and the colour is supposed to arise from a

suffusion of bile, owing either to the obstruction of the ducts, or

too great secretion.

The names of the gentlemen upon whole authority the above facts

stand cannot be mentioned, as permission for so doing has not been

obtained. Their authenticity, however, can be proved by undeniable

documents.

The origin of the fever at Boston has, as usual, been disputed;

but the common opinion is that it was generated. It now appears,

however, that, though there are very strong reasons for supposing

it to have originated in the place, there are others equally strong

for believing that it was imported. It is ascertained that a vessel

on board which persons had died with the yellow fever lay in the

neighbourhood of the family first seized with the disease in 1798.

On the other hand, there were instances of many that were seized

with the distemper who had not even left their houses for months

previous to the contagious period. This year (1799) there have

been unquestionable proofs of the importation of the fever from

the Havana. The quarantine, however has kept the infection from

spreading; though the state of the atmosphere has been much less

favourable to the disease than last year, and has therefore no doubt

contributed to preserve the health of the people.

We have been favoured with the following list of those affected with

the disease this year at Newburyport:

_When taken._ _Remarks._

Ossytaway June 8. A seaman on board the vessel.

* March 28. do.

* Sol. Haskel July 3. On board while her cargo was discharging, &c.

* His nephew 4. do.

Duggins 5. { Present when the ballast was thrown out, also

{ on board.

Tho’s Norwood 6. } Worked in a hatter’s shop about 16 rods from

Tho’s Nor’d jun. 6. } the vessel when graving, the wind blowing

* Robert Lord 6. } all or most of the time from the vessel

} towards shop.

Stephen Tilton 6. { Worked on the wharf where the vessel was

{ hauled in.

Paine 7. } Loaded and stowed the vessel for another

Herbert 7. } outward bound voyage. These men lived at

* Walleigh 7. } Amesbury.

* Miss Dole 9. { Worked in a tailor’s shop, by Norwood’s

{ hatter’s shop.

Sally Wood 10. do.

{ Along side the vessel, and filled the old

James Wood 11. { bread casks for her outward voyage. He also

{ lived near the wharf.

Widow Waite 11. { Doubtful whether her disorder was the fever.

{ Lived at the bottom of the wharf.

* Wm. Thompson 11. { Lived at the bottom of the wharf, & was along

{ side of the vessel.

Jona Pearson 13. { Kept a store near the wharf, & was along side

{ the vessel.

Danl. Favour jun. 15. Worked near the bottom of the wharf.

Goodhue 15. { On board the schooner, and trimmed the sugar

{ casks.

* Rev. Mr. Milton 15. Visited the sick at Norwood’s.

* Mary Dunn 15. Lived at Norwood’s.

{ Handled the bags of money that came in the

Giles Parsons 16. { vessel, and counted it. Was along side of

{ the vessel.

* Sol. Currier 16. On board the schooner. Helped to haul her in.

* Sam. Currier 18. On board. Helped to discharge the ballast.

* Greaty 18. { On board when the vessel was discharging her

{ cargo.

Mrs. Wood 19. Widow of James Wood, above mentioned.

* Sally Edwards 19. Lived with James Wood.

* Her brother 19. { Lived opposite, & often in, Wood’s house

{ during the sickness.

_Those marked with asterisks recovered._

“The fever unequivocally the same which prevailed in this town in

1796, and in Boston and Portsmouth the last summer.

“The vessel supposed to have introduced the disease was the schooner

Sally, Joseph Gunnison master, which arrived at Bartlett’s wharf on

the morning of the 29th of June last, after a passage of 18 days,

from St. Thomas’s, where the yellow fever prevailed and was very

mortal, with 17 tierces of sugar, and cash in bags. She discharged

her cargo before one o’clock on the day of her arrival. In the same

afternoon her stone ballast, taken on board at St. Thomas’s, was

thrown on deck. On the first of July she was moved to a wharf 10

rods below, and her ballast was thrown on a pier wholly covered with

water. This ballast was covered with a viscous substance, which

adhered to the fingers, and was very offensive to the people working

on the pier. On the same day she was hauled in between the two

wharves, and graved, and removed back to Bartlett’s wharf, where she

was loaded with lumber for another voyage, on which the sailed the

11th of July.

“It is still questioned whether this fever was imported, or generated

in the town. You will find that all who have had it have been

connected with that vessel, or lived or worked near where she lay,

or visited the sick near the place where the vessel was graved. And

undoubtedly there were many persons alike connected and situated who

did not take it, although the inhabitants living near the wharf very

soon moved away. It is said that there is an old distil-house near

the bottom of the wharf, which has not been used for many years, and

that the tubs and cisterns are replete with putrid exhalations. I do

not know that this fact has been verified. It is also said that back

of the store used by the deceased Jonathan Pearson, were brewers’,

soap boilers’ and tallow-chandlers’ works which had all been used in

the last-spring. This is true; but I do not know that it is evident

that any putrid substances were formed there. Dr. Vergnies informs

me that there was one case of the yellow fever 2 days before the

vessel arrived. In my mind the weight of evidence in favour of the

importation greatly preponderates. In 1796 the evidence was very

unequivocal that the fever was generated.

“Just before the vessel arrived we had some very warm weather,

and the heat was oppressive to the feelings. The thermometer two

afternoons was at 90 deg. Perhaps it may not be unuseful to mention

that calomel was given liberally. All who recovered were salivated.

All who could not be salivated died: and unfortunately some who were

evidently salivated died. Since forming my table I find that a Mrs.

Plummer who lived near the wharf will die.[208] Her case for the

first seven days was supposed to be an intermittent fever; then it

assumed the symptoms of the yellow fever. She was taken on the 11th

July.

[208] “This patient is now dead.”

SECTION IV.

_Remarkable Cases._

So many cases have been enumerated in the course of this work, that

little more remains to be done in that way. The following are given,

not merely on account of their singularity, or to give instances of

surprising and unexpected recovery, but to elucidate some points of

doctrine hinted at before, and not sufficiently explained.

1. _Spontaneous burning._ In the former part of this treatise several

extraordinary instances of this kind are given; but a doubt was

suggested whether the fire was produced _internally_, or _externally_.

The following account, from the Medical Extracts, determines the

matter. The circumstance took place in England, in the year 1613. One

Hitchill, a carpenter, came home from his work as usual, without being

sensible of any indisposition, and went to bed. In the night time, or

early in the morning, his wife awaked and found him dead by her side.

His body was so hot that it could not be touched, and he continued

burning internally for _three days_. No flame appeared on the outside,

only an hot steam issued from his body; and we are not told what was

the ultimate effect of the fire, or whether his body was consumed to

ashes or not. In the same work we are told of a woman who was found

dead in her room in the morning, and consumed to ashes, her very bones

being calcined to whiteness. The floor on which she lay was very little

burned. This last case, however, is not so directly in point as the

former, which seems decisive with regard to the internal origin of the

fire.

2. _M. D’Obsonville’s case of the plague._ In the former part of this

treatise it has been said that heat destroyed the plague; but, on the

authority of the Russian physicians, that the disease could not be

treated in hot rooms. The following case, however, shows that even

exposure to a burning sun in a desert, to the cold air of night, and

to the most injurious usage, cannot always render fatal an attack

even of the most dreadful distemper in the world. M. D’Obsonville had

undertaken a journey over land to the East Indies, in order to execute

an important commission from the French government, in 1761, the very

time when the plague raged violently in the east. He describes his

case in the following words: “I felt the first symptoms of the plague

two small days journey from Aleppo, when I had entered the desert;

and at night, when going to rest, complained of a general uneasiness

and heaviness of the head. In the morning the fever was known to

be inflammatory; and from that time I had no longer any sleep. The

third, the fever and head-ach became more violent, two buboes began

to rise on my left side, my tongue was swelled, and of a brown violet

colour. The fourth and fifth days, sores began to appear on my loins,

the spine of my back, and the scrotum; some of which were as large

as the palm of my hand, and their colour at first was a red purple.

I was obliged, however, to rise, like other passengers, at two in

the morning, and travel on horseback till eleven. Unable to swallow

any thing but a little water, abandoned by my Christian servant, who

durst not come near me, and attended by an Arab, that I could not

understand, the violence even of my illness, and a little fortitude,

had hitherto contributed to support me; but my weakness increased

hourly, and I could no longer sit my horse, when an Armenian lady,

named _Tcheremani_, determined to ride him herself, and with the utmost

humanity gave up her camel to me, on which was a kind of litter. On the

sixth day the symptoms all appeared aggravated; at one moment my pulse

beat with an astonishing quickness, and fire seemed to run through my

veins; and the next, my blood was intercepted in its course, a moisture

covered my forehead, and I felt myself fainting, though without being

delirious, or losing my senses.”

The caravan having arrived at a small ruined village named _Soccun_,

in the desert, it was resolved to leave M. D’Obsonville to his fate,

his case being considered as desperate; and indeed he says he was

left alone at his own request. A small horde of Arabs resided in that

village, though ruined, and our patient was consigned to the care

of a religious person called a _moullah_. This gentleman, like too

many others, did not choose to _serve God for nought_, and therefore

demanded fifty piastres in silver, besides some effects, in recompense

for the charity which he was about to extend to the unhappy traveller.

Having received those, and the caravan being gone, the moullah and

his wife in the night time laid M. D’Obsonville across an ass, and

carried him about a mile into the desert, where they left him to shift

for himself. Happily, however, either through accident or design,

these religious devils had deposited their prey near some water,

which undoubtedly, as he still retained his senses, was the means of

preserving his life. “It was there (says he) that, extended upon the

earth, with no other succour than a little water, nature laboured to

expel the poison by which I was oppressed. One of the buboes burst of

itself; the pestilential sores, which appeared first of a red purple,

became yellowish, then brown, and lastly black. These parts then

becoming gangrenous, formed hard and thick scabs, which, kernelling and

falling away from the quick flesh, left very deep ulcers. This was the

first epocha of health; an abundant suppuration began, and the fever

almost immediately left me.”

Having remained alone in the desert for eight or ten days, he was found

by chance by some Arabian women, who brought him to their place of

residence, washed his sores with water, brought him dried herbs for

his bed, and gave him barley bread, butter and curds for his food;

endeavouring besides by their songs to comfort him, and alleviate

his distress as much as possible. With these women he remained twenty

days, reduced to an extremity of weakness by reason of the discharge

from the sores. At last, having learnt a few Arabic words, he prevailed

upon two of the husbands to conduct him to Aleppo, about seven days

journey distant. He was now mounted astride on a camel (a very hard

trotting animal) and by forced marches accomplished the journey in six

days, when he appeared before the consul, the European merchants, and

a crowd of people, in a condition without example; almost naked, with

five running buboes, the little covering he had foul, infected with

ulcers as long as the palm of the hand, which had eaten away the flesh,

and in some places discovered the bones, having besides two holes in

the scrotum. From this miserable condition he recovered in a month. It

would seem that in some cases the human body, as well as mind, rises

superior to every indignity; and that in proportion to the degree of

injury and oppression is the tenacity of life, as well as energy of

spirit.

3. _Remarkable cure of the plague by exposure to cold and wet._ M.

Savary relates that the captain of a vessel informed him that, having

touched at Constantinople when the plague was raging there, some of his

sailors caught the distemper; two died suddenly, and by assisting them

he was infected. “I felt excessive heat (says he) which made my blood

boil; the disease seized my head, and I perceived that I had only a few

moments to live. The little remaining reason I had taught me to attempt

an experiment. I laid myself, quite naked, all night on the deck; the

heavy dews that fell penetrated to my very bones; in a few hours I

could breathe freer, and my head was better; my agitated blood became

calm, and, bathing the morning after in the sea, I was perfectly cured.”

4. _Extraordinary effect of_ FEAR _in rendering the contagion of the_

SMALL POX _effectual_.[209] “A very beautiful girl, twenty-five years

of age, servant to captain Morton, had never had the small pox, and

had the most dreadful apprehensions of that disease. On the twentieth

of January, 1791, about four in the afternoon, she was standing near

the kitchen fire, when a joiner in the neighbourhood came to the door,

which is about sixteen feet from the fire place where the girl stood.

Mrs. Morton found fault with the man for not coming sooner to finish

some work, and he excused himself by saying his apprentice was ill of

the small pox, which had delayed him. The girl immediately clasped her

hands, and exclaimed, God forgive you, but I will lay my death to you.

From that moment she became chilly, then hot and restless. She passed

a very bad night, frequently exclaiming, God forgive Calder, he has

killed me; meaning he had given her the small pox. In the morning of

the twenty-first I was sent for, and found her very hot, with a quick

pulse, great sickness and anxiety. I ordered her an emetic, and assured

her she did not need to be in the least alarmed, as she could not

possibly have caught the disease. She seemed to be convinced that her

fears were groundless; but next day, the twenty-second, a violent rash

appeared; on the twenty-third the small pox came out, of the worst kind

I had ever seen, and she died on the ninth day from the eruption.”

[209] Haygarth’s Sketch, vol. ii, p. 405.

5. _Inefficacy of_ FEAR _to render the contagion of_ YELLOW FEVER

_effectual_. Dr. Rush mentions a young woman so exceedingly fearful of

the disease, that she was troublesome to all around her. Afterwards she

happened to be under the necessity of attending _seven_ persons ill

of the fever, and yet escaped unhurt. This shows that fear (and the

same may be said of any predisposing cause) is not always sufficient

to produce the disease. The foregoing case is so extraordinary that

Dr. Haygarth is of opinion that the patient must have been previously

infected; but of this there is no evidence; and it is bad reasoning to

endeavour to establish a fact by our own ignorance. The only argument

that is or can be used in such cases is, “I cannot understand how such

a thing could have happened, _therefore_ it _has not_ been so.” 6.

_Boullam fever cured by a blister._[210] The patient was a tradesman in

St. George’s, Grenada, and had “all the symptoms of the disease except

the febrile heat. A blister was applied between the shoulders, without

administering any medicine previously except the solution (mentioned

p. 530) which operated very moderately. The effect was wonderful; the

discharge was uncommonly large, black, and fœtid in an intolerable

degree; and the instant this took place the patient became better; and

soon after, without the use of any other remedy, recovered.”

[210] Chisholm’s Essay, p. 169.

7. _Yellow fever of Barbadoes cured by vomiting._[211] The patient

was a young man, about twenty-four years of age, surgeon to a Guinea

ship. Being a lover of spiritous liquors, he had been drunk three days

and nights successively, and in that condition had run races with the

sailors on the shore, in the heat of the mid day sun. The last night

he slept in the open air under a tamarind tree, and in the morning

was seized with the fever, attended with the most violent retching

to vomit, insomuch that he could scarcely answer yes or no to the

questions asked him by the Doctor. Sixteen ounces of blood were taken

away, which was very florid, thin and dissolved. He was directed then

to drink warm water to cleanse his stomach, which he did to the amount

of three gallons, which he discharged, together with immense quantities

of yellow and blackish bilious matter. He then took a grain and an

half of opium, and slept some hours, after which a dose of manna and

tamarinds carried off by stool a good deal more of bilious matter, and,

with the help of some elixir of vitriol, mint and snakeroot tea, he

recovered in a short time.

[211] Hillary’s Observations, p. 175.

Dr. Rush, in a letter published in the newspapers last year, after

regretting the inefficacy of bleeding and purging, suspects “that death

occurred from the stagnation of acrid bile in the gall-bladder, or its

adherence to the upper bowels, as mentioned by Dr. Mitchell in 1741,”

which he proposes to evacuate by strong emetics and purgatives, so

as to occasion an artificial cholera morbus; and he greatly commends

this mode of practice. “Vomits (says he) are old remedies in the yellow

fever of the West Indies. I gave them on the first day of the disease

in the year 1793, and always without success. They uniformly did harm

when given in the beginning of the fever in its worst grade, in 1797.

The reason of this failure in their efficacy I now perceive was because

they were given _before_ the violent morbid action in the system

was reduced or moderated by bleeding and purging. After this change

is introduced in the disease they are perfectly safe. The time for

exhibiting them should be regulated by the pulse and other symptoms.

In moderate cases of the fever they are as proper in its first stage

as on the 4th day. As there is a blistering point in all fevers, so

there appears to be an _emetic point_ in the yellow fever. It may occur

on the second, and it may be protracted to the sixth or seventh day

of the disease. I have not given the medicine I have mentioned in any

case where the patient complained of pain or burning in the stomach;

but I have considered a nausea, and a moderate degree of puking, as no

obstacle to its use; for Dr. Physic has taught me by his dissections

that these symptoms may exist without the least inflammation in the

stomach, and that they have been absent where the stomach has appeared

after death to have been highly inflamed.

“The cure of the fever should not rest upon a single dose of the

medicine. I have given two doses of it in a day in several cases, and

have given it in one case every day for three successive days.

“It has often been remarked, that no two epidemics are exactly alike.

They vary not only in different climates, but in the same climate in

different years. They even vary with the changes of the weather in the

same season. The fever of 1797 differed in several particulars from the

fever of 1793; and the present epidemic differs materially from both.

In many of the cases I have seen it exceeds the fever of last year in

its malignity. These variations in diseases call for corresponding

changes in our practice.”