forty years of age were most subject to it. Many old people had it, but
it was not so fatal to them as to robust persons in middle life. It
affected children of all ages. I met with a violent case of the disease,
in a child of four months, and a moderate case of it, in a child of but
ten weeks old. The latter had a deep yellow skin. Both these children
recovered.
The proportion of children who suffered by this fever may be conceived
from a single fact. Seventy-five persons were buried in the grave-yard of
the Swedish church in the months of August, September, and October,
twenty-four of whom were children. They were buried chiefly in September
and October; months in which children generally enjoy good health in our
city.
Men were more subject to the disease than women. Pregnancy seemed to
expose women to it.
The refugees from the French West-Indies universally escaped it. This was
not the case with the natives of France, who had been settled in the
city.
It is nothing new for epidemics to affect persons of one nation, and to
pass by persons of other nations, in the same city or country. At
Nimeguen, in the year 1736, Deigner informs us, that the French people
(two old men excepted), and the Jews, escaped a dysentery which was
universal among persons of all other nations. Ramazini tells us, that the
Jews at Modena escaped a tertian fever which affected nearly all the
other inhabitants of the town. Shenkius says, that the Dutch and Italians
escaped a plague, which prevailed for two years in one of the towns of
Switzerland; and Dr. Bell, in an inaugural dissertation, published at
Edinburgh, in 1779, remarks, that the jail fever, which attacked the
soldiers of the duke of Buccleugh's regiment, spared the French prisoners
who were guarded by them. It is difficult to account for these facts.
However numerous their causes may be, a difference in diet, which is as
much a distinguishing mark of nations as dress or manners, will probably
be found to be one of them.
From the accounts of the yellow fever which had been published by many
writers, I was led to believe that the negroes in our city would escape
it. In consequence of this belief, I published the following extract in
the American Daily Advertiser, from Dr. Lining's history of the yellow
fever, as it had four times appeared in Charleston, in South-Carolina.
"There is something very singular (says the doctor) in the constitution
of the negroes, which renders them not liable to this fever; for though
many of them were as much exposed as the nurses to the infection, yet I
never knew of one instance of this fever among them, though they are
equally subject with the white people to the bilious fever[46]."
[46] Essays and Observations, Physical and Literary, vol. xi. page 409.
A day or two after this publication the following letter from the mayor
of the city, to Mr. Claypoole, the printer of the Mail, appeared in his
paper.
"SIR,
"It is with peculiar satisfaction that I communicate to the public,
through your paper, that the AFRICAN SOCIETY, touched with the distresses
which arise from the present dangerous disorder, have voluntarily
undertaken to furnish nurses to attend the afflicted; and that, by
applying to ABSALOM JONES and WILLIAM GRAY, both members of that
society, they may be supplied.
MATTH. CLARKSON,
_September 6th, 1793._ _Mayor_."
It was not long after these worthy Africans undertook the execution of
their humane offer of services to the sick before I was convinced I had
been mistaken. They took the disease in common with the white people, and
many of them died with it. I think I observed the greatest number of them
to sicken after the mornings and evenings became cool. A large number of
them were my patients. The disease was lighter in them than in white
people. I met with no case of hæmorrhage in a black patient.
The tobacconists and persons who used tobacco did not escape the disease.
I observed snuff-takers to be more devoted to their boxes than usual,
during the prevalence of the fever.
I have remarked, formerly, that servant maids suffered much by the
disease. They were the only patients I lost in several large families. I
ascribe their deaths to the following causes:
_1st._ To the great and unusual debility induced upon their systems by
labour in attending their masters and mistresses, or their children.
Debility, according to its degrees and duration, seems to have had the
same effect upon the mortality of this fever that it has upon the
mortality of an inflammation of the lungs. When it is moderate and of
short duration it predisposes only to a common pneumony, but when it is
violent and protracted, in its degrees and duration, it predisposes to a
pulmonary consumption.
_2dly._ To their receiving large quantities of impure air into their
bodies, and in a most concentrated state, by being obliged to perform the
most menial offices for the sick, and by washing, as well as removing
foul linen, and the like.
_3dly._ To their being left more alone in confined or distant rooms, and
thereby suffering from depression of spirits, or the want of a punctual
supply of food and medicines.
There did not appear to be any advantage from smelling vinegar, tar,
camphor, or volatile salts, in preventing the disease. Bark and wine were
equally ineffectual for that purpose. I was called to many hundred people
who were infected after using one or more of them. Nor did the white
washing of walls secure families from the disease. I am disposed to
believe garlic was the only substance that was in any degree useful in
preventing it. I met with several persons who chewed it constantly, and
who were much exposed to the miasmata, without being infected. All other
substances seemed to do harm by begetting a false confidence in the mind,
to the exclusion of more rational preservatives. I have suspected
further, that such of them as were of a volatile nature helped to spread
the disease by affording a vehicle for miasmata through the air.
There was great mortality in all those families who lived in wooden
houses. Whether this arose from the small size of these houses, or from
the want of cleanliness of the people who occupied them, or from the
miasmata becoming more accumulated, by adhering to the wood, I am unable
to determine. Perhaps it was the effect of the co-operation of all three
of those causes.
I have said, formerly, that intemperance in drinking predisposed to the
disease; but there were several instances of persons having escaped it
who were constantly under the influence of strong drink. The stimulus of
ardent spirits probably predominated over the stimulus of the miasmata,
and thus excited an artificial fever which defended the system from that
which was epidemic.
I heard of some sea-faring people who lived on board their vessels who
escaped the disease. The smell of the tar was supposed to have preserved
them; but, from its being ineffectual in other cases, I am disposed to
ascribe their escape to the infected air of the city being destroyed by a
mixture with the water of the Delaware.
Many people who were infected in the city were attacked by the disease in
the country, but they did not propagate it, even to persons who slept in
the same room with them.
Dr. Lind informs us that many persons escaped the yellow fever which
prevailed in Pensacola in the year 1765, by retiring to the ships which
lay in the harbour, and that when the disease had been taken, the pure
air of the water changed it into an intermitting fever[47]. The same
changes have frequently been produced in malignant fevers, by sending
patients infected with them from the foul air of a city, into the pure
air of the country.
[47] Diseases of Warm Climates, p. 169.
Persons confined in the house of employment, in the hospital, and in the
jail, escaped the fever. The airy and remote situation of those buildings
was probably the chief means of their preservation. Perhaps they derived
additional security from their simple diet, their exemption from hard
labour, and from being constantly sheltered from heat and cold.
Several families, who shut up their front and back doors and windows, and
avoided going out of their houses except to procure provisions, escaped
the disease.
I have taken some pains to ascertain, whether any class of tradesmen
escaped the fever, or whether there was any species of labour which
protected from it. The result of my inquiries is as follows: Three
butchers only, out of nearly one hundred who remained in the city, died
with the disease. Many of them attended the markets every day. Two
painters, who worked at their business during the whole time of the
prevalence of the fever, and in exposed situations, escaped it. Out of
forty scavengers who were employed in collecting and carrying away the
dirt of the streets, only one was affected by the fever and died. Very
few grave-diggers, compared with the number who were employed in that
business, were infected; and it is well known, that scarcely an instance
was heard of persons taking the disease, who were constantly employed in
digging cellars. The fact is not new that grave-diggers escape malignant
fevers. It is taken notice of by Dr. Clark.
It was said by some physicians in the public papers, that the
neighbourhood of the grave-yards was more infected than other parts of
the city. The reverse of this assertion was true in several cases, owing
probably to the miasmata being diluted and weakened by its mixture with
the air of the grave-yards: for this air was pure, compared with that
which stagnated in the streets.
It was said further, that the disease was propagated by the inhabitants
assembling on Sundays for public worship; and, as a proof of this
assertion, it was reported, that the deaths were more numerous on Sundays
than on other days; occasioned by the infection received on one Sunday
producing death on the succeeding first day of the week. The register of
the deaths shows that this was not the case. I am disposed to believe
that fewer people sickened on Sundays, than on any other day of the week;
owing to the general rest from labour, which I have before said was one
of the exciting causes of the disease. From some facts to be mentioned
presently, it will appear probable, that places of public worship, in
consequence of their size, as well as of their being shut up during the
greatest part of the week, were the freest from miasmata of any houses in
the city. It is agreeable to discover in this, as well as in all other
cases of public and private duty, that the means of health and moral
happiness are in no one instance opposed to each other.
The disease, which was at first confined to Water-street, soon spread
through the whole city. After the 15th of September, the atmosphere of
every street in the city was charged with miasmata; and there were few
citizens in apparent good health, who did not exhibit one or more of the
following marks of their presence in their bodies.
1. A yellowness in the eyes, and a sallow colour upon their skin.
2. A preternatural quickness in the pulse. I found but two exceptions to
this remark, out of a great number of persons whose pulses I examined. In
one of them it discovered several preternatural intermissions in the
course of a minute. This quickness of pulse occurred in the negroes, as
well as in the white people. I met with it in a woman who had had the
yellow fever in 1762. In two women, and in one man above 70, the pulse
beat upwards of 90 strokes in a minute. This preternatural state of the
pulse during the prevalence of a pestilential fever, in persons in
health, is taken notice of by Riverius[48].
[48] "Pulsus sanorum pulsibus similes admodum, periculosi."--_De Febre
Pestilenti, p. 114._
3. Frequent and copious discharges by the skin of yellow sweats. In some
persons these sweats sometimes had an offensive smell, resembling that of
the washings of a gun.
4. A scanty discharge of high coloured or turbid urine.
5. A deficiency of appetite, or a greater degree of it than was natural.
6. Costiveness.
7. Wakefulness.
8. Head-ach.
9. A preternatural dilatation of the pupils. This was universal. I was
much struck in observing the pupil in one of the eyes of a young man who
called upon me for advice, to be of an oblong figure. Whether it was
natural, or the effect of the miasmata acting on his brain, I could not
determine.
It will be thought less strange that the miasmata should produce these
changes in the systems of persons who resided constantly in the city,
when I add, that many country people who spent but a few hours in the
streets in the day, in attending the markets, were infected by the
disease, and sickened and died after they returned home; and that others,
whom business compelled to spend a day or two in the city during the
prevalence of the fever, but who escaped an attack of it, declared that
they were indisposed, during the whole time, with languor or head-ach.
I was led to observe and record the above effects of the miasmata upon
persons in apparent good health, by a fact I met with in Dr. Mitchell's
history of the yellow fever in Virginia, in the year 1741. In that fever,
blood drawn from a vein was always dissolved. The same state of the blood
was observed in many persons who had been exposed to the miasmata, who
discovered no other symptom of the disease.
A woman whom I had formerly cured of a mania, who lived in an infected
neighbourhood, had a fresh attack of that disease, accompanied by an
unusual menstrual flux. I ascribed both these complaints to the action of
the miasmata upon her system.
The smell emitted from a patient, in a clean room, was like that of the
small-pox, but in most cases of a less disagreeable nature. Putrid smells
in sick rooms were the effects of the excretions, or of some other filthy
matters. In small rooms, crowded in some instances with four or five sick
people, there was an effluvia that produced giddiness, sickness at
stomach, a weakness of the limbs, faintness, and in some cases a
diarrh[oe]a. I met with a f[oe]tid breath in one patient, which was not
the effect of that medicine which sometimes produces it.
The state of the atmosphere, during the whole month of September, and the
first two weeks in October, favoured the accumulation of the miasmata in
the city.
The register of the weather shows how little the air was agitated by
winds during the above time. In vain were changes in the moon expected to
alter the state of the air. The light of the morning mocked the hopes
that were raised by a cloudy sky in the evening. The sun ceased to be
viewed with pleasure. Hundreds sickened every day beneath the influence
of his rays: and even where they did not excite the disease, they
produced a languor in the body unknown to the oldest inhabitant of the
city, at the same season of the year.
A meteor was seen at two o'clock in the morning, on or about the twelfth
of September. It fell between Third-street and the hospital, nearly in a
line with Pine-street. Moschetoes (the usual attendants of a sickly
autumn) were uncommonly numerous. Here and there a dead cat added to the
impurity of the air of the streets. It was supposed those animals
perished with hunger in the city, in consequence of so many houses being
deserted by the inhabitants who had fled into the country, but the
observations of subsequent years made it more probable they were
destroyed by the same morbid state of the atmosphere which produced the
reigning epidemic.
It appears further, from the register of the weather, that there was no
rain between the 25th of August and the 15th of October, except a few
drops, hardly enough to lay the dust of the streets, on the 9th of
September, and the 12th of October. In consequence of this drought, the
springs and wells failed in many parts of the country. The dust in some
places extended two feet below the surface of the ground. The pastures
were deficient, or burnt up. There was a scarcity of autumnal fruits in
the neighbourhood of the city. But while vegetation drooped or died from
the want of moisture in some places, it revived with preternatural vigour
from unusual heat in others. Cherry-trees blossomed, and apple, pear, and
plum-trees bore young fruit in several gardens in Trenton, thirty miles
from Philadelphia, in the month of October.
However inoffensive uniform heat, when agitated by gentle breezes, may
be, there is, I believe, no record of a dry, warm, and stagnating air,
having existed for any length of time without producing diseases.
Hippocrates, in describing a pestilential fever, says the year in which
it prevailed was without a breeze of wind[49]. The same state of the
atmosphere, for six weeks, is mentioned in many of the histories of the
plague which prevailed in London, in 1665[50]. Even the sea air itself
becomes unwholesome by stagnating; hence Dr. Clark informs us, that
sailors become sickly after long calms in East-India voyages[51]. Sir
John Pringle delivers the following aphorism from a number of similar
observations upon this subject: "When the heats come on soon, and
continue throughout autumn, not moderated by winds or rains, the season
proves sickly, distempers appear early, and are dangerous[52]."
[49] "Sine aura, usque annus fuit."--_Epid. 3._
[50] Letter from Sir John Bernard to Dr. Floyer, p. 233.
[51] Vol. i. p. 5.
[52] Diseases of the Army, p. 5. of the 7th London edition.
Who can review this account of the universal diffusion of the miasmata
which produced this disease, its universal effects upon persons
apparently in good health, and its accumulation and concentration, in
consequence of the calmness of the air, and believe that it was possible
for a febrile disease to exist at that time in our city that was not
derived from that source?
The West-India writers upon the yellow fever have said that it is seldom
taken twice, except by persons who have spent some years in Europe or
America in the interval between its first and second attack. I directed
my inquiries to this question, and I now proceed to mention the result of
them. I met with five persons, during the prevalence of the disease, who
had had it formerly, two of them in the year 1741, and three in 1762, who
escaped it in 1793, although they were all more or less exposed to the
infection. One of them felt a constant pain in her head while the disease
was in her family. Four of them were aged, and of course less liable to
be acted upon by the miasmata than persons in early or middle life. Mr.
Thomas Shields furnished an unequivocal proof that the disease could be
taken after an interval of many years. He had it in the year 1762, and
narrowly escaped from a violent attack of it this year. Cases of
reinfection were very common during the prevalence of this fever. They
occurred most frequently where the first attack had been light. But they
succeeded attacks that were severe in Dr. Griffitts, Dr. Mease, my pupil
Mr. Coxe, and several others, whose cases came under my notice.
I have before remarked that the miasmata sometimes excited a fever as
soon as they were taken into the body, but that they often lay there from
one to sixteen days before they produced the disease. How long they
existed in the body after a recovery from the fever I could not tell, for
persons who recovered were, in most cases, exposed to their action from
external sources. The preternatural dilatation of the pupils was a
certain mark of the continuance of some portion of them in the system. In
one person who was attacked with the fever on the night of the 9th of
October, the pupils did not contract to their natural dimensions until
the 7th of November.
Having described the effects of the miasmata upon the body, I proceed now
to mention the changes induced upon it by death.
Let us first take a view of it as it appeared soon after death. Some new
light may perhaps be thrown upon the proximate cause of the disease by
this mode of examining the body.
My information upon this subject was derived from the attendants upon the
sick, and from the two African citizens who were employed in burying the
dead, viz. Richard Allen and Absalom Jones. The coincidence of the
information received from different persons satisfied me that all that I
shall here relate is both accurate and just.
A deep yellow colour appeared in many cases within a few minutes after
death. In some the skin became purple, and in others black. I heard of
one case in which the body was yellow above, and black below its middle.
In some the skin was as pale as it is in persons who die of common
fevers. A placid countenance was observed in many, resembling that which
occurs in an easy and healthful sleep.
Some were stiff within one hour after death. Others were not so for six
hours afterwards. This sudden stiffness after death, Dr. Valli informs
us, occurred in persons who died of the plague in Smyrna, in the year
1784[53].
[53] Experiments on Animal Electricity, p. 90.
Some grew cold soon after death, while others retained a considerable
degree of heat for six hours, more especially on their backs.
A stream of tears appeared on the cheeks of a young woman, which seemed
to have flowed after her death.
Some putrified in a short time after their dissolution, but others had no
smell for twelve, eighteen, and twenty hours afterwards. This absence of
smell occurred in those cases in which evacuations had been used without
success in the treatment of the disease.
Many discharged large quantities of black matter from the bowels, and
others blood from the nose, mouth, and bowels after death. The frequency
of these discharges gave rise to the practice of pitching the joints of
the coffins which were used to bury the dead.
The morbid appearances of the internal parts of the body, as they appear
by dissection after death from the yellow fever, are different in
different countries, and in the same countries in different years. I
consider them all as effects only of a stimulus acting upon the whole
system, and determined more or less by accidental circumstances to
particular viscera. Perhaps the stimulus of the miasmata determines the
fluids more violently in most cases to the liver, stomach, and bowels,
and thereby disposes them more than other parts to inflammation and
mortification, and to similar effusions and eruptions with those which
take place on the skin. There can be no doubt of the miasmata acting upon
the liver, and thereby altering the qualities of the bile. I transcribe,
with great pleasure, the following account of the state of the bile in a
female slave of forty years of age, from Dr. Mitchell's History of the
Yellow Fever, as it prevailed in Virginia, in the years 1737 and 1741,
inasmuch as it was part of that clue which led me to adopt one of the
remedies on which much of the success of my practice depended.
"The gall bladder (says the doctor) appeared outwardly of a deep yellow,
but within was full of a black ropy coagulated atrabilis, which sort of
substance obstructed the pori biliarii, and ductus choledochus. This
atrabilis was hardly fluid, but upon opening the gall bladder, it
retained its form and shape, without being evacuated, being of the
consistence of a thin extract, and, within, glutinous and ropy, like soap
when boiling. This black matter seemed so much unlike bile, that I
doubted if there were any bile in the gall bladder. It more resembled
bruised or mortified blood, evacuated from the mortified parts of the
liver, surrounding it, although it would stain a knife or probe thrust
into it of a yellow colour, which, with its ropy consistence, seemed more
peculiar to a bilious humour."
The same appearance of the bile was discovered in several other subjects
dissected by Dr. Mitchell.
The liver, in the above-mentioned slave, was turgid and plump on its
outside, but on its concave surface, two thirds of it were of a deep
black colour, and round the gall bladder it seemed to be mortified and
corrupted.
The duodenum was lined on its inside, near the gall bladder, with a
viscid ropy bile, like that which has been described. Its villous coat
was lined with a thick fur or slime, which, when scraped or pealed off,
the other vascular and muscular coats of the gut appeared red and
inflamed.