autumnal epidemic, were in general healthy. A catarrh affected a number
of people in November. I suspected it to be the influenza which had
revived from a dormant state, and which had not spent itself, when it
yielded to the predominance of the yellow fever. This opinion derives
some support from a curious fact related by the late Mr. Hunter of the
revival of the small-pox in a patient, in whom it had been suspended for
some time by the measles[60]. The few fevers which prevailed in the
winter were highly inflammatory. The small-pox in the natural way was in
several instances confluent; and in one or two fatal. I was prepared to
expect this inflammatory diathesis in the fevers of the winter; for I had
been taught by Dr. Sydenham, that the diseases which follow a great and
mortal epidemic partake more or less of its general character. But the
diseases of the winter had a peculiarity still more extraordinary; and
that was, many of them had several of the symptoms of the yellow fever,
particularly a puking of bile, dark-coloured stools, and a yellow eye.
Mr. Samuel D. Alexander, a student of medicine from South-Carolina, who
was seized with a pneumony about Christmas, had, with a yellow eye, a
dilated pupil and a hard pulse, which beat only fifty strokes in a
minute. His blood was such as I had frequently observed in the yellow
fever. Dr. Griffitts informed me that he attended a patient on the 9th of
January, in a pneumony, who had a universal yellowness on his skin. I met
with a case of pneumony on the 20th of the same month, in which I
observed the same degrees of redness in the eyes that were common in the
yellow fever. My pupil, Mr. Coxe, lost blood in an inflammatory fever,
on the 18th of February, which was dissolved. Mr. Innes, the brewer, had
a deep yellow colour in his eyes, on the fourth day of a pneumony, on the
27th of the same month; and Mr. Magnus Miller had the same symptom of a
similar disease on the 16th of March. None of these bilious and anomalous
symptoms of the inflammatory fevers of the winter and spring surprised
me. I had been early taught, by Dr. Sydenham, that the epidemics of
autumn often insinuate some of their symptoms into the winter diseases
which follow them. Dr. Cleghorn informs us, that "the pleurisies which
succeeded the autumnal tertians in Minorca, were accompanied by a
vomiting and purging of green or yellow bilious matters[61]."
[60] Introduction to a Treatise on the Venereal Disease, p. 3. of the
American edition.
[61] Page 273.
It belongs to powerful epidemics to be followed by similar diseases after
they disappear, as well as to run into others at their first appearance.
In the former case it is occasioned by a peculiar state of the body,
created by the epidemic constitution of the air, not having been changed
by the weather which succeeded it.
The weather in March resembled that of May; while the weather in April
resembled that of March in common years. A rash prevailed in many
families, in April, accompanied in a few cases by a sore throat. It was
attended with an itching, a redness of the eyes, and a slight fever in a
few instances. The small-pox by inoculation in this month was more mortal
than in former years. However unimportant these facts may appear at this
time, future observations may perhaps connect them with a similar
constitution of the air which produced the previous autumnal epidemic.
The appearance of bilious symptoms in the diseases of the winter, excited
apprehensions in several instances of the revival of the yellow fever.
The alarms, though false, served to produce vigilance and industry in the
corporation, in airing and purifying such houses and articles of
furniture as belonged to the poor; and which had been neglected in the
autumn, after the ceasing of the disease.
The modes of purifying houses, beds, and clothes were various.
Fumigations of nitre and aromatic substances were used by some people.
Burying infected articles of furniture under ground, and baking them in
ovens, were used by others. Some destroyed all their beds and clothing
that had been infected, or threw them into the Delaware. Many
white-washed their walls, and painted the wood-work of their house. I did
not conceive the seeds of the disease required all, or any of those means
to destroy it. I believed _cold_ and _water_ to be sufficient for that
purpose. I therefore advised keeping the windows of infected rooms open
night and day, for a few days; to have the floors and walls of houses
well washed; and to expose beds and such articles of household furniture
as might be injured by washing, upon the bare earth for a week or two,
taking care to turn them every day. I used no other methods of destroying
the accumulated miasmata in my house and furniture, and experience showed
that they were sufficient.
It is possible a portion of the excretions of the sick may be retained in
clothes or beds, so as to afford an exhalation that may in the course of
a succeeding summer and autumn, or from accidental warmth at any time,
create a solitary case of fever, but it cannot render it epidemic. A
trunk full of clothes, the property of Mr. James Bingham, who died of the
yellow fever in one of the West-India islands about 50 years ago, was
opened, some months after they were received by his friends, by a young
man who lived in his brother's family. This young man took the disease,
and died; but without infecting any of the family; nor did the disease
spread afterwards in the city. The father of Mr. Joseph Paschall was
infected with the yellow fever of 1741, by the smell of a foul bed in
passing through Norris's Alley, in the latter end of December, after the
disease had left the city. He died on the 25th of the month, but without
reviving the fever in the city, or even infecting his family.
The matter which produced the fever in both these cases, had nothing
specific in it. It acted in the same manner that the exhalation from any
other putrid matters would have done in a highly concentrated state.
In a letter from Dr. Senter of Newport, dated January 7th, 1794, I find
the following fact, which I shall communicate in his own words. It is
introduced to support the principle, that the yellow fever does not
spread by contagion. "This place (says the doctor) has traded formerly
very much to the West-India islands, and more or less of our people have
died there every season, when the disease prevails in those parts.
Clothes of these unfortunate people have been repeatedly brought home to
their friends, without any accident happening to them."
I feel with my reader the fatigue of this long detail of facts, and equal
impatience with him to proceed to the history of the treatment of the
fever; but I must beg leave to detain him a little longer from that part
of the work, while I resume the subject of the origin of the fever. It is
an interesting question, as it involves in it the means of preventing the
return of the disease, and thereby of saving the lives of thousands of
our citizens.
Soon after the fever left the city, the governor of the state addressed a
letter to the college of physicians, requesting to know their opinion of
its origin; if imported, from what _place_, at what _time_, and in what
_manner_. The design of this inquiry was to procure such information as
was proper to lay before the legislature, in order to improve the laws
for preventing the importation or generation of infectious diseases, or
to enact new ones, if necessary for that purpose. To the governor's
letter the college of physicians sent the following answer:
"SIR,
"It has not been from a want of respect to yourself, nor from inattention
to the subject, that your letter of the 30th ult. was not sooner
answered; but the importance of the questions proposed has made it
necessary for us to devote a considerable portion of time and attention
to the subject, in order to arrive at a safe and just conclusion.
"No instance has ever occurred of the disease called the _yellow fever_
having been generated in this city, or in any other parts of the United
States, as far as we know; but there have been frequent instances of its
having been imported, not only into this, but into other parts of
North-America, and prevailing there for a certain period of time; and
from the rise, progress, and nature of the malignant fever, which began
to prevail here about the beginning of last August, and extended itself
gradually over a great part of the city, we are of opinion that this
disease was imported into Philadelphia, by some of the vessels which
arrived in the port after the middle of July. This opinion we are
further confirmed in by various accounts we have received from
unquestionable authorities.
"Signed, by order of the college of physicians,
"JOHN REDMAN, _President_.
"_November 26th, 1793._
"_To the governor of Pennsylvania._"
Dr. Redman, the president of the college, Dr. Foulke, and Dr. Leib,
dissented from the report contained in this letter. I have been
necessarily led to continue it in the present edition of this work, not
only because all the other members of that body still retain their belief
of the importation of the fever, but as a reason for republishing the
facts and arguments in support of its domestic origin.
I have asserted, in the introduction to the history of this fever, that I
believed it to have been generated in our city; I shall now deliver my
reasons for that belief.
1. The yellow fever in the West-Indies, and in all other countries where
it is endemic, is the offspring of vegetable putrefaction. Heat,
exercise, and intemperance in drinking (says Dr. Lind) _dispose_ to this
fever in hot climates, but they do not produce it without the concurrence
of a remote cause. This remote cause exists at all times, in some spots
of the islands, but in other parts even of the same islands, where there
are no marsh exhalations, the disease is unknown. I shall not waste a
moment in inquiring into the truth of Dr. Warren's account of the origin
of this fever. It is fully refuted by Dr. Hillary, and it is treated as
chimerical by Dr. Lind. They have very limited ideas of the history of
this fever who suppose it to be peculiar to the East or West-Indies. It
was admitted to have been generated in Cadiz after a hot and dry summer
in 1764, and in Pensacola in 1765[62]. The tertian fever of Minorca, when
it attacked Englishmen, put on the usual symptoms of the yellow
fever[63]. In short, this disease appears, according to Dr. Lind, in all
the southern parts of Europe, after hot and dry weather[64].
[62] Lind on the Diseases of Hot Climates, p. 36 and 124.
[63] Cleghorn, p. 176.
[64] Diseases of Hot Climates, p. 123.
2. The same causes (under like circumstances) must always produce the
same effects. There is nothing in the air of the West-Indies, above
other hot countries, which disposes it to produce a yellow fever. Similar
degrees of heat, acting upon dead and moist vegetable matters, are
capable of producing it, together with all its various modifications, in
every part of the world. In support of this opinion, I shall transcribe
part of a letter from Dr. Miller, formerly of the Delaware state, and now
of New-York.
"_Dover, Nov. 5, 1793._
"DEAR SIR,
"Since the middle of last July we have had a bilious colic epidemic in
this neighbourhood, which exhibits phænomena very singular in this
climate; and, so far as I am informed, unprecedented in the medical
records, or popular traditions of this country. To avoid unnecessary
details it will suffice at present to observe, that the disease, on this
occasion, has assumed, not only all the essential characters, but
likewise all the violence, obstinacy, and malignity described by the East
and West-Indian practitioners. If any difference can be observed it seems
here to manifest higher degrees of stubbornness and malignity than we
usually meet in the histories of tropical writers. In the course of the
disease, not only extreme constipation, frequent vomiting, and the most
excruciating pains of the bowels and limbs, harass the unhappy patient;
but to these succeed paralysis, convulsions, &c. and almost always
uncommon muscular debility, oppression of the præcordia, &c. are the
consequence of a severe attack. Bile discharged in enormous quantities
constantly assumes the most corrupted and acrimonious appearances,
commonly æruginous in a very high degree, and sometimes quite
atrabilious.
"The inference I mean to draw from the phænomena of this disease, as it
appears in this neighbourhood, and which I presume will also apply to
your epidemic, is _this_, that from the uncommon protraction and
intenseness of our summer and autumnal heats, but principally from the
unusual drought, we have had, since the middle of July, a near approach
to a _tropical_ season, and that of consequence we ought not to be
surprised if tropical diseases, even of the most malignant nature, are
_engendered_ amongst us."
To the above information it may be added, that the dysentery which
prevailed during the autumn of 1793, in several of the villages of
Pennsylvania, was attended with a malignity and mortality unknown before
in any part of the state. I need not pause to remark that this dysentery
arose from putrid exhalation, and that it is, like the bilious colic,
only a modification of bilious fever.
But further, a malignant fever, resembling that which was epidemic in our
city, prevailed during the autumn in many parts of the United States,
viz. at Lynn in Massachusetts, at Weatherfield and Coventry in
Connecticut, at New-Galloway in the state of New-York, on Walkill and on
Pensocken creeks in New-Jersey, at Harrisburgh and Hummelstown in
Pennsylvania, in Caroline county in Maryland, on the south branch of the
Potowmac in Hardie county, also in Lynchburgh and in Alexandria in
Virginia, and in several counties in North-Carolina. In none of these
places was there a suspicion of the disease being imported from abroad,
or conveyed by an intercourse with the city of Philadelphia.
It is no objection to the inference which follows from these facts, that
the common remitting fever was not known during the above period in the
neighbourhood of this city, and in many other parts of the state, where
it had usually appeared in the autumnal months. There is a certain
combination of moisture with heat, which is essential to the production
of the remote cause of a bilious fever. Where the heat is so intense, or
of such long duration, as wholly to dissipate moisture, or when the rains
are so great as totally to overflow the marshy ground, or to wash away
putrid masses of matter, no fever can be produced.
Dr. Dazilles, in his treatise upon the diseases of the negroes in the
West-Indies, informs us, that the _rainy_ season is the most healthy at
Cayenne, owing to the neighbouring morasses being _deeply_ overflowed;
whereas, at St. Domingo, a _dry_ season is most productive of diseases,
owing to its favouring those degrees of moisture which produce morbid
exhalations. These facts will explain the reason why, in certain seasons,
places which are naturally healthy in our country become sickly, while
those places which are naturally sickly escape the prevailing epidemic.
Previously to the dissipation of the moisture from the putrid masses of
vegetable matters in our streets, and in the neighbourhood of the city,
there were (as several practitioners can testify) many cases of mild
remittents, but they all disappeared about the first week in September.
It is worthy of notice, that the yellow fever prevailed in Virginia in
the year 1741, and in Charleston, in South-Carolina, in the year 1699, in
both which years it prevailed in Philadelphia. Its prevalence in
Charleston is taken notice of in a letter, dated November 18th, O. S.
1699, from Isaac Norris to one of his correspondents. The letter says,
that "150 persons had died in Charleston in a few days," that "the
survivors fled into the country," and that "the town was thinned to a
very few people." Is it not probable, from the prevalence of this fever
twice in two places in the same years, that it was produced (as in 1793)
by a general constitution of air, co-operating with miasmata, which
favoured its generation in different parts of the continent? But again,
such was the state of the air in the summer of 1793, that it predisposed
other animals to diseases, besides the human species. In some parts of
New-Jersey, a disease prevailed with great mortality among the horses,
and in Virginia among the cows, during the autumn. The urine in both was
yellow.--Large abscesses appeared in different parts of the body in the
latter animals, which, when opened, discharged a yellow serous fluid.
From the colour of these discharges, and of the urine, the disease got
the name of the _yellow water_.
3. I have before remarked, that a quantity of damaged coffee was exposed
at a time (July the 24th) and in a situation (on a wharf and in a dock)
which favoured its putrefaction and exhalation. Its smell was highly
putrid and offensive, insomuch that the inhabitants of the houses in
Water and Front-streets, who were near it, were obliged, in the hottest
weather, to exclude it by shutting their doors and windows. Even persons,
who only walked along those streets, complained of an intolerable
f[oe]tor, which, upon inquiring, was constantly traced to the putrid
coffee. It should not surprise us, that this seed, so inoffensive in its
natural state, should produce, after its putrefaction, a violent fever.
The records of medicine (to be mentioned hereafter) furnish instances of
similar fevers being produced, by the putrefaction of many other
vegetable substances.
4. The rapid progress of the fever from Water-street, and the courses
through which it travelled into other parts of the city, afford a strong
evidence that it was at first propagated by exhalation from the putrid
coffee. It was observed that it passed first through those alleys and
streets which were in the course of the winds that blew across the dock
and wharf, where the coffee had been thrown in a state of putrefaction.
5. Many persons who had worked, or even visited, in the neighbourhood of
the exhalation from the coffee, early in the month of August, were
indisposed afterwards with sickness, puking, and yellow sweats, long
before the air of Water-street was so much impregnated with the
exhalation, as to produce such effects; and several patients, whom I
attended in the yellow fever, declared to me, or to their friends, that
their indispositions began exactly at the time they inhaled the offensive
effluvia of the coffee.
6. The first cases of the yellow fever have been clearly traced to the
sailors of the vessel who were first exposed to the effluvia of the
coffee. Their sickness commenced with the day on which the coffee began
to emit its putrid smell. The disease spread with the increase of the
poisonous exhalation. A journeyman of Mr. Peter Brown's, who worked near
the corner of Race and Water-streets, caught the disease on the 27th of
July. Elizabeth Hill, the wife of a fisherman, was infected by only
sailing near the pestilential wharf, about the 1st of August, and died at
Kensington on the 14th of the same month. Many other names might be
mentioned of persons who sickened during the last week in July or the
first week in August, who ascribed their illnesses to the smell of the
coffee.
7. It has been remarked that this fever did not spread in the country,
when carried there by persons who were infected, and who afterwards died
with it. During four times in which it prevailed in Charleston, in no one
instance, according to Dr. Lining, was it propagated in any other part of
the state.
8. In the histories of the disease which have been preserved in this
country, it has _six_ times appeared about the first or middle of August,
and declined or ceased about the middle of October: viz. in 1732, 1739,
1745, and 1748 in Charleston, in 1791 in New-York, and in 1793 in
Philadelphia. This frequent occurrence of the yellow fever at the usual
period of our common bilious remittents, cannot be ascribed to accidental
coincidence, but must be resolved, in most cases, into the combination of
more active miasmata with the predisposition of a tropical season. In
speaking of a tropical season, I include that kind of weather in which
rains and heats are alternated with each other, as well as that which is
uniformly warm.
9. Several circumstances attended this epidemic, which do not occur in
the West-India yellow fever. It affected children as well as adults, in
common with our annual bilious fevers. In the West-Indies, Dr. Hume
tells us, it never attacked any person under puberty. It had, moreover,
many peculiar symptoms (as I have already shown) which are not to be met
with in any of the histories of the West India yellow fever.
10. Why should it surprise us to see a yellow fever generated amongst us?
It is only a higher grade of a fever which prevails every year in our
city, from vegetable putrefaction. It conforms, in the difference of its
degrees of violence and danger, to season as well as climate, and in this
respect it is upon a footing with the small-pox, the measles, the
sore-throat, and several other diseases. There are few years pass, in
which a plethoric habit, and more active but limited miasmata, do not
produce sporadic cases of true yellow fever in Philadelphia. It is very
common in South and North-Carolina and in Virginia, and there are facts
which prove, that not only strangers, but native individuals, and, in one
instance, a whole family, have been carried off by it in the state of
Maryland. It proved fatal to one hundred persons in the city of New-York
in the year of 1791, where it was evidently generated by putrid
exhalation. The yellow colour of the skin has unfortunately too often
been considered as the characteristic mark of this fever, otherwise many
other instances of its prevalence might be discovered, I have no doubt,
in every part of the United States. I wish, with Dr. Mosely, the term
_yellow_ could be abolished from the titles of this fever, for this
colour is not only frequently absent, but sometimes occurs in the mildest
bilious remittents. Dr. Haller, in his pathology, describes an epidemic
of this kind in Switzerland, in which this colour generally attended, and
I have once seen it almost universal in a common bilious fever, which
prevailed in the American army, in the year 1776.
I cannot help taking notice, in this place, of an omission in the answer
to the governor's letter, by the college of physicians. The governor
requested to know whether it was imported; if it were, from _what place_,
at _what time_, and in _what manner_. In the answer of the college of
physicians to the governor's letter no notice was taken of any of those
questions. In vain did Dr. Foulke call upon the college to be more
definite in their answer to them. They had faithfully sought for the
information required, but to no purpose. The character of their departed
brother, Dr. Hutchinson, for capacity and vigilance in his office, as
inspector of sickly vessels, was urged without effect as an argument
against the probability of the disease being imported. Public report had
derived it from several different islands; had chased it from ship to
ship, and from shore to shore; and finally conveyed it at different
times into the city, alternately by dead and living bodies; and from
these tales, all of which, when investigated, were proved to be without
foundation, the college of physicians composed their letter. It would
seem, from this conduct of the college, as if medical superstition had
changed its names, and that, in accounting for the origin of pestilential
fevers, celestial, planetary, and demoniacal influence had only yielded
to the term _importation_.
Let not the reader reject the opinion I have delivered because it is
opposed by so great a majority of the physicians of Philadelphia. A
single physician supported an opinion of the existence of the plague at
Messina, in the year 1743, in opposition to all the physicians (33 in
number) of that city. They denied the disease in question to exist,
because it was not accompanied by glandular swellings. Time showed that
they were all mistaken, and the plague, which might probably have been
checked, at its first appearance, by their united efforts, was, by means
of their ignorance, introduced with great mortality into every part of
the city. This disposition of physicians to limit the symptoms of several
other diseases, cannot be sufficiently lamented. The frequent absence of
a yellow colour, in this epidemic, led to mistakes which cost the city
of Philadelphia several hundred lives.