disposition in nature to relieve herself by the pores, that I observed in
the years 1802 and 1803, my remedies were the same as in the latter year,
and attended with the same success. Dr. Caldwell and Dr. Stewart, whose
practice was extensive in Southwark, informed me, those remedies had been
generally successful in their hands.
The only new medicine that the experience of this year suggested in this
disease, was for one of its most distressing and dangerous symptoms, that
is, the vomiting which occurs in its second stage. Dr. Physick
discovered, that ten drops of the spirit of turpentine, given every two
hours, in a little molasses, or syrup, or sweet oil, effectually checked
it in several instances, in patients who afterwards recovered. It was
administered with equal success in a case which came under my care, after
an absence of pulse, and a coldness of the extremities had taken place.
Dr. Church informed me that he gave great relief to the sick in the city
hospital, by this medicine, by prescribing it in glysters, as well as by
the mouth, in distressing affections of the stomach and bowels.
Dr. Stewart observed that all those persons who had been affected by the
yellow fever in former years, had mild remittents in the same situations
that others had the prevailing epidemic in a malignant form.
In one of four bodies the doctor examined, he found six, and in another
three intussusceptions of the intestines, without any signs of
inflammation. He discovered the common marks of disease from this fever
in other parts of those bodies.
The deaths from this fever amounted to between three and four hundred.
They would probably have been more numerous, had not those families who
were in competent circumstances fled into the country, and had not the
poor been removed, by the board of health, from the infected atmosphere
of Southwark, to tents provided for them in the neighbourhood of the
city; and they would probably have been fewer, considering the tractable
nature of the disease, when met by suitable remedies in its early stage,
had not the sick concealed their indisposition, in many instances, for
two or three days, lest they should be dragged to the city hospital, or
have centinels placed at their doors, to prevent any communication with
their friends and neighbours. While these attempts were made to check
the progress of the fever, it did not escape the notice of many of the
citizens of Philadelphia, that not a single instance occurred of its
being communicated by contagion, in any of the families in the city, in
which persons had sickened or died with it, and that while the sick were
deprived of the kind offices of their friends and neighbours, lest they
should be infected, physicians, and the members of the board of health,
passed by the guards every day, in their visits to the same sick people,
and afterwards mixed with their fellow-citizens, in every part of the
city, without changing their clothes.
The yellow fever appeared early in the season in New-Haven, in
Connecticut, and in Providence, on Rhode-Island, in both of which places
it was derived from putrid exhalation, and was speedily and effectually
checked by removing the healthy persons who lived in its neighbourhood to
a distance from it. Several sporadic cases of it occurred during the
autumn in Gloucester county, in New-Jersey, and in Mifflin and Chester
counties, in Pennsylvania. It was epidemic in New-York at the same time
it prevailed in Southwark and Philadelphia. The following extract of a
letter from the health officer of New-York, to one of his friends,
contains a satisfactory proof that it was not, in that city, an imported
disease.
_Quarantine-ground, Sept. 7._
I most sincerely and tenderly deplore the unfortunate situation of our
city. What do people say now of the origin of the disease? You may state,
for the information of those who wished to be informed, that not a single
vessel, on board of which a person has been sick with fever of any kind,
or on board of which any person has died with any disease, while in the
West-Indies, or on the voyage home, has ever gone up to the city during
this whole season. This we know, and this we vouch for; and farther
state, that all the cases of fever that have come down as from the city,
have been _all_ people of, and belonging to the city, and unconnected
with the shipping, excepting one, a sailor, who had no connection with
any foul vessel. There is not a shadow of proof or suspicion that can
attach to the health-office, or to infected vessels, this season.
I am, &c.
JOHN R. B. RODGERS.
Having concluded the history of the bilious yellow fever, as it has
appeared in eleven successive years, since 1793, as an epidemic, or in
sporadic cases, I shall proceed next to enumerate all the sources of
that fever, as well as all the other usual forms of the summer and
autumnal disease of the United States, and afterwards mention the means
of preventing them.
AN INQUIRY
INTO
THE VARIOUS SOURCES
OF THE USUAL FORMS OF
_SUMMER & AUTUMNAL DISEASE_
IN THE UNITED STATES,
AND THE MEANS OF PREVENTING THEM.
The business of the following inquiry is,
I. To enumerate the various sources of the usual forms of the summer and
autumnal disease in the United States. And,
II. To mention the means of preventing them.
To render the application of those means as extensive as possible, it
will be proper to mention, under the first head, all those sources of
summer and autumnal disease, which have been known to produce it in other
countries, as well as in the United States. They are,
1. Exhalations from marshes. These are supposed to be partly of a
vegetable, and partly of an animal nature. They are derived from the
shores of creeks and mill ponds, as well as from low and wet grounds;
also from the following vegetable substances in a state of putrefaction.
2. Cabbage. A malignant fever was produced at Oxford, by a putrid heap of
this vegetable some years ago, which proved fatal to many of the
inhabitants, and to several of the students of the university at that
place.
3. Potatoes. Nearly a whole ship's crew perished at Tortola, by removing
from her hold, a quantity of putrid potatoes.
4. Pepper.
5. Indian meal.
6. Onions.
7. Mint.
8. Anise and caraway seeds, confined in the hold of a ship.
9. Coffee. "About the time," says Dr. Trotter, "when notice was taken of
the putrifying coffee on the wharf at Philadelphia, in the year 1793, a
captain of a man of war, just returned from the Jamaica station, informed
me, that several vessels laden with the same produce came to Kingston,
from St. Domingo. During the distracted state of that colony, this
article, with other productions, had been allowed to spoil and ferment.
The evolution of a great quantity of fixed air, or carbonic acid gas, was
the consequence; and in these vessels, when opening the hatchways, such
was its concentrated state, that the whole of the crew, in some of them,
were found dead on the deck. A pilot boarded one of them in this
condition, and had nearly perished himself[10]."
[10] Medicina Nautica, p. 324.
10. Chocolate shells.
11. Cotton which had been wetted on board of a vessel that arrived in
New-York, a few years ago, from Savannah, in Georgia.
12. Hemp, flax, and straw.
13. The canvas of an old tent.
14. Old books, and old paper money, that had been wetted, and confined in
close rooms and closets.
15. The timber of an old house. A fever produced by this cause is
mentioned by Dr. Haller, in his Bibliotheca Medicinæ.
16. Green wood confined in a close cellar during the summer months. A
fever from this cause was once produced in this city, in a family that
was attended by the late Dr. Cadwallader.
17. The green timber of a new ship. Captain Thomas Bell informed me, that
in a voyage to the East-Indies, in the year 1784, he lost six of his men
with the scurvy, which he supposed to be derived wholly from the foul air
emitted by the green timber of his ship. The hammocks which were near the
sides of the ship rotted during the voyage, while those which were
suspended in the middle of the ship, retained their sound and natural
state. This scurvy has been lately proved by Dr. Claiborne, in an
ingenious inaugural dissertation, published in Philadelphia, in the year
1798, to be a misplaced state of malignant fever. Dr. Lind mentions
likewise the timber of new ships as one of the sources of febrile
diseases. The timber of soldiers' huts, and of the cabins of men who
follow the business of making charcoal in the woods, often produce
fevers, as soon as the bark begins to rot and fall from them, which is
generally on the second year after they are erected. Fevers have been
excited even by the exhalation from trees, that have been killed by being
girdled in an old field.
18. The stagnating air of the hold of a ship.
19. Bilge water.
20. Water that had long been confined in hogsheads at sea.
21. Stagnating rain water.
22. The stagnating air of close cellars.
23. The matters which usually stagnate in the gutters, common sewers,
docks, and alleys of cities, and in the sinks of kitchens. A citizen of
Philadelphia, who had a sink in his kitchen, lost a number of cats and
dogs by convulsions. At length one of his servants was affected with the
same disease. This led him to investigate the cause of it. He soon traced
it to his sink. By altering its construction, so as to prevent the escape
of noxious air from it, he destroyed its unwholesome quality, so that all
his domestics lived in good health in his kitchen-afterwards.
24. Air emitted by agitating foul and stagnating water. Dr. Franklin was
once infected with an intermitting fever from this cause.
25. A duck pond. The children of a family in this city were observed, for
several successive years, to be affected with a bilious remitting fever.
The physician of the family, Dr. Phineas Bond, observing no other persons
to be affected with the same fever in the neighbourhood, suspected that
it arose from some local cause. He examined the yard belonging to the
house, where he found an offensive duck pond. The pond was filled with
earth, and the family were afterwards free from an annual bilious fever.
26. A hog-stye has been known to produce violent bilious fevers
throughout a whole neighbourhood in Philadelphia.
27. Weeds cut down, and exposed to heat and moisture near a house.
Fevers are less frequently produced by putrid animal, than by putrid
vegetable matters. There are, however, instances of their having been
generated by the following animal substances in a state of putrefaction.
1. Human bodies that have been left unburied upon a field of battle.
2. Salted beef and pork.
3. Locusts.
4. Raw hides confined in stores, and in the holds of ships.
5. A whale thrown upon the sea shore in Holland.
6. A large bed of oysters. The malignant fevers which prevailed in
Alexandria, in Virginia, in 1803, and in Southwark, adjoining
Philadelphia, in the year 1805, were derived from this cause[11].
[11] It has been a common practice with many families, in New-York and
Philadelphia, for several years past, to lay in a winter store of
oysters in their cellars in the fall of the year. May not a part
of these oysters, left in these cellars from forgetfulness, or
from being unfit for use, become, by putrifying there, the cause
of malignant fevers in the succeeding summer and autumn?
7. The entrails of fish. And,
8. Privies. The diarrh[oe]a and dysentery are produced, oftener than any
other form of summer and autumnal disease, by the f[oe]tor of privies.
During the revolutionary war, an American regiment, consisting of 600
men, were affected with a dysentery, from being encamped near a large
mass of human fæces. The disease was suddenly checked by removing their
encampment to a distance from it. Five persons in one family were
affected with the yellow fever in Philadelphia, in 1805, who lived in a
house in which a privy in the cellar emitted a most offensive smell. No
one of them had been exposed to the foul air of Southwark, in which the
fever chiefly prevailed in the autumn of that year. Three of them
sickened at the same time, which obviated the suspicion of the disease
being produced by contagion.
There are several other sources of malignant fevers besides those which
have been mentioned. They are, exhalations from volcanoes, wells, and
springs of water; also flesh[12], fish, and vegetables, eaten in a
putrid state; but these seldom act in any country, and two of them only,
and that rarely, in the United States.
[12] The following fact, communicated to me by Mr. Samuel Lyman, a
member of congress from the state of Massachusetts, shows the
importance of attending to the condition of butchers' meat in our
attempts to prevent malignant fevers.
A farmer in New-Hampshire, who had overheated a fat ox by
excessive labour in the time of harvest, perceiving him to be
indisposed, instantly killed him, and sent his flesh to a
neighbouring market. Of twenty four persons who ate of this flesh,
fifteen died in a few days. The fatal disease produced by this
aliment fell, with its chief force, upon the stomach and bowels.
The usual forms of the disease produced by miasmata from the sources of
them which have been enumerated are,
1. Malignant or bilious yellow fever.
2. Inflammatory bilious fever.
3. Mild remittent.
4. Mild intermittent.
5. Chronic, or what is called nervous fever.
6. Febricula.
7. Dysentery.
8. Colic.
9. Cholera morbus.
10. Diarrh[oe]a.
In deriving all the above forms of disease from miasmata, I do not mean
to insinuate, that sporadic cases of each of them are not produced by
other causes.
In designating them by a single name, I commit no breach upon the ancient
nomenclature of medicine. The gout affects not only the blood-vessels and
bowels, but every other part of the body, and yet no writer has, upon
that account, distinguished it by a plural epithet.
The four last of the forms of disease, that have been mentioned, have
been very properly called intestinal states of fever. They nearly accord,
in their greater or less degrees of violence and danger, with the first
four states of fever which occupy the blood-vessels, and in the order in
which both of them have been named. I shall illustrate this remark by
barely mentioning the resemblance of the yellow fever to the dysentery,
in being attended with costiveness in its first stage, from a suspended
or defective secretion or excretion of bile, and in terminating very
generally in death, when not met by the early use of depleting remedies.
The variety in the forms and grades of the summer and autumnal disease,
in different seasons, and their occasional changes into each other in the
same seasons, are to be sought for in the variety of the sensible and
insensible qualities of the atmosphere, of the course of the winds, and
of the aliments of different years.
II. The means of preventing the different forms of disease that have been
mentioned, come next under our consideration.
Happily for mankind, Heaven has kindly sent certain premonitory signs of
the most fatal of them. These signs appear,
I. Externally, in certain changes in previous diseases, in the
atmosphere, and in the animal and vegetable creation.
II. In the human body.
1. The first external premonitory sign that I shall mention is, an
unusual degree of violence in the diseases of the previous year or
season. Many proofs of the truth of this remark are to be met with in the
works of Dr. Sydenham. It has been confirmed in Philadelphia, in nearly
all her malignant fevers since the year 1793. It would seem as if great
and mortal epidemics, like the planets, had satellites revolving round
them, for they are not only preceded, but accompanied and followed, by
diseases which appear to reflect back upon them some of their malignity.
But there is an exception to this remark, for we now and then observe
uncommon and general healthiness, before the appearance of a malignant
epidemic. This was the case in Philadelphia, previously to the fevers of
1798 and 1799. I have ascribed this to the stimulus of the pestilential
miasmata barely overcoming the action of weak diseases, without being
powerful enough to excite a malignant fever.
2. Substances, painted with white lead, and exposed to the air, suddenly
assuming a dark colour; and winds from unusual quarters, and unusual and
long protracted calms, indicate the approach of a pestilential disease.
The south winds have blown upon the city of Philadelphia, ever since
1793, more constantly than in former years. A smokiness or mist in the
air, the late Dr. Matthew Wilson has remarked, generally precedes a
sickly autumn in the state of Delaware.
3. Malignant and mortal epidemics are often preceded by uncommon sickness
and mortality among certain birds and beasts. They have both appeared,
chiefly among wild pigeons and cats in the United States. The mortality
among cats, previous to the appearance of epidemics, has been taken
notice of in other countries. Dr. Willan says it occurred in the city of
London, between the 20th of March and the 20th of April, in the year
1797, before a sickly season, and Dr. Buneiva says it preceded a mortal
epidemic in Paris. The cats, the doctor remarks, lose, on the second day
of their disease, the power of emitting electrical sparks from their
backs, and, when thrown from a height, do not, as in health, fall upon
their feet[13].
[13] Medical Journal, vol. iv.
4. The common house fly has nearly disappeared from our cities,
moschetoes have been multiplied, and several new insects have appeared,
just before the prevalence of our late malignant epidemics.
5. Certain trees have emitted an unusual smell; the leaves of others have
fallen prematurely; summer fruits have been less in size, and of an
inferior quality; and apples and pears have been knotty, in the summers
previous to several of our malignant autumnal fevers. Dr. Ambrose Parey
says, an unusually rapid growth of mushrooms once preceded the plague in
Paris.
II. The premonitory signs of an approaching malignant epidemic in the
human body are,
1. A sudden drying up, or breaking out of an old sore; fresh eruptions in
different parts of the body; a cessation of a chronic disease, or a
conversion of a periodical into a continual disease. Of this there were
many instances in Philadelphia, in the year 1793.
2. A peculiar sallowness of the complexion. This was observed to be
general in Philadelphia, previous to the yellow fever of 1793. Dr. Dick
informed me, that he had observed the same appearance in the faces of the
people of Alexandria, accompanied in some cases with a yellowness of the
eyes, during the summer of 1793, and previous to the appearance of a
violent bilious fever on the banks of the Potomac.
3. I have observed one or more of the following symptoms, namely,
head-ach; a decay, or increase of appetite; costiveness; a diminished or
increased secretion of urine; a hot and offensive breath[14]; constant
sweats, and sometimes of a f[oe]tid nature, or a dry skin; wakefulness,
or a disposition to early or protracted sleep; a preternaturally frequent
pulse; unusual vivacity, or depression of spirits; fatigue and sweats
from light exertions; hands, when rubbed, emitting a smell like hepar
sulphuris; and, lastly, a sense of burning in the mouth; to be present in
different persons, during the prevalence of our malignant epidemics.
[14] I have once known this breath, in a gentleman who had carried the
seeds of the yellow fever in his body from Philadelphia into its
neighbourhood, create sickness at the stomach in his wife; and I
have heard of an instance in which a person, who left Philadelphia
when highly impregnated with the miasmata of the same fever,
creating sickness at the stomach in four or five persons who sat
at the same table with him in the country. None of the above
persons were afterwards affected by the fever. In an anonymous
history of the plague in London, in the year 1664, in the
possession of the author, it is said, the breath was a well-known
signal of infection to persons who were not infected, and that
whenever it was perceived, individuals and companies fled from it.
The sickness in the above-mentioned persons was similar to that
which is sometimes excited by the smell of a sore leg, or a
gun-shot wound, upon the removal of its first dressing. It does
not produce fever, because there is no predisposition to it.
The means of preventing the different forms of our summer and autumnal
disease come next under our consideration. I shall first mention such as
have been most effectual in guarding against its malignant form, and
afterwards take notice of such as are proper in its milder grades. These
means naturally divide themselves again,
I. Into such as are proper to protect individuals.
II. Such as are proper to defend whole communities from the disease. And,
III. Such as are proper to exterminate it, by removing its causes.
I. Of the means of protecting individuals.
Where flight is practicable, it should be resorted to in every case, to
avoid an attack of a malignant fever. The heights of Germantown and Darby
have, for many years, afforded a secure retreat to a large number of the
citizens of Philadelphia, from their late annual epidemics. It were to be
wished our governments possessed a power of compelling our citizens to
desert the whole, or parts, of infected cities and villages. In this way
the yellow fever was suddenly annihilated in Providence, on
Rhode-Island, and in New-Haven, in Connecticut, in the year 1805. But the
same power should rigorously prevent the removal of the sick, except it
be that class of them which have neither homes nor friends. The less the
distance they are carried beyond the infected atmosphere, the better. The
injury sustained by conveying them in a jolting carriage, for two or
three miles, has often been proclaimed in the reports of our city
hospitals, of patients being admitted without a pulse, and dying a few
hours afterwards.
In leaving a place infected by miasmata, care should be taken not to
expose the body to great cold, heat, or fatigue, for eighteen or twenty
days, lest they should excite the dormant seeds of the disease into
action.
But where flight is not enforced by law, or where it is not practicable,
or preferred, safety should be sought for in such means as reduce the
preternatural tone and fulness induced in the blood-vessels by the
stimulus of the miasmata, and the suppression of customary secretions.
These are,