the action of miasmata, and to the greater or less degrees of labour, or
exercise, which are taken. In cases of great exposure to an infected
atmosphere, with but little exercise, the diet should be simple in its
quality, and small in its quantity. Fresh meats and wine should be
avoided. A little salted meat, and Cayenne pepper with vegetables,
prevent an undue languor of the stomach, from the want of its usual
cordial aliments. The less mortality of the yellow fever in the French
and Spanish West-India islands than in the British, has been justly
attributed to the more temperate habits of the natives of France and
Spain. The Bramins, who live wholly upon vegetables, escape the malignant
fevers of India, while whole regiments of Europeans, who eat animal food,
die in their neighbourhood. The people of Minorca, Dr. Cleghorn says, who
reside near gardens, and live chiefly upon fruit during the summer,
escape the violent autumnal fever of that island. The field negroes of
South-Carolina owe their exemption from bilious fevers to their living
chiefly upon vegetables. There is a fact which shows, that not only
temperance, but abstinence bordering upon famine, has afforded a
protection from malignant fevers. In a letter which I received a few
months ago, from the Rev. Thomas Hall, chaplain to the British factory at
Leghorn, containing an account of the yellow fever which prevailed in
that city, in the summer and autumn of 1804, there is the following
communication. "Of the _rich_, who live in large airy houses, there died
but four persons with the fever. Of the _commodious_, who live
comfortably, but not affluently, there died ten. Of the _poor_, who
inhabited small and crowded rooms, in the dirty and confined parts of the
city, there died nearly seven hundred. But of the _beggars_, who had
scarcely any thing to eat, and who slept half naked every night upon hard
pavements, not one died." From the reduced and exhausted state of the
system in these people, they were incapable, if I may be allowed the
expression, of the combustion of fever. Persons reduced by chronic
diseases, in like manner, often escape such as are acute. Six French
ships of the line landed 300 sick, at St. Domingo, while the yellow fever
prevailed there in the year 1745, and yet no one of them was infected by
it[15].
[15] Desportes, vol. i. p. 140.
Where the body is exposed to miasmata, and a great deal of exercise taken
at the same time, broths, a little wine, or malt liquors, may be used
with the fruits and garden vegetables of the season, with safety and
advantage. The change from a full to a low diet should be made gradually.
When made suddenly, it predisposes to an attack of the disease.
2. Laxative medicines. Hundreds, perhaps thousands, of the citizens of
Philadelphia were indebted for their preservation from the yellow fever
to the occasional use of a calomel pill, a few grains of rhubarb, or a
table-spoonful of sweet, or castor oil, during the prevalence of our late
pestilential fevers. Even the air of Batavia has been deprived of its
poisonous quality, by means of this class of medicines. A citizen of
Philadelphia asked a captain of a New-England ship, whom he met at that
island, how he preserved the whole crew of his ship in health, while half
the sailors of all the other ships in the harbour were sick or dead. He
informed him, that it was by giving each of them a gentle purge of
sulphur every day.
3. A plentiful perspiration, or moderate sweats, kept up by means of warm
clothing and bed-clothes. The excretion which takes place by the skin, is
a discharge of the first necessity. I have never known an instance of a
person's being attacked by the yellow fever in whom this discharge was
constant, and equally diffused all over the body. Its effects are equally
salutary in preventing the plague. So well known is this fact, that Mr.
Volney informs us, in his Travels into Egypt, that the common salutation
at Cairo, during the prevalence of the plague, is, "Do you sweat freely?"
For the purpose of promoting this excretion, flannel shirts or
waistcoats worn next to the skin have been found more useful than linen.
As the perspiration and sweats, which are thus discharged in a
pestilential season, are often unusual in their quantity, and of a morbid
quality, clean body-linen or flannel should be put on every day, and
where this is not practicable, that which has been worn should be
exchanged every morning and evening for that which has been exposed
during the previous day and night, in a dry air.
4. Blood-letting. In addition to the authorities of Dr. Haller and Dr.
Hodges, mentioned in another place[16], in favour of this remedy, I shall
subjoin a few others. Dr. Mitchell, in his Account of the Yellow Fever
which prevailed in Virginia, in the year 1741, informs us, that it was
often prevented in persons who were under the influence of its remote
cause, by the loss of a few ounces of blood. It was formerly a practice
among the physicians in St. Domingo, to bleed whole regiments of troops
as soon as they arrived from France, by which means they were preserved
from the malignant fever of the island.
[16] Account of the Yellow Fever in 1793, vol. iii.
During the short visit paid to this city, in the year 1798, by Dr.
Borland, a respectable physician of the British army, he put into my
hands the following communication. "In the beginning of August, 1797, 109
Dutch artillery arrived at Port au Prince, in the Bangalore transport.
The florid appearance of the men, their cumbersome clothing, and the
season of the year, seemed all unfavourable omens of the melancholy fate
we presumed awaited them. It was, however, thought a favourable
opportunity, by Dr. Jackson and myself, to try what could be done in
warding off the fever. It was accordingly suggested to Monsieur
Conturier, the chief surgeon of the foreign troops, and the surgeon of
the regiment, that the whole detachment should be blooded freely, and
that, the morning after, a dose of physic should be administered to every
man. This was implicitly complied with, a day or two after, and at this
moment in which I write, although a period of four months has elapsed,
but two of that detachment have died, one of whom was in a dangerous
state when he landed. A success unparalleled during the war in St
Domingo! It is true, several have been attacked with the disease, but in
those the symptoms were less violent, and readily subsided by the use of
the lancet.
"The _crew_ of the Bangalore, on her arrival at Port au Prince, consisted
of twenty-eight men. With them no preventive plan was followed. In a very
few weeks eight died, and at present, of the original number, but
fourteen remain."
All these depleting remedies, whether used separately or together, induce
such an artificial debility in the system, as disposes it to vibrate more
readily under the impression of the miasmata. Thus the willow rises,
after bowing before a blast of wind, while the unyielding oak falls to
the ground by its side. It is from the similarity of the natural weakness
in the systems of women, in the West-Indies, with that which has been
induced by the artificial means that have been mentioned, that they so
generally escape the malignant endemic of the islands.
A second class of preventives of malignant fever are such as obviate the
internal action of miasmata, by exciting a general or partial
determination to the external surface of the body. These are,
1. The warm bath. I have known this grateful remedy used with success in
our city. It serves the treble purposes of keeping the skin clean, and
the pores open, and of defending what are called the vital organs from
disease, by inviting its remote cause to the external surface of the
body.
2. The cold bath, or cold water applied to the external surface of the
body. Ulloa, in his travels through Cuba, tells us the Spaniards make it
a practice, when partially wetted by the rain, to plunge themselves, with
their wet clothes on, into the first stream of water they meet with
afterwards, by which means they avoid taking the fever of the island.
Where this cannot be conveniently done, the peasants strip off their
clothes, and put them under a shelter, and receive showers of rain upon
their naked bodies, and thus preserve themselves from the fever. Dr.
Baynard has left it upon record, in his treatise upon the cold bath, that
those persons who lived in water-mills, also watermen, bargemen, and
fishermen, who were employed upon the river, and in dabbling in cold
water, were rarely affected by the plague in London, in 1665, and that
but two persons died with it on London bridge. The water carriers at
Cairo, Mr. Volney says, uniformly escape the plague; and Dr. Chisholm
informs us, that those negroes in Demarara who go naked, and are thereby
disposed not to avoid showers of rain, are never affected with the fever
of that country.
3. Washing the body, every morning and evening, with salt water. A whole
ship's crew from Philadelphia was preserved by this means from the yellow
fever, some years ago, in one of the West-India islands, while a large
proportion of the crews of several ships, that lay in the same harbour,
perished by that disease.
4. Anointing the body with oil. The natives of Africa, and some American
Indians, use this preventive with success during their sickly seasons. It
has lately been used, it is said, with effect in preventing the plague.
Its efficacy for that purpose was first suggested by no oilman having
died of that disease during four years, in which time 100,000 people
perished with it in Egypt. Oliver, in his Travels into that country, says
the men who make and sell butter, are equally fortunate in escaping it.
5. Issues, setons, and blisters belong to this class of preventives of
malignant and bilious fevers. Issues, according to Parisinus,
Florentinus, Forestus, and several other authors quoted by Diemerbroeck,
have prevented the plague in many hundred instances. Paræus says, all who
had ulcers from the venereal disease, or any other cause, escaped it. Dr.
Hodges owed his preservation from the plague in London, in 1665, to an
issue in his leg. He says he always felt a slight pain in it when he went
into a sick room. Dr. Gallaher ascribed his escape from the yellow fever
of 1799 to a perpetual blister, which he applied to his arm for that
purpose. Dr. Barton favoured me with the sight of a letter from Dr. James
Stevens, dated January 12, 1801, in which he says he believed Dr. Beach
(formerly of Connecticut) had been preserved from the bilious fever by a
seton in his side. He adds further, that Dr. Beach had been called to
attend the labourers at the Onandoga salt springs, in the state of
New-York, ninety-eight of whom out of a hundred had the bilious fever. Of
the two who escaped it, one had a sore leg, the other what is called a
scald-head. The discharge from the sores in each of them, as well as from
the doctor's issue, was more copious during the prevalence of the fever,
than it had been at any other time.
A third class of preventives of malignant fever, are such as excite a
general action, more powerful than that which the miasmata are disposed
to create in the system, or an action of a contrary nature. These are,
1. Onions and garlic. All those citizens who used these vegetables in
their diet, escaped the yellow fever in 1793. The greater exemption of
the natives of France from this disease, wherever they are exposed to it,
than of the inhabitants of other European countries, has been ascribed in
part to the liberal use of those condiments in their food. The Jews, it
has been said, have often owed to them their preservation from the
plagues which formerly prevailed in Europe. It is probable leeks and
onions, which to this day form a material part of the diet of the
inhabitants of Egypt, were cultivated and eaten originally as the means
of obviating the plagues of that country. I have been at a loss to know
why the Author of Nature, who has endowed these vegetables with so many
excellent qualities for diet and medicine, should have accompanied them
with such a disagreeable smell. Perhaps the reason was, kindly to force
them into universal use; for it is remarkable their smell in the breath
is imperceptible to those who use them.
2. Calomel, taken in such small doses as gently to affect the gums. It
preserved most of the crew of a Russian ship at Plymouth, in the year
1777, from a fever generated by filth in her hold. In a letter which I
received from Captain Thomas Truxton, in the year 1797, he informed me,
that an old and respectable merchant at Batavia had assured him, he had
been preserved in good health by calomel, taken in the way that has been
mentioned, during the sickly seasons, for upwards of thirty years. The
mortality of the fevers of that island may easily be conceived of, when I
add, on the authority of a physician quoted in Sir George Staunton's
Account of his Embassy to China, that one half of all new comers die
there on the first year of their arrival.
Our principal dependence should be placed upon those two preventives
under this head. There are several others which have been in common use,
some of which I believe are hurtful, and the rest are of feeble, or
doubtful efficacy. They are,
3. Wine and ardent spirits. They both prevent a malignant fever, only
when they excite an action in the system above that which is ordinarily
excited by the miasmata of the fever; but this cannot be done without
producing intoxication, which, to be effectual, must be perpetual; for
the weakness and excitability, which take place in the intervals of
drunkenness, predispose to the disease. Agreeably to this remark, I
observed three persons, who were constantly drunk, survive two of our
most fatal epidemics, while all those persons who were alternately drunk
and sober, rarely escaped an attack of the fever. In most of them, it
terminated in death.
4. Tobacco. Many hundreds of the citizens of Philadelphia can witness,
that no benefit was derived from this weed, in any of the ways in which
it is commonly used, in the late epidemics of our city. Mr. Howard says
it has no effect in preserving from the plague.
5. Camphor suspended in a bag round the neck, and rags wetted in vinegar,
and applied to the nose. These means were in general use in the fever of
1793, in Philadelphia, but they afforded no protection from it. It is
possible they had a contrary effect, by entangling, in their volatile
particles, more of the miasmata of the fever, and thus increasing a
predisposition to it.
A fourth class of the preventives of malignant fevers are certain
substances which are said to destroy miasmata by entering into mixture
with them. Two persons, who were very much exposed to the causes of the
fever in 1798, took each of them a table spoonful of sweet oil every
morning. They both escaped the fever. Did the oil, in these cases, act by
destroying miasmata in the stomach chemically? or did it defend the
stomach mechanically from their action? or did it prevent the disease,
only by gently opening the bowels? It is certain the fat of pork meat
protects the men who work in the lead-mines of Great-Britain from the
deleterious effects which the fumes of that metal are apt to bring upon
the stomach and bowels, and that a poisoned arrow, discharged into the
side of a hog, will not injure him, if it be arrested by the fat which
lines that part of his body.
The vapour which issues from fresh earth has been supposed to destroy the
miasmata which produce malignant fevers, by entering into mixture with
them. Most of the men who were employed in digging graves and cellars,
and in removing the dirt from the streets of Philadelphia, in 1793,
escaped the fever of that year. In the new settlements of our country, it
is said, the poison of the rattlesnake is deprived of its deadly effects
upon the body, by thrusting the wounded limb into a hole, recently made
in the earth. The fable of Anteus, who rose with renewed strength from
the ground after repeated falls, was probably intended to signify, among
other things, the salutary virtues which are contained in the effluvia
which issue from fresh clods of earth.
3. There are many facts which show the efficacy of the volatile alkali in
destroying, by mixture, the poison of snakes. One of them was lately
communicated to the public by Dr. Ramsay, of South-Carolina. What would
be the effect of the daily use of a few tea spoonfuls of this medicine in
a liquid form, and of frequently washing the body with it, during the
prevalence of pestilential epidemics?
The miasmata which produce malignant fevers often exist in an inoffensive
state in the body, for weeks, and perhaps months, without doing any harm.
With but a few exceptions, they seldom induce a disease without the
reinforcement of an exciting cause. In vain, therefore, shall we use all
the preventives that have been recommended, without,
V. Avoiding of all its exciting causes. These are,
1. Heat and cold. While the former has excited the yellow fever in
thousands, the latter has excited it in tens of thousands. It is not in
middle latitudes only that cold awakens this disease in the body. Dr.
Mosely says it is a more frequent exciting cause of that, and of other
diseases, in the island of Jamaica, than in any of the most temperate
climates of the globe. It is this which renders cases of yellow fever,
when epidemic in our cities, more numerous in the cool months of
September and October, than in July and August. For the purpose of
avoiding this pernicious and universal influence of cold, the clothing
and bed-covers should be rather warmer in those months, in middle and
northern latitudes, than is agreeable, and fires should be made every
morning and evening in common sitting rooms, and during the whole day,
when the weather is damp or cool. They serve, not only to prevent the
reduction of the excitement of the blood-vessels, by the gradual and
imperceptible abstraction of the heat of the body, but to convey up a
chimney all the unwholesome air that accumulates in those rooms during a
sickly season. By these precautions, I have known whole families
preserved in health, while all their neighbours who neglected them, have
been confined by a prevailing autumnal fever.
3. The early morning and evening air, even in warm weather.
4. Fatigue from amusements, such as fishing, gunning, and dancing, and
from _unusual_ labour or exercise. The effects of fatigue from this
cause have been already noticed[17], in the maids of large families
being the only persons who die of the fever, in consequence of their
having performed great and _unusual_ services to those branches of the
family who survive them, while nurses, who only exercise their ordinary
habits in attending sick people, are seldom carried off by it.
[17] Account of the Yellow Fever in 1793, vol. iii.
5. Intemperance in eating and drinking.
6. Partaking of _new_ aliments and drinks. The stomach, during the
prevalence of malignant fevers, is always in an irritable state, and
constantly disposed to be affected by impressions that are not habitual
to it.
7. Violent emotions or passions of the mind.
8. The entire cessation of moderate labour. This, by permitting the mind
to ramble upon subjects of terror and distress, and by exposing the body
to idleness and company, favours an attack of fever. A predisposition to
it, is likewise created by alternating labour and idleness with each
other.
9. The continuance of hard labour. The miasmata which produce malignant
fevers sometimes possess so much force, that the least addition to it,
even from customary acts of labour, is sufficient to excite the disease.
In this case, safety should be sought in retirement, more especially by
those persons whose occupations expose them to the heat of fires, and the
rays of the sun, such as hatters, smiths, bricklayers, and house and ship
carpenters. The wealthy inhabitants of Constantinople and Smyrna
erroneously suppose they escape the contagion of the plague, by shutting
themselves up in their houses during its prevalence. They owe their
preservation chiefly to their being removed, by an exemption from care
and business, from all its exciting causes. Most of the nobility and
gentry of Moscow, by these means escaped a plague which carried off
27,000 persons in that city, in the year 1771, and many whole families in
Philadelphia were indebted for their safety to the same precautions in
the year 1793. Confinement is more certain in its beneficial effects,
when persons occupy the upper stories only of their houses. The
inhabitants of St. Lucia, Dr. Chisholm says, by this means often escape
the yellow fever of that island. Such is the difference between the
healthiness of the upper and lower stories of a house, that, travellers
tell us, birds live in the former, and die in the latter, during the
prevalence of a plague in the eastern countries.
All the exciting causes that have been enumerated should be avoided with
double care three days before, and three days after, as well as on the
days of the full and change of the moon. The reason for this caution was
given in the account of the yellow fever in Philadelphia in the year
1797.
To persons who have retired from infected cities, or countries, it will
be necessary to suggest a caution, not to visit them while the malignant
fever from which they fled prevails in them. Dr. Dow informed me, in his
visit to Philadelphia in the year 1800, that the natives and old citizens
of New-Orleans who retired into the country, and returned during the
prevalence of the yellow fever in that city, the year before, were often
affected by it, while all such persons as did not change their residence,
escaped it. The danger from visiting an infected city is greater to
persons who breathe an atmosphere of a uniform temperature, than one that
is subject to alternate changes in its degrees of heat and cold. The
inhabitants of Mexico, Baron Humboldt informed me, who descend from their
elevated situation, where the thermometer seldom varies more than ten
degrees in the year, and visit Vera Cruz during the prevalence of the
yellow fever in that city, are much oftener affected by it than the new
comers from the variable climates of European countries. But the habits
of insensibility to the impressions of the miasmata of this disease in
one country, do not always protect the system from their action in
another. The same illustrious traveller informed me, that the inhabitants
of the Havannah who visit Vera Cruz, and the inhabitants of Vera Cruz who
visit the Havannah, are affected in common with strangers with the fever
of those places.
I shall take leave of this part of our subject, by adding, that I am so
much impressed with a belief in the general, and almost necessary
connection of an exciting cause with a yellow fever, that were I to enter
a city, and meet its inhabitants under the first impressions of terror
and distress from its appearance, my advice to them should be, "BEWARE,
not of contagion, for the yellow fever of our country is not contagious,
nor of putrid exhalations, when the duties of humanity or consanguinity
require your attendance, but BEWARE OF EXCITING CAUSES!"
In the mild grades of the summer and autumnal fevers of the United
States, the means of prevention should be different from those which have
been recommended to prevent the yellow fever. They consist of such things
as gently invigorate the system, and thus create an action superior to
that which the miasmata have excited in it. The means commonly employed
for this purpose are,
1. Cordial diet and drinks; consisting of salted meat, and fish, with a
moderate quantity of wine and malt liquors. Dr. Blane says, the British
soldiers who lived upon salt meat, during the American war, were much
less afflicted with the intermitting fever than the neighbouring country
people; and, it is well known, the American army was much less afflicted
with summer and autumnal fevers, after they exchanged their fresh meat
for rations of salted beef and pork. Ardent spirits should be used
cautiously, for, when taken long enough to do good, they create a
dangerous attachment to them. A strong infusion of any bitter herb in
water, taken upon an empty stomach, is a cheap substitute for all the
above liquors where they cannot be afforded. The Peruvian bark has in
many instances been used with success as a preventive of the mild grades
of the summer and autumnal fevers of our country.
2. An equable and constant perspiration. This should be kept up by all
the means formerly mentioned for that purpose.
3. Avoiding certain exciting causes, particularly great heat and cold,
fatigue, long intervals between meals, intemperance, and the morning and
evening air, more especially during the lunar periods formerly mentioned.
Dr. Lind says, the farmers of Holdernesse, in England, who go out early
to their work, are seldom long lived, probably from their constitutions
being destroyed by frequent attacks of intermitting fevers, to which that
practice exposes them. Where peculiar circumstances of business render it
necessary for persons to inhale the morning air, care should be taken
never to do it without first eating a cordial breakfast.