several specific means to prevent it, different from those which have
been advised to defend the blood-vessels from fever. Unripe and decayed
fruit should be avoided, and that which is ripe and sound should not be
eaten in an excessive quantity. Spices, and particularly Cayenne pepper,
and the red pepper of our country, should be taken daily with food. Mr.
Dewar, a British surgeon, tells us, the French soldiers, while in Egypt,
carried pepper in boxes with them, wherever they went, to eat with the
fruits of the country, and thereby often escaped its diseases. The whole
diet, during the prevalence of intestinal diseases, when they are not
highly inflammatory, should be of a cordial nature. A dysentery
prevailed, a few years ago, upon the Potomac, in a part of the country
which was inhabited by a number of protestant and catholic families. The
disease was observed to exist only in the former. The latter, who ate of
salted fish every Friday, and occasionally on other days of the week,
very generally escaped it. In the year 1759, a dysentery broke out in the
village of Princeton, in New-Jersey, and affected many of the students of
the college. It was remarked, that it passed by all those boys who came
from the cities of New-York and Philadelphia. This was ascribed to their
having lived more upon tea and coffee than the farmers' sons in the
college; for those cordial articles of diet were but rarely used, six and
forty years ago, in the farm houses of the middle states of America. I
mentioned formerly that the cordial diet of the inhabitants of our cities
was probably the reason why the dysentery so seldom prevailed as an
epidemic in them.
Another means of preventing the dysentery is, by avoiding costiveness,
and by occasionally taking purging physic, even when the bowels are in
their natural state. A militia captain, in the Pennsylvania service,
preserved his whole company from a dysentery which prevailed in a part of
the American army at Amboy, in the year 1776, by giving each of them a
purge of sea-water. He preserved his family, and many of his neighbours,
some years afterwards, from the same disease, by dividing among them a
few pounds of purging salts. It was prevented, a few years ago, in the
academy of Bordentown, in New-Jersey, by giving all the boys molasses, in
large quantities, in their diet and drinks. The molasses probably acted
only by keeping the bowels in a laxative state.
As the dysentery is often excited by the dampness of the night air, great
care should be taken to avoid it, and, when necessarily exposed to it, to
defend the bowels by more warmth than other parts of the body. The
Egyptians, Mr. Dewar says, tie a belt about their bowels for that
purpose, and with the happiest effects.
II. I come now, according to the order I proposed, to mention the means
of preserving whole cities or communities from the influence of those
morbid exhalations which produce the different forms of summer and
autumnal disease, and, in particular, that which is of a malignant
nature.
As the flight of a whole city is rarely practicable, it will be necessary
to point out the means of destroying the morbid miasmata.
1. Where the putrid matters which emit them are of a small extent, they
should be covered with water or earth. Purchas tells us, 500 persons less
died of the plague the day after the Nile overflowed the grounds which
had emitted the putrid exhalations that produced it, than had died the
day before. During the prevalence of a malignant fever, it will be unsafe
to remove putrid matters. A plague was generated by an attempt to remove
the filth which had accumulated on the banks of the waters which surround
the city of Mantua, during the summer and autumnal months[18]. Even a
shower of rain, by disturbing the green pellicle which is sometimes
formed over putrid matters, I shall mention in another place, has let
loose exhalations that have produced a pestilential disease.
[18] Burserus.
2. Impregnating the air with certain effluvia, which act either by
destroying miasmata by means of mixture, or by exciting a new action in
the system, has, in some instances, checked the progress of a malignant
fever. The air extricated from fermenting wines, during a plentiful
vintage, Vansweiten tells us, has once checked the ravages of a plague in
Germany. Ambrose Parey informs us, the plague was checked in a city in
Italy by killing all the cats and dogs in the place, and leaving them to
putrify in the streets. Mr. Bruce relates, that all those persons who
lived in smoky houses, in one of the countries which he visited, escaped
bilious fevers, and Dr. Clark mentions an instance, in which several
cooks, who were constantly exposed to smoke, escaped a fever which
affected the whole crew of a galley. The yellow fever has never appeared
within the limits of the effluvia of the sal ammoniac manufactory, nor of
the tan-pits in the suburbs of Philadelphia, nor has the city of London
been visited with a plague since its inhabitants have used sea-coal for
fuel. But other causes have contributed more certainly to the exemption
of that city from the plague for upwards of a century, one of which shall
be mentioned under our next head.
3. Desquenette tells us, the infection of the plague never crosses the
Nile, and that it is arrested by means of ditches, dug and filled with
water for that purpose. Dr. Whitman has remarked, that the plague never
passes from Abydos, on the Turkish, to Mito, on the European side of the
water of the Dardanelles, which forms the entrance to Constantinople.
The yellow fever has never been known to pass from Philadelphia to the
Jersey shore, and the miasmata generated on the east side of the
Schuylkill rarely infect the inhabitants of the opposite side of the
river. Many persons found safety from the plague of London, in 1665, by
flying to ships which lay in the middle of the Thames, and, it is well
known, no instance of yellow fever occurred in those Philadelphia
families that confined themselves to ships in the middle of the Delaware,
in the year 1793. But three or four, of four hundred men, on board a ship
of war called the Jason, commanded by captain Coteneuil, perished with an
epidemic yellow fever, in the year 1746, at St. Domingo, in consequence,
Dr. Desportes says, of her hold being constantly half filled with
water[19]. I have multiplied facts upon this subject, because they lead
to important conclusions. They show the immense consequence of frequently
washing the streets and houses of cities, both to prevent and check
pestilential fevers. What would be the effect of placing tubs of fresh
water in the rooms of patients infected with malignant fevers, and in an
atmosphere charged with putrid exhalations? Their efficacy in absorbing
the matter which constitutes the odour of fresh paint, favours a hope
that they would be useful for that purpose. I have mentioned an instance,
in the Account of the Yellow Fever in Philadelphia, in the year 1797, in
which they were supposed to have been employed with evident advantage.
[19] Vol. I. p. 161.
4. Intercepting the passage of miasmata to the inhabitants of cities.
Varro, in his Treatise upon Agriculture, relates, that his namesake
Varro, a Roman general, was in great danger of suffering, with a large
fleet and army, from a malignant fever at Conyra. Having discovered the
course of the miasmata which produced it to be from the south, he
fastened up all the southern windows and doors of the houses in which his
troops were quartered, and opened new ones to the north, by which means
he preserved them from the fever which prevailed in all the other houses
of the town and neighbourhood. Mr. Howard advises keeping the doors and
windows, of houses which are exposed to the plague, constantly shut,
except during the time of sunshine.
Several other means have been recommended to preserve cities from
malignant fevers during their prevalence, which are of doubtful
efficacy, or evidently hurtful. They are,
5. Strewing lime over putrid matters. Dr. Dalzelle says, he once checked
a bilious fever, by spreading twelve barrels of lime on a piece of marshy
ground, from whence the exhalations that produced it were derived[20]. A
mixture of quick lime and ashes in water, when thrown into a privy,
discharges from it a large quantity of offensive air, and leaves it
afterwards without a smell. As this foul air is discharged into the
atmosphere, it has been doubted whether the lime and ashes should be used
for that purpose, after a malignant fever has made its appearance.
[20] Sur les Maladies des Climats Chauds.
6. Mr. Quiton Morveau has lately proposed the muriatic gas as a means of
destroying miasmata. However effectual it may be in destroying the
volatile and foul excretions which are discharged from the human body in
confined situations, as in filthy jails, hospitals, and ships, it is not
calculated to oppose the seeds of a disease which exist in the
atmosphere, and which are diffused over a large extent of city or
country. Mr. Morveau ascribes great virtues to it, in checking the
malignant fever in Cadiz, in 1801, but from the time at which it was
used, being late in the autumn, there is more reason to believe it had
run its ordinary course, or that it was destroyed by cold weather.
7. The explosion of gunpowder has been recommended for checking
pestilential diseases. Mr. Quiton Morveau says, it destroys the offensive
odour of putrid exhalations, but does not act upon the fevers produced by
them.
8. Washing the floors of houses with a solution of alkaline salts in
water, has been recommended by Dr. Mitchell, as an antidote to malignant
fevers. As yet, I believe, there are no facts which establish the
efficacy of the practice, when they are produced by exhalations from
decayed vegetable and animal substances in a putrid state.
9. Large fires have sometimes been made in cities, in order to destroy
the miasmata of pestilential diseases. They were obviously hurtful in the
plague of London, in the year 1665. Dr. Hodges, who relates this fact,
says, "Heaven wept for the mistake of kindling them, and mercifully put
them out, with showers of rain."
I cannot conclude this head, without lamenting the want of laws in all
our states, to compel physicians to make public the first cases of
malignant fever that come under their notice. The cry of fire is not more
useful to save a city from destruction, than the early knowledge of such
cases would be to save it from the ravages of pestilential and mortal
epidemics. Hundreds of instances have occurred, in all ages and
countries, in which they might have been stifled in their birth, by the
means that have been mentioned, had this practice been adopted. But when,
and where, will science, humanity, and government first combine to
accomplish this salutary purpose? Most of our histories of mortal
epidemics abound with facts which show a contrary disposition and conduct
in physicians, rulers, and the people. I shall mention one of these facts
only, to show how far we must travel over mountains of prejudice and
error, before we shall witness that desirable event. It is extracted from
the second volume of the Life of the late Empress of Russia. "The Russian
army (says the biographer), after defeating the Turks, on entering their
territories were met by the plague, and brought it to their country,
where the folly of several of their generals contributed to its
propagation, as if they thought by a military word of command to alter
the nature of things. Lieutenantgeneral Stoffeln, at Yassy, where the
pestilence raged in the winter of 1770, issued peremptory orders that its
name should not be pronounced; he even obliged the physicians and
surgeons to draw up a declaration in writing, that it was only _a spotted
fever_. One honest surgeon of the name of Kluge refused to sign it. In
this manner the season of prevention was neglected. Several thousand
Russian soldiers were by this means carried off. The men fell dead upon
the road in heaps. The number of burghers that died was never known, as
they had run into the country, and into the forests. At length the havoc
of death reached the general's own people: he remained true to his
persuasion, left the town, and went into the more perilous camp. But his
intrepidity availed him nothing; he died of the plague in July,
1771[21]."
[21] The above disease appears to have been the camp fever, the origin
and character of which will be noticed in the next article.
III. Let us now consider, in the last place, the means of exterminating
malignant and other forms of summer and autumnal disease, by removing
their causes. These means are,
1. The removal or destruction of all those putrid matters formerly
enumerated, which are capable of producing fevers. Many of the
institutions of the Jewish nation, for this purpose, are worthy of our
imitation. The following verses contain a fund of useful knowledge upon
this subject.--"Thou shalt have a place without the camp, whether thou
shalt go forth abroad; and shalt have a paddle upon thy weapon, and it
shall be when thou wilt ease thyself abroad, thou shalt dig therewith,
and shalt turn back, and cover that which cometh from thee; for the Lord
thy God walketh in the midst of thy camp to deliver thee, therefore shall
he _see no unclean thing in thee_, and turn away from thee." Deuteronomy,
chapter xxiii. verses 12, 13, and 14. "But the flesh of the bullock, and
his skin, and his dung, shalt thou _burn with fire without the camp_."
Exodus, chapter xxxix. verse 14. The advantages of thus burying and
removing all putrid matters, and of burning such as were disposed to a
speedy putrefaction, in a crowded camp, and in a warm climate, are very
obvious. Their benefits have often been realized in other countries. The
United Provinces of Holland hold their exemption from the plague, only by
the tenure of their cleanliness. In the character given by Luther of Pope
Julius, he says, "he kept the streets of Rome so clean and sweet, that
there were no plagues nor sicknesses during his time." The city of Oxford
was prepared to afford an asylum to the royal family of Great-Britain
from the plague, when it ravaged London, and other parts of England, in
the year 1665, only in consequence of its having been cleaned, some years
before, by the Bishop of Winchester. In a manuscript account of the life
of Doctor, afterwards Governor Colden, of New-York, there is the
following fact. It was first communicated to the public in the daily
gazette of the capital of that state, on the 30th of October, 1799. "A
malignant fever having raged with exceeding violence for two summers
successively in the city of New-York, about forty years ago, he
communicated his thoughts to the public, on the most probable cure of the
calamity. He published a little treatise on the occasion, in which he
collected the sentiments of the best authority, on the bad effects of
_stagnating waters_, _moist air_, _damp cellars_, _filthy shores_, and
_dirty streets_. He showed how much these nuisances prevailed in many
parts of the city, and pointed out the remedies. The corporation of the
city voted him their thanks, adopted his reasoning, and established a
plan for draining and cleaning the city, which was attended with the most
happy effects." The advantages of burning offal matters, capable by
putrefaction of producing fevers, has been demonstrated by those
housekeepers, who, instead of collecting the entrails of fish and
poultry, and the parings and skins of vegetables, in barrels, instantly
throw them into their kitchen fires. The families of such persons are
generally healthy.
2. In the construction of cities, narrow streets and alleys should be
carefully avoided. Deep lots should be reserved for yards and gardens for
all the houses, and subterraneous passages should be dug to convey, when
practicable, to running water, the contents of privies, and the foul
water of kitchens. In cities that are wholly supplied with fresh water by
pipes from neighbouring springs or rivers, all the evils from privies
might be prevented by digging them so deep as to connect them with water.
Great advantages, it has been suggested, would arise in the construction
of cities, from leaving open squares, equal in number and size to those
which are covered with houses. The light and dark squares of a
chequer-board might serve as models for the execution of such a plan. The
city of London, which had been afflicted nearly every year for above half
a century by the plague, has never been visited by it since the year
1666. In that memorable year, while the inhabitants were venting their
execrations upon a harmless bale of silks imported from Holland, as the
vehicle of the seeds of their late mortal epidemic, Heaven kindly pointed
out, and removed its cause, by permitting a fire to destroy whole
streets and lanes of small wooden buildings, which had been the
reservoirs of filth for centuries, and thereby the sources of all the
plagues of that city[22]. Those streets and lanes were to London, what
Water-street and Farmer's-row are to Philadelphia, Fell's-point to
Baltimore, the slips and docks to New-York, and Water-street to the town
of Norfolk.
[22] A proposal was made to replace the houses that had been burnt, by
similar buildings, and upon the same space of ground. Sir
Christopher Wren opposed it, and with the following argument: "By
so doing, you will show you have not _deserved_ the late fire!"
3. Where the different forms of summer and autumnal disease arise from
marsh exhalations, they should be destroyed by drains, by wells
communicating with their subterraneous springs, or by cultivating upon
them certain grasses, which form a kind of mat over the soil, and, when
none of these modes of destroying them is practicable, by overflowing
them with water.
I have met with many excellent quotations from a work upon this part of
our subject, by Tozzetti, an Italian physician, from which, I have no
doubt, much useful information might be obtained. The Rev. Thomas Hall,
to whom I made an unsuccessful application for this work, speaks of it,
in his answer to my letter, in the following terms. "It is in such high
estimation, that the late emperor Leopold, when grand duke of Tuscany,
caused it to be re-printed at his own expence, and presented it to his
friends. The consequence of this was, it influenced the owners of low
marshy grounds, in the neighbourhood of the river Arno, to drain and
cultivate them, and thereby rendered the abode of noxious air, and
malignant fevers, a terrestrial paradise."
4. The summer and autumnal diseases of our country have often followed
the erection of mill-dams. They may easily be obviated by surrounding
those receptacles of water with trees, which prevent the sun's acting
upon their shores, so as to exhale miasmata from them. Trees planted upon
the sides of creeks and rivers, near a house, serve the same salutary
purpose.
5. It has often been observed, that families enjoy good health, for many
years, in the swamps of Delaware and North-Carolina, while they are in
their natural state, but that sickness always follows the action of the
rays of the sun upon the moist surface of the earth, after they are
cleared. For this reason, the cultivation of a country should always
follow the cutting down of its timber, in order to prevent the new
ground becoming, by its exhalations, a source of disease.
6. In commercial cities, no vessel that arrives with a cargo of
putrescent articles should ever be suffered to approach a wharf, before
the air that has been confined in her hold has been discharged. The same
thing should be done after the arrival of a vessel from a distant or hot
country, though her cargo be not capable of putrefaction, for air
acquires a morbid quality by stagnating contiguous to wood, under
circumstances formerly mentioned.
All these modes of removing the causes of malignant and yellow fevers,
and of promoting strict and universal cleanliness, are of more
consequence in the middle and northern states of America, than in
countries uniformly warm, inasmuch as the disease may be taken as often
as our inhabitants are exposed to its sources. In the West-Indies, a
second attack of the yellow fever is prevented by the insensibility
induced upon the system, by its being constantly exposed to the
impressions of heat and exhalation. After a seasoning, as it is called,
or a residence of two or three years in those islands, the miasmata
affect the old settlers, as they do the natives, only with mild
remittents. Nearly the same thing takes place at Madras, in the
East-Indies, where, Dr. Clark says, the exhalations which bring on
bilious fevers, colic, cholera, and spasmodic affections in new comers,
produce a puking in the morning, only in old residents. But very
different is the condition of the inhabitants of the middle and northern
states of America, in whom the winters prevent the acquisition of habits
of insensibility to the heat and exhalations of the previous summers, and
thus place them every year in the condition of new comers in the West and
East-Indies, or of persons who have spent two or three years in a cold
climate. This circumstance increases the danger of depopulation from our
malignant epidemics, and should produce corresponding exertions to
prevent them.
In enumerating the various means of preventing and exterminating the
malignant forms of fever, it may appear strange that I have said nothing
of the efficacy of quarantines for that purpose. Did I believe these
pages would be read only by the citizens of Pennsylvania, I would do
homage to their prejudices, by passing over this subject by a respectful
and melancholy silence; but as it is probable they will fall into the
hands of physicians and citizens of other states, I feel myself under an
obligation to declare, that I believe quarantines are of no efficacy in
preventing the yellow fever, in any other way than by excluding the
unwholesome air that is generated in the holds of ships, which may be
done as easily in a single day, as in weeks or months. They originated in
error, and have been kept up by a supine and traditional faith in the
opinions and conduct of our ancestors in medicine. Millions of dollars
have been wasted by them. From their influence, the commerce,
agriculture, and manufactures of our country have suffered for many
years. But this is not all. Thousands of lives have been sacrificed, by
that faith in their efficacy, which has led to the neglect of domestic
cleanliness. Distressing as these evils are, still greater have
originated from them; for a belief in the contagious nature of the yellow
fever, which is so solemnly enforced by the execution of quarantine laws,
has demoralized our citizens. It has, in many instances, extinguished
friendship, annihilated religion, and violated the sacraments of nature,
by resisting even the loud and vehement cries of filial and parental
blood.
While I thus deny the yellow fever to be the offspring of a specific
contagion, and of course incapable of being imported so as to become an
epidemic in any country, I shall admit presently, that the excretions of
a patient in this disease may, by confinement, become so acrid as to
produce, under circumstances to be mentioned hereafter, a similar disease
in a person, but from this person it cannot be communicated, if he
possess only the common advantages of pure air and cleanliness. To
enforce a quarantine law, therefore, under such a contingent
circumstance, and at the expence of such a profusion of blessings as have
been mentioned, is to imitate the conduct of the man, who, in attempting
to kill a fly upon his child's forehead, knocked out its brains.
From the detail that has been given of the sources of malignant fevers,
and of the means of preventing them, it is evident that they do not exist
by an unchangeable law of nature, and that Heaven has surrendered every
part of the globe to man, in a state capable of being inhabited, and
enjoyed. The facts that have been mentioned show further, the connection
of health and longevity, with the reason and labour of man.
To every natural evil the Author of Nature has kindly prepared an
antidote. Pestilential fevers furnish no exception to this remark. The
means of preventing them are as much under the power of human reason and
industry, as the means of preventing the evils of lightning and common
fire. I am so satisfied of the truth of this opinion, that I look for a
time when our courts of law shall punish cities and villages, for
permitting any of the sources of bilious and malignant fevers to exist
within their jurisdiction.