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MEDICAL  INQUIRIES
OBSERVATIONS.
     BY BENJAMIN RUSH, M. D.

PROFESSOR OF THE INSTITUTES AND PRACTICE OE MEDICINE
   AND OF CLINICAL PRACTICE, IN THE UNIVERSITY
            OF PENNSYLVANIA.
IN FOUR VOLUMES.

     VOL. IV.
    THE THIRD EDITION,

REVISED AND ENLARGED BY THE AUTHOR.
            PHILADELPHIA,

Published bvMathew Carey, Hopkins and Earle, Johnson and Waraer,
 Kimber aiid Conrad, Bradford and Inskeep, Thomas and William
 Bradford, Benjamin and Thomas Kite, and Bennett and Walton.

                 1809. 
vN,
^ 
CONTENTS OF VOLUME IV.
                                          page
AN Account of the Bilious Remitting and In-
  termitting Yellow Fever, as it appeared in
  Philadelphia in 1797                        1
An  Account of the Bilious Yellow Fever, as it
  appeared in Philadelphia in the year 1798   63
An  Account of the Bilious Yellow Fever, as it
  appeared in Philadelphia in the year 1799   89
An  Account of Sporadic Cases of Yellow Fe-
  ver, as they appeared in Philadelphia in
  1800                                    101
An  Account of Sporadic Cases of Yellow Fe-
  ver, as they appeared in Philadelphia in
  1801                                    109
An Account of the Measles, as they appeared
  in Philadelphia in 1801                   115
An Account of the Bilious Yellow Fever, as it
  appeared in Philadelphia in the year 1802  121
An Account of the Bilious Yellow Fever, as it
  appeared in Philadelphia in the year 1803  131 
IV
                                           page
 An Account of Sporadic Cases of Yellow Fe-
   ver, as they appeared^ in Philadelphia in
   1804                                    145
 An Account of the Bilious Yelloxv Fever, as it
   appeared in Philadelphia in the year 1805  151
 An Account of the Diseases of 1806, 1807,
   1808, and 1809                          161
 An Inquiry into the various sources of the
   usual forms of Summer and Autumnal
   Disease, in the United States, and the
   means of preventing them                 171
 Facts, intended to prove the Yellow Fever not
   to be  Contagious                         233
A Defence of Blood-letting, as a remedy for
   certain Diseases                          285
An Inquiry into the comparative state of me-
   dicine, in Philadelphia, between the years
   1760  and 1766, and the year 1809        383 
INDEX.
                                              VOL.  P.
Air the primary stimulus of life     -     -    -    i.   12
Adam, the first motions of life in  him from the
   stimulus of air      .    .    .     .     .    .  i.  ib.
Actions originally involuntary, become  voluntary
   from habit      -      --                i.  16
Actions which become voluntary from habit again
   become involuntary       -     -      -      i.   17
Arsenic, an account of its use in cancers      -     i. 377
Age, an account of the state of the body and mind
   in old       ....       -   i. 403
Circumstances which favour longevity       -       i. 404
Phoenomena which occur in the body and mind in
   old age    -       -       -      -            i. 412
Diseases of old age      -      -      -    -     i. 423
Of the remedies for them                         i. 427
Autumn, account of it in Pennsylvania   -    -    ii.  24
Air, cold and dry, when proper in pulmonary con-
   sumption       -      -       -      -      ii. 124
                          A 
                        INDEX.

Air, cool and cold advised in the gout
Arteries,  facts in support of their muscularity and
    irritability
Arteriotomy, when necessary%
Its advantages     -.._.-

                           B.
Barometer, its mean elevation in Pennsylvania
Bletding, when proper in pulmonary consumption
---------, advised in inflammatory gout
---------■, in hydrophobia     ....
---------, used in the yellow fever of 1793
Blood not putrid in fevers     -       -       -
-----, appearances of it after bleeding in 1793
Bleeding, its salutary  effects in the fever of 1793
Circumstances which  regulated its use
Objections to it answered     ....
Blisters useful in the fever of 1793
Bark hurtful in it, and in  the yellow fever of 1794 -
Bowels, complaints of in  1808, and their cause  -
Blood-letting, a defence of it
What circumstances indicate it
Its salutary effects       -     -     .    _    .
Objections to it answered     - '
Its advantages over all other depleting remedies
Circumstances which regulate its use
Appearances of the blood to be attended to in advis-
   ing it     -    -      -    -    .
It is animated by the stimulus of disease
The quantity of it which may be drawn with  safety iv. 245
It is  rapidly reproduced       .       .      -     iv  251
VOI	.. T.
ii.	284
iii.	10
iv.	357
iv.	ib.
ii.	32
ii.	116
ii.	276
ii.	341
iii.	254
iii	129
iii.	256
iii.	257
iii	261
iii.	269
iii.	286
iii.	293
iv.	165
iv.	287
iv	ibid
iv.	290
iv.	297
iv.	326
iv.	329
iv.	341
iv.	344
 
                       INDEX.
                                                VOL. V.
Bleeding useful in pregnancy       -              iv.  371
Bleeding useful in parturition       -       -       iv.  373
----during the cessation of the menses    .       iv.  376
----in the disease from taking an excessive dose of
      opium                                     iv.  377
----in the diabetes         -              -      iv.  ibid
----in chronic intermittents       -      -      iv.  378
----in dislocated bones                          iv.  ibid
Baths, warm and cold, when established in Philadel-
    phia     .._.---    iv.  403

                           C
Climate of Pennsylvania, history of
----its changes    ..---.
Cold,  its greatest degrees in Pennsylvania
Consumption, pulmonary, thoughts upon
Inquiry into its causes and cure
Its predisposing cause         -
It is a disease of the whole system*
It is more common among women than men  -
It is not contagious    ....
Its supposed causes, proved to be its effects
 Its premonitory signs   -      ....
 Its cure       -
 Trachea diseased in it
 Anamalous symptoms described in it
 Divided into inflammatory, hectic, and typhus states  ii. 111
 Remedies for its inflammatory  state
 Blood-l.tting       -
 Vegetable diet     -
 Vomits      -                         -
 Nitre, and cold and dry air               .:     i
ii.	7
ii	12
ii.	22
ii.	61
ii.	79
ii.	80
ii.	82
iv.	407
ii.	95
ii	100
ii.	105
ii.	ibid
ii.	102
ii.	109
ii.	111
ii.	116
ii.	ibid
ii	122
ii.	123
ii.	124
 
                        INDEX.

 For its hectic state     -
 For its typhus state     -
 Cough in consumption, remedies for
 —— for Diarrhoea, remedies for
 Remedies radical for
 Signs of a favourable and unfavourable issue of the
    disease          -
 Cynanche trachealis, observations on
 History of its symptoms       -
 Its remedies     -
 Colera Infantum described       -
 Its supposed causes     -              -    -
 Its real causes      ....
 Its remedies       -      -
 Means of preventing it
 College of physicians, their address to  the citizens
    of Philadelphia      -
 Air, inflammatory and malignant
 Convalescence from the yellow fever of 1793,  its
    symptoms      -        -                     iii. 284
 Causes which rendered it mortal       -       -    iii. 302
 Cupping, when indicated and most proper     -     iv. 360
 Clubs common in Philadelphia between  1760 Sc  1766 iv. 409
 Convulsions withir. that period in pregnancy fatal    iv. 393

                           D
 Death, how produced       -        -
 Diseases of the military hospitals, observations on
 Diseases, when and how produced in Pennsylvania
 Debility, the pre-disposing cause of consumption
Diet vegetable, when proper in it
 Diarrhoea, how relieved in it
VOL. V.	
ii.	125
ii.	126
ii.	144
ii.	147
ii	148
iP	165
ii.	375
ii.	376
ii.	378
ii.	361
ii.	365
ii.	ibid
ii.	366
ii.	370
ii.	82
iv.	263
i.	88
i.	261
ii.	44
ii.	101
ii	122
ii.	147
 
                        INDEX.

Dropsy, observations on
Its causes    -      -       -
Proofs of inflammatory action in dropsy
Its remedies      -            -
Bleeding    -
Vomits and purges       -
Nitre    -       -       -       -      .
Cremor Tartar and Foxglore
Hard labour    -       -      -
Low diet, thirst, and fasting    -    -
Fear      -       -           .
Recumbent posture of the body and punctures
Of atonic dropsies     -      -       -
Reflections upon the opinions and  practice delivered
   in the observations upon  dropsies
Debility, the pre-disposing cause of general fever
Debility from action, and abstraction described
Disease, its unity and six primary  forms
Diet recommended to prevent the yellow fever  -
Diseases of 18J6, 1807, 1809, account of
Disease, summer and autumnal,  inquiry into  its
   causes       .....
Enumeration of them    -              -     -
Varied by circumstances    -      ...
Its different forms       -            -     .
Means of preventing it    -       -
Its premonitory signs
Means of preventing its mild  grades
Also its intestinal state      -       -
Means of defending from its remote causes
Means of extirpating its remote causes
Insufficiency of quarantines for that  purpose,  and
   their evils       .       .       .        .       iv. 229
VOI	. p.
ii	173
ii.	174
ii.	176
ii.	179
ii.	180
ii.	182
ii.	184
ii.	185
ii.	186
ii.	187
ii.	190
ii.	194
ii.	190
ii.	204
iii.	4
iii.	5
iii.	18
iii.	290
iv.	163
iv.	173
iv.	174
iv.	180
iv.	180
iv.	184
iv.	ibid
iv.	210
iv.	212
iv.	220
iv	222
 
                        INDEX.
                                                VOL. V.
 Diabetes, bleeding useful in     -       -       -   iv. 377
 Diseases in Philadelphia betwen 1760 and 1766     iv. 390
                             E
 Epidemics  one of its laws     ...      iii. 394
 Exercise, its different moces    -    -    -       ii. 150

                           F
 Faculty moral, inquiry into the influence of physical
    causes on      -     -     -     -    -    -     i. 171
 Moral faculty defined.....i- 172
 ----It  is innate    -       ....       i. 175
 Influence  of climate and diet upon it    -    -      i. 194
 Of certain drinks    -     -     -       -     -    i. 193
 Of hunger       -       -       .       -       -   i. 194
 Of diseases       -      -       -       -       -   i. 195
 Of idleness     ...     .     .       .     i. 197
 Of excessive sleep      -      -       -      -     i. 198
 Of cleanliness       -       -      -      -       i. 199
 Of solitude       -       ...             j. 200
 Of silence       -      -       -       -     -     i. 211
 Of music        -----       i. 202
Of the eloquence of the pulpit                     i. 203
 Of odors      -              -      -       -     i. 204
 Of airs       -----        i. 205
 Of medicines      -       -                       i. 205
Means of improving moral feeling      -       -     i. 210
 Of lessening it    -       -    -       -    -      j. 213
 Fever bilious, remitting of 1780 described     -    ii. 387
 Its remedies      -                              ii. 394
 Fever, phsenomenon of described     -       -      iii.   2
Its predisposing  and remote causes     -    -      iii    4
 Its unity     -      -       ...     -     iii   16
 Consists in convulsions in the blood vessels    -     iii.  18 
INDEX.
Its symptoms
Its morbid effects
Its different states
Malignant     -      -
Gangrenous
Synochus fortis
Synocha
Synochula
Synochoid
Synochus mitis
Typhus
Typhoid
Hectic
Intermitting
Febricula
Sweating
Fainting
Burning
Cold and chilly
Intestinal
Pulmonary
Eruptive
Anginose
Rheumatic
Arthrictic
Cephalic
Nephritic
Hydrophic
Hemorrhagic
 Amenorhagie
 Misplaced seats of fever
Chionic  hepatic state of fever 
INDEX.
                        VOL.  F..
1
 Haemorrohoidal    ....       ui.  62
 Opthalmic       .       •       •                  »"•  ib>
 Odantalgic
 Otalgic
 Apthorus              .                ^        m-  1D<
 Scrophulous
 Scorbutic     .       •                 J
 Convulsive or spasmodic       •       •      •      ni.  63
 Hysterical and hypochondriacal      -       -      "i-  63
 Cutaneous        ......»»•  64
 Fever, bilious yellow, in Philadelphia of 1793   -    iii.  69
 Its remote cause        -                         m  77
 Its exciting causes        -       -      -         X1''  88
 Its premonitory signs        ...      m.  93
 Its symptoms       -       -              -      1U-  96
 In the blood-vessels     -       -       -       -   iii.  97
 In the liver, lungs and brain        -              iii.  104
 In the stomach and bowels        -       -        iii.  108
 In the secretions and excretions     -    -        iii.  HO
 In the nervous system        ...    Hi.  116
 In the senses and appetite    -      -          -    iii  122
 In the lymphatic and glandular  system      -      iii.  124
 Upon the skin       ....       iii.  125
 Its remissions and intermissions      -       -      iii.  133
 Its division into three grades       -      -       iii  137
Its predominance over ail other disease        -    iii.  141
 Who were chiefly affected by it        -            iii.  148
 Who were exempted from it         -      -     iii.  149
 Symptoms of infection before patients were confined
   by it            -       -      *       -        iii.  157
 State of the weather during its prevalence          iii.  161
 It is taken twice by several persons    -     -     iii.  164 
iii	181
iii.	184
iii.	186
iii	199
iii.	223
iii.	226
iii	230
iii	239
iii.	241
                        INDEX.
                                                VOL.  P.
Appearances of the body after death, both external
  and internal       ....      iii. 167
Distress of the  city     ...       -   iii. 175
A list of the deaths in August, September and Octo-
  ber     -
The cessation of the disease  -
Checked by wet and cold weather  -
Its origin       -           ...
Method of cure         ...
Unsuccessful issue of stimulants
Of the use of calomel and jalap as a purge
Of purging  generally       ...
Its salutary effects      -
Objections  to  purging with calomel and jalap
  answered        ......iii. 253
Of blood-letting in the cure of the fever of 1793, and
  reasons for it    -     -     -    -    -    -    iii. 254
Appearances of the blood     ....    iii. 256
Its salutary effects.....iii. 257
Circumstances which  regulated its use  -    -    iii. 267
Objections to it answered      ...    Hi. 269
Cold water, its advantages in this fever    -       iii. 281
Salivation its efficacy    -       -      -    -    iii. 285
Causes of the occasional failure of  the above reme-
  dies       .....     iii, 302
Comparative view of their success with other reme-
  dies    -----        jji. 307
Fever yellow, of 1794 described    ...    iii. 357
Its predisposing causes  .     -                   iii. 366
Its symptoms.....-    iii. 369
In the blood-vessels     -     -    -    -    -    iii. ibid
In the liver        -.....iii. 371,
                        B 
                        INDEX.
                                                VOL.  P.
 In the alimentary canal       ...    Hi. 372
 In the secretions and excretions      .       •    Hi. 375
 In the nervous system      -      -       -      in. 379
 In the senses and appetites          •        •      >»• 382
 In the lymphatic system     -                    iii* 383
 Upon the skin    ------    iii- 384
 In the blood         ....      Hi. 387
 The different forms of this fever      -       -    Ui. 388
 Its critical days obvious       ...    Hi. 392
 Combines with other diseases                     iii. 390
 Its origin     ....       -      iii. 397
 Method of cure     -                           iii. 401
 By bleeding          ....    iii. 403
 Appearances of the blood    ....    Hi. 405
 By purging      -     -      -       ,        -    Hi. 407
 By cold air, cold drinks, and cold water  applied to
   the  body    .....    Hi. 409
 By a salivation    -         -       -      -      Hi. 411
 Comparative view of the success of the different
   modes of practice in the fever of 1794     -    iii. 424
 Superiority of the   orth American mode     -    iii. 431
 Fever, bilious  yellow of 1795  and 1796, sporadic
   cases of         ....
 -----of 1797, account of
 Its predisposing causes and premonitory signs
Its symptoms in the blood vessels
In the alimentary canal      -
 In the nervous system
In the senses       -
In the glands       -
Upon the skin
iii.	437
iv.	3
iv.	13
iv.	14
iv.	15
iv.	16
iv.	18
iv.	ib.
iv.	19
 
                        INDEX.

In the blood*       -
Its types     -     -     -      ...
Its different states           ...
Cases of its being taken a second time
Its mortality     ...       -
Its origin           ....
Its remedies        ....
Bleeding     .....
Purging
Salivation     .....
Different modes in which mercury acted
Emetics       .....
Diet and drinks       ....
Cold applications to the body
Blisters       .....
The relative effects of different modes of practice
Favourable signs       -
Unfavourable signs    -              -      -
Fever, yellow of the year 1798, account of
 Its symptoms in the different systems
 Its exciting causes •        -
 Manner in which it terminated fatally
 State of the body as exhibited after death by dissection iv
 Its origin       ...
 Its remedies       -           •   -      -
 Emetics, their good effects
 Purges, a salivation, and bleeding
 Blisters       .....
 Favourable and unfavourable signs
 Results of different modes of practice in thi&fever
 Fever yellow, of 1799, an account of
 Its premonitory signs        .        . *
 Its symptoms in the different systems
VOL.	p.
iv.	19
iv.	20
iv.	21
iv.	28
iv.	30
iv.	33
iv.	ib.
iv.	ib.
iv.	37
iv.	39
iv.	41
iv.	44
iv	45
iv	47
iv.	49
iv.	54
iv.	55
iv.	57
iv.	65
iv	68
iv.	73
iv.	74
n iv.	76
iv.	77
iv.	78
iv.	79
iv.	81
iv.	83
iv.	84
iv.	86
iv.	91
iv.	94
iv.	95
 
                        INDEX.

Its remedies
Sporadic cases in 1800 and 1801
Fever yellow, as it appeared in  1802
Fever yellow, sporadic cases of in 1804
----- ditto in 1805.....
----- of their origin
Fever yellow, sporadic cases of in 1806, 1807, 1809
----- not contagious
----- distinguished from the jail fever
Proofs of the yellow fever being an atmospherical
   disease
Objections to this opinion answered
.     is rendered malignant by a peculiar constitu-
   tion of the air     -
A belief in its contagiousness superstitious

                           G
Gout, observations on     -       ...
Is a disease of the solids     -
Who are most subject to it    -
Its remote causes    -
Its exciting causes     -            -
Its seats     .        -            -    -
Remedies for it
Bleeding      ------
Its salutary effects    .....
Vomits         -             -    -
Nitre          .......
Cool and cold air         ...
Diluting liquors         -       .     .     -
Abstinence    -            -     -
Blisters, fear and tetror     -     -     -     -
Other volatiles, aromatics, and oil of amber
VOI	. v.
iv.	96
iv.	117
iv.	123
iv.	148
iv.	153
iv	154
iv.	163
iv.	236
iv.	236
iv.	252
iv.	257
iv.	263
iv.	282
ii.	247
ii.	247
ii.	248
ii.	250
ii.	252
ii.	253
ii	272
ii.	276
ii.	281
H	283
ii.	284
ii.	ibid
ii.	286
ii.	285
ii.	ibid.
ii.	294
 
                       INDEX.
                                               VOL.  P.
Warm bath and a salivation    -    -    -    -   ii. 295
Frictions       -       -     -     -       -     -   ii. 296
Remedies for symptoms    ...     -     ii. 297
Head-ache    -     -       ...       -    ii. 298
Opthalmia    ....      -      -   ii. 299
Pains in the limbs      -      -      -      -   ii. ibid
Diarrhoea, angina pectoris, spasms  in the  stomach,
    and pains in the bowels    -      -       -    ii 300
Pain in the rectum       -      -      -      -  ii 301
Preternatural  secretion and  excretion of bile, and
    itching of the anus and vagina    -      -      ii ibid
Eruptions      -      -      -                 ii. 302
Gonorrhoea      ....           jj. ibi<j
Gout, a curable disease     -      -       -      ii. 305
Means of preventing a return of its inflammatory
    paroxysms    -       -       -               ii. 307
Means of preventing the return of paroxysms of fee-
    ble morbid action      -       -     -      -  ii. 315
Summary of opinions defended in the observations
    upon the gout       -      -      -      -   ii. 320

                          H
Heat, its greatest degree in Philadelphia     -     ii.   23
Its medium temperature in      -       .     -    ii ibid
Hail, account of a storm      -      -       -     ii.   27
Heat, its medium temperature during the prevalence
    of the yellow fever in Philadelphia        -       i.  167
Hymoptysis, remedies for     -      -       -    iv.   53
Hydrocephalus internus described   -    -    -   iv. 215
Its causes     -       -    -       -            -   iv. 223
Water in the brain is the effects of previous morbid
    action and inflammation     -    -    -    -  iv. 228 
                       INDEX.

Iti remedies     -       -
Bleeding       -      ...
Purges    -      .    .       -
Blisters and Mercury    -    -
Cold applications to the head
Hydrophobia, observations on
Its causes       -     -
Its grades     -           ...
Is a state of fever    .      -      -       -
Means of preventing it

                            I
Infancy, life first excited in it by air
Indians, oration on the state of medicine among them
Of the birth and treatment of their children
Of the diet of the Indians
Of the custom peculiar to each sex
Of the customs common to both  sexes
Their diseases     -       -       -
Their remedies
A comparative view of their diseases and remedies
   with those of civilised nations
Of their diseases       ...
Of the powers of nature in  curing them
Of the remedies of civilised nations
June described in Pennsylvania
A healthy month       ...
Influenza, account of in Philadelphia in  1789, 1790,
    1791, also in  1807       -       .     .       jv  164
Importation of the yellow fever impossible    -     iv. 275
Benefits to be derived from this opinion       -     iVi 277
Intermittentschronic, bleeding useful in them       iv. 278
V04,	. P.
iv.	230
iv.	ioO
iv.	240
iv.	241
iv.	24.2
iv.	325
iv.	326
iv.	329
iv.	330
iv.	341
	16
m i.	103
	107
	108
l.	109
	112
i.	115
	120
	130
i.	132
	135
	145
i.	'24
	47
 
                        INDEX
                                                VOL.  P.
                           L
Life, animal       ...            .       i.   1
----consists in heat, motion, sensation, and thought i.   8
----is an effect of stimuli      .     -     -     -  i.   10
----originally involuntary     -       -            i.   17
Of external stimuli          -      -       -       i.   12
Particularly air    ...       .            i. ibid
Of internaLstimuli    -    -       -                i.  24
Life animal, how supported in sleep    -            i.  35
In the foetus in utero       -       -                i.  42
In infancy and childhood    -    -                 i.  44
In youth    ...       ----i.  47
In middle life       -      -    -       .       -   i.  48
In old age       -           -            -    -   i. ibid
In persons blind and deaf from their birth     -      i.  52
In apparent death       -                          i.  57
In Indians of northern  latitudes       -             i.  65
In the  inhabitants of the torrid regions       .       i-  66
In cold countries     ...       -           i.  67
In enslaved countries      -      -       -    -   i. ibid
Stimuli which act upon the whole human species     i.  72
Stimuli which act upon all the species of animals     i.  79
Inferences from the doctrine of life delivered    -    i.  83
Death, how produced       -    -       -      -     i.  88
Legs sore, an inquiry into their cause and cure       i. 385
Labour advised in the consumption         -        ii. 163
Leeches, when indicated, and most proper     -    iv. 360
By whom introduced into general use in Philadelphia iv. 411

                           M
Matter animated and inanimated alike, in being mov-
    ed only by  stimuli    -      -       -     -     i.   7 
                        INDEX.
                                                VOL. P«
 Medicine, means of improving it    """.!"  *49
 Measles, account of in Philadelphia in 1789     -    ii.  423
 Of the external measles     -                 -    "•  447
 M iasmata, signs of their presence in the body      iii.  396
 Moon, its influence upon the mortality of the fever
    of 1797       .    -     -       '       "      iv*   27
 Measles, epidemic in       -       -       -      1V>   65
 Menses, bleeding about the time of their cessation  iv.  376
 Medicine, the state of,  between 1760 and  1766, and  ^
    compared with its state in 1809     -      -    iv.  385
 Medicine, different systems in Philadelphia     -   iv.  411
 Midwifery, improvements in Philadelphia since 1766 iv.  416
 Mortality  of diseases  discovered  in  Philadelphia
    since 1766      -       -        -       -     iv.  420
 The reasons of it                         .      iv.  222

                           N
 Nosology, objections to it       -            -    iii.   33
 Narrative of the state of the author's body  and mind
    during the prevalence  of  the  yellow  fever in
    1793      .       -       -                  iv.  330
Nature much confined in Philadelphia between 1760
    and 1766     -            -      -     -      iv.  396
Statement of her powers       -                    i.  135

                           O
Omentum supplies the  matter for the production of
   chyle and  blood through the medium of the liver iv.  351
Opium, bleeding useful in the disease created by an
    excessive  dose of                             iv.  377
Physicians, the duties of       -     ,        -     i.  437
Pennsylvania) its climate     -           -     .     ii.   7 
INDEX.
                       VOL.  F.
Its extent and boundaries -	i.	ibid
Its rivers - - -	i.	8
Its mountains -	i.	9
Its soil - - - - -	i.	10
Philadelphia, its situation - - -	i.	11
Its population in 1809 -	i.	12
Phthisis trachealis described -	i.	102
Preventives of yellow fever -	iii.	323
Pulse, its different states described in fevers	iv.	329
-----, how to be felt - - - -	iv.	373
Pregnancy, bleeding usfeul in - ' -	iv	371
Also in parturition -	iv.	373
Poisons, bleeding useful in obviating their effects	iv.	374
Quarantines, their folly and evils    -       -       iv. 229

                           R
Revolution American, its influences upon the hu-
   man body     -       -       .       -    -     i. 229
Rain, the quantity  which  falls annually in  Penn-
   sylvania        -       -       -      -      ii.  32
Riding on horseback,  its good effects in pulmonary
   consumption     -      -      -      -       ii.  154

                           S
Stimuli, their effects in the  production of life        i.   11
Spirits ardent, their influence upon the body and mind i.  271
Drunkenness produced by  them, described    -    i.  272
Diseases induced by them     -      -        -    i.  277
Their effects upon the mind         -       -      i.  280
Arguments in their favour refuted     -       -     i.  283
 Substitutes for them       -      -       -        i.  286
                          C 
                       INDEX.
                                                VOL.  P.
Cautions against their use, to certain classes of people  i. 292
Remedies for a fit of drunkenness         -          1. 304
----  for the  habitual use of spirits     -       -     »• 3o7
Spring, account of in Pennsylvania       -     -    "•  2S
Summer, a dry one described       -       -       n«  3n
------, a wet one described    -       -       -    ii.  34
Storms in Pennsylvania not uncommon       -      u.  35
Salt common, its efficacy  in Homoptysis       -    ii.  53
Savoyages, when proper in consumption      -      ii. 152
Scarlitina Anginosa described    -     -      -      ii. 406
------- its remedies       -       -       -        ii. 412
Means of preventing it      -        -        -    ii- 418
Salivation, its efficacy in the fever of 1793     -    iii. 285
-------, its efficacy in the fever of 1794       -    iii. 411
Different modes  in  which  mercury  acts  during
   a salivation      ...       -      HI.  41
A salivation excited  and checked by cold water     Hi. 412
Surgery, improvements in Philadelphia since 1766  iii. 417
Teeth, when decayed, the cause of severa  diseases
Tastes and aliments,  their relation to each other
Tetanus, observations on              -      -
Its causes from wounds      -
From  other causes      -     -     -
Its causes in infants         ...
Its remedies       -        -     *  -
Thaw, a remarkable one in Pennsylvania
Tubercles in the lungs, the effects, and not the cause
   of consumptions      -
Travelling advised in them
1.	349
i.	24
i.	317
i.	318
i.	321
i.	325
i.	330
H.	29
ii.	100
ii.	156
 
                       INDEX.
                                               VOL. P.
Turpentine, spirit of, useful to check the vomiting
   in the yellow fever    -      -       -      -  iv. 156

                           U
Ulcers in the lungs, the effects, and not the  cause
   of pulmonary consumption     -       -      ii. 283
Vomiting, means of checking it in the yellow  fever iv.  83
------also      -     -      -      -      -    iii. 288

                          W
Water cold, the disease induced  by  drinking it
   described       -        -       -        -      i. 342
Its remedies                                     j, 343
Worms in the alimentary canal         -           i. 357
Observations on     -      -      ...      j# ibid
Remedies for them     -    -     -     -     -    i. 36s
They act chemically and mechanically        -      i. 368
Weather variable in Pennsylvania     -       -    ii.  2S
Winter in Pennsylvania described       -    •     H. 261
Weather, thermometrical account of in 1793       Hi. 215
Winds in the  spring, their influence  upon  the
   healthiness of the autumn    -       -         Hi. 168 
 
           AN ACCOUNT





               OF THE





BILIOUS REMITTING AND INTERMITTING






       YELLOW FEVER,





               AS IT





     APPEARED IN PHILADELPHIA,





               in 1797-
VOL, IV.
A 
 
AN  ACCOUNT,  &fc.
    THE winter of 1797 was in general healthy.
During the spring, which was cold and wet, no
diseases of any consequence occurred. The spring
vegetables were late in coming  to maturity, and
there were every where in the neighbourhood of
Philadelphia  scanty crops of hay.   In  June and
July there fell but little rain. ^Dysenteries, chole-
ras, scarlatina, and mumps,  appeared in the sub-
urbs in the latter  month.   On the 8th of July I
visited Mr. Frisk, and on the  25th of  the same
month I visited Mr. Charles Burrel in the yellow
fever, in consultation  with Dr. Physick.  They
both  recovered by the use of  plentiful depleting
remedies.

  The weather from the 2d to  the 9th of August
was rainy.  On the 1st of this month I was called 
4
AN  ACCOUNT OF  THE
to visit Mr. Nathaniel Lewis, in a malignant bilious
fever. On the 3d I visited Mr.  Elisha Hall, with
the same disease. He had been ill several days be-
fore I saw him. Both these gentlemen died on the
6th of the month.  They were  both very  yellow
after  death.  Mr. Hall  had a black  vomiting on
the day he died.

  The news of the death of these two  citizens,
with unequivocal symptoms of yellow fever, excit-
ed a general  alarm in the  city.   Attempts were
made to trace it to importation,  but a little inves-
tigation soon proved  that it was derived  from the
foul air of a ship which had just arrived from Mar-
seilles, and which' discharged her cargo at Pine-
street wharf, near the stores occupied by Mr. Lewis
and Mr. Hall.   Many other persons about the
same  time were  affected with the fever  from the
same  cause, in Water and  Penn-streets.   About
the middle of the month, a ship from Hamburgh
communicated the disease, by means of her foul air
to the village of Kensington. It prevailed, more-
over,  in many instances  in the suburbs, and  in
Kensington, from putrid exhalations from gutters
and marshy grounds, at a distance from the Dela-
ware, and from the foul ships which have been
mentioned.   Proofs of the truth of each of these
assertions were afterwards laid before the public. 
     BILIOUS  YELLOW  FEVER  OF 1797.    5

  The disease was confined chiefly to the district
of Southwark and the village of Kensington, for
several weeks.  In September and October, many
cases occurred in the city, but most of them were
easily traced to the above sources.

  The following  account of the weather, during
the months of August, September, and October,
was obtained from Mr. Thomas Pryor.  It is dif-
ferent from the weather in 1793. It is of conse-
quence to attend to this fact, inasmuch as it shows
that an inflammatory constitution of the atmosphere
can exist under different circumstances of the wea-
ther.  It likewise accounts for  the variety in the
symptoms of the fever in different years and coun-
tries. Such is the influence of season and climate
upon the symptoms of this fever, that it led Dr.
M'Kitterick to suppose that  the  yellow  fever of
Charleston, so accurately described by Dr. Lining,
in the second volume of the Physical and Literary
Essays of Edinburgh, was a different disease from
the yellow fever of the West-Indies.*
* De Fobrc Imli?c-Ocoi<lrntalis Maligna Flava, p. l'J. 
6              AN  ACCOUNT OF  THE


METEOROLOGICAL  OBSERVATIONS,

         MADE  IN  PHILADELPHIA.
AUGUST,  1797.
D Ther Bar
73 75 30
727630
3 72 78;30
4 72 78 JO
5 74 79'29
6 73 76-30
7'70 76130
 8 72
 9 72
10 69
1170
12 71
  i
13'73
1470
15 56
16 60
17 60
.18 68

19 72
20 7u
2174
'32,68
Winds ;md Weather.
76E9
76|29
73,30
74J30
7430

75*29
74 29
6030
64 30
6530
75 30

78 29
77 29
76!29
76\
S. E. E.  Rain in the forenoon and afternoon.
N E. by E   Cloudy, with rain in the afternoon and
  night.  Wind E. by N.
E. ft N ■  Rain in the morning, and all day and night.
E. Rained hard all day and at night
Wind light, S  W.  Cloudy. Rain this morning. The
  aft' extremely damp ; wind shifted to N. W.  This
  evening heavy showers,  with thunder.
W. N. W. Cloudy
N. W.  Close day.  Rain in the evening and all night.
  WindioE.
£.  Rain this morning.
S. W.  Cloudy morning.
N. W.  Clear.
               Rain all night.
               Rain in the morning. Cloudy all day.
N. W.  Clear.
S. W. Cloudy.
  Ruin at night,
S. W.  Cloudy.   Rain all day.
N. W.  Clear fine morning.
N. W.  Clear fine morning.
N. W.  Clear fine morning.
N. W.  Air d:anp.
S. W.  Cloudy.   Rain, with thunder at night: a fine
  shower.
N. W. Clear- Cloudy in the evening with thunder.
W- N. W. Fine clear morning.
N. W.  Clear to E.
E.  Small shower this morning.  Hard shower at 11,
  A.M.  V/indN.E. 
BILIOUS  YELLOW  FEVER  OF  1797.
AUGUST,  1797.
I) Ther		Bar. 29 92	Winds and Weather.
23 71	76		E. Cloudy. At noon calm.
24 71	75	29 95	Calm morning and clear.
25 70	75	30 5	N. E. Clear. Rain in the afternoon, with thunder.
26,70 1	75	30 5	S E Rain in the morning. Rained hard in the night, with thunder, N. W.
27 68	76	29 9	N. W. Fine clear morning.
28 64	75	29 96	N.W. Clear.
29 59	70	30 0	E. Clear.
3070	76	30 1	E. by S. Rain in the morningf.
3l|68	74	30 14JS. E. Cloudy. Damp air ancl sultry.	
SEPTEMBER,  1797.
D 1	Th	er	Bar. 30 6
	75	80	
2	79	30	29 9
3	68	74	30 0
4	66	74	30 7
5	58	73	30 1
6	58	72	30 13
7	56	76	30 28
8	54	6i	30 1
9	56	03	30 1
10	58	61	30 26
11	Jo	04	30 13
12	51	62	30 6
Winds and Weather.
  W. Cloudy.  Damp air. Rain in the morning.
N. W. Clear. Cloudy in the evening, with lightning
  to the southward.
N. by W. Cloudy.  Clear in the afternoon and night
W. N. W. Clear fine morning.
N. W.  Clear. Cloudy in the evening.
Fresh at E.  Clear.  Rain in the evening.
E. Clear. Cloudy in the evening.
N-E. Clear and cool morning. Flying clouds at noon.
E. N. E. Clear.
N. E. Clear fine morning. Wind fresh at N. E. all day.
N- to E. with flying clouds.
W. N-  W.  Clear cool morning. 
AN  ACCOUNT  OF THE
SEPTEMBER, 1797.
DITher Bar.
13 56
14 64
15 66
16,62
17;56
18'58

19,55
2047

21J46

22156
Winds and Weather.
30  3S. W.  Cloudy. Clear in the afternoon.
29 98;S. W.  Clear.
29 85|S. W.  Rain in the morning. Cloudy in the afternoon.
29 95IN- W.  Clear.             *
30  ON. W.  Clear.
29 88 E. Cloiuly. Rained all day, and thunder.
29 62   Rained very heavy at night.
29 75|W. N  W.  Clear fine morning.
 0  8 W.N W. Clear fine morning.  New moon at 9 50
        morning.
30  ON. E.  Clear fine morning ; to S. E. in the evening.
        Cloudy at night.
     N.W.  Rain  in the morning.  Rain at night.
48|63
4863
5463
6065
0|N. N. E.  Cloudy.
E. by S.  Clear fine morning.  Cloudy at
  night.
W. N. W. Clear fine morning ; clear all day.
E.  In the morning flying clouds.
N W.  Clear fine morning ; clear all day.
W. N. W.  Clear fine morning ; clear all day.
E. Clear fine morning.
E.  Fresh.  Cloudy morning.  Rain in the. night- 
BILIOUS  YELLOW FEVER  OF  1797.
OCTOBER,  1797.
D Ther Bar
 155 65
 25566
 3 6070
 460.70
 54660
  I  !
 6 55 65
 75676
 8j5670
    {
 95060
    i
1014058
li;3856
1213452
13J35'55
144060
 15
 16
 17
 18
 19
 20

 21

 22
 23
 24
 25
 26
 27
28
29
30
31
50,65
36,56
37156
47|60
4860
42|55
Winds and Weather.
Clear all day.
42 50 29
 16 N. E-  Rain this morning, and great part of the day.
 0N.W. Clear.
 9 S. E. Clear. Air damp.
 5 W. N. W  Rain this morning.
 OWN. W. to S. by W. in the evening
     White frost this morning.
 OiS. W.  Clear fine morning.  White frost.
 OjS.W.  Cloudy.  Rain in the night.
 29IS. Cloudy this morning; air damp. Wind shifted to
  |  W N  W. Blows fresh.
 85|W. N. W. Clear morning.  Fresh at N. W. in the
     evening.
 l|W. N. W. Clear. Frost this morning.
 2!W. N. W. Cloudy.
 38W. N. W. Clear." Ice this  morning.
 5 N. Clear fine morning. Ice this morning.
 28 N. E.  Cloudy.
 16 W. N. W  Clear.
 2,W. N. W- Clear fine morning.
 18:W. N. W.  Clear fine morning.
 86WNW.  Clear fine weather.
 6N. W. Clear fine day.
 8,N. E. Cloudy. Rain in the afternoon and night. Blows
  |   fresh at N. E.
 92,N E- Blows fresh (with a little rain.) Thunder in the
  |   night, with rain.
 57 N. W.  Rain in the morning.
95 S. W.  Clear fine morning.
 5(N. E. Cloudy. A great deal of rain in the  night.
15'N. E. Clear fine morning.
29 W. N. W. Clear.
23 Fresh at  S. W.  Clear.
W. N. W. Cloudy.
W. Cloudy.
N. W. Clear.  Hard frost this morning.
W. S. W. Cloudy part of this day; clear the remainder.
VOL.  IV 
10
AN  ACCOUNT OF  THE
   In addition to the register of the weather it may
 not be improper to add, that moschetoeswere more
 numerous during the prevalence of the fever than
 in 1793.  An unusual number of ants and cock-
 roaches were likewise observed; and it was said
 that the martins and swallows disappeared, for a
 while, from the city and its neighbourhood.

  A disease prevailed among the cats some weeks
 before the yellow fever appeared in the city.   It
 excited a belief in an unwholesome state of the at-
 mosphere, and apprehensions of a sickly fall.   It
 generally proved fatal to them.

  After the first week in September there were no
diseases to be seen but yellow fever.  In that part
of the town which is between Walnut and Vine-
streets it was uncommonly healthy.  A similar re-
treat of inferior diseases has been observed  to take
place during the prevalence of the plague in Lon-
don, Holland, and Germany, according to the his-
tories of that disease by Sydenham, Diemerbroek,
Sennertus, and Hildanus.  It appears, from the
register of the weather, that it  rained  during the
greatest part of the  day  on the 1st of October.
The effects of this rain upon the disease shall be
mentioned hereafter.  On the  10th the weather
became cool, and on the  nights of the 12th and 
       BILIOUS YELLOW  FEVER OF  1797.   11

 13th of the month there was a frost accompanied
 with  ice, which  appeared to give a sudden  and
 complete check to the disease.

   The reader will probably expect an account of
 the effects of this distressing epidemic  upon the
 public mind. The terror of the citizens for a while
 was very great. Rumours of an opposite and con-
 tradictory nature of the increase and mortality of
 the fever were in constant circulation.  A stoppage
 was put  to business, and  it was  computed that
 about two thirds of the inhabitants left the city.

   The legislature of the state early passed a law,
 granting  10,000 dollars for the relief of the suffer-
 ers by the fever. The citizens in and out of town,
 as also many of the citizens of  our sister states,
 contributed more than that sum for the same cha-
 ritable purpose. This money was issued by a com-
 mittee appointed by the governor of the state. An
 hospital for the reception of the poor was establish-
 ed on the east side of the river Schuylkill, and
 amply provided with every thing necessary for the
 accommodation of the sick. Tents were likewise
 pitched on the east side of Schuylkill, to which all
those people were invited who were exposed to the
danger of taking the disease, and who had not 
12
AN  ACCOUNT OF  THE
means to provide a more comfortable retreat for
themselves in the country.

  I am sorry to add that the moral effects of the
fever upon the minds of our citizens were confined
chiefly to these  acts of benevolence. Many of the
publications in the newspapers upon its existence,
mode of cure,  and origin partook of a virulent
spirit, which ill accorded with the distresses of the
city.  It was a cause of lamentation  likewise to
many serious people,  that the citizens in general
were less disposed, than in 1793, to acknowledge
the agency of a divine hand in their afflictions.  In
some a levity of mind appeared upon this solemn
occasion.  A worthy bookseller gave me a melan-
choly proof of this assertion, by  informing me,
that he had never been asked for playing cards so
often, in the same time, as he had been during the
prevalence of the fever.

   Philadelphia was not the only place in the Uni-
ted States which suffered by the yellow fever.   It
prevailed, at the  same  time, at  Providence,  in
 Rhode-Island,  at Norfolk, in  Virginia, at Balti-
 more, and in many of the country  towns of New-
 England, New-Jersey, and Pennsylvania. 
     BILIOUS YELLOW  FEVER OF  1797.    13

  The influenza followed the yellow fever, as it
did in  the year 1793.  It made  its  appearance in
the latter end of October, and affected chiefly those
citizens who had been out of town.

  The predisposing causes of the yellow fever, in
the year 1797, were the same as  in the year 1793.
Strangers were as usual most subject to it.  The
heat of the body in such persons, in the West-In-
dies, has been found to be between three and four
degrees above that of the temperature of the  na-
tives. This fact is taken notice of by  Dr. M'Kit-
terick, and to this he ascribes, in part, the predis-
position of new comers to the yellow  fever.

  In addition to the common exciting causes of
this disease formerly enumerated,  I have only to
add, that it was induced in one of my patients by
smoking a segar. He had not  been  accustomed
to the use of tobacco.

  I saw no newpremonitory'symptomsof this fever
except a tooth-ach.   It occurred in Dr. Physick,
Dr. Caldwell, and in my pupil, Mr. Bellenger.  In
Miss Elliot there was such a soreness  in her teeth,
that she could hardly close her mouth on the day
in which she was attacked by the fever.  Neither 
14
AN ACCOUNT OF  THE
of these persons had taken mercury to obviate the
disease.

  I shall now deliver a short account of the symp-
toms of the yellow  fever, as they appeared in se-
veral of the different systems of the body.

  I. There was but little difference in the state of
the pulse in this epidemic from what has been re-
corded  in the fevers of 1793  and 1794.  I per-
ceived a pulse, in several cases, which felt  like a
soft quill which had been shattered by being trod-
den upon.  It occurred in Dr. Jones and Dr. Do-
bell, and in several  other persons who had been
worn down by great fatigue, and it was, in every
instance, followed by a fatal issue of the fever.  In
Dr. Jones this state  of the pulse was accompanied
with such a difficulty of breathing, that every breath
he drew, on the day  of his attack, he informed me,
was  the effort of a sigh. He died on  the 17th of
September, and on the sixth day of his fever.

  The action  of the arteries was,  as usual, very
irregular in many cases. In some there was a dis-
tressing throbbing of the vessels in the brain, and
in one of  my  patients a similar sensation in the
bowels, but without pain. Many people had issues
of blood from their blisters in this fever. 
      BILIOUS  YELLOW FEVER  OF 1797.   15

   I  saw nothing new in the effects of the fever
upon the liver, lungs, brain, nor upon the stomach
and bowels.

   II. The excretions were distinguished by noun-
usual marks. I met with no recoveries where there
were not black stools. They excoriated the rectum
in Dr. Way. It was a happy circumstance where
morbid bilious  matter  came away in the begin-
ning of the disease. But it frequently resisted the
most powerful cathartics until the 5th or 7th day of
the fever, at which time  it appeared rather to yield
to the disorganization of the liver than to medi-
cine.  Where sufficient blood-letting  had been
previously used, the patient frequently recovered,
even after the black  discharges from the bowels
took place in a late stage of the disease.

   Dr. Coxe informed me, that he attended a child
of seventeen months old which had white stools
for several days. Towards the close of its disease
it had black stools, and  soon afterwards died.

   Several of my patients discharged worms du*
ring  the  fever.  In one instance they were dis-
charged from the mouth. 
16         'an account  of the
    A preternatural frequency in making pale water
 attended the first attack of the disease in Mr. Jo-
 seph Fisher.

   A discharge of an unusual  quantity of urine
 preceded a few hours, the death of the daughter
 of Mrs. Read.

   In two of my patients there was a total suppres-
 sion of urine. In  one of them it  continued  five
 days without exciting any pain.

   There was no disposition to sweat after the first
 and second days  of the fever.  Even in those
 states  of the  fever,  in which  the intermissions
 were most complete, there was seldom any moist-
 ure, or even softness on the skin. This was so cha-
 racteristic of malignity in the  bilious fever, that
 where  I  found the opposite state of the skin, to-
 wards the close of a paroxysm,  I did not hesitate
 to encourage my patient, by assuring him that his
 fever was of a mild nature, and would most pro-
bably be safe in its issue.

  III.  I saw no  unusual  marks of the disease in
the nervous system. The mind was seldom affected
by delirium after the loss of blood. There  was a 
      BILIOUS YELLOW FEVER  OF 1797.   17

 disposition to shed tears in two of my patients.
 One of them wept during the whole time of a pa-
 roxysm of the fever.  In one case I observed an
 uncommon dulness of apprehension, with no other
 mark of a diseased state of the mind. It was in a
 man whose faculties, in ordinary health, acted with
 celerity and vigour.

   Dr. Caldwell informed me of a singular change
 which took place in the operations of his mind
 during his recovery from the fever. His imagina-
 tion carried him back to an early period of his life,
 and engaged him, for a day or two, in playing with
 a bow and arrow, and in amusements of which he
 had been fond when a boy. A similar change oc-
 curred in the mind of my former pupil, Dr. Fisher,
 during his convalescence from the yellow fever in
 1793. He amused himself for two days in looking
 over the pictures of a family bible which lay in his
 room, and declared that he found the same kind of
 pleasure in this employment that he did when a
 child. However uninteresting these facts may now
 appear, the time will come when they may proba-
 bly furnish useful hints for completing  the phy-
 siology and pathology  of the mind.

  Where  blood-letting had not been used, pati-
ents frequently died of convulsions.
    vol.  iv.          c 
 18         an account of  the

   IV. The senses of seeing and feeling were im-
 paired in several  cases.  Mrs. Bradford's vision
 was so weak that she hardly knew her  friends at
 her bed-side.  I had  great pleasure in observing
 this alarming symptom, suddenly yield to the loss
 of four ounces of blood.

   Several persons who died of this fever did not,
 from the beginning to the end of the disease, feel
any pain.  I shall hereafter endeavour to explain
the cause of this insensible  state of the nerves.

   The appetite for food was unimpaired for three
days in Mr. Andrew Brown, at a time when  his
pulse  indicated a high grade of the fever.  I heard
of several persons who ate with avidity just before
they died.

   V. Glandular swellings were very uncommon in
this fever. I should have ascribed their absence to
the copious use of depleting remedies in my prac-
tice, had I not been informed that morbid affections
of the lymphatic glands were unknown in the city
hospital, where blood-letting was seldom used, and
where the patients, in many instances, died before
 they had time  to take medicine of any kind. 
     BILIOUS  YELLOW  FEVER OF 1797.   19

  VI.  The skin was cool, dry, smooth, and even
shining in some cases. Yellowness was  not  uni-
versal.  Those small red  spots, which have been
compared to moscheto bites, occurred  in several
of my patients.  Dr. John Duffield,  who acted as
house surgeon and apothecary at the city hospital,
informed  me that he saw vibices on the skin in
many cases, and that they were all more or less
sore to the touch.

 VII.  The  blood was dissolved in a few  cases.
That appearance of the blood, which has been com-
pared to the washings of flesh, was very common.
It was  more or less  sizy towards the close of the
disease in most cases. I have suspected, from this
circumstance, that this mark of ordinary morbid
action or inflammation was in part the effect of the
mercury acting upon the blood-vessels. It is well
known that sizy blood generally accompanies  a sa-
livation.  If this conjecture be well founded, it will
not militate against the use of mercury in malignant
fevers, for it shows that this valuable medicine pos-
sesses a power of changing an extraordinary and
dangerous degree of morbid action in the blood-
vessels to that which is more common and safe. I
have seldom seen a  yellow fever terminate fatally
after the  appearance of sizy blood. 
20          an  account of  the

  Dr. Stewart informed me, that in those cases in
which the serum of the blood had a yellow colour,
it imparted a saline taste only to his tongue.  He
was the more struck with this fact, as he perceived
a strong bitter taste upon his skin, in a severe at-
tack of the yellow fever in 1793.

  I proceed next to take notice of the type of the
fever.

  In many cases, it appeared in the form of a re-
mitting and intermitting fever. The quotidian and
tertian forms were most common. In Mr, Robert
Wharton, it appeared in the  form of a quartan.
But it frequently assumed the character which is
given of the same fever in Charleston, by Dr. Lin-
ing.   It came on without chills, and  continued
without any remission for three days, after which
the patient believed himself to be well, and some-
times rose from his bed, and applied to business.
On the fourth or fifth day, the fever returned, and
unless copious evacuations had been used in the
early stage of the disease, it generally proved fatal.
Sometimes the powers of the system were depress-
ed below the return of active fever, and the patient
sunk away by an easy death, without pain, heat, or
a quick pulse. I have been much puzzled to dis-
tinguish a crisis of the fever on the third or fourth 
      BILIOUS  YELLOW FEVER  OF 1797.   21

day, from the insidious appearance which has been
described.  It deceived me in 1793.  It  may be
known by a preternatural coolness in the skin, and
languor in  the pulse, by an inability to sit up long
without fatigue or faintness, by a dull eye, and by
great depression of mind, or such a flow of spirits
as sometimes  to produce a declaration  from  the
patient  that " he feels too  well." Where  these
symptoms  appear, the patient should be informed
of his danger, and urged to the continuance of such
remedies as are proper for him.

   The following  states or forms were observable
in the fever:

   1. In a few cases, the miasmata produced death
in four and twenty hours, with convulsions, coma,
or apoplexy.

   2. There were open cases, in which the pulse was
full and tense as in a pleurisy or rheumatism, from
the beginning to the end of the fever. They were
generally attended with a good deal of pain.

   3.  There were depressed or locked cases, in
which there  were a sense of great debility, but
little or no pain, a depressed and slow pulse, a cool 
22
AN  ACCOUNT OF  THE
 skin, cold hands and feet, and obstructed excre,-
 tions.

   4. There were divided or mixed cases, in which
 the pulse was active until the 4th day, after which
 it became depressed.  All the other symptoms of
 the locked state of the fever accompanied this de-
 pressed state of the pulse.

   5. There were cases in which the pulse imparted
 a perception like that of a soft and shattered quill.
 I have before mentioned that this state of the pulse
 occurred in Dr. Jones and Dr. Dobell. I felt it but
 once, and on the day  of his  attack, in the  latter
 gentlemen, and expressed my opinion of his ex-
 treme danger to one of my pupils upon my return
 from  visiting  him.  I did not meet with a case
 which terminated favourably, where I perceived
 this  shattered pulse. A disposition to sweat oc-
 curred in this state of  the fever.

  6. There were what Dr. Caldwell happily called
walking cases. The patients here were flushed or
pale, had a full or tense pulse, but complained of no
pain, had a good appetite, and walked about their
rooms or houses, as if  they were but little indis-
posed, until a day or two, and, in some instances,
until a few hours before they died.  We speak of 
     BILIOUS YELLOW  FEVER OF  1797.   23

a dumb gout  and dumb rheumatism ;  with equal
propriety, the epithet might be applied to this form
of yellow fever in its early stage.  The impression
of the remote cause of the fever, in these cases,
was beyond sensation, for, upon removing a part of
it by bleeding or purging, the patients complained
of pain, and the excitement of the muscles passed
so completely into the blood-vessels and alimentary
canal, as to convert the fever into a common and
more natural form. These cases were always dan-
gerous, and, when neglected, generally terminated
in death. Mr. Brown's fever came on in this insi-
dious shape.  It was cured by the loss of upwards
of 100 ounces of blood, and a plentiful salivation.

  7. There was the intermitting form in this fever.
This, like the last, often  deceived the patient, by
leading him to suppose his disease was of a com-
mon or trifling nature.  It prevented Mr. Richard
Smith from applying for medical aid in an attack of
the fever for several days, by which means it made
such an impression upon his viscera, that depleting
remedies were in vain used to cure him.  He died
in the prime of life, beloved  and lamented by a
numerous circle of relations and friends.

  8. There was a form  of this fever in which it
resembled the mild remittent of common seasons. 
24
AN ACCOUNT OF  THE
 It was distinguished from it chiefly by the black
 colour of the intestinal evacuations.

   9. There were cases of this fever so light, that
 patients were said to be neither sick nor well; or,
 in other words, they were sick and well half a do-
 zen times in a day.  Such persons walked about,
 and transacted their ordinary business, but com-
 plained of dulness, and, occasionally, of shooting
 pains in their heads.  Sometimes the stomach was
 affected with sickness, and the bowels with  diar-
 rhoea or costiveness. All of them complained of
 night sweats. The pulse was quicker than natural,
 but seldom had that convulsive action which con-
 stitutes fever.  Purges always brought away black
 stools from such patients, and this  circumstance
served to establish its relationship to the prevailing
epidemic. Now and then, by neglect or improper
treatment, it assumed a higher and more danger-
ous grade of the fever, and  became fatal, but it
more commonly \ ielded to nature, or to a single
dose of purging physic.

   10. There  were a few cases in which the skin
was affected with universal yellowness, but without
more pain or indisposition than usually occurs in
 the jaundice. They were very frequent in the year 
      BILIOUS  YELLOW FEVER  OF 1797.   25

 1793, and generally prevailed in the autumn, in all
 places subject to bilious fever.

   11. There were chronic cases of this fever. It is
 from the want of observation that physicians limit
 the duration of the yellow fever to certain days.  I
 have seen many instances in which it has been pro-
 tracted into what is called by authors a slow ner-
 vous fever. The wife of captain  Peter Bell died
 with a black vomiting after an illness of nearly one
 month. Dr. Pinckard, formerly one of the physi-
 cians of the British army in the West-Indies, in a
 late  visit to this city informed me,  that he had
 often seen the yellow fever put on  a chronic form
 in the West-India islands.

   In delivering this detail of the various forms of
 the yellow fever, I am aware that I oppose the opi-
 nions of many of my medical brethren, who ascribe
 to it a certain uniform character, which is removed
 beyond the influence of climate, habit, predisposi-
 tion, and the different strength and combinations of
 remote and exciting causes.  This uniformity in
 the symptoms of this fever is said to  exist in the
West-Indies, and every  deviation  from  it in the
 United States is called by another name.  The fol-
lowing communication, which I received from Dr.
Pinckard, will  shew that this disease is as different
   VOL. IV.          d 
26          AN  ACCOUNT  OF THE

in its forms in the West-Indies  as it is  in  this
country.

  " The yellow  fever, as it appeared among the
" troops in Guiana and the West-India islands, in
" the years 1796 and 1797, exhibited  such perpe-
" tual instability, and varied so incessantly in its
"character, that I  could  not discover  any one
" symptom to be decidedly diagnostic; and hence
" I have  been led into an opinion that the yellow
" fever, so called, is not a distinct or  specific dis-
" ease, but merely  an aggravated degree of the
" common  remittent or bilious fever of hot cli-
" mates, rendered irregular in form, and augment-
" ed in malignity, from appearing in subjects un-
" accustomed to the climate.

  "Philadelphia, January \2th, 1798."

  Many other authorities equally respectable with
Dr. Pinckard's, among whom are Pringle, Huck,
and Hunter, might be adduced in support of the
unity of bilious  fever. But to multiply them fur-
ther would be an act of homage to the weakness of
human reason, and an acknowledgment of the in-
fant state of our knowledge in medicine.  As well
might we suppose nature to be an artist, and that
diseases were shaped by her like a piece of statuary 
       BILIOUS  YELLOW FEVER  OF 1797.   27

  or a suit of clothes, by means of a chissel, or pair
  of scissars, as admit every different form and grade
  of morbid action  in the system  to be a distinct
  disease.

   Notwithstanding the  fever put on the eleven
  forms which  have been described, the moderate
  cases were few, compared with  those of a malig-
  nant and dangerous nature.  It was upon  this ac-
  count that  the mortality was greater in the same
 number of patients, who were  treated with the
 same remedies, than it was in the years 1793 and
 1794. The disease, moreover, partook of a more
 malignant character than the two  epidemics that
 have been mentioned. The yellow fever in Nor-
 folk, Drs. Taylor and Hansford  informed me, in
 a letter I received from  them, was much more
 malignant and fatal, under equal circumstances,
 than it was in 1795.

   There were evident marks of the disease attack-
 ing more persons three days before,  and three days
 after the full and change of the moon, and of more
 deaths occurring at those periods than at any other
 time. The same thing has been  remarked  in the
plague by Diemerbroeck, in the fevers of Bengal
by Dr. Balfour, and in those of Demarara by Dr.
Pinckard. 
28
AN  ACCOUNT  OF THE
  During the prevalence of the fever I attended the
following persons who had been affected by the
epidemic of 1793,  viz.  Dr. Physick, Thomas
Learning, Thomas Canby, Samuel Bradford, and
George Loxley, also Mrs. Eggar, who had a vio-
lent attack of it in the year 1794.  Samuel Brad-
ford was likewise affected by it in 1794.

  During my intercourse with the sick, I felt the
miasmata of the fever operate upon my system in
the most sensible manner. It produced languor, a
pain in my head, and sickness at my stomach.  A
sighing attended me occasionally,  for upwards of
two weeks. This symptom left me suddenly, and
was succeeded by a hoarseness, and, at times, with
such a feebleness in my voice as to make speaking
painful to me.  Having observed  this affection of
the trachea to be a precursor of the fever in several f"
cases, it kept me under daily apprehensions of be-
ing confined by it.  It gradually went off after the
first of October. I ascribed my recovery from it,
and a sudden diminution of the effects of the mias-
mata upon my system, to a change produced in the
atmosphere by the rain which fell on that day.

   The peculiar matter  emitted by the breath or
perspiration of persons affected by this fever, in-
duced a sneezing in Dr. Dobell, every time he went 
     BILIOUS YELLOW FEVER  OF 1797.   29

into a sick room.  Ambrose Parey says the same
thing occurred to him, upon entering the room of
patients confined by the plague.

  The gutters emitted, in many places, a sulphure-
ous smell during the prevalence of the fever. Up-
on rubbing my hands together I could at any time
excite a similar smell in them.  I have taken notice
of this effect of the  matters which  produced the
disease upon the body, in the year 1794.

  In order to prevent an attack of the fever, I care-
fully avoided all its exciting causes.  I reduced my
diet, and lived sparingly upon tea, coffee, milk,
and the common fruits and garden vegetables of
the  season, with a small quantity of salted meat,
and  smoked herring.  My drinks were milk and
water, weak claret and water, and weak porter and
water. I sheltered myself as much as possible from
the rays of the sun, and from the action of the even-
ing air, and accommodated my dress to the changes
in the  temperature of the atmosphere.  By similar
means, I have reason to believe, many  hundred
people escaped the disease, who were constantly
exposed to it.

   The number of deaths by the fever, in the months
of August, September, and October, amounted to 
30
AN  ACCOUNT OF  THE
between ten and eleven hundred. In the list of the
dead were nine practitioners of physic, several of
whom were gentlemen of the most respectable cha-
racters. This number will be thought considerable
when it is added, that not more than three or four
and twenty physicians attended patients in the dis-
ease.  Of the survivors of that number, eight were
affected with the fever.  This extraordinary mor-
tality and sickness among the physicians must be
ascribed to their uncommon  fatigue in attending
upon the sick, and to their inability to command
their time and labours, so as to avoid the exciting
causes of the fever.

  Among the medical gentlemen whose  deaths
have been mentioned, was my excellent friend, Dr.
Nicholas Way. I shall carry to my grave an affec-
tionate remembrance of him. We passed our youth
together in  the  study of medicine, and lived to
the time of his death in the habits of the tenderest
friendship.   In the year  1794, he removed from
Wilmington, in the Delaware state, to Philadelphia
where his talentsand manners soon introduced him
into extensive business.  His independent fortune
furnished his friends with arguments to advise him
to retire from the city, upon the first appearance of
the fever.  But  his humanity  prevailed over the
dictates of interest and the love of life. He was 
     BILIOUS YELLOW  FEVER OF  1797.   31

active and intelligent in suggesting and executing
plans to arrest the progress of the disease, and to
lessen the distresses of the poor. On the 27th of
August, he was seized, after a ride from the coun-
try in the evening air, with a chilly fit and fever.
I saw him the next day, and advised the usual de-
pleting  remedies.  He submitted to my prescrip-
tions with reluctance, and in a sparing manner,
from an opinion that his fever was nothing but a
common remittent. To enforce obedience to my
advice, I called upon Dr.  Griffitts to visit him with
me. Our  combined exertions to overcome his
prejudices against  our  remedies were ineffectual.
At two o'clock in the afternoon, on the sixth day
of his disease, with an aching heart I saw the sweat
of death upon his forehead, and felt  his cold arm
without a pulse. He spoke to me with difficulty :
upon rising  from  his bed-side to leave him, his
eyes filled with tears, and  his countenance spoke
a language which I am unable to describe. I pro-
mised to return in a short time, with a view of at-
tending the  last scene of his  life.  Immediately
 after I left his room, he  wept aloud.  I returned
 hastily to him, and fo»»nd him in convulsions. He
died a few hours afterwards. Had I met with no
 other  affliction in  the autumn  of  1797 than that
 which I experienced from this affecting  scene, it
 would have been a severe  one ; but it was a part 
 32         AN ACCOUNT  OF THE

 only of what I suffered from the death of other
 friends, and from the malice of enemies.

   I beg the reader's pardon for this digression. It
 shall be the last time and place in which any notice
 shall be taken of my sorrows and persecutions in
 the course of these volumes.

   Soon after the citizens returned from the coun-
 try, the governor of the state, Mr. Mifflin, addressed
 a letter to the college of physicians of Philadelphia,
 requesting to know the origin, progress, and nature
 of the fever which had recently afflicted the  city,
 and the means of preventing its return.  He ad-
dressed a similar letter to me,-to be communicated
to such gentlemen of  the faculty of medicine as
were not members of the college of physicians.

   The college,  in a memorial to the legislature of
the state, asserted that the fever had been imported
in two ships, the one  from Havannah, the other
from  Port au Prince,  and recommended, as the
most effectual means of preventing its recurrence,
 a more rigid quarantine law.

   The gentlemen of the faculty of medicine, thir-
 teen in number, in two letters  to the governor of
 the state, the one in their private capacity, and the 
      BILIOUS YELLOW FEVER OF  1797.    33

 other after they had associated themselves into an
 "Academy of Medicine," asserted that the fever
 had originated from the putrid exhalations from the
 gutters and streets of the city, and from ponds and
 marshy grounds in its neighbourhood; also from
 the foul air of two ships, the one from Marseilles
 and the other from Hamburgh.  They enumerated
 all the common sources of malignant fevers, and
 recommended the removal of them from the city,
 as the most effectual method of preventing the re-
 turn of the fever. These sources of fever, and die
 various means of destroying them, shall be men-
 tioned in another place.

   I proceed now to say a few words upon  the
.treatment which was used  in this fever.   It was,
 in general, the same as that which was pursued in
 the fevers of 1793 and 1794.

   I began the cure, in most cases, by bleeding,
 when I was called on the first day  of the disease,
 and was happy in observing its usual  salutary ef-
 fects in its early stage.  On  the second day, it fre-
 quently failed of doing service, and on the subse-
 quent  days of the fever, I believe, it often did
 harm; more  especially if no other depleting re-
 medy had preceded it. The  violent action of the
 blood-vessels in this disease, when left to itself for
    VOL. iv.          e 
34
AN  ACCOUNT OF THE
 two or three days, fills and suffocates the viscera
 with such an immense mass of blood, as to leave a
 quantity in the vessels so small, as barely to keep
 up the actions of life.  By abstracting  but a few
 ounces of this circulating blood, we precipitate
 death. In those cases where a doubt is entertained
 of such an engorgement of stagnating blood having
 taken  place, it will always be safest  to take but
 three or four ounces at a time, and to repeat it four
 or five times a day. By this mode of bleeding, we
 give the  viscera an opportunity of emptying their
 superfluous blood into the vessels, and thereby pre-
 vent their collapsing, from the sudden abstraction
 of the stimulus which remained  in them. I con-
 fine this observation upon bleeding, after the first
 stage of the disease, only to the  epidemic of 1797.
 It was frequently  effectual when used for the first
 time after the first and second  days, in the fevers of
 1793 and 1794, and it is often  useful in the ad-
vanced stage of the common bilious  fever.  The
different and contradictory accounts of the effects
of bleeding in the  yellow fever, in the West-Indies,
probably originate in its being used  in different
stages  of the disease.  Dr. Jackson, of the British
army, in his late visit to Philadelphia, informed me,
that he had cured  nineteen out of twenty of all the
soldiers whom he attended, by copious  bleeding,
provided it was performed within six  hours after 
      BILIOUS  YELLOW  FEVER  OF 1797.    35

 the attack of the fever. Beyond that period, it mi-
 tigated its force, but seldom cured. The quantity
 of blood drawn by the doctor, in this early stage of
 the disease, was always from twenty  to  thirty
 ounces.  I have said the yellow fever of 1797 was
 more malignant than the fevers of 1793 and 1794.
 Its resemblance to the  yellow fever in the West-
 Indies, in not yielding  to bleeding after the first
 day, is a proof of this assertion.

   I was struck, during my attendance upon this
 fever, in observing the analogy between its mixed
 form and the malignant  state of the small-pox.
 The fever,  in  both, continues for three or four
 days without -any remission.  They both have a
 second stage, in which death usually takes place,
 if the diseases be left to themselves. By means of
 copious bleeding in their first, they are generally
 deprived of their malignity and mortality in their
 second stage. This remark, so trite in the small-
 pox, has been less attended to in the yellow fever.
 The bleeding in the first stage of this disease does.
 not, it is true, destroy it altogether, any more than
 it destroys an eruption in the second stage of the
 small-pox, but it weakens it in such a manner that
the patient passes through its second stage without
pain or danger, and with no other aid from medi-
cine than what is commonly derived from good 
36          AN  ACCOUNT  OF  THE

nursing, proper  aliment, and a little gently open-
ing physic.

  It is common with those practitioners who object
to bleedinginthe yellow fever, to admit it occasion-
ally in robust habits. This rule leads to great error
in practice. From the weak action of predisposing,
or exciting causes, the disease often exists in a fee-
ble state in such habits, while from the protracted
or violent operation of the same causes, it appears
in great force in persons of delicate constitutions.
A physician, therefore, in prescribing for a patient
in this fever, should forget the natural strength of
his muscles, and accommodate the loss of blood
wholly to the morbid strength of his disease.

   The quantity of blood drawn in this fever was al-
ways proportioned to its violence.  I cured many
by a single bleeding.  A few required the loss of
upwards of a hundred ounces  of blood to cure
them. The persons from wrhom that large quantity
of  blood  was taken,  were,  Messieurs  Andrew
Brown, Horace Hall, George Cummins, J. Ramsay,
and George Eyre.  But I was not  singular in the
liberal and frequent use of the lancet. The follow-
ing physicians drew the quantities of blood annex-
ed to  their respective names  from the following
persons, viz. 
BILIOUS  YELLOW  FEVER OF  1797.    37
Dr. Dewees  176 ounces from Dr. Physick,
Dr. Griffitts  110            Mr. S. Thomson,
Dr. Stewart  106            Mrs. M'Phail,
Dr. Cooper   150            Mr. David Evans,
Dr. Gillespie  103            himself.

  All the above named persons had a rapid and
easy recovery, and  now enjoy good health.  I lost
but one patient who had been the subject of early
and copious bleeding.  His death was evidently
induced by a supper of beef-stakes and porter, after
he had exhibited the most  promising signs of
convalescence.
              OF  PURGING.

  From the great difficulty that was found in dis-
charging bile from the bowels,  by the  common
modes of administering purges, Dr. Griffitts sug-
gested to me the propriety of giving large doses of
calomel, without jalap or any other purging medi-
cine, in order to loosen the bile from its close con-
nection with the gall-bladder and duodenum, dur-
ing the first day of the  disease.  This method of 
38
AN  ACCOUNT OF  THE
 discharging acrid bile was  found useful.  I ob-
 served the same relief from large evacuations of
 foetid bile, in the epidemic of 1797, that I have re-
 marked  in the fever of  1793.   Mr. Bryce has
 taken notice of the same salutary effects from simi-
 lar evacuations, in the yellow fever on board the
 Busbridge Indiaman, in the year 1792. His words
 are: " It was observable,  that the more dark-co-
 loured and foetid such  discharges were,  the more
 early and certainly did the symptoms disappear.
 Their good effects were so instantaneous, that I
 have often seen a man carried upon deck, perfectly
 delirious with subsultus tendinum, and in a state of
 the greatest apparent debility, who, after one or
 two copious evacuations of this kind, has returned
 of himself, and astonished at his newly acquired
 strength*." Very different are the effects of tonic
remedies, when given to remove this apparent de-
bility.  The clown who supposes the crooked ap-
pearance of a stick, when thrust into a pail of water,
to be real,  does not err more against the laws of
light, than that physician errs against a law of the
animal economy, who mistakes the debility which
arisesfrom oppression for anexhausted state of the
 system, and attempts to remove it by stimulating
medicines.
* Annajs of Medicine, p. 12J. 
      BILIOUS YELLOW  FEVER OF  1797.   39

   After unlocking the bowels, by means of calo-
 mel and jalap, in  the beginning of  the fever, I
 found no difficulty afterwards in keeping  them
 gently open by more lenient purges.  In addition
 to these which I have mentioned in the account of
 the fever of 1793,  I yielded to the advice of Dr.
 Griffitts, by adopting the  soluble tartar, and gave
 small doses of it daily in  many cases. It seldom
 offended  the  stomach, and generally  operated,
 without griping, in the most plentiful manner.

   However powerful bleeding and purging were
 in the cure of this fever, they often required the aid
 of a salivation  to assist them in subduing it.

   Besides the usual methods of introducing mer-
 cury into the system, Dr.  Stewart accelerated its
 action, by obliging his patients to wear socks filled
 with mercurial ointment; and Dr. Gillespie aimed
 at the same thing, by injecting the ointment, in a
 suitable vehicle, into  the  bowels, in the form of
 glysters.

  The following fact, communicated to me by
 Dr. Stewart, will shew the safety of large doses of
calomel in this fever. Mrs.  M'Phail took 60 grains
of calomel, by mistake, at a dose, after having taken
three or four 4oses, of 20 grains each, on the same 
40
AN  ACCOUNT OF  THE
 day.  She took in all, 356 grains in six days, and
 yet, says the doctor, " such was  the state of her
 stomach and intestines, that that large quantity was
 retained without producing  the least  griping,  or
 more stools than she had when she  took three
 grains every two hours."

   I observed the mercury to affect the mouth and
 throat in the following ways.  1. It sometimes pro-
 duced a swelling only in the throat, resembling a
 common inflammatory angina. 2.  It  sometimes
 produced ulcers upon the lips, cheeks, and tongue,
 without any discharge from the salivary glands.  3.
 It sometimes produced swellings and ulcers in the
 gums, and loosened the teeth without inducing a
salivation. 4. There were  instances in which the
mercury induced a rigidity in the masseter muscles
of the jaw, by which means the mouth was  kept
constantly open, or so much closed, as to render it
difficult for the patient to take food, and  impos-
sible  for him  to  masticate it.  5.  It  sometimes
affected the salivary glands only,  producing from
them  a copious secretion and excretion of saliva.
But, 6. It more frequently acted upon all the above
 parts, and it was then it produced most speedily  its
 salutary effects. 7. The discharge of the saliva fre-
 quently took place only during the remission  or
 intermission of the fever, and ceased with each re- 
      BILIOUS YELLOW  FEVER OF  1797.   41

 turn of  its paroxysms. 8. The salivation did not
 take place, in some cases, until the solution of the
 fever.  This was more especially the case in those
 forms  of the fever in which there was no remis-
 sions or intermissions. 9. It ceased in most cases
 with the fever, but it sometimes continued for six
 weeks or two months after the complete recovery
 of the  patient.  10. The mercury rarely dislodged
 the teeth.  Not a single instance occurred of a pa-
 tient losing a tooth in the city hospital, where the
 physicians, Dr. J. Duffield informed me, relied
 chiefly upon a salivation  for a cure of  the fever.
 11. Sometimes the mercury produced a discharge
 of blood with the saliva.  Dr. Coulter, of Balti-
 more,  gave me an account, in a letter dated the
 17th of September, 1797, of a boy in whom a hae-
 morrhage from the salivary glands, excited by calo-
 mel, was succeeded  by a plentiful flow of saliva,
 which  saved  his patient. 1 saw no inconvenience
 from the mixture of blood with saliva in any of my
 patients. It occurred  in Dr. Caldwell, Mr. Brad-
 ford, Mr. Brown, and  several others.

  It has been said that mercury does no service
 unless  it purges or salivates. I am disposed to be-
lieve that it may act as a counter stimulus to that
of the miasmata of the yellow fever, and thus be
useful without producing any evacuation from the
   VOL. IV.              F 
42          AN  ACCOUNT OF  THE
bowels or mouth.  It  more  certainly acts in this
way, provided blood-letting has preceded its exhi-
bition. I have supposed the stimulus from the re-
mote cause of the yellow fever to be equal in force
to five, and that of mercury to three.  To enable
the mercury to produce its action upon the system,
it is necessary to reduce the febrile action, by bleed-
ing, to two and a half, or below it, so that the
stimulus of the mercury shall transcend it.  The
safety of mercury, when introduced into the system,
has three advantages as a stimulus over that of the
matter which produces the fever.  1. It excites an
action in the system preternatural only in force. It
does not derange the natural order of actions.  2.
It determines the actions chiefly  to external  parts
of the body.  And, 3. It fixes them, when it affects
the mouth and throat, upon parts which are capable
of bearing great inflammation and effusion without
any danger to life. The stimulus which produces
the yellow fever acts in ways the reverse of those
which have been mentioned. It produces violent
irregular or wrong actions.  It determines them to
internal parts of the body, and it fixes them  upon
viscera which bear, with difficulty and danger, the
usual effects of disease.  A late French writer, Dr.
Fabre,  ascribed to diseases a centrifugal, and a
centripetal direction.  From what has been said it 
      BILIOUS YELLOW  FEVER  OF 1797.   43

 would seem,  the former belongs to mercury, and
 the latter to the yellow fever.

   Considering the great prejudices against blood-
 letting, I have wished to combat this fever with
 mercury alone. But, for reasons formerly given, I
 have been afraid to trust to it without the assistance
 of the lancet. The  character of  the fever, more-
 over, like that  which the  pott has ascribed to
 Achilles, is of " so swift, irritable, inexorable, and
 " cruel " a nature, that it would be  unsafe to rely
 exclusively upon a medicine which is not only of
 less efficacy than bleeding, but often slow and un-
 certain in its operation, more especially  upon the
 throat and mouth.

   Let not the reader be offended at my attempts
 to reason. I am aware of the evils which the weak
 and perverted exercise of this power of the mind
 has introduced into medicine.  But let us act with
 the same  consistency upon this subject that we do
 in other things.

   We do not consign a child to its cradle for life,
 because it falls in its first unsuccessful efforts to use
 its legs.   In like  manner we must  not  abandon
reason, because, in our first efforts to use it, we
have been deceived. A single just principle in our 
44
AN  ACCOUNT OF  THE
science will lead to more truth, in one year, than
whole volumes of uncombined facts will do in a
century.

  I lost but two patients in this epidemic in whom
the mercury  excited a salivation. One of them
died from the want of nursing;  the other by the
late application of the remedy.
              OF EMETICS.

  It was said a practitioner, who was opposed to
bleeding and mercury, cured this fever by means
of strong emetics. I gave one to a man who refus-
ed to be bled. It operated freely, and brought on
a plentiful sweat. The next day he arose from his
bed and went to his work.   On the fourth day he
sent for me again. My son visited him, and found
him without a pulse. He died the next day.

  I heard of two other persons who took emetics
in the beginning of the fever, without the advice
of a physician, both of whom died. 
     BILIOUS  YELLOW FEVER  OF 1797.   45

  Dr. Pinckard informed  me, that their  effects
were generally hurtful in the violent grades of the
yellow fever in the West-Indies. The same infor-
mation has since been given to me by Dr. Jack-
son. In the second and third grades of the  bilious
fever they appear not only to be safe, but  useful.
         OF DIET  AND DRINKS.

  The advantages of a weak vegetable diet were
very great iii this fever. I found but little difficulty,
in most cases, in having my prohibition of animal
food complied with before the crisis of the fever,
but there was often such a sudden excitement of
the  appetite for it, immediately afterwards, that it
was difficult to restrain it. I have mentioned  the
case of a young man, who was upon the recovery,
who died in consequence of supping upon  beef-
stakes.  Many other  instances of the mortality of
this fever from a similar cause, I believe, occurred
in our epidemic, which were concealed from  our
physicians.  I am not singular  in ascribing  the
death of convalescents to the too early use of ani-
mal food.  Dr. Poissonnier has the following  im- 
46
AN  ACCOUNT OF THE
portant remark upon this subject. " The physi-
cians of Brest have observed, that the relapses in
the malignant fever, which prevailed in their naval
hospitals, were as much the effect of a  fault in the
diet of the sick as of the contagious air to which
they were exposed, and that as many patients pe-
rished  from this cause as from the original fever.
For this reason light soups, with leguminous vege-
tables in them, panada,  rice seasoned with cinna-
mon, fresh eggs, Sec. are all that  they should be
permitted to eat. The use of flesh should be for-
bidden for many days after the entire cure of the
disorder.*"

  Dr. Huxham has furnished another evidence of
the danger from the premature use of animal food,
in his history of a malignant fever which prevailed
at Plymouth, in the year 1740.  " If any one (says
the doctor) made use of a flesh or fish diet, before
he had been very well purged, and his recovery
confirmed, he  infallibly  indulged himself  herein
at the utmost danger of his life.f"

  In addition to the mild articles of diet, mention-
ed by Dr. Poissonnier,  I  found bread and milk,

  * Maladies de Gens de Mer, yol. i. p. 345.
j Epidemics, vol ii. p. 67. 
     BILIOUS YELLOW FEVER OF  1797.   47

with a little water, sugar, and the pulp of a roasted
apple mixed with it, very acceptable to my patients
during their convalescence. Oysters were equally
innocent and agreeable.  Ripe grapes  were de-
voured by them with avidity, in every stage of the
fever.  The season had been favourable to the per-
fection of this pleasant fruit, and all the gardens in
the city and neighbourhood in which it was culti-
vated were gratuitously opened by the citizens for
the benefit of the sick.

   The drinks were, cold  water, toast  and water,
balm tea, water in which jellies of different kinds
had been dissolved, lemonade, apple water, barley
and rice water,  and, in cases wliere  the stomach
was affected with sickness or puking, weak porter
and water, and cold camomile  tea.  In the conva-
lescent stage of the fever,  and in such of its remis-
sions or intermissions as were  accompanied with
great languor in the pulse, wine-whey, porter and
water, and brandy and water, were taken with ad-
vantage.

   Cold water applied to the body,  cool and fresh
air, and cleanliness, produced their usual good ef-
fects in this fever.  In the external use of cold wa-
ter, care was taken to confine it to such cases as
were accompanied with preternatural heat, and to 
48
AN  ACCOUNT  OF THE
forbid it in the cold fit of the fever, and in those
cases which were attended with cold hands and feet,
and where the disease showed a disposition to ter-
minate, in its first stage, by a profuse perspiration.
It has lately given me great pleasure to find the
same practice, in  the external use of cold water in
fevers, recommended by Dr. Currie of Liverpool,
in his medical reports of the effects of water, cold
and warm, as a remedy in febrile diseases. Of the
benefit of fresh air in this fever, Dr. Dawson of
Tortola has lately furnished me with a striking in-
stance.  He informed me, that by removing pa-
tients from the low grounds on that island, where
the fever is generated, to a neighbouring mountain,
they generally recovered in a few days.

   Finding a disagreeable smell to arise from vine-
gar sprinkled upon the floor, after it had emitted all
its acid vapour, I directed the floors of sick rooms
to be sprinkled only with water.   I found the va-
pour which arose from it to be more grateful to my
patients. A citizen of Philadelphia, whose whole
family  recovered  from the fever, thought he per-
ceived evident advantages from tubs of fresh water
being kept constantly in the sick rooms. 
      BILIOUS YELLOW  FE?ER OF  1797.    49


      OF STIMULATING REMEDIES.

    There were now and then remissions and inter-
 missions of the fever, accompanied with such signs
 of danger from debility, as to render the exhibition
 of a kxv drops of laudanum, a little wine-whey, a
 glass of brandy and water, and, in some instances,
 a cup of weak chicken-broth, highly necessary and
 useful.  In addition to these cordial drinks, I di-
 rected the feet  to be placed in a tub of warm water,
 which was  introduced  under the bed-clothes,  so
 that the patient was not weakened by being raised
 from a horizontal posture. All these remedies
 were laid aside upon the return of a paroxysm  of
 fever.

   I did not prescribe bark in a single case of this
 disease.  An infusion of the quassia root was sub-
 stituted in  its  room, in several instances, with
 advantage.

   Blisters were applied as usual, but, from the
 insensibility of  the skin, they were less effectual
 than applications of mustard to the arms and legs.
 It  is a circumstance worthy of notice, that while
the stomach, bowels, and even the large blood-ves-
sels are sometimes in a highly excited  state, and
   VOL.  IV.         G 
50
AN  ACCOUNT OF  THE'
overcharged, as it were, with  life, the whole sur-
face of the body is in a state of the greatest torpor.
To attempt to excite it by internal remedies is like
adding fuel to a chimney already on fire.  The ex-
citement of the blood-vessels, and the  circulation
of the blood, can only be equalized by the applica-
tion of stimulants to the skin. These, to be effec-
tual, should be of the most powerful kind. Caus-
tics might probably be used in  such  cases with
advantage. I am led to this opinion by a fact com-
municated to me  by Dr. Stewart. A lighted can-
dle, which had been left  on the  bed of a woman
whom he was attending in the apparent  last stage
of the yellow fever, fell upon her breast. She was
too insensible to feel, or too  weak to remove  it.
Before her nurse came into her room, it had made
a deep and extensive impression upon her flesh.
From that time she revived,  and in the  course of
a few days recovered. As a tonic remedy in this
fever, Dr. Jackson has spoken to me in high terms
of the good effects of riding in a carriage. Patients,
he informed me, who were moved with  difficulty,
after riding a few miles were able to sit up, and,
 when they returned from their excursions, were
 frequently able to walk to their beds.

   Much has been said, of late years, in favour of
 the application of warm olive oil  to the body in the 
      BIL.I0US  YELLOW FEVER  OF 1797.   51

plague, and a wish has been expressed, by some
people, that its efficacy might be tried in the yellow
fever.  Upon examining the  account of this re-
medy, as published by Mr. Baldwin, three things
suggest themselves to our notice. 1. That the oil
is effectual only in the forming state of the disease;
2.  That the friction which is used with it  contri-
butes to excite the torpid vessels of the skin; and
3.  That it acts chiefly by depleting from the pores
of the body. From  the unity of the remedy of
depletion, it is probable purging or bleeding might
be substituted to the expensive parade of the sweat
induced by the  warm oil, and the smoke of odori-
ferous vegetables. But I must not conceal here,
that there are facts which favour an idea, that oil
produces a sedative action upon the blood-vessels,
through the medium  of the skin.  Bontius says it
is used in this manner in the  East-Indies,  for the
cure of malignant fevers, after the previous use of
bleeding and purging.  It seems to have  been a
remedy well known  among the Jews; hence we
find the apostle James advises its being applied to
the body, in addition to the prayers of the elders
of the church.* It is thus in other cases, the bles-
sings of heaven are conveyed to men through th*
use of natural means.
* Chapter v- verse 14 
52
AN  ACCOUNT OF  THE
   During the existence of the premonitory symp-
toms, and  before  patients were confined to their
rooms, a gentle purge, or the loss of a few ounces
of blood, in many hundred instances, prevented the
formation of the fever. I did not meet with a sin-
gle exception to this remark.

   Fevers are the affliction chiefly of poor people.
To prevent or to cure  them, remedies must be
cheap, and  capable of being applied with but little
attendance. From the  affinity  established by the
creator between evil and its antidotes, in other parts
of his works, I am disposed to believe no remedy
will ever be effectual in any general disease, that is
not cheap, and that cannot easily be made universal.

  It is to be  lamented that the  greatest part of all
the deaths  which occur, are from diseases that are
under the power of medicine.  To  prevent their
fatal issue, it would  seem to be agreeable to the
order of Heaven in other things, that they should
be attacked in their  forming state. Weeds, ver-
min, public oppression, and private vice, are easily
eradicated and destroyed, if opposed by their pro-
per remedies, as soon as they show themselves.
The principal obstacle to the successful use of the
antidotes of malignant fevers, in their early stage,
arises from physicians  refusing to declare when 
      BILIOUS YELLOW  FEVER OF  1797.   53

 they appear in a city, and from their practice of
 calling their mild forms by other names than that
 of a mortal epidemic.

   I shall now say a few words upon  the success
 of the depleting practice in this epidemic.

   From the more malignant state of the fever, and
 from the fears and prejudices that were excited
 against bleeding and mercury by means of the news-
 papers, the success of those remedies was  much
 less than in the years 1793 and  1794.  Hundreds
 refused to submit to them at the time,*and in the
 manner,  that were necessary to render them effec-
 tual. From the publications of a number of physi-
 cians, who used the lancet and mercury in their
 greatest  extent, it appears that they lost but one in
 ten of all they attended.  It was said of several
 practitioners who were opposed to copious bleed-
 ing, that they lost a much smaller proportion of their
 patients with the prevailing fever.  Upon inquiry
 it appeared they had lost many more. To conceal
 their want of success, they said their patients had
died of other diseases.  This mode of deceiving
the public began in 1793.  The men who used it
did not recollect, that it is less in favour of a phy-
 sician'* skill to lose patients in pleurisies, colics, 
 54          AN  ACCOUNT OF  THE

 haemorrhages, contusions, and  common  remit-
 tents, than in a malignant yellow fever.

   Dr. Sayre attended fifteen patients in the disease,
 all of whom recovered by the plentiful use of the
 depleting remedies.  His place of residence being
 remote  from those parts of the  city in which the
 fever prevailed most,  prevented his being called
 to a  greater number of cases.

   A French  physician, who bled and purged mo-
 derately, candidly acknowledged that he saved but
 three out of four of his patients.

   In the city hospital, where bleeding was sparing-
 ly used, and where the physicians depended chiefly
 upon a salivation, more  than  one half  died of all
 the patients who were admitted. It is an act of
justice to the  physicians of the  hospital to add, that
 many, perhaps most of their patients, were admit-
 ted after the  first day  of the disease.

   I cannot conclude this comparative view of the
 success of the different modes of treating the yellow
fever, without taking  notice, that the stimulating
 mode as recommended  by Dr.  Kuhn and  Dr.
 Stevens, in the year 1793, was deserted by every
physician in the city.  Dr. Stevens acknowledged 
     BILIOUS  YELLOW FEVER  OF 1797.   55

the disease to require a different  treatment from
that which is required  in the West-Indies;  Dr.
Kuhn adopted the lancet and mercury in his prac-
tice ; and several other physicians, who had written
against those remedies, or who had doubted of their
safety and efficacy, in 1793, used them with con-
fidence, and in the most liberal manner, in 1797.

   In the histories I have given of the yellow fevers
of 1793 and 1794,1 have scattered here and there a
few observations upon their degrees of danger, and
the signs of their favourable  or unfavourable issue.
I shall close the present history, by collecting those
observations into one  view, and adding to them
such other  signs as have occurred to me in ob-
serving this epidemic.

   Signs of moderate danger, and a favourable is-
sue of the yellow fever.

   1. A chilly fit accompanying the attack of the
fever.  The longer this chili continues, the more
favourable the disease.

   2. The recurrence of chills every day, or twice
a day, or every other day, with the return of the
exacerbations  of the fever.  A  coldness  of the
whole body, at the above periods, without chills, a 
56
AN ACCOUNT  OF  TH~E
 coldness with a profuse sweat, cold feet and hands,
 with febrile heat in  other parts of the body, and a
 profuse  sweat without  chills or coldness, are all
 less favourable symptoms than a regular chilly fit,
 but they indicate less danger than  their total ab-
 sence during the course of the fever.

   3. A puking of green or yellow bile on the first
 day of the disease is favourable.  A discharge of
 black bile, if it occur on the first day of the fever,
 is not unfavourable.

   4. A discharge of green  and yellow  stools. It
 is more favourable if the stools are of a dark or
 black colour, and of a foetid and acrid  nature, on
 the first or second day of the  fever.

   5. A softness and  moisture on the skin in the
 beginning of the fever.

   6. A sense of pain  in the  head, or a sudden
translation of  pain from internal to external parts
of the body, particularly to the back.  An increase
of pain after bleeding.

   7. A sore mouth.

   8. A moist  white, or  a yellow tongue. 
      BILIOUS YELLOW  FEVER OF  1797.   57

   9. An early disposition to spit freely, whether
 excited by nature or the use of mercury.

   10. Blood becoming sizy, after  having exhi-
 bited the usual marks of great  morbid action in
 the blood-vessels.

   11. Great and exquisite sensibility in the sense
 of feeling coming on near the close  of the fever,,

   12. Acute pain in the back and limbs.

   13, The appearance of an inflammatory spot on
 a finger or toe, Dr. H.  M'Clen says,  is favourable.
 It appears, the doctor says, as if the cause of the
 fever had escaped by explosion.

   Signs of  great danger, and of an  unfavourable
 issue of the yellow fever are,

   1. An attack of the fever, suddenly succeeding
 great terror, anger, or the intemperate use of ve-
 nery, or strong drink.

  2. The first paroxysm coming on without any
premonitory symptoms,  or a chilly fit.
\70L.  IV.
II 
58
AN  ACC0UN1  OF THE
  3. A coldness over the whole body without
chills for two or three days.

  4. A sleepiness on the first and second days of
the fever.

  5. Uncommon paleness of the face not induced
by  blood-letting.

   6. Constant or violent vomiting, without any
discharge of bile.

   7. Obstinate costiveness, or a discharge of natu-
ral, or white stools; also  quick, watery stools after
taking drink.

    8. A diarrhoea  towards the  close of the fever.
 I lost two patients, in 1797, with this symptom,
 who had exhibited, a few days before, signs of a
 recovery.  Dr. Pinckard informed me, that it was
 generally attended with  a fatal issue in the yellow
 fever of the West-Indies. Diemerbroeck declares,
 that " scarcely  one in a  hundred recovered, with
 this symptom from the  plague.*"

    9.  A suppression of urine. It is most alarming
  when it is without pain.
                   * Lib. i. cap. 15. 
      BILIOUS  YELLOW FEVER OF  1797.   59

   10. A discharge of dark  coloured and  bloody
 urine..

   11. A cold, cool, dry, smooth, or shining skin.

   12. The appearance of a yellow colour  in the
 face on the first or second day of the fever.

   13. The absence of pain, or a sudden cessation
 of it, with the common symptoms of great danger.

   14. A disposition to faint  upon a little motion,
 and fainting after losing but a few ounces of blood.

   15. A watery,  glassy, or  brilliant eye.  A red
 eye on the fourth or fifth day of the disease. It is
 more alarming if it become  so after having been
 previously yellow.

   16. Imperfect vision, and blindness in the close
of the disease.

   17. Deafness.

   18. A preteniatural appetite, more especially in
the last stage of the fever.
19. A slow, intermitting, and shattered pulse. 
60          AN ACCOUNT OF THE

  20. Great restlessness, delirium, and long con-
tinued coma.

  21. A discharge of coffee  coloured  or black
matter from the stomach, after the fourth day of
the fever.

  22. A smooth red tongue, covered with a lead-
coloured crust, while its edges are of a bright red.

  23. A dull vacant face, expressive of distress.

  24. Great insensibility to common occurrences,
and an indifference about the issue of the disease.

  25. Uncommon serenity of mind accompanied
with an unusually placid countenance.

  I shall conclude this head by the following re-
marks :

  1. The violence, danger, and probable issue of
this fever, seem to be in proportion to the duration
and force of the predisposing and exciting causes.
However steady the former are in bringing on de-
bility, and the latter in acting as irritants upon ac-
cumulated  excitability, yet a knowledge of their
duration and  force is always  useful, not  only in 
       BILIOUS YELLOW  FEVER  OF 1797.   61

  forming an opinion of the probable issue of the
  fever, but in regulating the force of remedies.

    2.  The signs of danger vary in different years,
  from the influence of the weather upon the disease.

    3. Notwithstanding the signs of the favourable
  and unfavourable  issue of the fever are in general
  uniform, when the  cure of the disease is committed
  to nature, or to tonic medicines, yet they are far
  from  being so when the treatment of the fever is
  taken out of the hands of  nature, and  attempted
  by the use of depleting  remedies. We often see
 patients recover with nearly all the unfavourable
 symptoms that have been mentioned, and we some-
 times see them die, with all those that are favoura-
 ble. The words of Morellus, therefore, which he
 has applied to the plague, are equally true when
 applied to the yellow fever. " In the plague, our
 senses deceive us.   Reason  deceives us.  The
 aphorisms of Hippocrates deceive us.*" An im-
 portant lesson may be learned from these facts, and
 that is, never to give a patient over. On the con-
 trary,  it is our duty in this, as well as in all other
 acute diseases, to dispute every inch of ground with

  * De  Feb. Pestilent, cap. v. "Acutorum morborum incertx ad-
modum, ac fallaces sunt prxdictiones."
                                  Hippocrates. 
62
AN  ACCOUNT, &C.
death. By means of this  practice, which is war-
ranted by science, as well as dictated by humanity,
the grave has often been deprived for a while of its
prey, and a prelude thereby exhibited of that ap-
proaching and delightful time foretold by ancient
prophets, when the power of medicine  over dis-
eases shall be such, as to render old age the only
outlet of human life. 
        AN ACCOUNT





           OP THE







BILIOUS YELLOW FEVER,






            AS IT






  APPEARED IN PHILADELPHIA,





        IN THE YEAR 1798. 
>**.«t 
AN  ACCOUNT, &c.
      THE yellow fever of the year 1797 was
succeeded by scarlatina, catarrhs, and bilious pleu-
risies, in the months of November and December
of the same year. The weather favoured the gene-
ration of the latter diseases.  It became suddenly
cold about the middle of November.  On the 5th
of December, the navigation of the Delaware was
obstructed.  There was a thaw on  the 13th and
14di of this month, but not sufficient to open the
river.

  In the month of January, 1798, the fevers disco-
vered an uncommon  determination to the brain.
Four cases of the hydrocephalic state of fever oc-
curred under my care during this  month, all of
which  yielded to depleting remedies.  The sub-
jects of this state of fever were Mr. Robert Lewis.
VOL.  IV.
T 
66
AN  ACCOUNT OF
THE
and the daughters of Messrs. John Brooks, An-
drew Ellicott, and David Maffat.

  The weather was variable during the months of
February and March.  The navigation of the De-
laware  was not completely opened until the latter
end of February.   The diseases of  these two
months were catarrhs and bilious pleurisies.  The
former were confined chiefly to children, and were
cured  by  gentle pukes, purges of calomel, and
blood-letting.   The  last remedy was employed
twice in a  child of Isaac Pisso, of six weeks old,
and once in a child of Thomas Billington, of three
weeks  old, with success.

  On the 7th of April, I visited Mr. Pollock, lately
from the state of Georgia, in consultation with Dr.
Physick, in a yellow fever.  He  died the evening
after I  saw him, on the third day of his disease.

  There was a snow storm  on the 16th of April,
and the weather was  afterwards  very cold.  Such
leaves and blossoms as had appeared, were injured
by it.

  On the  1st of May, the mercury in Fahrenheit's
thermometer rose to 84°.   The weather, during
the latter part of this month, and  in June, was very 
BILIOUS YELLOW
FEVER  OF 1798.
67
dry. On the 6th of June, Dr. Cooper lost a patient
in the yellow fever, near the corner of Twelfth and
Walnut-streets.  Mark Miller died with the same
state of fever on the 2d of July. About a dozen
cases of a similar nature occurred, under the care
of different practitioners, between the 2d and 20th
of this month, and all of them in parts of the city
remote from Water-street.

  On the 19th of July, the weather was so cool as
to render winter clothes  comfortable. A severe
hail storm had occurred, a few days before, in the
neighbourhood of  Wilmington, in the Delaware
state.

  On the 21st of the month, the ship Deborah ar-
rived from one of the West-India islands, and dis-
charged  her cargo in the  city.  She was  moored
afterwards at Kensington, where the foul air which
was emitted from her hold produced several cases
of yellow fever, near the shores of that village.

  In August the disease appeared in nearly every
part of the city, and particularly in places where
there was the greatest exhalation from foul gutters
and common sewers. 
68
AN  ACCOUNT OF  THE
  In  describing the disease, as it appeared this
year, I shall take  notice of its sypmtoms as they
appeared  in the blood-vessels, alimentary canal,
the tongue, the nervous  system, in the eyes, the
lymphatic system, and the blood.

  The subjects which furnished the materials for
this history were not only private patients, but the
poor in the city hospital,  who were committed to
the care of Dr. Physick and myself, by the board
of health.

  I. The  pulse was, in many cases, less active
in the beginning of this fever than in former years.
It was seldom preternaturally slow.  It resembled
the pulse  which occurs in the  first stage of the
common jail fever. Haemorrhages were common
about the fourth and fifth days, and generally from
the gums, throat,  or stomach.

  II.  The whole alimentary canal was much af-
fected in most cases. Costiveness and a vomiting
were  general. The alvine discharges were occa-
sionally green, dark-coloured, black, and natural.
The black vomiting was more common this  year
than in former years, in all the forms of the fever.
It was sometimes suspended for several days before
death, and hopes were entertained of a recovery of 
     BILIOUS  YELLOW  FEVER OF 1798.   69

patients in whom it had appeared.   In  a boy, at
the city hospital, it ceased ten days before he died.
It was sometimes succeeded by delirium or coma,
but it more commonly left the patient free of pain,
and in the possession of all the faculties of his mind.

  III. The  tongue was by no means an index of
the state of the fever, as in the years 1793 and 1797.
I saw several deaths, attended with a black vomit-
ing, in which the tongue retained a natural appear-
ance. This  phenomenon at first deceived me. I
ascribed it to such a concentration of the disease in
the stomach and other vital parts, as to prevent its
diffusing itself tlirough the external parts of the
system.  We observe the effects of the same cause
in a natural  state of the skin, and in a natural ap-
pearance of the urine, in the most malignant forms
of this fever.

   IV. In the nervous system, the disease appeared
with several new symptoms. A relation of Peter
Field attempted to bite his attendants in the deli-
rium of his  fever, just before he died.

   I  attended a young woman at Mrs. Easby's,
who started every time I touched her pulse. Loud
talking,  or a question suddenly  proposed to her,
produced the same convulsive  motion. She re- 
70
AN  ACCOUNT OF  THL
 tained her reason during the whole of her illness,,
 and was cured by bleeding and a salivation.

   Hiccup was a common  symptom.  I saw  but
 two patients recover who had it.  In one of them,
 Dr. Hedges, it came on after the sixth day of the
 fever, and continued, without any other symptom
 of disease, for four or five days.

  I lost a patient who complained of no pain but
 in the calves of his legs. Dr. Physick lost a girl,
 in the city hospital, who complained only of pains
 in her toes.  Her stomach discovered, after death,
 strong marks of inflammation.

  Many people passed through every stage of the
 disease, without uttering a complaint of pain of
 any kind.

  An uncommon stiffness in the limbs preceded
death a few hours, in several cases. This stiffness
 ceased, in one of Dr. Physick's  patients, imme-
diately after death, but  returned as soon as he
became cold.

  An obstinate wakefulness  continued through
the whole of the disease in Dr. Leib.  It was com-
mon during the convalescence, in many cases. 
     BILIOUS YELLOW  FEVER OF  1798.    71

  The whole body was affected,  in many cases,
with a morbid sensibility, or what has been called
supersensation, so that patients complained of pain
upon being  touched, when they were  moved in
their beds. This extreme sensibility was general
in parts to which blisters had been applied.  It
continued through every stage of the disease. Dr.
Physick  informed  me, that  he observed  it in a
man two hours before he died. In this man there
was an absence of pulse, and a coldness of his ex-
tremities. Upon touching his wrist, he cried out,
as if he felt great pain.

  V. A redness in the eyes was a general  symp-
tom.  I saw few recoveries where this redness was
not removed.

  A discharge of matter from one ear relieved Mr.
J. C. Warren from a distressing  pulsation  of the
arteries in his head.

  VI. Glandular swellings occurred in several in-
stances.  Two cases of them  came under my no*
tice. They both terminated favourably.

  VII. The blood had its usual appearances in this
disease.  In the yellow fever  which  prevailed at 
72
AN  ACCOUNT OF  THE
 the same time in Boston, Dr. Rand says the blood
 was sizy in but one out of a hundred cases.

   The forms of the fever were nearly similar to
 those which have been described in the year 1797.
 I saw several cases in which the disease appeared
 in the form of a tertian fever.  In one of them it
 terminated in death.

   The system, in many cases, was prostrated be-
 low  the point  of inflammatory re-action.   These
 were called, by some practitioners, typhous fevers.
 It was the most  dangerous and fatal form of thev
 disease. Its frequent occurrence gave occasion  to
 a remark, that our epidemic resembled the yellow
 fever of the West-Indies, much more than the fe-
 vers of  1793 and 1797.

   I attended two patients in whom the disease was
protracted nearly to the 30th day.  They both re-
 covered.

   Dr. Francis Savre informed me, that he saw a
child, in which the morbid affection of the wind-
pipe, called Tiyrianche trachealis, appeared with all
the usual symptoms of yellow fever. 
*
      BILIOUS  YELLOW FEVER  OF 1798.   73

   I attended one case in which the force of the
disease was weakened, in its first stage by a pro-
fuse haemorrhage from the bowels. This haemor-
rhage was  followed by a bloody diarrhoea, which
continued for four or five weeks.

   Persons  of all ages and colours were affected by
this fever.   I saw a  case of it in a child of six
months old. In the blacks, it was attended with less
violence and mortality than in white people.  It
affected many persons who had previously had it.

   The  disease was excited by the same causes
which excited it  in former years.  I observed a
number of people to  be affected by the fever, who
lived in solitude in their houses, without doing any
business. The system, in these persons, was pre-
disposed to the disease, by the debility induced by
ceasing to  labour at  their former occupations. It
was excited in a  young  man by a fractured leg.
He died five days afterwards, with a black vomit-
ing.  I observed, in  several instances, an interval
of four and five days between the debility induced
upon the system by a predisposing, and the action
of an exciting cause.  Dr. Clark says, he has seen
an interval of several  weeks between the operation
of those causes, in the yellow fever of Dominique.
vol- iv.
K 
74         AN ACCOUNT OF  THE

These facts are worthy of notice, as they lead to a
protracted use of the means of obviating an attack
of the disease.

  During my attendance upon  the sick,  I twice
perceived in my system the premonitory signs of
the epidemic.   Its complete formation was pre-
vented each time by rest, a moderate dose  of phy-
sic, and a plentiful sweat.

  I shall now take notice of the different manner in
which patients died of this fever.   The detail may
be useful, by unfolding new principles in the ani-
mal economy, as well as new facts in the  history
of the disease.

  1. The disease terminated in death, in some in-
stances, by means of convulsions.

  2. By delirium, which prompted  to exertions
and actions  similar to those which take place in
madness.

  3. By profuse  haemorrhages  from the gums.
This occurred in  two patients of Dr. Stewart.

   4. By an incessant vomiting and hiccup. 
     bilious  yellow  fever of  1798.   75

   5. By extreme pain in the  calves of the legs
and toes, which, by destroying the excitement of
the system, destroyed life.

   6. By a total absence of pain. In this way it put
an end to the life of Mr.  Henry Hill.

   7. By a disposition to easy, and apparently na-
tural sleep. I have reason to believe that Mr. Hill
encouraged  this disposition to sleep, a few hours
before he died, under the influence of a belief that
he would be refreshed by it. Diemerbroeck says
the plague often killed in the same way.

   8. The mind was in many cases  torpid, whei;e
no delirium  attended, and  death was submitted
to with a degree of insensibility, which was often
mistaken for fortitude and resignation.

  I shall now mention the morbid appearances
exhibited  by the bodies of persons who died of
this fever, as communicated to me by my friend,
Dr. Physick;  being the result of numerous dis-
sections made by him at the city hospital.

  In all of them the stomach was inflamed. The
matter which  constitutes what is called the black
vomit, was found in the stomachs of several patients 
76
AN  ACCOUNT OF  THE
who had not discharged it at any time by vomiting.
In some stomachs, he found  lines which seemed
to separate the living from their dead parts. Those
parts, though dead, were not always in a mortified
state. They were distinguished from  the  living
parts by a peculiar paleness, and by discovering a
weak texture upon being pressed between the fin-
gers. He observed the greatest marks of inflam-
mation in the stomachs of several persons in whom
there had  been no vomiting, during the  whole
course of  the  disease.  The brain in a few  in-
stances, discovered marks of inflammation. Water
was now and then found in its ventricles, but al-
ways of its natural  colour, even in those persons
whose  skins were yellow.  The liver suffered but
little in this disease.  It may serve to increase our
knowledge of the influence of local circumstances
upon epidemics to remark, that this viscus, which
was rarely  diseased in the fever of Philadelphia in
1798, discovered marks of great inflammation in
the bodies which were examined by Dr. Rand and
Dr. Warren, in the  town  of Boston,  where the
yellow fever  prevailed at the same time  itdid in
Philadelphia.

   The weather was hot and  dry in August and
September, during the prevalence of this fever. Its
influence upon animal and vegeiable life are worthy 
     BILIOUS YELLOW  FEVER  OF 1798.   77

of notice. Moschetoes abounded, as usual in sickly
seasons; grasshoppers covered the ground in many
places; cabbages and other garden vegetables, and
even fields  of clover, were devoured  by them.
Peaches ripened this year three weeks sooner than
in ordinary summers, and apples rotted much soon-
er than usual after being gathered in the autumn.
Many fruit-trees blossomed in October, and a se-
cond crop of small apples and cherries were seen
in November, on the west side of Schuylkill, near
the city.  Meteors were observed in several places.
On the 29th of September there was a white  frost.
Its effects upon the fever were  obvious and general.
It declined, in every part of the city, to such a de-
gree as to induce many people to return from the
country. In the beginning of October the weather
again became warm, and the disease  revived.  It
was observable, that all great changes in the wea-
ther from heat to cold that  were less than that de-
gree which produces  frost,  also of cold to heat,
increased the mortality  of the  fever.   It spread
most rapidly in moist weather.

   The origin of  this fever was from the exhala-
tions of  gutters,  docks, cellars, common sewers,
ponds of stagnating water, and from the foul air
of the  ship  formerly mentioned. 
78
AN ACCOUNT OF  THE
   The fever prevailed at the same time in the town
 of  Chester, in Pennsylvania;  in Wilmington, in
 the state of Delaware :  in New-York ;  in New-
 London, in Connecticut; in  Windsor, in Ver-
 mont ; and in Boston ;  in all which places its ori-
 gin was traced to domestic sources.

  I shall now  deliver a short account of the reme-
 dies employed in the cure of this disease.

  I have said  that the pulse was less active in this
fever than  in the fevers of former  years.  It  was
seldom, however, so feeble as to forbid bleeding.
In Dr. Mease  it called for the loss of 162 ounces
of blood, and in  Mr. J.  C. Warren for the loss of
200, by successive  bleedings,  before it was sub-
dued.  But such cases were not common. In most
of  them,  the  pulse flagged after two  or three
bleedings.  But there were cases in which the lan-
cet  was forbidden  altogether.  In these, the  sys-
tem appeared to be prostrated, by the force of the
miasmata, below the point of re-action. This state
of the disease manifested itself in a weak,  quick,
and frequent pulse, languid eye, sighing, great in-
quietude, or great  insensibility.  However unsafe
bleeding was on the first day of this fever, when it
appeared with  those symptoms, nature often per- 
BILIOUS YELLOW FEVER  OF 1798.
79
formed that operation upon herself from the gums,
on the fourth or fifth day.   I saw several pounds
of blood discharged on those days, and in that way,
with the happiest effects.   It  appeared to take
place after  the revival of the blood-vessels from
their prostrated state.

  From a conviction that the system was depressed
only in  these cases, and finding that it did not
rise upon blood-letting, I resolved to try the effects
of emetics, in exciting and equalizing the action of
the blood-vessels.   The experience  I had  had of
the inefficacy of this remedy in 1793, and of its ill
effects in one instance in 1797, led me to exhibit
it with a trembling hand.  I gave it for the first
time to  a son of Richard  Renshaw.  I had bled
him but once, and had in vain  tried  to bring on  a
salivation.   On the fifth day of his disease, his
pulse became languid and slow, his skin  cool,  a
haemorrhage had taken place from his gums, and
he discovered a restlessness and  anxiety which  I
had often seen a few hours before death. He took
four grains of tartar emetic,  with twenty grains of
calomel, at two doses. They operated powerfully,
upwards and downwards, and brought away a large
quantity of  bile.   The effects of this medicine
were such as I wished.  The next day he was out
of danger.   I prescribed the  same  medicine in 
/
 80         AN ACCOUNT  OF THE

 many other cases with the same success. To se-
 veral of my patients  I gave two emetics in the
 course of the disease. Some of them discharged
 bile resembling in viscidity  the white of an egg.
 But I saw one case in which great relief was ob-
 tained from the operation of an emetic, where no
 bile was discharged.

   In the exhibition of this remedy, I was  regu-
 lated by the pulse.  If I found it languid on the
 first day of the fever, I gave it  before any other
 medicine.  When it was full  and tense, I deferred
 it until I had reduced the pulse to the emetic point
 by bleeding and  purges.  I observed, with great
pleasure,  that mercury affected the mouth more
 speedily and  certainly where an  emetic had been
administered, than in other cases, probably from
awakening, by its stimulus,  the sensibility of the
stomach;  for such was its torpor, that in one case
ten grains of tartar emetic,  and in another thirty
grains, did not operate upon  it,  so as to excite
even the slightest degree of nausea.

   In many cases, an emetic, given in the forming
state of the disease, seemed to effect an immedi-
ate cure. 
     BILIOUS  YELLOW FEVER  OF 1798.    81

  Purges produced the same salutary effects that
they did in former years.  I always combined ca-
lomel with them in the first stage of the disease.

  A salivation was found to be the most certain
remedy of any that was used in this fever.  I did
not lose a single  patient,  in whom the mercury
acted upon the salivary glands. It was difficult  to
excite it in many cases, from the mercury being
rejected by the stomach,  from its  passing off by
the bowels, or from its stimulus being exceeded
by the morbid action in the blood-vessels.

  Bleeding rendered  the action of the mercury
upon the mouth more  speedy and more  certain,
but I saw several cases in which a salivation was
excited in the most malignant forms of the fever,
where no blood had been drawn.   It will not be
difficult to explain the reason of this factif we recur
to what was said formerly of the prostration of the
system in this fever.  In its worst forms,  there is
often a total absence, or a feeble degree of actioit
in the blood-vessels, from an excess of the stimulus
of the remote cause of the fever.  Here the mer-
cury meets with no resistance in its tendency  to
the mouth.' Bleeding in this case would probably
do harm, by taking off a part of the pressure  upon
the system, and thereby produce a re-action in the
   VOL. iv.              l 
82
AN  ACCOUNT OF  THE
vessels, that might predominate over the action of
the mercury.  The disease here  does that for us
by its force, which,  in  other cases)  we effect by
depleting remedies.

   Where the mercury showed a disposition to pass
too rapidly through the bowels, I observed no in-
convenience from combining it with opium, in my
attempts to excite a salivation.  The calomel was
constantly aided by  mercurial ointment, applied
by friction to different parts of the body.

   Now and then a salivation continued for weeks
and months after the crisis of this fever, to the great
distress of the patient, and injury of  the credit of
mercury as a remedy in this disease.  Dr. Phy-
sick has discovered, that in these cases the saliva-
tion is kept up by carious teeth or bone, and that
it is to be cured only by removing them.

   From the impracticability of exciting a salivation
in all cases, I attempted the cure of this fever, af-
ter bleeding, by means of copious sweats. They
succeeded in several  instances where no other re-
medy promised or afforded any relief.  They were
excited by wrapping the  patient in a blanket, with
half a dozen hot bricks wetted with vinegar, and
applied to different parts of the body.  The sweat? 
     BILIOUS  YELLOW  FEVER OF  1798.   85

ing was  continued for six  hours, and repeated
daily for  four or five days.

  In those cases where the fever put on the form
of an intermittent, I gave bark after bleeding and
purging with advantage.  I gave it likewise in all
those cases where the fever put on the type of the
slow chronic fever.  Laudanum was acceptable
and useful in many cases of pain, wakefulness,
vomiting, and diarrhoea, after the use  of depleting
remedies.

  I applied blisters in the usual way in this fever,
but I think with less effect  than in the yellow fe-
vers of former years.

  To relieve a  vomiting, which was very distres-
sing in many cases about the fourth and fifth days,
I gave a julep, composed of the salt of tartar  and
laudanum. I also gave Dr. Hosack's  anti-emetic
medicine, composed of equal parts of lime-water
and milk. I do not know that it saved any lives,
but I am sure it gave ease by removing a painful
symptom, and thus, where it did not cure, lessen-
ed the sufferings of the sick.

  The diet and drinks were the same in this fever
as they were in the fevers formerly described. 
84
AN  ACCOUNT OF  THE
  Cool air, cold water, and cleanliness  produced
their usual sanitary effects in this fever..

  I shall now deliver a short account of the symp-
toms  which indicated a favourable  and an unfa-
vourable issue of the disease.

  It has been said,* that the signs of danger vary
in this fever, from the  influence of the weather.
The autumn of 1798 confirmed in many  instan-
ces, the truth of this remark.

  I saw  no instance of  death where a bleeding
occurred from the gums on the fourth or fifth day,
provided depleting remedies had been used from
the beginning of the disease. Few recovered who
had this symptom in 1793.

  I saw three recoveries after convulsions in the
year 1798. All died who were convulsed in 1793
and 1797.

  A dry, hoarse, and sore throat was followed by
death in every  case in which  it occurred in my
practice. In the fever of 1793 a sore throat was a
favourable sign. It was one of the circumstances
' History of the Fever in 1797. 
     BILIOUS YELLOW FEVER  OF 1798.   85

which  determined me to use a salivation  in that
fever.

  The absence of pain was  always a bad sign.
Small, but frequent stools, and the continuance of
a redness in the eyes after the ample use of deplet-
ing remedies, were likewise bad signs.

  An appetite for food on the fourth or fifth day of
the fever, without a remission or cessation of the
fever, was always unfavourable.

  A want of delicacy, in  exposing parts of the
body which are usually covered, was" a bad symp-
tom. I saw but one recovery where it took place.
Boccacio says the same symptom occurred in the
plague in Italy. " It  suspended (he tells us) all
modesty, so that young women, of great rank and
delicacy, submitted to be attended, dressed, and
even cleansed by male nurses."

  I have remarked, in another place, that but tw©
of my patients recovered who had the hiccup.

  A dry tongue was a bad  sign.  I saw but one
recovery where it occurred, and none  where the
tongue was black.  A moist and natural tongue,
where symptoms of violence or malignity appeared 
-86
AN ACCOUNT OF THE
 in other parts of the body, was always followed by
 a fatal issue of the disease.

   A desire to ride out, or to go home, in persons
 who were absent from their families, was in every
 instance  where it took  place, a  fatal symptom.
 These desires arose from an insensibility to pain,
 or a false idea of the state of the disease. It exist-
 ed to such a degree in some of the patients in the
 city hospital, that they often left  their beds, and
 dressed themselves, in order to go home. All these
 patients died, and some of them in the act of put-
 ting on their clothes.

  From  the  history that has been given of the
 symptoms, treatment, and prognosis of this fever,
we see how imperfect all treatises  upon epidemics
must be, which are not connected with climate and
 season. As well  might a traveller  describe a fo-
 reign climate, by the state of the weather, or by
the productions of the earth, during a single au-
tumn, as a  physician adopt a uniform  opinion of
the history, treatment, and prognosis of a fever,
from its phenomena in any one country, or during
a single season.

  There were three modes of practice used in this
epidemic. The first consisted in the exhibition of 
      BILIOUS  YELLOW  FEVER OF  1798.   87

purges of castor oil, salts, and manna, and cooling
glysters, and in the use of the warm bath.  These
remedies were  prescribed chiefly by the French
physicians.  The second consisted in the use of
mercury alone, in such doses, and in such a manner,
as to excite a salivation. This mode was used chief-
ly by an itinerant and popular quack. The third
mode consisted in using all the remedies which I
have mentioned in the account of the treatment of
this fever, and accommodating them to the state of
the disease. This mode of practice was followed
by most of the  American physicians.

   The first mode of practice was the least success-
ful.   It succeeded  only in .such cases as would
probably have cured themselves.

   The second mode succeeded in mild cases, and
now and then in that malignant  state of the fever,
in which the action of the blood-vessels was  so
much prostrated by the force of the miasmata, as
to permit the mercury to pass over them, and thus
to act upon  the salivary glands  in the course of
four or five days.

   The last mode  was by far the most successful.
It is worthy of notice, that the business and repu-
tation of the physicians, during; this epidemic, were 
 88         AN ACCOUNT OF  THE

 in the inverse ratio of their success.  The number
 of deaths by it amounted to between three and four
 thousand, among whom were three physicians, and
 two students of medicine. Its mortality was nearly
 as great as it was in 1793, and yet the number of
 people who were affected by it was four times as
 great in 1793 as it was in 1798, for,  in the latter
 year, the city was deserted by nearly all its inhabi-
 tants.  The cause of this disproportion of deaths
 to the  number who were sick, was owing to the
 liberal and general use of the  lancet in 1793, and
 to the publications in 1797 having excited general
 fears and prejudices against it in 1798. Such  was
 the influence of these publications, that many  per-
 sons who had  recovered  from this fever  in the
 two former years, by the use of depleting remedies,
deserted the physicians who had prescribed them,
 and put themselves under the care of physicians of
 opposite modes of practice.  Most of them died.
 Two of them had been my patients, one of  whom
had recovered pf a third attack of the  fever under
my care. 
AN ACCOUNT
BILIOUS YELLOW FEVEB,
APPEARED IN PHILADELPHIA,
IN THE YEAR 1799.
VOL. IV.       M 
 
AN  ACCOUNT, &c.
       THE diseases which succeeded the fever
of 1798, in November and December, were highly
inflammatory. A catarrh was nearly universal. Se-
veral cases of sore throat, and one of erysipelas,
came under my care in the month of November.
The weather in December was extremely cold. It
was equally so in the beginning of January, 1799,
accompanied with several falls of snow.

  About the middle of the month, the weather mo-
derated so much, so as to open  the  navigation of
the Delaware. I met with two cases of malignant
colic in the latter part of this month, and one of
yellow fever.   The last was Swen Warner.  Dr.
Physick, who attended him with me, informed me
that he had, nearly at the same time, attended two
other persons with the same disease. 
92
AN  ACCOUNT OF THE
  The weather was very cold, and bilious pleuri-
sies were common, during the latter part of the
month of February.

  March was equally cold.  The newspapers con-
tained accounts of the winter having been uncom-
monly severe in Canada, and in several European
countries.

  The first  two weeks in April were still cold.
The Delaware, which had been frozen a second
time during the winter, was crossed near its origin,
on the ice, on  the 15th day of this month.  The
diseases, though fewer than in the winter, were
bilious and inflammatory.  During this month, I
was called to a case of yellow fever, which yielded
to copious bleeding, and other depleting medicines.

  May was colder than is  usual  in that  month,
but very healthy.

  In the first week of June, several cases of highly
bilious fever came under my care.  In one of them,
all the usual symptoms of the highest grade of that
fever occurred.  On the  13th of the month, Dr.
Physick informed me, that he had  lost a patient
with that disease. On the 23d of the same month,
Joseph Ashmead,  a young merchant, died of it. 
      BILIOUS YELLOW FEVER OF  1799.   93

Several other cases of the disease occurred between
the 20th and 29th days of the month, in different
parts of the city. About this time, I was informed
that the inhabitants of  Keys's-alley had  predicted
a return of the yellow fever, from the trees before
their doors emitting  a  smell, exactly  the same
which they perceived just before the breaking out
of that disease in 1793.

   In July, the city was alarmed, by Dr. Griffitts,
with an account of several cases of the fever in
Penn-street, near the water.  The  strictness with
which the quarantine law had been executed, for a
while rendered this account incredible with many
people and exposed the doctor to a good deal of
obloquy. At length a vessel was discovered, that
had arrived from one of the West-India islands
on the 14th of May, and one day before the qua-
rantine law was put into operation, from which the
disease was said to be derived. Upon  investigat-
ing the state of this vessel, it appeared that she had
arrived with a healthy crew, and that no  person
had been sick on board of her during her voyage.

   In the latter part of July and in the beginning of
August, the disease gradually  disappeared from
every part of the city. This circumstance deserves 
y4
AN  ACCOUNT OF  THE
attention, as it shows  the disease did not  spread
by contagion.

   About this time we were informed by the news-
papers, that dogs, geese, and other poultry, also
that  wild pigeons were sickly in many parts of
the country, and that fish on the  Susquehannah,
and oysters in the Delaware bay, were so unplea-
sant  that the inhabitants declined  eating them.
At the same time, flies were found  dead in great
numbers, in the unhealthy parts of the city. The
weather was dry in August and September. There
was no second crop of grass.  The gardens yielded
a scanty supply of vegetables, and of an inferior size
and quality.  Cherries  were smaller than  usual,
and pear and apple-trees dropped their fruits pre-
maturely, in large quantities. The peaches, which
arrived at maturity, were small and ill-tasted. The
grain was in general abundant, and of a good qua-
lity.  A fly, of an unusual kind, covered the pota-
toe fields, and devoured in some instances, the
leaves of the potatoe. This fly has lately been used
with success  in our country, instead of the  fly im-
ported from  Spain.  It is equal to it in every re-
spect.  Like the Spanish fly, it sometimes  indu-
ces strangury. 
      BILIOUS YELLOW FEVER  OF 1799\   95

   About the middle of August the disease revived,
 and appeared in different parts of the city. A pub-
 lication from the academy of medicine, in which
 they delared the seeds of the disease to spread from
 the atmosphere only, produced a sudden flight of
 the inhabitants. In no year, since the prevalence of
 the fever, was the desertion of the city so general.

   I shall now add a short account of  the symp-
 toms and treatment of this epidemic.

   The arterial system was in most cases active. I
 met with a tense  pulse  in a patient after the ap-
 pearance of the black vomiting.  Delirium was
 less  frequent  in adults  than in former years. In
 children  there  was a great  determination of the
 disease to the brain.

   I observed no new symptoms in the stomach
and bowels. One of the worst cases of the fever
which I saw was accompanied with colic. A girl
of Thomas  Shortall, who recovered, discharged
nine worms during her fever. It appeared in Mr.
Thomas  Roan, one of my pupils, in the form of
a dysentery.

  A stiffness, such as follows death, occurred in
several patients in the city hospital before death. 
96
AN ACCOUNT  OF THF.
  Miss Shortall  had an eruption  of pimples on
her breast, such as I have described in the short
account I  gave of the yellow fever of 1762 in this
city, in my account of the disease in 1793.

  The blood  exhibited  its usual appearances in
the yellow fever.  It was  seldom sizy till towards
the close of the disease.

  The tongue was generally whitish. Sometimes
it was of a red colour, and had a polished appear-
ance.  I saw no case of a black tongue, and  but
few that were yellow before the seventh day of the
disease.

  The type of this  disease was nearly the same
as described in 1797.  It now and  then appeared
in the  form of a quartan, in which  state it gene-
rally proved  fatal.   It appeared with rheumatic
pains in one of my patients.  It blended itself with
gout and small-pox. Its union with the latter dis-
ease was  evident in two patients in the city hos-
pital, in each of whom the stools  were such as
were discharged  in the  most malignant state of
the fever.

  The remedies for this  fever were bleeding, vo-
mits, purges, sweats, and a salivation and blisters. 
      BILIOUS YELLOW  FEVER OF  1799.   97

   There were few cases that did not indicate bleed-
 ing. It was performed, when proper, in the usual
 way, and with its usual good effects. It was indi-
 cated as much when the  disease appeared in the
 bowels as in the blood-vessels.  Mr. Roan, in
 whom it was accompanied with symptoms of dy-
 sentery, lost nearly 200 ounces of blood by twenty-
 two bleedings.

   I found the same benefit  from emetics, in this
 fever, that I did in the fever of 1798.  They were
 never administered except on the first day, before
 violent action had taken place in the system, or
 after it was moderated by one or two bleedings.

   Purges of calomel and jalap, also castor oil, salts,
 and injections were  prescribed with their usual
 advantages.

   In those cases where the system was prostrated
 below the point of re-action, I began the cure by
 sweating. Blankets, with hot bricks wetted with
vinegar, and the hot bath, as mentioned formerly,
 when practicable, were  used for  this purpose.
 The latter produced, in a boy of 14 years of age,
who came into the city hospital  without a pulse,
and with a cold skin,  in  a few hours,  a  general
warmth and an active pulse.  The determination
    VOL. IV.          v 
98
AN  ACCOUNT OF  THE
of the disease to the pores was evinced in one of
my patients, by her sweating under the use of the
above-mentioned remedies, for the first time in her
life.  A moisture upon her skin had never before
been induced, she informed me, even by the warm-
est day in summer.

   The advantages of a salivation were as great as
in former years.   From the efficacy of bleeding,
purges, emetics, and sweating, I had the pleasure
of seeing many recoveries before the mercury had
time to affect the mouth.   In no one case did I
rest the cure exclusively upon any one of these re-
medies.  The more numerous the outlets were to
convey off superfluous fluids and excitement from
the body, the more safe and certain were the reco-
veries. A vein, the gall-bladder, the bowels, the
pores, and the salivary glands were all opened, in
succession, in part, or together, according to cir-
cumstances, so as to give the disease every possible
chance of passing out of the body without injuring
or destroying any of its  vital parts.

   Blisters were applied  with advantage.  The vo-
miting and sickness which attend this fever were
relieved in many instances, by a blister to the sto-
mach. 
BILIOUS YELLOW FEVER OF  1799.
99
  In those cases in which the fever was protracted
to the chronic state, bark, wine, laudanum,and aether
produced the most salutary effects. I think I saw
life recalled, in  several  cases in which it appeared
to be departing, by frequent and liberal doses of
the last of those medicines. The bark was given,
with safety and advantage, after the seventh day,
when the fever  assumed the form of an intermit-
tent.

   The following symptoms were generally favour-
able, viz. a bleeding from the  mouth and gums,
and a disposition to weep, when spoken to in any
stage of the fever.

   A hoarseness and sore throat indicated a fatal
issue of the disease, as it did in 1798. Dr. Phy-
sick remarked, that all those persons who sighed
after waking suddenly,  before they were able to
speak, died.

   The recurrence of a redness of the eyes, after it
had disappeared, or of but one eye, was generally
followed  by death.  I saw but  one recovery with
a red  face.

   I saw several persons, a few hours before death,
in whom the countenance, tongue, voice, and pulse 
100
AN  ACCOUNT,  &.C.
were perfectly natural.  They complained of no
pain, and discovered no distress nor solicitude of
mind.  Their danger was only to be known by the
circumstances which had preceded this apparently
healthy and tranquil  state of the system.  They
had all passed  through extreme suffering,  and
some of them had puked black matter.

  The success of the mode of practice I have de-
scribed was the same as in former years, in private
families; but in the city hospital, which was again
placed under the care of Dr. Physick and myself,
there was a very different issue to it, from causes
that are too obvious to be mentioned.

  There were two opinions given to the public upon
the subject of the origin of this fever; the one by
the academy of medicine, the other by the college of
physicians. The former declared it to be generated
in the city, from putrid domestic exhalations, be-
cause they saw it only in their vicinity, and disco-
vered  no  channel by which it could  have been
derived from a foreign country; the latter asserted
it to be "imported, because it  had been imported
in former  years.'V j 
ACCOUNT OF SPORADIC CASES





            OF






    YELLOW FEVER,






           AS THEY





  APPEARED IN PHILADELPHIA,





           ix 1800 
 
AN ACCOUNT,  fcfr.
      THE weather in the month of January was
less cold than is common in that month. Catarrhs,
the cynanche  trachealis,  and bilious  pleurisies
were prevalent in every part of it.  A few cases of
yellow fever occurred likewise during this month.

   Several cases of erysipelas appeared in February.

   The month of March was unusually healthy.

   The weather was warm in April, and the city
as healthy as in March.

   It was equally so in May and June.  The spring
fruits appeared early in the latter month, in large
quantities, and  were of an excellent quality. Lo-
custs were  universal  in June.  They had not ap- 
  104  AN ACCOUNT OF  SPORADIC  CASES

  peared  since the year 1783.  A record from the
  journal of the Swedish missionaries was published
  at this time, which  described  their appearance in
  1715, in which year it was said to be very healthy.

    On the 14th of June there was a severe thunder
 gust with more lightning than had  been known
 for seven years before.

   There fell, during all the months that have been
 mentioned, frequent  and plentiful showers of rain,
 which rendered the crops of grass luxuriant in the
 neighbourhood of Philadelphia.

   The winds at this time were chiefly from the
 south-east.

   A few intermittents appeared in June, which
 yielded readily to the bark.

   On the 16th day of June, Dr. Physick informed
me he had a black boy under  his care with the
yellow fever.

   In July, the hooping cough, cholera  infantum,
and some cases of dysentery and bilious fever ap-
peared in the city. 
          OF YELLOW  FEVER IN  1800.     105

    On the 30th of July, Dr. Pascalis informed mc
  that he had lost a patient on the fifth day of a yel-
  low fever.

    In August, the dysentery was the principal form
  of disease that prevailed in the city.

    On the 22d of this month, a woman died of the
  yellow  fever in Gaskill-street, under the  care of
  Dr. Church.

    On  the  28th and 30th, there fell an unusu?-
 quantity of rain.  The winds were south-west and
 north-west  during the  greatest part of the sum-
 mer  months. The latter was sometimes accom-
 panied  with rain.

   On the 11th of September, a clerk of Mr. Levi
 Hollingsworth, and,  on  the 12th, a clerk of Mr.
 John Connelly, died  with the yellow fever.

   A plentiful  shower of rain fell on the night of
 the 21st of this month.

   About this time there appeared one and twenty
cases of  yellow fever in Spruce-street, between
Front and Second-streets.  They were all in the
   VOL. iv.           o 
106  AN  ACCOUNT OF  SPORADIC CASES

neighbourhood of putrid exhalations.  Fourteen
of them ended fatally.

  No one of the above cases of malignant fever
could be traced to a ship, or to a direct or indirect
intercourse with persons affected by that disease.

  While  Philadelphia was thus visited by a few
sporadic cases only of  yellow fever, it was epide-
mic in several of  the cities of the United States,
particularly in New-York, Providence, in Rhode
Island, Norfolk, and Baltimore.  In the last named
place, it was publicly declared by the committee
of health to be of domestic origin.

  The dysentery was epidemic, at the same time,
in several of the towns of Massachusetts and New-
Hampshire. It was attended with uncommon mor-
tality at Hanover, in the latter state.

  This difference in the states of health and sick-
ness in the different  parts of the  United  States
must be sought for chiefly in the different states
of the weather in those places.  The  exemption
of Philadelphia from the  yellow fever, as an epi-
demic, may  perhaps be ascribed to the  strength
and vigour of the vegetable products of the year,
which retarded their  putrefaction ;  to  frequent 
        OF YELLOW  FEVER IN  1800.     107

showers of rain, which washed away the  filth of
the streets and  gutters ; and to the perfection of
the summer and autumnal fruits.

  The months of November and December this
year were uncommonly healthy. During the for-
mer, several light shocks of earthquakes were felt
in Lancaster  and Harrisburg, in Pennsylvania,
and in Wilmington, in the state of Delaware. 
7?&tii*K> 
ACCOUNT OF SPORADIC CASES
YELLOW  FEVER,
APPEARED IN PHILADELPHIA,
in 1801 
 
AN  ACCOUNT, fcfc.
      THE month of January was intensely cold.
In February it became more moderate.  The dis-
eases, during these two months, were catarrhs and
a few pleurisies.

   In March and April there fell an unusual quan-
tity of rain. The hay harvest began in the neigh-
bourhood of Philadelphia on the 28th of May. A
few  mild cases of scarlatina anginosa  occurred
during these months.

   In June the weather was dry and healthy.

   On the 8th of July, a case of  yellow fever oc-
curred in the practice of Dr. Stewart. About the
15th of the month,  a patient died with it in the
Pennsylvania hospital. Dr. Physick informed me 
 112  AN ACCOUNT  OF SPORADIC CASES

 that he had, at the same time, two patients under
 his care with  that disease.   Several cases of the
 measles appeared in the south end of the city dur-
 ing this month.   In every part of  it, the weather
 was warm and dry in consequence of which there
 were no second crops of grass, and a smaller quan-
 tity  than usual of summer fruits and vegetables.
 The winds were less steady than they had been for
 seven years. They blew, every two or three days,
 from nearly every point of the compass.

   On the 4th  of August there fell a considerable
 quantity of rain, which was succeeded by cool and
 pleasant weather.  The cholera morbus  was a fre-
 quent disease among  both adults and children in
 the city, and the dysentery in several of the adjoin-
 ing counties of the state.

  A number of emigrantfamilies arrived this month
 from Ireland and  Wales, who brought with them
 the ship fever.  They were carefully attended, at
 the lazaretto and the city hospital,  in airy rooms,
 by which means they did not propagate the disease.
 Contrary to its usual character,  it partook of the
 remissions of the  bilious fever, probably from the
influence of the season upon it. 
OF YELLOW  FEVER IN  1801.     113
   In September there were a few extremely warm
 days. In the beginning and middle of the month
 a number of mild remittents occurred, and about
 the 22d there were five or six cases of yellow fever
 in Eighth-street, between  Chesnut and Walnut-
 streets, in two  houses ill ventilated, and exposed
 to a good deal of exhalation. I attended most of
 these cases in consultation with Dr. Gallaher. One
 of the persons who was affected with this fever
 puked black matter  while I sat by his bed-side,
 a few hours before he died.

  During the summer and  autumn of this year, a
 number of cases of yellow fever appeared at New-
 Bedford, Portland, and Norwich, in the New-
 England states ; in New-York ; in some parts of
 New-Jersey;  and  in Northampton  and  Bucks
 counties, in Pennsylvania. It prevailed so generally
 in New-York, as to produce a considerable deser-
 tion of the city. In none of the above places could
 the least proof be adduced of the disease being im-
 ported. In Philadelphia its existence was doubted
 or denied by most of the citizens, because it appear-
 ed in situations remote from the water, and of course
could not be derived from any foreign source.

  It will be difficult to tell why the  fever appeared
only in sporadic cases in Philadelphia. Perhaps its
   vol. iv.          p 
114 AN ACCOUNT  OF SPORADIC  CASES, &C.

prevalence as an epidemic was prevented by the
plentiful rains in the spring months, by the absence
of moisture from the filth of the streets and gutters,
in consequence of the dry weather in June and July,
by the vigour and perfection of the products of the
earth, and by the variable state of the winds in the
month  of July.  If none of these causes defended
the city from more numerous cases of the yellow
fever, it must be resolved into the want of a con-
curring inflammatory constitution of the atmos-
phere with  the common impure sources of that
disease.

  On the 12th of November, about twelve o'clock
in the night, an earthquake was felt in Philadelphia,
attended with a noise as if something  heavy had
fallen upon  a floor.  Several  cases of scarlet  fever
appeared in December, but  the prevailing disease,
during the  two last autumnal and the first winter
months, was the measles. I  have taken notice that
it appeared in the south end  of the city in July.
During the months of August and September it
was  stationary, but in October, November, and
December it spread through every part of the city.
The following circumstances occurred in this epi-
dtmic, as far as it came under my notice. 
      AN ACCOUNT






           OF







   THE MEASLES,






         AS THEY






APPEARED IN PHILADELPHIA,






       IN THE YEAR 1801- 
 
AN ACCOUNT,  &e.
      I. THE disease wore the livery of the au-
tumnal fever in the following particulars.

  It was strongly marked by remissions and inter-
missions.   The exacerbations came on chiefly at
night.

  There were in many cases a constant nausea,
and discharge of bile by puking.

  I saw one case in which the disease appeared
with a violent cholera morbus, and several in which
it was accompanied with diarrhoea and dysentery.

  II. Many severe cases of phrenzy, and two of
cynanche trachealis appeared with the measles. 
118
AN  ACCOUNT OF  THE
  III. A distressing sore mouth followed them, in
a child of two years old, that came under my care.

  IV.  A fatal hydrocephalus  internus followed
them in a boy of eight years old, whom I saw two
days before he died.

  V. I met with a few cases  in which the fever
and eruption came on in the same day, but I saw
one case in which the eruption did not take place
until the tenth, and another, in which it did not ap-
pear until the fourteenth day after the fever.

  VI.  Two children had pustules on their skins,
resembling the small-pox,  before the eruption of
the measles.

  VII. Many children had coughs and watery eyes,
but without the measles. The same children had
them two or three weeks afterwards.

  VIII. Many people who had had the measles,
had coughs during the prevalence of the measles,
resembling the cough which occurs in that disease.

  The remedies made use of in my practice were. 
MEASLES IN  1801.
119
  1. Bleeding, from four to sixty ounces, accord-
ing to the age of the patient, and the state  of  the
pulse.   This remedy relieved the  cough, eased
the pains in the head, and in one case produced,
when used a third time, an immediate  eruption
of the measles.

   2. Lenient purges.

   3. Demulcent drinks.

   4. Opiates at night.

   5. Blisters.  And,

   6. Astringent medicines, where a diarrhoea took
 place.

   I saw evident advantages from advising a vege-
table diet to many children, as soon as any one of
 the families to which they belonged were attacked
 by the measles.

   I lost but one patient in this disease, and  that
 was a child in convulsions.  I ascribed my success
 to bleeding more generally and more  copiously
 than I had been accustomed to do in the  measles
 of former vears. 
 
        AN ACCOUNT





           OF THE







BILIOUS YELLOW FEVER,






           AS IT






  APPEARED IN PHILADELPHIA,





        IN THE YEAR 1802. 
 
AN ACCOUNT, &c.
     THE weather during the month of January
was unusually moderate and pleasant. In the latter
end of it, many shrubs put forth leaves and blos-
somed.  I saw a leaf of the honeysuckle, which
was more than an inch in length, and above half an
inch in breadth.  There was but  one fall of snow,
and that a light one, during the whole month,   •

  The winds blew chiefly from the south-west in
February.  There was a light fall of snow on the
6th.  A shad was caught in the Delaware, near the
city, on the 17th. On the 18th and  19th of the
month, the weather  became suddenly very cold.
On the 22d there was a snow storm, and on the
28th, rain and  a general thaw. 
124
AN ACCOUNT  OF THE
   In March, the  weather was  wet, cold,  and
stormy, with the exception of a few pleasant days.

   The scarlatina anginosa and the cynanche tra-
chealis were the principal diseases  that prevailed
during the three months that have been mentioned.

   In April, there were several frosts, which de-
stroyed the blossoms of the peach-trees.

   In  May, the weather was so cool as to make
fires agreeable to the last day of the month.  The
wind blew chiefly, during the whole of it, from
the north-east.

   The scarlatina continued to be the reigning dis-
ease.  I saw one fatal case of it, in which a redness
only, without any ulcers or sloughs, appeared  in
the throat; and I attended another, in which a total
immobility in the limbs was substituted by nature
for the pain and  swellings in those parts which ge-
nerally attend the disease. There were three distinct
grades of this epidemic. It was attended with such
inflammatory or malignant symptoms, in  some
instances, as  to require two or three bleedings;  in
others it appeared with a typhoid pulse, which yield-
ed to emetics: turbith mineral was preferred for this 
     BILIOUS  YELLOW FEVER OF  1802.   125

purpose; while a redness, without a fever, which
yielded to a single purge, was the only symptom
of it in many people.

   The weather was cool, rainy, and hot, in succes-
sion, in the month of June.  The scarlatina conti-
nued to be the prevailing disease.

   During the first and second weeks in July, there
fell a good deal of rain.  On the 4th of the month
I was called to visit Mrs. Harris, in Front-street,
between Arch and Market-streets, with a bilious
fever.  The scarlatina had imparted to it a general
redness on her skin, which induced her to believe
it was  that disease, and to neglect sending for me-
dical relief for several days.  She died on the 13th
of the  month, with a red eye, a black tongue, hic-
cup, and a yellow skin.  Three other cases of ma-
lignant bilious fever occurred this month.  Two
of them were  attended  by Dr. Dewees and Dr.
Otto.

   On the 15th of the month, the city was alarmed
by an account of this fever having appeared nearthe
corners of Front and Vine-streets, a part of the city
which  had for many weeks before been complained
of by many people for emitting a foetid smell, de-
rived from a great quantity of filthy matters stag- 
126          AN  ACCOUNT OF  THE

nating in that neighbourhood, and from the foul
air discharged from a vessel called the Esperanza,
which lay at Vine-street wharf.

  On the 2d of August, it appeared in other parts
of the city, particularly in Front and Water-streets,
near the draw-bridge, where it evidently originated
from putrid sources. Reports were circulated that
it was derived from contagion, conveyed to Vine-
street wharf in the timbers of a vessel called the St.
Domingo Packet, but faithful and accurate inqui-
ries proved that this vessel had been detained one
and twenty days, and well cleaned at the lazaretto,
and that no one, of fourteen men who had worked
on board of her afterwards, had been affected with
sickness of any kind.

   On the 5th of August, the board of health pub-
licly declared the fever to be contagious, and ad-
vised an immediate desertion of the city.   The
advice was followed with uncommon degrees of
terror and precipitation.

   The disease  continued, in different parts of the
city, during the whole  of August and September.
On the 5th of October, the citizens were publicly
invited from the countrv bv the board of health. 
    BILIOUS  YELLOW  FEVER OF  1802.  127

  During this season, the yellow fever was epide-
mic in Baltimore and Wilmington. In the former
place it was admitted by their board of health, and
in the latter it was proved by Dr. Vaughan, to be
of domestic origin. It prevailed, at the same time,
in Sussex county and near Woodbury s in New-
Jersey.  Sporadic cases of it likewise occurred in
New-York  and  Boston, and in Portsmouth, in
New-Hampshire. The chronic fever was epide-
mic in several of the towns of North-Carolina;
cases  of fever, which terminated in a swelling and
mortification  of the legs, and in death on the third
day, appeared on the waters of the Juniata, in Penn-
sylvania ; and bilious fevers, of a highly inflamma-
tory grade, were likewise common near German-
town  and Frankford, in the neighbourhood  of
Philadelphia.

  But few of the cases of yellow fever which have
been mentioned  came under my care, but I saw a
considerable  number of fevers of a less violent
grade. They were the inflammatory, bilious, mild
remitting, chronic, and  intermitting fevers, and
the febricula.  They appeared, in some instances,
distinct from each other, but they generally blend-
ed their symptoms in their different  stages.  The
yellow fever often came on in the mild form  of an
intermittent,  and even a febricula, and as often. 
128
AN  ACCOUNT OF  THE
after a single paroxysm, ended in a mild remittent
or chronic fever.  When it appeared in the latter
form, it was frequently attended with a slow or low
pulse, and a vomiting and hiccup, such as attend in
the yellow fever.  This diversity of symptoms,
with which the summer and autumnal fever came
on, made it impossible to decide upon its type on
the day of its attack.  Having been  deceived in
one instance, I made  it a practice afterwards to
watch every case I was called  to with double vigi-
lance, lest it should contract  a malignant form in
my hands, without my being prepared to meet it.
Of the five original and obvious cases of yellow fe-
ver to which I was called, I saved none, for I saw
but one of them before the last stage of the disease.
In many others, I have reason  to believe I pre-
vented that malignant  form of fever,  by the early
and liberal use of depleting medicines. The prac-
tice of those physicians who attended most of the
persons who had the yellow fever, was much less
successful than in our former epidemics.   I sus-
pected at the time, and I was convinced afterwards,
that it was occasioned by relying exclusively upon
bleeding, purges, and  mercury.   The skin, in se-
veral of the cases which I  saw, was covered with
moisture.   This  clearly pointed  out  nature's at-
tempt to relieve herself by sweating.  Upon my
mentioning  this fact to the late Dr.  Pfeiffer, jun. 
     BILIOUS YELLOW  FEVER OF  1802.   129

he  instantly  adopted my opinion, and  informed
me, as a reason  for doing so, that he had  heard
of several whole families in the Northern  Liber-
ties, where the disease  prevailed most, who, by
attacking it in its forming state by profuse sweats,
had cured themselves, without  the  advice of  a
physician.
vol.  iv.
R 
 
        AN ACCOUNT






            OF THE







BILIOUS YELLOW FEVER,






            AS IT





   APPEARED IN PHILADELPHIA,





         IN THE YEAR 1803- 
 
AN ACCOUNT,  fcv.
      THE weather in January  was uniformly
cold.  On  the  21st of  the  month, the Delaware
was completely frozen.

  On the 4th of February there was a  general
thaw, attended with a storm of hail, thunder, and
lightning,  which lasted  about three quarters of an
hour.  The diseases of  both these winter months
were  catarrhs and bilious  pleurisies.  The latter
appeared in a tertian type.  The pain in the side
was most  sensible every other day.

  The weather was cold  and dry  in March, in
consequence of which, vegetation was unusually
backward  in April.  The hooping cough, catarrhs,
and scarlatina were the  diseases of this month. 
134        AN ACCOUNT  OF THE
  The beginning of May was very cool. There
was ice on the 7th of the month. The winds, dur-
ing the greatest parts of this  and the previous
month, were from the north-east.

  In June, the weather was cool. Intermittents
were common in this month, as well as in May.
Such was the predominance of this type of fever
over all other diseases, that it appeared in the form
of profuse sweats, every other night, in a lady un-
der the care  of Dr. Dewees and  myself, in the
puerperile fever. On the intermediate nights she
had a fever, without the least moisture on her skin.
There were a few choleras  this month.  During
the latter end of the month, I lost a patient with
many of the symptoms of yellow fever.

  The weather in July was alternately hot, mode-
rate, and cool, with but little rain. The first two
weeks of  this month were healthy. A few tertian
fevers  occurred, which readily yielded to bark,
without previous bleeding.  Between the 25th and
31st of the month, three deaths took place from
the yellow fever.

  In the month of August, the weather  was the
same as in July, except that there fell more rain in
it. Mild remittents and cholera infantum were now 
      BILIOUS  YELLOW FEVER  OF 1803.  135

common.  There  ivere  likewise several cases of
yellow fever during this  month.  One of them was
in Fromberger's-court.   It was induced by the
foetor of putrid fish in a cellar. A malignant dysen-
tery was epidemic during this month in the upper
part of Germantown, and in its neighbourhood.
Several persons, Dr. Bensell informed me, died of
it in thirty hours sickness. It prevailed, at the same
time, in many parts of  the New-England states.

   In September, cases of yellow fever appeared in
different parts of the  city, but  chiefly in Water,
near Walnut-street. On  the  12th of the  month,
the board  of health published a declaration of its
existence in the city, but said it was not contagious.
This opinion gave great offence, for it was generally
said to have been  imported by means of a  packet-
boat from New-York, where the fever then pre-
vailed, because a  man had sickened and  died in
the neighbourhood of the wharf  where this packet
was moored. It was to no purpose to oppose to this
belief, proofs that no sick person, and no goods
supposed to be infected, had arrived in this boat,
and that no one of three men, who had received
the seeds of the disease in New-York, had  com-
municated it to any one of the  families in Phila-
delphia, in  which they had sickened and died. 
136
AN  ACCOUNT OF  THE
   The disease assumed a new character this year,
and  was cured  by a  different force of medicine
from that which was  employed in some  of the
years in which it had prevailed in Philadelphia.

   I shall briefly describe it in each of the systems,
and  then take notice of some peculiarities which
attended it.  Afterwards I shall mention the reme-
dies which were effectual in curing it.

   1.  The  pulse was  moderately  tense in most
cases.  It intermitted in one case, and  in several
others the tension was of a transient nature.

   Haemorrhages occurred  in many cases. They
were chiefly from the nose, but in some instances
they occurred from the stomach, bowels, and he-
morrhoidal vessels.

   2. Great flatulency attended in the stomach, but
sickness and vomiting were much less  frequent
than in former  years. I saw but one case in which
diarrhoea attended this fever.

   3. I did  not meet with a single  instance of a
glandular swelling in any part of the body. 
     BILIOUS  YELLOW FEVER  OF  1803.   137

  4. There was a general  disposition to sweat in
this fever from its beginning. Two of my patients
died, in whom no  moisture could be excited on
the skin. But I recovered  one with a dry skin, by
means of a purge,  two bleedings, and blisters.

  An efflorescence on the skin occurred in several
instances.  I saw black matter discharged from a
blister in one case, and blood in  another.

  5. The  stools were  green and black.  Bile was
generally discharged in puking.

  6. The  blood exhibited the following appear-
ances: siziness, lotura carnium, sunken crassa-
mentum, red sediment, and what is  called dense
or unseparated blood.  I  saw no instance of its
being dissolved.

  7. The  tongue was whitish and dark-coloured.
This diseased appearance continued, in some in-
stances, several days  after a recovery took place.
I saw no smooth, red, nor black  tongue, and  but
one dry and one natural tongue.  The latter was
followed by death.

  T did not see a single case in which the disease
came on without an exciting cause; such as light
    VOL.  IV.               S 
138
AN  ACCOUNT OF  THE
clothingand bed-clothes, sitting at doors after night,
a long walk, gunning, and violent and unusual ex-
ercises of any kind.  It was  excited in a number
of people by their  exertions  to extinguish  a fire
which took place in Water-street, between Market
and Chesnut-streets, on the morning of the 25th of
August.  I saw a fatal instance of it succeed a se-
vere tooth-ach.   Whether this  pain was the ex-
citing cause, or the first morbid symptom of the
fever, I know not; but I was led by it to bleed a
young lady twice who complained of that pain, and
who had  at the  same  time  a tense pulse.  Her
blood had  the usual  appearances which occur in
the yellow fever.

  The disease had different appearances in differ-
ent parts of the  city.   It was most  malignant  in
Water-street; but in many instances it became less
so,  as it travelled westward,  so that about Ninth-
street it appeared in the form of a common inter-
mittent.

  In every part  of the city it often came on, as  in
the year 1802, in all the milder forms of autumnal
fever formerly enumerated, and went off with the
usual symptoms of yellow fever. Again, it came
on with all the force and malignity of a yellow fe-
ver, and terminated, in a day  or two, in a common 
     BILIOUS  YELLOW FEVER  OF  1803.   139

 remittent or intermittent. These  modes of attack
 were so common, that it was  impossible  to tell
 what the  character,  or probable  issue of a fever
 would be, for two or three days.

   The following  remedies were found, very ge-
 nerally, to be effectual in this fever.

   1. Moderate bleeding. I bled but three patients
 three,  and only one, four times.  In  general, the
 loss of from ten to twenty ounces of blood, reduced
 the pulse from asynochato a synoichoid or typhoid
 state, and thereby prepared the system for other
 remedies.

   2. Purges were always useful.  I gave calomel
 and jalap, castor oil, salts, and senna, according to
the grade of the disease, and often  according to the
humour or  taste of the patient.  I aided these
purges by glysters. In one case,  where a griping
and black stools attended, I directed injections of
lime water and milk  to be used, with the happiest
effects.

   3. I gave emetics in many cases with advantage
but never while the pulse was full or tense. 
140
AN ACCOUNT OF THE
  4.  Having  observed,  as  in the year 1802, a
spontaneous moisture on the skin on the first day
of the disease, in several cases, I was led to assist
this  disposition in nature to be relieved by the
pores, by means of sweating remedies, but in no
instance did I follow it, without previous evacua-
tions from the blood-vessels  or bowels; for, how-
ever useful the intimations  of nature may be in
acute diseases, her efforts should never be trusted
to alone, inasmuch  as they are in most cases too
feeble to do service, or so violent as to do mischief.
I saw one death, and I heard of another, from an
exclusive reliance upon spontaneous sweats in the
beginning of this fever. The remedies I employed
to promote this evacuation by the pores were, an
infusion of the eupatorium perfoliatum in boiling
water, aided by copious warm drinks, and  hot
bricks and blankets, applied to the external sur-
face  of the body.   The eupatorium sometimes
sickened the stomach, and puked.   The sweats
were intermitted, and renewed two or three times
in the course of four and twenty hours.

  5.1 derived great advantage from the application
of blisters to the wrists, before the system descend-
ed to what I have elsewhere called the blistering
point.   This was on the second and third days.
My design,  in applying them  thus early, was to 
     BILIOUS YELLOW FEVER OF  1803.  141

attract morbid excitement to the extremities, and
thereby to create a substitute for a  salivation.
They had this effect. The pain, increase of fever,
and  occasional strangury, which were produced
by them, served like anchors to prevent the system
being drifted and lost, by the concentration of mor-
bid excitement in the stomach and  brain, on the
fourth, fifth, sixth, and seventh days of the disease.
It gave me great pleasure to find, upon  revising
Dr.  Home's  account of the yellow fever, that this
mode of applying blisters, in the early stage of the
disease, was not a new one.  He often applied them
in the first stage of the fever, more especially when
the yellow colour of the skin made its appearance
on the first or second day.  By the advice of Dr.
Cheney of Jamaica, he was led to prefer them to
the  thighs, instead of the  trunk of  the body, or
the legs and arms.  He forbids their  ever  being
applied below the  calf of the legs. This caution
is probably  more  necessary in  the West-Indies
than in the United  States. The pain and inflam-
mation excited by the blisters were mitigated by
soft poultices of  bread and milk. The strangury
soon yielded to demulcent  drinks, particularly to
flaxseed tea.

   I was happy in not being compelled, by the vio-
 lence  or obstinacy of this fever, to resort to a sali- 
142         AN  ACCOUNT OF  THE
 vation  in order to cure it, in a single  instance;
 the discharges from the stomach and bowels, and
 from the veins, pores, and skin, have proved suf-
 ficient to convey the disease out of the system.

   Two persons recovered this year  who had the
 black vomiting.  One of them was  by means of
 large quantities of brandy and volatile alkali, admi-
 nistered by Dr. John Dorsey, in the city hospital;
 the other was by means of lime  and water  and
 milk, given by an intelligent  nurse to one of my
 patients, during the interval of my visits to her.

   From the history which has been given of the
 symptoms of  this fever;  from the less force of
 medicine that was necessary  to subdue  it; from
 the safety and advantage of  blisters in its early
 stage  ; and  from the  small proportion which the
 deaths bore to the number of those who were af-
 fected, being seldom more than five in a hundred
 (including all  the grades  and forms of the dis-
 ease,) in the practice of most  of the physicians, it
 is evident this fever was of a less malignant nature
than it had  been in most of the years in which it
had been epidemic.  There was one more circum-
 stance which proved  its diminution  of violence,
and that was, a more feeble operation of its remote
 cause. In the  year 1802, nearly all  the  persons 
     BILIOUS YELLOW  FEVER OF  1803.  143

who were  affected with  the  fever in the neigh-
bourhood of Vine and Water-streets, and in Wa-
ter, between Walnut and Spruce-streets,  died.
This  year, but two died of a great  number who
were sick in the former, and not one out of twelve
who were sick in the latter place.  The  filth, in
both parts of the city, was the  same in both years.
This  difference in the violence and  mortality of
the fever was probably occasioned by a less con-
centrated  state of the miasmata which produced
it, or  by the  co-operation of a less inflammatory
constitution of the atmosphere.

   The  yellow fever was epidemic, during the
summer and  autumn of this year, in New-York,
and in Alexandria, in Virginia. In the latter place,
Dr. Dick had informed the public, it was derived
from domestic putrefaction. 
 
ACCOUNT  OF SPORADIC  CASES





             OF






     YELLOW FEVER,






            AS THEY





  APPEARED IN PHILADELPHIA,





            in 1804.
VOL. IV.
T 
 
AN  ACCOUNT,  tfc.
      THE month of January was  marked by
deep snows, rain, clear and cold weather, and by
the general healthiness of the city.

   In February there fell a deep snow, which was
followed by several very cold  days.  There was
likewise a fall of snow in March, which was suc-
ceeded by an uncommon degree of cold. Catarrhs
and bilious pleurisies were very common during
both these months.

   In the beginning of April, the weather was cold
and rainy. There were but few signs of vegetation
before the 15th of the month.  Bilious  pleurisies
were still  the principal  diseases which prevailed
in the city. 
148  AN ACCOUNT  OF SPORADIC  CASES

  The month of May was wet, cool, and healthy.

  In June, the winds were easterly, and the wea-
ther  rainy.  The crops of grass were  luxuriant.
It was remarked, that the milk of cows  that fed
upon this grass yielded less butter than usual, and
that horses that fed upon it, sweated profusely with
but little exercise.  On the third of the month, I
was called upon by Dr. Physick to visit his father,
who was ill with a bilious fever. He died on the se-
venth, with a red eye, hiccup, and black vomiting.

  Four persons had the yellow fever in the month
of July.  One of them  was in Fourth-street, be-
tween Pine and Lombard-streets, another was in
Fifth-street,  between Race and Vine-streets, both
of whom recovered.  The remaining two were in
the Pennsylvania  hospital,  both of whom died.
Remitting and intermitting fevers were likewise
common in this month.

  In August, those fevers assumed  a  chronic
form. During this month, there died an  unusual
number of children with the cholera morbus.

  The city was uncommonly healthy in Septem-
ber. A storm of wind and  rain, from the south- 
         OF YELLOW FEVER IN  1804..    149

east, proved  destructive to the crops of cotton
this month, on the sea coast of South-Carolina.

   In  October, intermittents were very common
between Eighth-street and  Schuylkill. One case
of yellow fever came under my care, in conjunc-
tion with Dr. Gallaher, on the western banks of
that river.

   While Philadelphia and all the cities of the Unit-
ed  States  (Charleston  excepted)  were thus  ex-
empted from the yellow fever as an epidemic, the
western parts of all the middle, and several of the
southern states, were visited with the bilious fever,
in all its different forms.  In Delaware county, in
the state of New-York, at  Mill river, in Connecti-
cut, and in several of the middle counties of Penn-
sylvania, it prevailed in the form of a yellow fever.
In other parts of the United States, it appeared
chiefly as a highly inflammatory remittent. It was
so general, that not only whole families, but whole
neighbourhoods were confined by it. Many suffer-
ed from the want of medical advice and nursing,
and some from the want of even a single attendant.
In consequence of the general prevalence of this
fever in some parts of Pennsylvania, the usual la-
bours of the  season were  suspended.  Apples fell
and perished  upon the ground; no winter grain was 
 150 AN ACCOUNT  OF SPORADIC CASES, &C.

 sowed; and even cows passed whole  days and
 nights without being milked.

   The  mortality of this fever was considerable,
 where those distressing circumstances took place.
 In  more favourable circumstances, it yielded to
 early depletion, and  afterwards to the  bark. Re-
 lapses were  frequent,  from premature  exposure
 to the  air.   Those  only escaped  them who had
 been salivated, by accident or design, for the cure
 of the fever.

   This disease  was observed  very generally to
 prevail most in high  situations, whjch  had  been
for years distinguished  for their healthiness, while
the low grounds, and  the banks of creeks and
rivers, were but little affected by it.  The  unu-
 sual quantity of rain, which had fallen during the
summer months, had  produced  moisture in the
former places, which favoured putrefaction  and
exhalation,  while both  were prevented, in the lat-
ter places, by the grounds being  completely co-
vered with water. 
       AN ACCOUNT






          OF THE







BILIOUS YELLOW FEVER,






          AS IT






 APPEARED IN PHILADELPHIA,






       IN THE YEAR 1805 
 
AN ACCOUNT, %
      FOR a history of the uncommonly cold and
 tempestuous winter of 1804 and 1805, the reader
 is referred to the Account of the Climate of Penn-
 sylvania, in the first volume of these Inquiries and
 Observations.

   During the  months of January, February, and
 March, there  were a number of bilious catarrhs
 and pleurisies.

   On the 7th of April, I visited a patient in the
yellow fever with  Dr. Steuart.  He was  cured,
chiefly by copious  bleeding.

  The weather was rainy in May.  After the mid-
dle of June,  and during the whole  month of July,
there fell no rain.   The  mercury in  Fahrenheit
    VOL.  IV.          TJ 
154
AN ACCOUNT OF  THE
fluctuated, for ten days, between 90° and 94°, dur-
ing this month.  The diseases which occurred in
it were cholera infantum, dysenteries, a few com-
mon bilious, and eight cases of  yellow  fever.
Three of the last were in Twelfth, between Locust
and Walnut-streets, and were first visited, on the
14th and 15th of the month, by Dr. Hartshorn, as
out-patients of the Pennsylvania hospital. Two of
them were attended, about a week afterwards, by
Dr. Church, in Southwark, and the remaining three
by Dr. Rouisseau and Dr. Steuart, in the south
end of the city.

   On the third of August, there fell a heavy shower
of rain, but the weather, during the remaining part
of the month, was warm and dry. The pastures
were burnt up,  and there was a great deficiency of
 summer vegetables in the neighbourhood of Phila-
 delphia.  The water in the Schuylkill was lower
 by three  inches than it had been in the memory of
 a man of 70 years of age, who had lived constantly
 within sight of it.

    In September, a number of cases of yellow fever
 appeared in Southwark*,  near  Catharine-street.

    * This extensive district is continued, from the city of Phila-
 delphia, along the Delaware, but is not subject to its government- 
     BILIOUS YELLOW FEVER OF  1805.   155

They were readily traced to a large bed of oysters,
which had putrefied on Catharine-street wharf, and
which had emitted a most offensive exhalation
throughout the whole neighbourhood, for several
Weeks before the fever made its appearance.  This
exhalation  proved fatal to a number of cats and
dogs, and it now became obvious that the two cases
of yellow fever, that were attended by Dr. Church,
in the month of July, were derived from it.   An
attempt was made to impose a belief that they were
taken by contagion  from a ship at  the lazaretto,
which had lately arrived from the West-Indies, but a
careful investigation of this tale proved, that neither
of the two subjects of the fever had been on board
that, nor any other ship, then under quarantine.

  The fever prevailed during  the whole of this
month in Southwark. A few cases of it appeared
in the city, most of which were in persons who had
resided in, or visited that district. It was brought
on by weak exciting causes in Southwark, but the
cases which originated in the city, required strong
exciting causes to produce them.

  A heavy rain, accompanied with a good deal of
wind, on the 28th of September, and a frost on the
night of the 7th of October, gave a considerable
check to the fever. 
156
AN ACCOUNT  OF THE
  But few cases of it came under my care.  Hav-
ing perceived the same disposition in nature to re-
lieve 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.  Steuart, 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 mo-
lasses, or syrup, or sweet oil, effectually checked it
in several instances,  in patients who afterwards re-
covered. It was administered with equal  success
in a case which came  under my care, after an ab-
sence 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. 
     BILIOUS  YELLOW  FEVER OF 1805.  157

   Dr. Steuart observed that all those persons
who had been affected by the yellow fever  in for-
mer years, had mild remittents in the same situa-
tions 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  proba-
bly have  been fewer, considering the tractable na-
ture 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 hos-
pital, or  have  centinels placed at their doors to
prevent any  communication with their friends and
neighbours.  While these attempts were made to 
158
AN  ACCOUNT OF THE
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 fami-
lies 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 chang-
ing 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 dis-
tance 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 Phila-
delphia. The following extract of a letter from the
health officer of New-York, to  one of his friends 
     BILIOUS YELLOW  FEVER  OF 1805.  159

contains a satisfactory proof that it was not, in that
city, an imported disease.

             Quarantine-ground, Sept. 7. 1805.

   I most sincerely and tenderly deplore the unfor-
tunate 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 in-
formed, 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 voy-
age 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 uncon-
nected 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 at-
tach to the health-office, or to infected vessels, this
season.

               I am, &c.
JOHN R.  B. RODGERS 
 
AN
ACCOUNT OF THE  DISEASES,






               OF





           1806, 1807, 1808,






             and 1809. 
 
AN ACCOUNT,  6fc.
      ON the  21st of January in the year 1806,
Lieutenant M'Keller  died of a yellow fever ac-
companied with a black vomiting. A son of Mr.
William  Flintham in Keys's-alley,  died of the
same disease,  and with the same black discharge
from his  stomach on the 5th of May.  On the 16th
of June, there was a partial eclipse  of the  sun.
The mercury descended in the thermometer dur-
ing its continuance, between 9°, and  10° in Phila-
delphia. At Haverhill in Massachusetts it fell from
92°  to 62°, in the thermometer. In  Boston the
mercury suddenly mounted  to a great height in
the  barometer.  During  the time of this partial
darkness, fowls and cattle near the city, retired to
rest, and all the maniacs in the Pennsylvania hos-
pital suddenly became silent, but I saw na change
induced in the symptoms of the diseases of any of 
 164   AN  ACCOUNT OF THE DISEASES

 the patients who were  then under my care, by
 means of this eclipse.  In the month of September
 the yellow fever prevailed in the Penitential house
 at Richmond in Virginia, where its origin was pre-
 viously traced to domestic putrefaction.

  In the month of March 1807,  the influenza ap-
 peared at the same time in nearly all the States in
 the Union. It prevailed in sporadic cases  during
 the months of April, May, June and July, in Phi-
 ladelphia, but in August it became general. It af-
 fected children as well  as adults, and  persons ill
 with other diseases, as well as the healthy. Asthma,
 consumption, madness, parturition, and even a sa-
 livation afforded no protection from it.  Seven old
 persons between 80 and 100, and one of 107 died
 with it.  The  bilious fever  which prevailed in
 August imparted to it  several of its symptoms.
 These were, obvious  remissions and intermis-
 sions, great pain in the back, an apparent cessation
 of all the symptoms of  the  disease on the  third,
 and a return of them  on the  fourth day, cholera
morbus, dysentery and an efflorescence upon the
skin.  The disease appeared in one respect to be
 a monster.  Its head, and breast wore the  charac-
 ters of influenza, while its trunk  and  limbs indi-
cated  it to be a bilious fever, 
       of  1806,  1807,  1808 and 1809.   165

   It increased gradually until the 20th of August.
 After which time it gradually declined.  This was
 evident not only from general observations, but
 from a list which was put into my hands of the
 number of persons that were bled each day of the
 month, by one  of the  most popular bleeders in
 the city.

   Dr. Dorsey informed me that he had  attended
 two persons in the yellow fever in the  course of
 this month.

   In February  1808, the measles made their ap-
 pearance,  and prevailed during the months  of
 March and April.  They were at first of a mild
 character, but afterwards they became highly in-
 flammatory, so as to require frequent and copious
 bleedings.

   In the month of August, bowel complaints were
 unusually common among  adults.  They were
 ascribed in part to the use of bread made of flour,
 which had  become musty from having remained
an unusual time in the mills and stores, in con-
sequence of the operation of the embargo law. On
the 17th of August I attended and cured an ap-
prentice of Mr. William M'Corkle who had all the
common symptoms of a malignant yellow fever. 
 166   AN ACCOUNT  OF THE  DISEASES

  The month of September was unusually dry
and  healthy.  The healthiness of a great number
of the citizens of Philadelphia during this season,
was ascribed to their general and constant employ-
ment in the open air, in all those arts and labours
which  are connected with the building of two
churches, two shot manufactories and 600 houses.

  The spring of the year 1809 was unusually cold,
so as to render vegetation every where in the neigh-
bourhood of Philadelphia eighteen days later, than
in ordinal*}'' years.  There were  a number of cases
of sporadic  influenza in the  month  of May. On
the  first and second days of June, fires were  com-
fortable.  The weather in the two succeeding sum-
mer months was uncommonly  cool.  On the 22d
day of July,  Mr. Richard Durdon the step son of
William  Lewis Esq.  died of the yellow fever ac-
companied with black and bloody discharges up-
wards  and downwards, on the fourth day of vhis
disease.  Its seeds were derived from some putrid
fish  in a store in Water-street between Walnut
and Chesnut-streets.  Several other  persons were
affected with the yellow fever, or lightly indisposed,
from the same cause.  By removing the putrid fish
and cleansing the  store, the disease ceased  in the
course of a few weeks. From the result of obser-
vations upon the degrees of  heat in  Philadelphia, 
of 1806,  1807,  1808 and 1809.    167
in June and July, between the year 1793 and 1809,
collected and published by Mr. Cadwallader Evans
in the " True  American," of the 2d of August
1809, it appears, that  the yellow fever has never
been epidemic in our city when the medium heat
of those two summer months was below 79° ex-
cept in  1802 when it was 78° and in which year
not more than 200 persons were supposed to have
died of  it. The medium heat of June  and July
of the present year, was but 74°.  Time alone can
determine,  whether  this moderate  temperature
of the air will produce the same  general exemp-
tion from the disease, that it has produced in for-
mer years.* There was one circumstance  which
favoured the expectation excited by  Mr. Evans',
observations,  of the city escaping  an  epidemic
yellow fever, and that was, a chronic,  or protracted
remitting  fever of a  moderate grade,  prevailed
during  the months of July and August in every
part of  the city and suburbs;  from  which  it was
natural to infer, the constitution of the atmosphere
did not  dispose to malignant fevers.

  Upon the subject of the meteorological obser-
vations  published by Mr. Evans,  I shall only add,
however generally the yellow  fever may require
  * This sentence was written about the middle of August 1809. 
 168   AN ACCOUNT OF  THE  DISEASES

 a greater degree of medium summer heat to pro-
 duce it than 79° in Philadelphia,  it is  certain fe-
 vers from exhalations have often prevailed in other
 countries  in a much lower temperature. Dr. Hux-
 ham and several other physicians  describe bilious
 fevers  in  open winters, and particularly after a
 sudden thaw has succeeded a great frost.*

  From a number of observations made through
 a course of  many years by an intelligent citizen
 of Philadelphia, I am  led to believe that  an ex-
 emption from the yellow fever in  our city is inti-
 mately connected with  the state of the winds in
 March and April.  The more they blow from the
 north-west, the dryer they are, and the more com-
pletely they carry off the putrid  matters which
have been thrown upon the surface of the earth by
the warmth of the vernal sun.  Those winds  have
been called " hungry," from their  being supposed
to devour the matters  which they convey from
our sight. A dry wind in the spring, in a certain
part of Ireland, has been observed to produce the
 same effect upon the healthiness of the succeeding
 months.

  Having concluded the history of the bilious yel-
 low fever as it has appeared in Philadelphia  every
* On air and epidemic diseases, vol. 1. p 19. 
of 1806,  1807,  1808 and  1809.    169
year, 1808  only excepted, since 1793 as an epi-
demic, 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 after-
wards mention the means of preventing them.
VOL. IV.
y 
 
          AN INQUIRY





              INTO




      THE VARIOUS SOURCES




         OF THE USUAL FORMS OF





SUMMER AND AUTUMNAL DISEASE,





      IN THE UNITED STATES,




     AND THE MEANS OF PREVENTING THEM. 
 
AN  INQUIRY, &fe.
     THE business of the following inquiry is,

  I. To enumerate the various sources of the usu-
al 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 ex-
tensive 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,

   I. Exhalations from marshes.  These are sup-
posed 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. 
174
ON  IHE  SOURCES 01
  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 inha-
 bitants, and to  several of the students of the uni-
 versity at that place.

   3. Potatoes.  Nearly a whole  ship's  crew pe-
 rished 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. Trot-
ter,  " when notice was taken of the  putrefying
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 ves-
sels laden with the same produce came to Kingston,
from St. Domingo.  During the  distracted state 
    SUMMER AND AUTUMNAL  DISEASE.   175

of that colony, this article, with other productions,
had been allowed to spoil and ferment.  The evo-
lution of a great quantity of fixed air, or carbonic
acid gas, was the consequence; and in these ves-
sels, 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. 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 clo-
sets.

   15. The timber of an old house.  A fever pro-
duced by this cause is mentioned by Dr. Haller,
in his Bibliotheca Medicinae.
" Medicina Nautica, p. 324. 
176          ON  THE  SOURCES OF

   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 at-
tended 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 tim-
ber 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 mis-
placed 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 bu-
siness of making charcoal in the woods, often pro-
duce 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 ex-
cited even by the  exhalation from trees, that have
been killed by being girdled in an old field. 
    SUMMER AND  AUTUMNAL DISEASE.   177

   18. The stagnating air of the hold of a ship.

   19. Bilge water.

   20. Water that had long been confined in hogs-
heads 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 ci-
ties, 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 es-
cape of noxious air from it,  he destroyed its un-
wholesome 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,
    vol.  iv.            z 
178         ON THE SOURCES  OF

  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 vio-
lent bilious fevers throughout a whole neighbour-
hood 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 gene-
rated by the following animal substances in a state
of putrefaction.

   1. Human bodies that have been left unburied
upon a field of battle. 
   SUMMER  AND AUTUMNAL  DISEASE.   179

  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 Hol-
land.

   6. A large bed of oysters.   The malignant fe-
vers which prevailed in Alexandria, in Virginia, in
1803,  and  in Southwark, adjoining Philadelphia,
in the  year 1805, were derived from this cause*.

   7. The entrails of fish.   And,

   8. Privies.  The diarrhoea  and dysentery are
produced, oftener  than  any other form of sum-
mer and autumnal disease, by the fcetor of privies.
During the revolutionary war, an American regi-
ment, consisting of 600 men, were affected with a
dysentery, from being encamped near a large mass
   * 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 putrefying there, the cause of
malignant fevers in the succeeding summer and autumn ? 
180
ON  THE  SOURCES 01
of human faeces. The disease was suddenly check-
ed 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 emit-
ted 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.

   The miasmata which are exhaled from  putrid
vegetable and animal matters, are much varied by
circumstances, in their effects upon the body. Cer-
tain vegetables, particularly coffee, potatoes, and
hemp, in a state of  putrefaction,  exhale a more
noxious gas than any other vegetables, and putrid
salted meat and fish, are more disposed to produce
malignant fevers than meat and fish that are fresh,
and both are more destructive when they  exhale
their miasmata from places which have been con-
fined,  than in the open air.  This is one  reason
why the yellow fever generally makes its first ap-
pearance and is attended with most mortality near
the wharves and water streets of  sea port  towns,
the miasmata in such places being emitted from
putrid animal and vegetable matters, which had 
SUMMER AND AUTUMNAL  DISEASE.
181
been confined in stores,  cellars and  the holds of
ships.

   There are several other sources of malignant fe-
vers  besides those which have been  mentioned.
They are, exhalations from volcanoes, wells,  and
springs  of water; also flesh*, 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.

   It has been said that we sometimes meet with bi-
lious fevers in situations where no exhalations had
taken place from any of the sources that have been
enumerated.  Dr. Gordon informed  me that  500
persons died of the yellow fever in Berbice between
July 1804 and May 1805, during which time
there fell not quite three inches of rain. The earth
in this case  was  every where  dry and  parched.

   * The following fact, communicated to me by Mr. Samuel Ly-
man, 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  indis-
posed, 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. 
182          ON  THE  SOURCES OF
Bilious  fevers, Sir John Pringle tells us occur
in a part of  Holland in  very dry seasons,  but in
these cases  the earth  cracks, and putrid exhala-
tions escape from water which stagnates below its
surface.  The same cause which produced these
fevers in Holland, probably induced  the fever at
Berbice, mentioned  by Dr. Gordon, as  also all
such bilious fevers as appear under the same cir-
cumstances  of the apparent  absence  of moisture
and putrefaction.

   The usual forms of the disease produced by mi-
asmata 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, or
the autumnal fever in a protracted form.
6. Febricula. 
   SUMMER  AND AUTUMNAL DISEASE.   183

  7. Dysentery.

  8. Colic.

  9. Cholera morbus.

  10. Diarrhoea.

  In deriving all the above forms of disease from
miasmata, I do not mean to insinuate, that spora-
dic 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 medi-
cine.  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 in-
testinal 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 re-
mark by barely mentioning the resemblance of the 
 184   ON  THE  MEANS  OF PREVENTING

 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 sum-
 mer 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 bod v. 
    SUMMER AND  AUTUMNAL  DISEASE.   185

   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 malig-
nant 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 excep-
tion to this remark, for we now and then observe
uncommon and general healthiness, before the ap-
pearance of a malignant epidemic.  This was the
case in Philadelphia, previously  to the  fevers of
1798 and 1799.  1 have ascribed this to the stimu-
lus of the pestilential miasmata barely overcoming
the action of weak diseases, without being power-
ful enough to excite a malignant fever.

   2. Substances, painted with white lead, and ex-
posed 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 smoki
    vol.  iv.         2 a 
186  ON  THE MEANS  OF PREVENTING

nessor mist in the air, the late Dr. Matthew Wil-
son has remarked, generally precedes a sickly au-
tumn in the state ol 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. Bu-
neiva 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 elec-
trical sparks from their backs, and, when thrown
from a height, do not, as in health, fall upon their
feet.*

  4. The  common house fly has nearly disappear-
ed from our cities, moschetoes have been multi-
plied, and  several new insects have appeared, just
before  the prevalence of *>ur late malignant epi-
demics.
Medical Journal, vol. iv. 
    SUMMER  AND AUTUMNAL DISEASE.  187

   5. Certain trees have emitted an unusual smell;
the leaves of others have fallen prematurely; sum-
mer 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 pre-
ceded 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 conver-
sion 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 ap-
pearance in the faces of the people of Alexandria,
accompanied in  some cases with a yellowness of
the eyes, during the summer of 1793, and previ-
ous to  the appearance of a violent bilious fever on
the banks of the Potowmac. 
 188   ON  THE  MEANS  OF  PREVENTING

   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;*
 constant sweats, and  sometimes of a foetid nature,
 or a dry  skin; wakefulness, or  a disposition  to
 early or protracted sleep;  a preternaturally  fre-
 quent  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.

   * I have once known this breath, in a gentleman who had car-
ried 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 Phila-
delphia 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 in-
fection 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 some-
times 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. 
   SUMMER  AND AUTUMNAL  DISEASE.   189

  The means of preventing the different forms of
our summer and autumnal disease come next un-
der 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 com-
munities 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 in-
fected cities and villages. In this way the yellow
fever was  suddenly annihilated in Providence, on 
 190   ON  THE  MEANS  OF  PREVENTING

 Rhode-Island, and in New-Haven, in Connecticut,
 in the year 1805. But the same power should ri-
 gorously 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 dy-
 ing 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 a 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,

  1. A diet, accommodated to the greater or less
exposure of the  body to the action of miasmata, 
    SUMMER  AND AUTUMNAL  DISEASE.  191

and to the greater or less degrees of labour, or ex-
ercise, which are taken.  In cases of great expo-
sure to an infected atmosphere, with but little ex-
ercise, 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 Cay-
enne  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 attri-
buted to the more temperate habits of the natives
of  France and Spain.  The Bramins, who live
wholly upon vegetables, escape the  malignant fe-
vers of India, while whole regiments  of  Euro-
peans, who eat animal food, die in their neighbour-
hood. The people of Minorca, Dr. Cleghorn says,
who  reside near gardens, and live chiefly upon
fruit  during the summer, escape the violent au-
tumnal fever of that island. The Jews in Surinam,
Dr. Nassy tells us in his history of that settlement,
escape bilious fevers, by eating fruit at  12 o'clock,
and using fish oil, and a considerable quantity of
spices,  particularly pepper in their aliment,  while
the christians who eat and drink agreeably to their
European habits, perish in great numbers by those
diseases.   The field  negroes of South-Carolina
owe their  exemption from  bilious fevers to their 
 192  ON THE  MEANS OF PREVENTING

 living  chiefly upon  vegetables.  There  is a fact
 which  shows, that not  only temperance, but ab-
 stinence bordering upon  famine, has  afforded a
 protection from malignant fevers. In a letter which
 I received a few months ago, from the Rev. Tho-
 mas Hall, chaplain to the British  factory at Leg-
 horn, containing an  account of the  yellow fever
 which  prevailed in that city, in the summer  and
 autumn of 1804, there is the following commu-
 nication. " Of the rich, who live in airy houses,
 there died but four persons with the fever.  Of the
 commodious, who live comfortably, but not afflu-
 ently, there died ten.  Of the poor,  who inhabited
 small and crowded  rooms, in the  dirty and.con-
 fined 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 al-
 lowed the expression, of the combustion of fever.
 Persons reduced by chronic diseases, in like man-
 ner, often escape such as are acute. Six French
 ships of the line landed three hundred sick, at St.
Domingo, while the yellow fever prevailed  there
 in the year 1745, and yet no one of them was in-
fected  by it.*
              * Desportes, vol. i. p. 140. 
    SUMMER AND AUTUMNAL  DISEASE.  193

  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 Philadel-
phia  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,
    vol.  iv.         2 b 
194    ON THE  MEANS  OF  PREVENTING

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 con-
stant, 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 pur-
pose 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 practi-
cable, that which has been worn  should  be  ex-
changed 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 ano-
ther place*,  in favour of this remedy, I shall sub-
join a few others.  Dr. Mitchell, in his Account
* Account of the Yellow Fever in 1793, vol. iii. 
   SUMMER AND  AUTUMNAL DISEASE.  195

of the Yellow Fever which prevailed in Virginia,
in the year 1741, informs us, that it was often pre-
vented 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 phy-
sicians in  St. Domingo, to bleed whole regiments
of troops as soon as they arrived from France, by
which means they were preserved from the malig-
nant fever of the island.

   Duringthe 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 cloth -
"  ing, and the season of the year, seemed all unfa-
"  vourable omens of the melancholy fate  we pre-
" sumed 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 phy-
"  sic should be administered to everv man.  This 
196    ON  THE MEANS  OF PREVENTING

" 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
   v
" dangerous state when he landed.  A success un-
" paralleled 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 depletingremedies, whether used sepa-
rately or together, induce such an artificial debility
in the system, as disposes it to vibrate more rea-
dily 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. 
SUMMER  AND AUTUMNAL  DISEASE.
197
  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,
die 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 re-
cord, in his treatise upon the cold bath, that those
persons who lived in water-mills, also watermen,
bargemen, and fishermen, who were employed up-
on the river, and in dabbling in cold water, were 
198   ON THE  MEANS  OF  PREVENTING

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. Chis-
holm 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 eve-
ning, 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 pe-
rished by  that disease.

  4. Anointing the body  with oil.   The natives
of Africa, and some American Indians, use this pre-
ventive with success during their sickly seasons. It
has lately been used, it is said, with effect in pre-
venting 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 es-
caping it. 
   SUMMER  AND AUTUMNAL  DISEASE.   199

  5. Issues, setons, and blisters belong to this class
of preventives  of malignant and bilious fevers.
Issues, according to Parisinus, Florentinus, Fores-
tus, and several other authors quoted by Diemer-
broeck, have prevented the plague in many hundred
instances.  Paraeus says, all who had ulcers from
the venereal disease, or any other cause, escaped it.
Dr. Hodges owed his preserv ation 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 es-
cape from the yellow fever of 1799 to a perpetual
blister,  which he applied to his arm for that pur-
pose.  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. 
200
ON  THE MEANS  OF
PREVENTING
  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 cre-
ate 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 yel-
low 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 pre-
vailed 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 endow-
ed 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 im-
perceptible to those who use them. 
SUMMER AND  AUTUMNAL DISEASE.
201
  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 as-
sured him, he had been preserved in good health
by calomel, taken in the  way that has been men-
tioned, 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 up-
on those two preventives under this head.   There
are several others which have been in common use,
some  of which 1  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 ex-
cited by the miasmata of the fever; but this cannot
 be done without producing intoxication, which, to
    vol. iv.         2 c 
202  ON  THE MEANS OF  PREVENTING

be effectual, must be perpetual;  for the weakness
and excitability, which take place in the intervals
of drunkenness, predispose to the disease.  Agree-
ably 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 at-
tack 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 de-
rived  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 preserv-
ing 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 pro-
tection 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 iiir
creasing a predisposition to it.

  A  fourth class of  the preventives of malignant
fevers are  certain substances which are said to de- 
    SUMMER AND AUTUMNAL  DISEASE.   203

stroy miasmata by entering into  mixture with
them. Two persons, who were very much exposed
to the  causes of the fever in 1798, took each pf
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 mecha-
nically from  their action? or did it prevent the dis-
ease, 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 vapours which issue from fresh earth  has
been supposed to destroy the  miasmata which pro-
duce 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 settle.
ments of our country, it is said, the poison of the
rattle snake  is deprived of its deadly effects upon
the body, by thrusting the wounded  limb into a
hole recently made jn the earth.  The fable of An- 
204   ON  THE  MEANS OF  PREVENTING

teus 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 effi-
cacy of the volatile alkali in destroying, by mix-
ture, the  poison of snakes.   One of them was
lately communicated to the  public by Dr.  Ram-
say, of South-Carolina.  What would be the effect
of the daily use of a few tea-spoonfuls of this me-
dicine in a liquid form, and of frequently washing
the body with it, during the prevalence of  pesti-
lential epidemics ?

  The miasmata which produce malignant fevers
often exist in an offensive 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, 
    SUMMER  AND AUTUMNAL DISEASE.  205

  1. Heat and cold. While the former has excit-
ed the yellow fever in thousands, the latter has ex-
cited 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 ex-
citing cause of that, and of other diseases, in the
island of Jamaica, than in any of the  most tempe-
rate 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 mid-
dle 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 die excitement
of the blood-vessels, by the gradual and impercep-
tible 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 sea-
son.  By these  precautions, I have  known whole
families preserved in health, while all the neigh-
bours who neglected them, have been confined by
a prevailing autumnal fever. 
 206   ON THE  MEANS  OF PREVENTING

   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,* in the maids of large
 families being the only persons who die of the fe-
 ver, 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.

   5. Intemperance in eating and drinking.

   6. Partaking of new aliments and drinks. The
 stomach, during  the prevalence of malignant fe-
vers, 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
       ' Account of the Yellow Fever in 1793, vol. iii. 
   SUMMER  AND AUTUMNAL DISEASE.   207

the body to idleness and company, favours an at-
tack  of fever. A predisposition to it, is likewise
created by alternating labour  and idleness, with
each other.

   9. The continuance of hard labour.  The mias-
mata which produce malignant fevers sometimes
possess so much force, that the least addition to
it, even from customary acts of labour, is suffici-
ent 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 hat-
ters, smiths,  bricklayers, and house and ship car-
penters. The wealthy inhabitants of Constantino-
ple and Smyrna, erroneously suppose they escape
the  contagion of the plague,  by  shutting them-
selves up in  their houses  during  its prevalence.
They owe their preservation chiefly to their being
removed, by an exemption from care and  busi-
ness, 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 ef-
fects, when persons occupy the upper stories only 
 208   ON  THE  MEANS  OF PREVENTING

 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 differ-
 ence 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, du-
 ring  the prevalence of a plague  in the eastern
 countries.  But  the  benefits of confinement and
 rest, are by no means general  in preserving per-
 sons from the plague and yellow fever. Some late
 accounts from Egypt, teach us that an atmosphere
 infected with putrid miasmata sometimes pene-
 trates into the retreats of the wealthy and the timid,
 and spreads with its usual mortality among them.
 Solitary instances of the same thing  have occurred
 in Philadelphia, in families which have lived in  re-
 tirement during the prevalence of the yellow fever.

   All the exciting causes that have been enume-
 rated 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 had retired from  infected ci-
ties, or countries, it  will be necessary to suggest a
caution, not to visit them  while the malignant fever 
    SUMMER AND AUTUMNAL  DISEASE.  209

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 vi-
siting 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 de*
scend  from  their  elevated situation, where the
thermometer seldom varies more than ten degrees
in the  year, and visit Vera Cruz  during the pre-
valence 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.
    vol.   iv.         2 D 
210    ON THE MEANS OF  PREVENTING

  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 im- ressions of terror and distress from its ap-
pearance,  my advice to  them should be,  "Be-
ware," not of contagion, for the yellow fever of
our country is not contagious, nor of putrid exha-
lations, where the duties  of humanity or consan-
guinity 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 preven-
tion 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 sol-
diers who lived upon salt meat, during the Ameri-
can war, were much less afflicted with the intermit-
ting fever, than the neighbouring country people; 
    SUMMER  AND AUTUMNAL  DISEASE.  211

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 wa-
ter, taken upon an empty stomach, is a cheap sub-
stitute for all  the above liquors where they cannot
be afforded.  The Peruvian bark has in many in-
stances 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 men-
tioned 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 for-
merly 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 expo-
ses them.   Where peculiar circumstances of bu- 
 212    ON  THE MEANS OF  PREVENTING

 siness render it necessary for persons to inhale the
 morning air, care  should be taken never to do it
 without first eating a cordial breakfast.

  The intestinal state of our summer and autumnal
 disease requires 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 pep-
 per, and the red pepper of our country, should be
taken daily with food.  Mr. Dewar, a British sur-
 geon, 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 coun-
 try 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 vil-
 lage of Princeton, in New-Jersey, and affected ma- 
   SUMMER  AND AUTUMNAL  DISEASE.   213

ny of the students of the college.  It was remark-
ed, 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, fifty 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 tak-
ing purging physic, even when the  bowels are in
their natural state. A militia captain, in the Penn-
sylvania service, preserved his whole company from
a dysentery which prevailed in a part of the Ame-
rican 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. 
214  ON THE  MEANS  OF PREVENTING

   As the dysentery is often excited by the damp-
ness 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 pro-
posed, 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  practica-
ble, 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  over-
flowed the ground which  had emitted the putrid
exhalations that  produced it, than had died the
day before.  A bilious fever was once checked in
Brabant by  inundating the marsh from whence
the miasmata came that produced it. During the 
   SUMMER  AND AUTUMNAL  DISEASE.   2l5

prevalence of a malignant fever, it will  be unsafe
to remove putrid matters.  A plague was gene-
rated 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.* Even a shower of rain,
by disturbing the green pellicle which is some-
times formed over putrid matters, I shall mention
in another place, has let  loose  exhalations that
have produced a pestilential disease.

   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 sys-
tem, has, in some instances, checked the progress
of a malignant fever.  The air extricated from fer-
menting wines, during a plentiful vintage, Van-
sweiten 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 putrefy in the streets. Mr. Bruce relates, that
 all those  persons who  lived in smoky houses,  in
 one of the countries which he visited, escaped bili-
 ous fevers, and Dr. Clark mentions an instance, in
 which several cooks, who were constantly exposed
 to smoke, escaped a fever which affected the whole
* Bur-seru^ 
 216   ON  THE  MEANS OF PREVENTING

 crew of a galley.  The yellow fever  has never ap-
 peared 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 Lon-
 don been visited with a plague  since  its inhabi-
 tants 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 cen-
 tury, 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 arrest-
ed 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 wa-
ter 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 instances of
yellow fever occurred in those  Philadelphia fami-
lies that confined  themselves to ships in the mid- 
SUMMER  AND  AUTUMNAL
DISEASE.
217
die 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 Co-
teneuil, 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.* I have multiplied facts
upon this subject,  because they lead to important
conclusions. They shew the immense consequence
of frequently washing the streets  and houses of
cities, both to prevent and check  pestilential fe-
vers.  What would be the effect of placing  tubs
of fresh water in the rooms of  patients  infected
with malignant fevers, and in an atmosphere charg-
ed with putrid exhalations ?  Their efficacy in ab-
sorbing the matter which  constitutes the odour of
fresh  paint, favours a hope  that they  would be
useful for that  purpose. I have  mentioned an in-
stance, 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.

   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,
                  *Vol.  I. p. 161,
    tOL. IV.         2 E 
218   ON THE MEANS OF  PREVENTING

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 neighbour-
hood.  Mr. Howard advises keeping the doors
and windows, of houses which  are exposed to the
plague, constantly shut, except during the time of
sunshine.

  5. Sir John Pringle tells us, that the inhabitants
of Breda defend themselves from the morbid exha-
lations of a piece of marshy  ground in its neigh-
bourhood, in the season of bilious fevers, by over-
flowing it with water.

  Several other means have been recommended to
preserve  cities from malignant fevers during their
prevalence, which are  of doubtful efficacy, or evi-
dently hurtful.  They are,

  6.  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 
    SUMME* AND AUTUMNAL  DISEASE.  219

produced it were derived*.  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.

   7. Mr. Quiton Morveau has lately proposed the
muriatic gas as a means of destroying  miasmata.
However effectual it may be in destroying the vo-
latile 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 at-
mosphere, and which are diffused over a large ex-
tent 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.

   8. The  explosion of gunpowder  has been re-
commended for checking pestilential diseases. Mr.
* Sur les Maladies des Climats Chauds. 
 220   ON THE MEANS OF  PREVENTING

 Quiton Morveau says,  it destroys  the offensive
 odour of putrid exhalations, but does not act upon
 the fevers produced by them.

   9. 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.

   10. Large fires have sometimes been made in
 cities, in order to destroy the miasmata of pestilen-
 tial disease* 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 physi-
 cians 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 destruc-
tion, than the early knowledge of such cases would
be to save it from the ravages of  pestilential am.
mortal epidemics. Hundreds of instances have oc- 
   SUMMER  AND AUTUMNAL  DISEASE.   221

curred 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, hu-
manity, and government first combine to accom-
plish 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 tra-
vel over  mountains of prejudice  and error, be-
fore we shall witness that desirable event.   It is
extracted from  the second volume of the Life of
the late Empress of Russia.  u The Russian army
(saysthe 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 propaga-
tion, as if they thought by a military word of com-
mand to alter the nature of things.  Lieutenant-
general Stoffeln,  at Yassy, where the pestilence
raged in the winter of 1770, issued peremptory or-
ders 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 spot-
ted fever.  One honest surgeon of  the  name of
Kluge refused to sign it.  In this manner the sea-
son of prevention was neglected.  Several thou- 
222   ON  THE  MEANS OF PREVENTING

sand 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.*"

   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 pu-
trid matters formerly enumerated, which are capa-
ble 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,  whi-
ther 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
  * The above disease  appears to have been the camp fever,  the
origin and character of which will be noticed in the next article. 
    SUMMER AND  AUTUMNAL  DISEASE.   223

 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 xxix.
 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 Hoi-
 land hold their exemption from the plague, only by
 the  tenor 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 sickness 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 fol-
 lowing fact. It was  first communicated  to the
 public in the daily gazette of the capital of that 
224  ON THE  MEANS  OF  PREVENTING*

state, on the 30th of October, 1799. " A malig-
nant 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 stagnat-
ing 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 ef-
fects." 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 poul-
try, 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 
    SUMMER AND  AUTUMNAL  DISEASE.  225

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 dig-
ging 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 Lon-
don, 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 vent-
ing 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.*  Those streets  and

  * 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 !"
    VOL.  IV.          2 F 
226   ON  THE  MEANS  OF PREVENTING

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.

  3. Where the different forms of summer and au-
tumnal disease arise from marsh exhalations, they
should be destroyed by drains, by wells communi-
cating with their subterraneous springs, or by cul-
tivating 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 over-
flowing 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 unsuccess-
ful 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 expense, and present^
ed 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 
    SUMMER AND  AUTUMNAL DISEASE.  227

noxious air, and malignant fevers, a terrestrial pa-
radise."

  4. The summer and autumnal diseases of our
country have often followed the erection of  mill-
dams.  They may easily be obviated by surround-
ing 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 De-
laware 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 rea-
son, the cultivation of a country should always fol-
low the cutting down of its timber, in order to pre-
vent the new ground becoming, by its exhalations,
a source of disease.

m 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 arrivalof 
228   ON  THE MEANS OF PREVENTING

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 ma-
lignant 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 dis-
ease may be taken as often as our inhabitants are
exposed to its sources.  In the West-Indies, a se-
cond 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-In-
dies, where, Dr. Clark says, the exhalations which"
bring on bilious fevers, colic, cholera, and spasmo-
dic affections in new comers, produce a puking in
the morning, only in old residents.  But very dif-
ferent is the condition of the inhabitants of the mid-
dle and northern states of America, in whom the
winters prevent the acquisition of habits of insensi-
bility to the heat and exhalations of the previous 
   SUMMER  AND AUTUMNAL  DISEASE.   229

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 in-
creases the danger of depopulation from our malig-
nant 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 be-
lieve these pages would be read only by  the citi-
zens of Pennsylvania, I would do homage to  their
prejudices, by passing over this subject by a res-
pectful and melancholy silence; but as it is proba-
ble they will fall into the hands of physicians and
citizens of other states, I feel myself under an obli-
gation 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 maybe 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.   Mil-
lions of dollars have been wasted by them. From
their influence, the commerce, agriculture, and ma-
nufactures of our country have suffered for many 
 230  ON  THE  MEANS OF  PREVENTING

 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 ori-
 ginated from them ; for a belief in the contagious
 nature of the yellow fever, which is so solemnly en-
 forced by the execution of quarantine laws, has de-
 moralized 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 in-
 capable of being imported so as to become an epi-
 demic 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 contin-
 gent  circumstance, and at the  expense of such a
profusion of blessings as have been  mentioned, is
 to imitate the conduct of a man, who, in attempt-
ing to kill  a fly upon his child's  forehead, knocked
 out its brains. 
   SUMMER  AND AUTUMNAL  DISEASE.  231

  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 un-
changeable law of nature, and that Heaven has sur-
rendered 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 con-
nection 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.

   I have repeatedly asserted the yellow fever of
 the United States  not to be contagious.  I shall
 now mention the proofs of that assertion, and en-
 deavour to explain instances of its supposed con-
 tagiousness upon other principles. 
 
        FACTS,




     INTENDED TO PROVE





THE YELLOW FEVER





 NOT TO BE CONTAGIOUS.
VOL. IV.      2 c 
 
FACTS, &fc.
      WHEN fevers are communicated from one
person to another, it is always in one of the follow-
ing ways.  1. By secreted matters. 2. By excreted
matters.  The small-pox and measles are commu-
nicated in the former way; the jail, or, as it is some-
times called, the ship, or camp, and hospital fever,
is communicated onlyby means of the excretions of
the body. The perspiration, by acquiring a morbid
and irritating quality more readily than any other
excretion, in consequence of its stagnation and con-
finement to the body in a tedious jail fever, is the
principal means of its propagation.  The perspira-
tion* is, moreover, predisposed to acquire this mor-

   * The deleterious nature of this fluid, and its disposition to cre-
ate disease, under the above circumstances, has been happily illus-
trated by Dr. Mitchill, in an ingenious letter to Dr. Duncan, of
Edinburgh, published in the fourth volume of the Annals  of Me-
dicine. 
236   YELLOW FEVER  NOT  CONTAGIOUS.

bid and acrid quality by the filthiness, scanty, or
bad aliment, and depression of mind, which gene-
rally  precede that fever.  It is confined to sailors,
passengers,  soldiers, prisoners, and patients, in
foul and crowded ships, tents, jails, and hospitals,
and to poor people who live in small, damp, and
confined  houses.  It prevails chiefly in cool and
cold weather, but  is never  epidemic;  for the
excreted matters which produce the fever do not
float in the  external atmosphere, nor are  they
communicated, so as to produce disease, more than
a few  feet from the persons who exhale them.
They are sometimes communicated by means of
the clothes which have been worn by the sick, and
there have been instances in which the fever has
been produced by persons who had not been con-
fined by  it, but who had previously been exposed
to all the causes which generate it. It has been but
little known in the United States since the revolu-
tionary war, at which time it prevailed with great
mortality in the hospitals and camps of the Ameri-
can army. It has now and then appeared in ships
that  were crowded with passengers from different
parts of Europe.   It is a common disease in the
manufacturing towns of Great-Britain, where it has
been the subject of several valuable publications,
particularly by Dr. Smith and Dr. John  Hunter.
Dr.  Haygarth has likewise written upon it, but he 
    YELLOW  FEVER NOT  CONTAGIOUS.  261

has unfortunately confounded it with the West-
India and American  yellow fever, which differs
from it in prevailing chiefly  in warm climates and
seasons; in being the offspring of dead and putrid
vegetable and animal matters; in affecting chiefly
young and robust habits; in being generally ac-
companied with a diseased  state  of the stomach,
and an obstruction or preternatural secretion and
excretion of bile; in terminating, most commonly,
within seven days; in becoming epidemic only by
 means of an impure atmosphere; and in not fur-
 nishing ordinarily those excretions which,  when
 received into other bodies,  re-produce the same
 disease.

    I have been compelled  to employ this tedious
 description of two forms of fever, widely different
 from each other  in their causes,  symptoms, and
 duration, from the want of two words which shall
 designate them.  Dr. Miller has boldly and inge-
  niously proposed to remedy this deficiency in our
  language, by calling the former idio-miasmatic, and
  the latter koino-miasmatic fevers, thereby denoting
  their private or personal, and their public or com-
  mon origin*. My best wishes attend the adoption
  of those terms!
* Medical Repository, hexade ii. vol.i. ■ 
238  YELLOW  FEVER NOT  CONTAGIOUS.

   I return to remark, that the yellow fever is not
contagious in its simple state, and that it spreads
exclusively by means of exhalations from putrid
matters, which are diffused in the air.  This is evi-
dent from the following considerations:

   1. It does not spread by contagion in the West-
Indies.  This has been proved in the most satis-
factory manner by Drs. Hillary, Huck,  Hunter,
Hector  M'Lean, Clark, Jackson, Borland, Pinck-
ard, and Scott. Dr. Chisholm stands alone, among
modern physicians, in maintaining a contrary opi-
nion.  It would be easy to prove, from many pas-
sages in the late edition of the doctor's learned and
instructive volumes, that  he has been mistaken;
and that the disease was an endemic of every island
in which he supposed it to be derived from conta-
gion.  A just idea of the great incorrectness of all
his statements, in favour  of his opinion, may be
formed  from the letter of J.  F. Eckard, Esq. Da-
nish consul, in Philadelphia, to Dr. James Mease,
published in a late number of the New-York Me-
dical Repository*.
* For February, March, and April, 1804; 
     YELLOW FEVER NOT CONTAGIOUS.   239

   2.  The yellow fever  does not spread in the
country, when carried thither from the  cities of
the United States.

   3. It does not spread in yellow fever hospitals,
when they are situated beyond the influence of the
impure air in  which it is generated.

   4.  It does  not spread in cities (as will appear
hereafter) from any specific matter emitted  from
the bodies of sick people.

   5. It generally requires the co-operation of an
exciting  cause, with  miasmata, to produce  it.—
This is never  the case  with diseases  which are
universally acknowledged to be contagious.

   6. It is not  propagated by the artificial means
which propagate contagious diseases.  Dr. Ffirth
inoculated himself above twenty times, in different
parts of his body, with the black matter discharged
from the stomach of patients in the yellow fever,
and several times with the serum of the blood, and
the saliva of patients ill with that  disease, without
being  infected by them ; nor was he indisposed
after swallowing half an ounce of the black matter
recently ejected from the stomach, nor by expos-
ing himself to the vapour which was produced by 
 240   YELLOW FEVER  NOT CONTAGIOUS.

 throwing a quantity of that matter upon iron heat-
 ed over a fire.*

   To the first  four of these assertions there are
 some seeming  exceptions in favour of the propa-
 gation of this  fever by contagion. I shall briefly
 mention them, and endeavour to explain them
 upon other principles.

   The circumstances which seem to favour the
 communication of the yellow fever from one  per-
 son to another, by means of what has  been sup-
 posed to be contagion, are as follows :

   1. A patient being attended in a  small, filthy, and
 close room. The excretions of the body, when thus
 accumulated, undergo an additional putrefactive
 process, and acquire the  same properties as those
 putrid animal matters which are known to produce
 malignant  fevers.  I have  heard of two or three
 instances in which a fever was produced by these
 means in the country, remote from the place where
 it originated, as well as from every external source
 of  putrid exhalation.  The plague is  sometimes
 propagated in this way in the low and filthy huts

  • Inaugural Dissertation on Malignant Fever, &c. published in
June, 1804. 
     BELLOW  FEVER NOT  CONTAGIOUS.   241

which compose the alleys and narrow streets of
Cairo, Smyrna, and Constantinople.

  2. A person sleeping in the sheets, or upon a bed
impregnated with the sweats or other excretions, or
being exposed to the smell of the foul linen, or other
clothing  of  persons  who had the yellow  fever.
The disease here, as in the former case, is commu-
nicated in the same way as from any other putrid
animal matters. It was once received in Philadel-
phia from the  effluvia  of a chest of unwashed
clothes, which had belonged to one of our citizens
who had died with it in Barbadoes; but it extended
no further in a large family, than to the person who
opened the chest. I have heard of but two instan-
ces more of  its having been propagated by these
means in the United  States, in which case the dis-
ease perished with the unfortunate subjects of it.

  To the above insolated cases of the yellow fever
being  produced by the  clothing of persons who
had died of it, I shall oppose a fact  communicated
to me by Dr. Mease. While the  doctor resided
at the lazaretto, as inspector of sickly vessels, be-
tween May, 1794, and the same month in 1798,
the clothing contained in the chests and trunks of
all the seamen and others, belonging to Philadel-
phia, who had died of the yellow fever in the West-
    vol.  iv.         2 H 
242   yellow fever  not  contagious.

Indies, or on their passage home, and the linen of
all the persons who had  been sent from the city
to the lazaretto with that disease, amounting in all
to more than one hundred, were opened, exposed
to the air, and washed, by the family of the steward
of the hospital, and yet no one of them contracted
the least indisposition from them.

  I am disposed to believe the linen, or any other
clothing of a person in good health that had been
strongly impregnated with sweats, and afterwards
suffered to putrefy in a confined place, would be
more apt to produce a yellow fever in a summer or
autumnal month, than the linen of a person who
had died of that disease, with the usual absence of
a t  :oisture on the skin. The  changes  which  the
healthy excretions  by the pores  undergo by pu-
trefaction, may easily be conceived, by recollecting
the  offensive smell which a pocket handkerchief
acquires that has been used for two or three days
 to wipe away the sweat  of the face and  hands in
 warm weather.*

   3. The protraction of a yellow  fever to such a
 period as to dispose it to assume the symptoms, and
 to generate the peculiar and highly volatilised ex-
* See Van Swciten on Epidemic Diseases, Aphorism 140?-'. 
yellow fever  not  contagious.  243
halation from the pores  of the  skin which takes
place in the jail fever.  I  am happy in finding I am
not the author of this opinion.  Sir John Pringle,
Dr. Monro, and Dr. Hillary, speak of a contagious
fever produced by the combined action of marsh
and human miasmata. The first of those physicians
supposes the Hungarian  bilious  fever, which pre-
vailed over the continent of Europe in the seven-
teenth century, was sometimes propagated in this
way, as well as by marsh and other putrid  exhala-
tions. Dr. Richard Pearson,  in his  observations
upon the bilious  fevers which  prevailed in the
neighbourhood of Birmingham,  in England, in the
the years 1797, 1798, and 1799,  has the following
remark: "In its first stage, this fever did not ap-
pear to be contagious, but  it evidently was so after
the eleventh and fourteenth day, when the typhoid
state was induced*."  As this protracted state of
bilious fever rarely occurs in our country, it has
seldom been communicated in this way.

   It is not peculiar, I believe, to a bilious and yel-
low fever, when much protracted beyond  its ordi-
nary duration to put on the symptoms of the jail
fever.  The same appearances occur in the pleurisy,
* Page 13. 
244  yellow fever not contagious.

and in other, of what Dr. Sydenham calls intercur-
rent fevers, all of which I have no doubt, under cer-
tain circumstances of filth, confinement, and long
duration, would produce a fever in  persons who
were exposed to it. This fever, if the weather were
cold,  would probably put on inflammatory symp-
toms, and be added, in our nosologies, to the class
of contagious diseases.

   From the necessary influence of time, in thus
rendering fevers of all kinds now and then conta-
gious by excretion, it follows, that the yellow fever,
when of its usual short duration, is incapable of
generating that excretion, and that, instead of be-
ing considered as the only form of bilious fever that
possesses a power of propagating itself, it should
be considered as the only one that is devoid of it.

  4. Miasmata, whether from marshes, or  other
external sources, acting upon a system previously
impregnated with the excreted matters which pro-
duce the jail or ship fever. Mr. Lempriere informs
us, that he saw what were supposed to be cases of
yellow fever communicated  by some sailors who
brought the seeds  of the ship fever with them to
the island  of Jamaica. The fevers which affected
most of  the crews of the Hussar frigate, mentioned 
YELLOW FEVER NOT CONTAGIOUS.   245
by Dr. Trotter*, and of the Busbridge Indiaman,
described by Mr. Brycef, appear to have been the
effect of the combined operation of foul air in those
ships, and human excretions, upon their systems.
The disease was barely tinged with bilious symp-
toms, and hence the facility with which it was cured,
for the jail fever more  readily yields to medicine
than the yellow fever.  The former was probably
excited by some latent exhalation from dead mat-
ters in the holds of the ships, and hence we find it
ceased on shore, where it was deprived of its ex-
citing cause.  It is true, great pains were taken to
clean the hold and  decks of the Busbridge, but
there are foul matters which adhere to tie timbers
of ships,  and which, according to Dr. Lind, are
sometimes generated by those timbers vhen new,
that are not to be destroyed by any of th* common
means employed for that purpose.  Of this Dr.
Kollock has  furnished us with a most satisfactory
proof, in his history of  the  yellow ferer, which
prevailed on  board of the frigate General Greene,
on her voyage to the Havanna, in  the year 1799.
" The air in the hold of the vessel (says the doctor)
was  so contaminated, as to extinguish lights imme-

  * Medicina Nautica, p. 360.
f Annals of Medicine, vol. i. p. 116. 
246  YELLOW FEVER NOT CONTAGIOUS.

diately, and candles in the cockpit were almost as
useless from the same cause. The fish were thrown
overboard, and the decks washed and scoured, the
ventilator and wind sails put in motion, and every
measure of purification adopted that their situation
allowed; notwithstanding these precautions disease
invaded us.  The men were unceasing  in  their
exertions  to purify the ship ; washing, scouring
with vir.egar,  burning powder and vinegar, old
junk, aid sulphur, added  to constant ventilation,
proved unequal even to the amelioration of their
calamities,  while they were in the latitude of great
heat. After the removal of the sick, the ship was
disburthtned of her stores, ballast, &.C. cleansed
and white-washed throughout; still new cases oc-
curred fcr nearly two months.   Some days, two,
three, or four were sent off to the hospital, which
would stem to indicate the retention of some por-
tion of tiis noxious principle, which was lodged
beyond tie reach of the cleansing process."  That
this noxiois principle or matter existed in the ship,
and not in the bodies of the crew, is evident from
its not having been communicated, in a single in-
stance, by  a hundred of them who were sent to an
hospital on Rhode-Island, notwithstanding an inter-
course sufficient  to  propagate  it was necessarily 
    YELLOW  FEVER  NOT  CONTAGIOUS.  247

kept up with the inhabitants. Even their nurses
did not take it.*

   5. A fifth instance in which contagion has been
supposed to take place in the yellow fever is, where
the exhalation from the excretions of a patient in
that disease acts as an exciting cause, in persons
previously impregnated with the  marsh, or other
external miasmata,  which produce it.   The acti-
vity of this exhalation, even when it  is attended
with no smell, is so great, as to induce sickness,
head-ach, vertigo, and fainting. It is not peculiar
to the exhalations  from such patients to produce
morbid effects upon persons who visit them. The
odour emitted by persons in the  confluent small-
pox has been known to produce the same symp-
toms together with a subsequent fever and apthous
 sore throat. This has been remarked long ago by
 Dr. Lind, and  latterly by Dr. Willan, in his Re-
 ports  of the diseases of London, f That the yellow
 fever is often excited in this way, without the inter-
 vention of a supposed  specific contagion, I  infer
 from its sometimes spreading through whole fami-
 lies, who have breathed the same impure atmo-
 sphere with the person first infected by the fever.

   * Medical Repository, vol. iv. No. 1=
f Page 13 and 113- 
248   YELLOW FEVER  NOT CONTAGIOUS.

This is more especially the case where the impres-
sion made by the exhalation from the sick  person
is assisted by fear, fatigue, or anxiety of mind in
other  branches of the family.  In favour  of this
mode of exciting the yellow fever, Dr. Otto com-
municated to me the  following  fact. In the au-
tumn of the year 1798, it prevailed upon the shores
of the Delaware, in Gloucester  county, in New-
Jersey. A mild remittent prevailed at  the same
time on the high grounds, a few miles from  the
river. During this time, the Doctor observed, if a
person who had inhaled the seeds of the yellow fe-
ver in Philadelphia afterwards came into a family
near the river, the same disease appeared in several
instances in one or more branches of that family ;
but where persons brought the fever from the city,
and went into a family on the high grounds, where
the mild remittents prevailed, there was not a sin-
gle instance of a yellow fever being excited by them
in any of its members.  This  fact is important,
and of extensive application.  It places the stimu-
lus from the breath, or other exhalations of persons
affected by the yellow fever, upon a footing with
intemperance, fatigue, heat, and all  the  common
exciting causes of the disease; none of which, it is
well known, can produce it, except in persons who
have previously inhaled the putrid miasmata, which
in all countries are its onlv remote  cause. The 
     YELLOW  FEVER  NOT  CONTAGIOUS.  249

city of Philadelphia has furnished, in all our yellow
fever years, many additional proofs of the correct-
ness of Dr. Otto's remark.  In the months of July
and August, when miasmata are generally local,
and float chiefly near to their hot beds, the docks
and  holds of ships, persons who are affected by
these miasmata, and  sicken in other parts of the
city, never communicate the disease; but after the
less prepared and heterogeneous filth of our whole
city has  been acted on by an autumnal, as well
as summer sun, so as to emit pestilential exhalati-
ons into all our streets and alleys, the fever is now
and then excited in the manner that has been men-
tioned  by a single  person in a whole family.  The
common intermittents of the southern states are
often excited in the same way, without being sus-
pected of spreading by contagion. Even the jail or
hospital  fever is vindicated by Dr. Hunter from
the highly contagious nature which has been as-
cribed to it, upon  the same principle. His words,
which  are directly to my purpose, are as follow :
" In considering the extent and power of the con-
tagion  [meaning of the jail or hospital fever,] I am
not inclined to impute to this cause  the fevers of
all those who are  taken ill in one family after the
first, as they are all along exposed to the same vi-
tiated air which occasions the first  fever. In like
manner,  when a poor woman visits  some of her
    VOL. iv.          2 T 
250   YELLOW FEVER  NOT CONTAGIOUS.

sick neighbours, and is taken ill herself, and after-
wards some of her children, I would not impute the
disease to infection alone; she and her family hav-
ing previously lived in the same kind of vitiated air
which originally produced the fever. If the cases
in which the  infection meets with the poison al-
ready half formed be excepted, the disease in itself
will be found to be much  less infectious than has
been commonly supposed.*" By  the modes of
communicating the yellow fever which have been
admitted, the dysentery, and all the milder  forms
of autumnal fevers, have been occasionally propa-
gated, and perhaps oftener  than the first-named
disease, from their being more apt to run on to the
typhus or chronic  state. Of this I could  adduce
many proofs, not only from books, but from my
own  observations ; but  none  of  these diseases
spread by contagion,  or become  epidemic from
that  cause in any country. A contrary opinion, I
know, is held by Dr.  Cleghorn, and Dr. Clarke ;
but they have deceived  themselves, as they for-
merly deceived me, by not attending to the differ-
ence between  secreted contagious and  morbid
excretions from the body, produced by the causes
which have  been enumerated, and which are rare
and accidental concomitants of bilious or summer
diseases.
•Medical Transactions, vol. iii. p. 351. 
     YELLOW FEVER  NOT CONTAGIOUS.  251

  G. The last instance of supposed contagiousness
of the yellow fever is said to arise from the effluvia
of a putrid body that has died of that disease.  The
effluvia in this case act either as the putrefied ex-
cretions mentioned under the first head,  or as  an
exciting cause upon miasmata, previously received
into the system.  A dead body, in a state of putre-
faction from any other disease, would produce, un-
der the same circumstances of season and predispo-
sition,  the same kind and degrees of fever.

  The  similarity of the fever induced by the means
that have been  enumerated, with the fever from
which it was derived, has been  supposed to favour
the opinion of its being communicated by a speci-
fic contagion.  But let it be recollected  that the
yellow fever is, at the time of  its being supposed
to be thus  received, the  reigning  epidemic, and
that irritants of all kinds necessarily produce that
disease.  The morbid sweats which now and then
produce an intermitting fever,  and the alvine ex-
cretions which occasionally produce a dysentery,
act only by exciting morbid actions in the system,
which conform in their symptomsto an immutable
and universal law of epidemics.   It is only when
those two diseases generally prevail, that they seem
to produce each other. 
252   YELLOW FEVER NOT CONTAGIOUS.

  Thus have I explained all the supposed cases of
the contagiousness of the yellow fever.  To infer
from the solitary instances of it thus excited, is to
reason as incorrectly as to say the small-pox is not
contagious,  because we now and then meet with
persons who cannot be infected by it.

  From the explanation that has been given of the
instances in  which the yellow fever has been sup-
posed to spread by contagion, we are compelled to
resort to certain noxious matters in the atmosphere,
as the exclusive causes of the prevalence, not only
of that fever, but (with a few exceptions) of all other
epidemic diseases. It is true, we are as yet ignorant
of the precise nature of those matters in the air
which produce epidemics ; but their effects are as
certainly felt by the human body as the effects of
heat, and yet who knows the nature of that great
and universal principle of activity in our globe?

   That the yellow fever is propagated  by means
of an impure atmosphere,  at all times, and in all
places, I infer from the following facts :

   1. It appears only in those climates and seasons
 of the year  in which heat, acting upon moist ani-
 mal and vegetable matters, fills the air with their
 putrid exhalations.  A vertical sun,  pouring its 
YELLOW FEVER  NOT  CONTAGIOUS.
253
beams for ages upon a dry soil; and sWamps, de-
fended from the influence of the sun by extensive
forests, have not, in a single  instance, produced
this disease.

  2. It is unknown in places where a connection
is not  perceptible between it, and marshes, mill-
ponds, docks, gutters, sinks,  unventilated ships,
and other sources of noxious air.   The truth of
this  remark is established by the  testimonies of
Dr. Lind and Dr. Chisholm, and by many facts in
Lempriere's excellent History of the Diseases of
Jamaica. Dr. Davidson furnished me with a strik-
ing confirmation of their remarks, in the following
extract from a letter, dated November 12th,  1794.
" I have mentioned (says the doctor) an instance
of the remarkable good health which the 66th re-
giment enjoyed at St. Vincents for several years,
upon a high hill above the town, removed from all
exhalations, and in a situation kept at all times cool
by the blowing of a constant trade wind.   They
did not lose, during eighteen months, above two
or three men (the regiment was completed to the
peace establishment), and during eight years they
lost but two officers, one of whom, the quarter-
master, resided constantly in town, and died from
over fatigue; the other arrived very ill from An-
tigua, and died within a few days afterwards." 
254  YELLOW  FEVER NOT CONTAGIOUS.

   In the United States, no advocate for the speci-
fic nature or importation of  the yellow fever, has
ever been able to discover a single case of it beyond
the influence of an atmosphere rendered impure by
putrid exhalations.

   It is no objection to the truth of this remark,
that malignant bilious fevers sometimes appear up-
on the summits of hills, while their declivities, and
the vallies below, are exempted from them.  The
miasmata, in all these cases, are arrested by those
heights, and are always to be  traced to putrefaction
and exhalation in their neighbourhood. Nor is it
any objection  to the indissoluble  connection be-
tween putrid  exhalations and the yellow fever,
which has been mentioned, that the disease some-
times appears in places remote from the source of
miasmata in time and place.   The bilious  pleuri-
sies, which occur in the winter and spring, after a
sickly autumn, prove that they are  retained in the
body  for many months,  and although they  are
sometimes limited in their extent to a single house,
and often to a village,  a city, and  the banks of a
creek or river, yet they are now and then carried
to a much greater distance.   Mr. Lempriere, in
his valuable Observations upon the  Diseases of the
British Army in Jamaica, informs us, that Kings-
ton is sometimes rendered sickly  by exhalations 
      YELLOW FEVER  NOT CONTAGIOUS.   255

 from a lagoon, which lies nine miles to the  east-
 ward of that town.*  The  greater or less distance,
 to which  miasmata  are  carried from the place
 where they are generated, appears to depend upon
 their quantity, upon the force and duration of cur-
 rents of wind which act upon them, and upon their
 being more or less opposed by rivers, woods, wa-
 ter, houses, wells, or mountains.

   3.  It is destroyed, like its fraternal diseases, the
 common bilious and intermitting fevers, by means
 of long-continued and heavy rains, f When rains
 are heavy, but of short duration, they suspend it
 only  in warm  weather, but when  they are suc-
 ceeded by cold weather they destroy all the forms
 of bilious fever. The  malignant tertians, described
 by Dr. Cleghorn, always ceased about the autum-
 nal equinox ; for at  that time, says  the  Doctor,
 "Rain falls in such torrents as to tear up trees by
 the roots, carry away cattle, break down fences,
 and do considerable  mischief  to the gardens and
 vineyards; but, after a long and scorching sum-
 mer,  they are very acceptable  and beneficial, for
 they mitigate the excessive heat of the air, and give

   • Vol. i. page 84.

   j- Clarke on the Diseases of Long- Voyag-es to Hot Climates.
page 116. 
256   YELLOW FEVER  NOT CONTAGIOUS-.

a check to epidemical diseases.*" There are facts,
however, which would seem to contradict the as:
sertion that miasmata are suspended or destroyed
^y heavy  rains. Dr. Lind, in his Treatise upon
the Diseases of Hot Climates, mentions instances
in which they suddenly created  fevers.  It is pro-
bable, in these  cases the rains may have had that
effect, by disturbing the pellicle which time often
throws over the  surface  of stagnating pools of
water, and putrid matters on dry land.  I was led
to entertain this opinion by a fact mentioned in a
letter I received from  Dr. Davidson, dated No-
vember 4th, 1794.  " Being ordered (says  the
doctor) up to  Barbadoes,  last  November, upon
service, I  found that the troops had suffered con-
siderably by that  formidable  scourge, the yellow
fever. The season  had been remarkably dry. It
was observed, a rainy season contributed to make
the season healthier, excepting at  Constitution-
Hill, where the sixth regiment was stationed, and
where a heavy shower of rain seldom failed to
bring back the fever, after it had ceased for some
time. I found  the barrack, where this regiment
was, surrounded by a  pond of  brackish  water,
which being but imperfectly drained by the conti-
nuance of the drought, the surface was covered
' Diseases of Minorca, p. R. 
     YELLOW FEVER NOT CONTAGIOUS.   257

 with a green scum, which prevented the exhalation
 of  marshy putrefaction.  After a heavy shower of
 rain, this scum was broken, and  the  miasmata
 evolved, and acted with double force, according
 to the time of their secretion."

  4. It  is completely destroyed  by frost.   As
 neither rains  nor frosts act in sick rooms, nor af-
 fect the bodies of sick people, they must annihilate
 the disease by acting exclusively upon the atmo-
 sphere.  Very different in their nature are the small-
 pox and measles, which are propagated by specific
 contagion. They do not wait for the suns of July
 or August, nor do they require an impure atmo-
 sphere, or an exciting cause, to give them activity.
 They spread in the winter and spring, as well as
 in the  summer and autumnal months :  wet and
 dry weather do not arrest their progress, and frost
 (so fatal to the yellow fever,) by rendering it ne-
 cessary to exclude  cold air from sick rooms,  in-
 creases the force of their contagion, and thereby
 propagates them more certainly through a country.

  5. It is likewise  destroyed by intense heat, and
 high winds. The latter, we are sure, like heavy
 rains and frost, do not produce  that salutary  ef-
fect by acting upon  the  bodies, or in the rooms
of sick people.
    vol.  IV.         2  K 
258   YELLOW FEVER NOT CONTAGIOUS.

  It is worthy of notice, that while the activity of
miasmata is destroyed by cold, when it descends to
frost;  by heat, when it is so intense as to dry up
all the sources of putrid exhalation; by heavy rains,
when they are succeeded by cool weather; and by
high winds, when they are not succeeded by warm
weather;  they are rendered more active by cool,
warm,  and damp  weather,  and by light winds.
The influence of damp weather, in retaining and
propagating miasmata, will be readily admitted, by
recollecting how much more easily hounds track
their prey, and how much more extensively odours
of all kinds pervade the atmosphere, when it  is
charged with moisture, than in dry weather.

  It has  been asked, if putrid  matters  produce
malignant bilious fevers in our cities, why do they
not produce them in Lisbon, and in several other
of the  filthiest cities in the south of Europe ? To
this I answer, that filth and dirt are two distinct
things. The  streets of a city  may be very dirty,
that is covered with  mud composed of inoffensive
clay, sand, or lime, and, at the same time, be per-
fectly free from those filthy vegetable  and animal
matters  which by putrefaction, contaminate the
air. But  admitting  the  streets of those cities  to
abound with the fii' iiy matters that produce pesti-
lential diseases in other countries, it is possible the 
    YELLOW  FEVER  NOT  CONTAGIOUS.  259

exhalations from them may be so constant, and so
powerful, in their impressions upon the bodies of
the inhabitants, as to produce, from habit, no mor-
bid effects,  or but feeble diseases, as was re-
marked formerly, is the case in the natives and old
settlers in the  East and West-Indies. But if this
explanation be not satisfactory, it may be resolved
mto a partial absence of an inflammatory constitu-
tion of the air, which,  I shall say presently, must
concur in producing  pestilential diseases.  Such
deviations from uniformity in the works of Nature
are universal.   In the present instances, they no
more invalidate the general proposition of malignant
fevers  being every where of domestic origin, than
the exemption of Ireland from venomous reptiles,
proves they are not generated in other countries,
or that the pleurisy and rheumatism are not the
effects of the alternate action of cold and heat upon
the body, because hundreds, who have been ex-
posed to them under equal circumstances, have not
been affected  by those diseases.   There may be
other parts of the world in which putrid matters do
not produce bilious  malignant diseases from the
causes that  have been mentioned, or from some
unknown cause, but I am safe in repeating, there
never  was a  bilious  epidemic yellow fever that
could  not be traced to putrid exhalation. 
 260  YELLOW  FEVER  NOT  CONTAGIOUS.

   It has been asked, if the yellow fever be not im-
 ported, why does it make its first appearance among
 sailors,  and  near the  docks and wharves of our
 cities ?   I answer, this  is far from being true.
 The disease has as often appeared first at a distance
 from the shores  of  our cities as  near them, but,
 from its connection with a ship not being disco-
 vered, it has  been called by another name.  But
 where the first cases of it occur in sailors, I believe
 the seeds of  it are always previously received by
 them from our filthy docks  and wharves, or from
 the foul air which is discharged with the cargoes
 of the ships in which they have arrived, which seeds
 are readily excited in them by hard labour, or in-
 temperance so as to produce the disease.  That
this is the case, is further evident from its appear-
ing in them, only in those months in which the
bilious fever prevails in our  cities.

   It has been asked further, why  were not these
bilious malignant fevers more common before the
years 1791, 1792, and 1793?  To this I answer,
by repeating what was mentioned in another place*,
that our climate  has been gradually undergoing a
change. The summers are more alternated by hot
and cool, and  wet and dry weather, than in former
Account of the Climate of Pennsylvania, vol. i. 
     YELLOW FEVER  NOT CONTAGIOUS.  261

years.  The winters are likewise less uniformly
cold.  Grass is two or three weeks later in the
spring in  affording pasture to cattle  than it was
within the  memory of  many  thousand people.
Above all, the summer has encroached upon the
autumn, and hence the frequent accounts we read
in ournewspapers of trees blossoming, of full grown
strawberries and raspberries being gathered, and
of cherries and apples, 'of a considerable size, be-
ing seen in the months of October and Novem-
ber, in all the middle states.  By means of this
protraction of the heat of summer, more time is
given for the generation of putrid exhalations, and
possibly for their greater  concentration and acti-
vity in producing malignant bilious diseases.

  It has been asked again, why do not the putrid
matters which produce the yellow fever in some
years produce it every year ? This question might
be answered by asking two others. 1st. Why, if
the yellow fever be derived from the West-Indies,
was it not imported every  year before 1791, and
before the existence, or during the feeble and par-
tial operation of quarantine laws?  It is no answer
to this question to say, that a war is necessary to
generate the disease in  the islands, for it exists in
some of them at all  times, and the seasons of its 
262   YELLOW  FEVER NOT  CONTAGIOUS.

prevalence in our cities have,  in many instances,
had no connection with war, nor with the presence
of European armies in those and in other sickly
parts of the globe. During the seven years revo-
lutionary war it was unknown as an epidemic in the
United States, and yet sailors arrived in all our
cities daily from sickly islands,  in small and crowd-
ed vessels, and  sometimes covered with the rags
they  had worn in the yellow fever, in British hos-
pitals and jails.  I ask, 2dly, why does the dysen-
tery (which is certainly a domestic disease) rise up
in our  country,  and  spread  sickness and death
through whole families and villages, and disappear
from the  same places for  fifteen or twenty years
afterwards ?

   The want of uniformity in the exhalations of our
country in producing those diseases depends upon
their being combined with more or less  heat or
moisture;  upon the surface of the earth being com-
pletely dry, or completely  covered with water* j

   * In the Account of the Yellow Fever of 1793, the different
and opposite  effects of a dry and rainy season in producing bilious
fevers are mentioned from Dr. Dazilles.  In the autumn of 1804,
I have  elsewhere remarked,  after a summer in which there had
fallen an unusual quantity of rain, the bilious fevers appeared chief-
ly on the high grounds in Pennsylvania, which were in a state of
moisture, while scarcely a case of them appeared in the neighbour-
hood of marshes, or low grounds, owing to their being so com- 
     YELLOW FEVER  NOT CONTAGIOUS.   263

upon different currents of winds, or the total  ab-
sence of wind;  upon the disproportion of the tem-
perature of the air in the day and night; upon the
quantity of dew; upon the early or late appearance
of warm or cold weather; and upon the predispo-
sition of the body to disease, derived from the qua-
lity of the aliments of the season. A  similar want
of uniformity in die annual operations of our cli-
mate appears in the size and quality of grain,  fruits,
and vegetables of all kinds.

   But the greater violence and mortality of our bi-
lious fevers, than in former years, must be sought
for chiefly in an inflammatory or malignant consti-
tution of the atmosphere, the effects of which have
been no less obvious upon the small-pox, measles,
and the intercurrent fevers of Dr. Sydenham, than
they are upon the summer and  autumnal disease
that has been mentioned.

   This malignant state of the air has been noticed,
 under  different names,  by all  the writers upon
 epidemics, from  Hippocrates down to the  pre-
 sent day.  It was  ascribed, by the venerable fa-
 ther of physic, to a " divine  something "  in the

pletely covered with water, as to be incapable of generating, by
putrefaction, the miasmata which produce those forms of disease- 
 264  YELLOW  FEVER NOT CONTAGIOUS.

 atmosphere. Dr. Sydenham, whose works abound
 with  references to  it, supposes  it to be derived
 from  a mineral exhalation from the bowels of the
 earth.  From numerous other  testimonies  of a
 belief in the influence of the insensible qualities
 of the air, altering  the character of epidemics, I
 shall  select the. following:

  " It is  certain (says Dr.  Mosely) that diseases
 undergo changes and revolutions. Some continue
 for a  succession of  years, and vanish  when they
 have  exhausted the temporary,  but secret cause
 which produced them. Others have appeared and
 disappeared suddenly; and others have their peri-
 odical returns."

  The doctor ascribes a malignant  fever among
the dogs in Jamaica (improperly  called, from one
 of its  symptoms, hydrophobia,) to a change in the
atmosphere, in the year 1783. It  was said to have
been  imported, but experience,  he  says, proved
the fact to be otherwise.*

  " This latent malignity in the atmosphere (says'
 Baron Vansweiten)  is known only by its effects,
 and cannot easily be reduced to any known species
* Treatise upon Tropical Diseases, p. 43, 44. 
     YELLOW FEVER  NOT CONTAGIOUS.   265

of acrimony." In another place he says," It seems
certain that this unknown matter disposes all the
humours to a sudden and bad putrefaction.*"

   Dr. John Stedman has related many facts, in his
Essay upon Insalutary Constitutions of the Air,
which prove, that diseases  are influenced by  a
quality  in it, which, he says, " is productive of
corruption," but which has  hitherto eluded the
researches of physicians.t

   Mr. Lempriere, after mentioning the  unusual
mortality occasioned by the yellow fever, within
the last five or six years, in the island of Jamaica,
ascribes it wholly " to that particular constitution
of atmosphere upon which the existence of epide-
mics, at one period rather than another, depend4"

   Not only diseases bear testimony to a change in
 the atmosphere, but the whole vegetable and ani-
 mal creation concur  in it, proofs of which were
 mentioned in another place.  Three things are re-

   ♦ Commentaries on Boerhaave's Aphorisms, vol. v. p. 226, 230.
   } Page 135.
   * Vol. ii. p. 31.
VOL.  IV.
2 T 
 266  YELLOW FEVER NOT  CONTAGIOUS.

 markable with  respect to this inflammatory con-
 stitution of the  air.

   1. It is sometimes of a local nature, and influen-
 ces the  diseases of a city, or country, while ad-
joining cities and countries are exempted from it.

   2.  It much  oftener pervades a great extent of
country. This was evident in the years 1793 and
 1794, in the United  States.   During the same
years, the yellow fever prevailed in most of the
West-India  islands. Many of the epidemics men-
tioned by Dr.  Sims, in  the  first volume of the
Medical  Memoirs, affected, in the same years, the
most  remote parts of the continent of Europe.
Even the ocean partakes of a morbid constitution
of its atmosphere, and diseases at sea sympathise
in violence with those of the land, at an immense
distance from each other. This appears in a letter
from a surgeon, on board a British ship of war, to
Mr. Gooch, published in the third volume of his
Medical and Surgical Observations.

   3. The predisposing state of the atmosphere to
induce malignant diseases continues for several
years, under all  the circumstances of wet and dry,
and of hot and cold weather. This will  appear,
from  attending to the accounts which have been 
     YELLOW FEVER NOT CONTAGIOUS.   267

given of the weather, in all the years in which the
yellow fever  has prevailed in Philadelphia since
1792.* The remark is confirmed by all  the re-
cords of malignant epidemics.

  It is to no purpose to say, the presence of the
peculiar matter which constitutes an inflammatory
or malignant state of the air has not been detected
by any chemical agents. The same thing has been
justly said  of the exhalations which produce the
bilious intermitting, remitting,  and yellow fever.
No experiment that has yet been made, has disco-
vered  their presence in the air. The eudiometer
has  been used in vain for this purpose.  In one
experiment made by Dr.  Gattani, the air from a
marsh at the mouth of the river Tataline was found
to be apparently purer by two degrees than the air
on a neighbouring mountain, which was 2880 feet
higher than the sea. The inhabitants of the moun-
tain were notwithstanding healthy, while those who
lived in the neighbourhood of the  marsh were an-
nually afflicted with bilious and intermitting fevers, f
The contagions of the small-pox and measles con-
sist  of matter, and   yet who  has ever discovered
this matter in the air ? We infer the existence of
  * Vol. iii. and iv.
  \ Alibert's  Dissertation sur les  Fievres Pernicieuses et Attax-
iqucs  Intcrmittentes, p. 185. 
268  YFLLOW FEVER  NOT  CONTAGIOUS.

those remote causes of disease in the atmosphere
only from their effects. Of the existence of putrid
exhalations in it, there are other evidences besides
bilious  and yellow fevers. They are sometimes
the objects of the sense of smelling. We see them
in the pale or sallow complexions of the inhabitants
of the countries which generate them, and we ob-
serve them occasionally in the diseases of several
domestic animals. The most frequent of these dis-
eases are inflammation,  tubercles, and ulcers in
the liver. Dr. Cleghorn describes a diseased state
of that viscus in cattle, in an unhealthy part of the
island of Minorca. Dr. Grainger takes notice of
several morbid appearances in the livers of domes-
tic animals in Holland, in  the  year 1743.  But the
United States have furnished facts to illustrate the
truth of this remark. Mr. James Wardrobe, near
Richmond in Virginia, informed me, that in  Au-
gust, 1794, at  a time when  bilious  fevers  were
prevalent  in  his neighbourhood, his cattle  were
seized with a disease, which, I said formerly, is
known  by the name of  the  yellow  water,  and
which appears  to be a true yellow fever.   They
were attacked with a staggering. Their eyes were
muddy, or ferocious. A costiveness attended in
all cases. It killed in two days.  Fifty-two of his
cattle perished  by it. Upon opening the bodies of
several of them, he found the liver swelled and ul 
YELLOW FEVER NOT CONTAGIOUS.
269
cerated. The blood was  dissolved in the veins.
In the bladder of one of them, he found thirteen
pints of blood and water.  Similar appearances
were observed in the  livers of sheep in the neigh-
bourhood of Cadiz, in the year 1799, during the
prevalence of the yellow fever in that  city. They
were considered as such unequivocal  marks of an
unwholesome atmosphere among the ancients, that
they examined the livers of domestic  animals, in
order to determine on the healthy or unhealthy si-
tuation of the spot on which they wished to live.

   The advocates for the yellow fever being a spe-
 cific disease, and  propagated  only by contagion,
 will gain nothing by denying an inflammatory con-
 stitution of the  atmosphere (the cause of which is
 unknown to us) to be necessary to raise common
 remittents to that grade in which they become ma-
 lignant yellow fevers; for they  are obliged to have
 recourse to an unknown quality in the air, every
 time they are called upon to account for the dis-
 ease prevailing chiefly in our cities, and not spread-
  ing when it is carried from them into the country.
  The same reference to an occult quality in  the air
  is  had  by all the writers upon the plague, in ac-
  counting for its immediate  and total extinction,
  when it is carried into a foreign port. 
270   YELLOW FEVER  NOT CONTAGIOUS.

  Iii speaking of the influence of an inflammatory
constitution of the atmosphere in raising common
bilious, to malignant yellow fevers, I wish not to
have it supposed, that its concurrence is necessary
to produce sporadic cases of that, or any other
malignant  disease.  Strong exciting causes, com-
bined with highly volatilised and active miasmata,
I believe,  will  produce a  yellow  fever  at  any
time.  I  have seen one  or  more  such cases
almost every year since I settled in Philadelphia,
and  particularly when my  business was confined
chiefly to that class of  people who live near the
wharves, and in the suburbs, and who are  still the
first, and frequently the only victims of the yellow
lever.

  It has been said, exultingly, that the opinion of
the importation of the yellow fever is of great anti-
quity in our country, and that it has lately been ad-
mitted by the most respectable physicians in Britain
and France, and sanctioned by the laws of several of
the governments in Europe. Had antiquity, num-
bers, rank, and power been just arguments in fa-
vour of existing opinions, a thousand truths would
have perished  in their birth, which  have  diffused
light and happiness over every part of our globe.
In favour of the ancient and general belief of the im-
portation of the yellow fever, there are several obvi- 
    YELLOW  FEVER  NOT  CONTAGIOUS.  271

ous reasons. The idea is produced by a single act
of the mind.  It requires neither comparison nor
reasoning to adopt it, and therefore accords with
the natural indolence of man. It, moreover, flatters
his avarice and pride, by throwing the origin of a
mortal disease from his property and country. The
principle of thus referring the origin of the evils of
life from ourselves to others, is universal. It began
in paradise,  and has  ever since been an essential
feature in the character of our species. It has con-
stantly  led  individuals and nations to consider
loathsome and dangerous diseases as of foreign ex-
traction. The venereal disease and the leprosy have
no native country, if we believe all the  authors
who have written  upon them.  Prosper  Alpinus
derives the plagues of Cairo from  Syria, and the
physicians of Alexandria import them from Smyr-
na or Constantinople.  The yellow fever is said to
have been first brought from Siam (where there
are proofs it never  existed) to the West-Indies,
whence it is believed to be imported into the cities
of the United States.  From them, Frenchmen and
Spaniards say it has been  re-shipped, directly or
indirectly, to St. Domingo, Havanna, Malaga, Ca-
diz, and other parts of the world.  Weak  and ab-
surd  credulity!  the causes of the  ferocious and
mortal disease which we thus thrust from our re- 
272
YELLOW FEVER  NOT CONTAGIOUS.
 spective ports, like the sin of Cain,  " lie exclu-
 sively at our own doors."

   Lastly, it has been asserted, if we admit the yel-
 low fever to be an indigenous disease of our cities,
 we shall destroy their commerce, and  the value of
 property in them, by disseminating a belief, that
 the cause of our disease is fixed in our climate,
 and that it is out of the power of human means to
 remove it.  The reverse  of this  supposition is
 true.   If it be an imported disease,  our  case is
 without a remedy ;  for if, with all the advantages
 of quarantine  laws enforced  by severe  penalties,
 and executed  in the  most despotic  manner, the
 disease has existed annually, in most of our cities,
as an epidemic, or in sporadic cases, ever since the
year 1791, it will be in vain to expect, from simi-
lar measures, a future exemption  from it.  No-
thing but a belief in its domestic origin, and the
adoption of means founded upon that belief, can
restore the character of our climate, and save our
commercial cities from destruction.  Those means
are cheap,  practicable, and certain.   They have
succeeded, as I shall say presently, in other coun-
tries.
  From the account that has been given of the dif-
ferent ways in which this disease is communicated 
      YELLOW FEVER  NOT CONTAGIOUS.   273

 from one person to another, and from the facts
 which establish its propagation exclusively through
 the medium of the atmosphere, when it becomes
 epidemic, we may explain several things which be-
 long to its history, that are inexplicable upon the
 principle of its specific contagion.

   1. We learn the reason why, in some instances,
 the fever does not spread from a person who sickens
 or dies at sea, who had carried the seeds of it in his
 body from a sickly shore.  It is because no febrile
 miasmata exist in the bodies of the rest of the crew
 to be excited into action by any peculiar smell from
 the disease, or by fear or fatigue, and because no
 morbid  excretions are generated by the person
 who dies. The fever which prevailed on board the
 Nottingham East-Indiaman, in the year 1766, af-
 fected those forty men only, who had slept on shore
 on the island of Joanna twenty days before.  Had
 the whole crew been on shore, the disease would
 probably have affected them all and been ascribed
 to contagion generated by the first persons who were
 confined by it*.  A Danish ship, in the year 1768,

   • Observations on the Bilious Fevers usual  in voyages to the
East-Indies, by James Badinach, M. D. Medical Observations and
Inquiries, vol. iv.
VOL.
rv.
2 M 
274   YELLOW FEVER  NOT CONTAGIOUS.

sent twelve of her crew on shore for water.   They
were all seized after their return to the ship with a
malignant fever, and  died without infecting  any
person on board, and from the same causes which
preserved the crew of the Nottingham Indiaman*.

   2. We learn the reason why the disease some-
times spreads  through a whole ship's crew appa-
rently from one, or more affected persons.   It is
either because they have been  confined to small
and close births by bad weather, or because the
fever has been protracted  to a typhus or chronic
state, or because the bodies of the whole crew are
impregnated with morbid miasmata, and thus pre-
disposed to have the disease excited in the manner
that has been  mentioned.  In the last way it was
excited in most of the  crew of the United States
frigate, in the Delaware,  opposite to the city of
Philadelphia, in the year 1797. It appears to  have
spread, from a similar cause, from a few  sailors, on
board the Grenville  Indiaman, after touching at
Batavia.  The whole crew had been predisposed to
the  disease by inhaling the noxious  air of that
island.

   * Clarke on the Diseases of Long Voyages to Hot Climates,
p. 123, 125. 
     YELLOW. FEVER  NOT CONTAGIOUS.  275

  The same reasons account for the fever expiring
in a health}- village or country; also for its spread-
ing when carried to those towns which are seated
upon creeks or rivers, and in the neighbourhood of
marsh  exhalations.  It has uniformly perished in
the high and healthy village of Germantown, when
carried from Philadelphia, and has three  times
been supposed, erroneously, to be contagious near
the muddy shores of the creeks which flow through
Wilmington and  Chester.

  3. From the  facts that  have been mentioned,
we are taught to disbelieve the possibility of the
disease being imported in the  masts and sails of a
ship, by a contagious matter  secreted by a sailor
who may have sickened or died on board her, on a
passage from a West-India  island.  The  death in
most of the cases  supposed to be imported, in this
way, occurs within a few days after the ship leaves
her West-India port, or within a few days after her
arrival.  In the former case, the disease is derived
from West-India miasmata; in the latter, it is de-
rived, as was before remarked, either from the foul
air of the hold of the ship, or of the dock  or wharf
to which the ship is moored.

   Many other facts might be adduced to show the
yellow fever not to be an imported disease. It has 
276  YELLOW FEVER NOT CONTAGIOUS.

often prevailed among the Indians remote from the'
sea coast, and many hundred cases of it have oc-
curred, since the year 1793, on the inland waters
of the  United States, from the Hudson and Sus-
quehannah, to the rivers of the Mississippi.  In
South-America, Baron Humboldt assured me, it
is every where believed to be an endemic of that
country.

  These simple and connected facts, in which all
the physicians in the United States who derive the
yellow fever from domestic causes have agreed, will
receive fresh support by comparing them with the
different and  contrary opinions  of the physicians
who maintain its importation. Some of them have
asserted it to be a specific disease, and derived it
from the East and West-Indies ;  others derive it
from Beulam, on the coast of Africa; a third sect
have called it a ship fever; a fourth have ascribed
it to a mixture of imported contagion with the foul
air of our cities; while a fifth, who believed it to
be imported in 1793, have supposed it to be the off-
spring of a contagion  left  by the disease of that
year, revived by the heat of our summers, and dis-
seminated, ever since, through the different cities
of our country. The  number of these opinions,
clearly proves, that no one of them is tenable. 
     YELLOW FEVER NOT CONTAGIOUS.   277

   A belief in the non-contagiousness of the yellow
fever, or of its being incommunicable except in
one of the five ways that have been mentioned, is
calculated to produce the following good effects :

   1. It will deliver the states which have sea-ports
from four-fifths of the expenses of their present
quarantine laws and lazarettoes. A very small ap-
paratus, in laws and officers, would be sufficient to
prevent the landing of persons affected by the ship
fever in our cities, and the more dangerous prac-
tice of ships pouring streams of pestilential  air,
from their holds,  upon the citizens who  live near
our docks and wharves.

   2. It will deliver our merchants from the losses
incurred by the delays of their ships, by long and
unnecessary quarantines.  It will, moreover, tend
to procure the immediate admission of our ships
into foreign  ports, by removing that belief in the
contagious nature of the yellow fever, which origi-
nated in our country, and which has been spread,
by the public acts of  our legislatures and boards
of health, throughout the globe.

   3. It will deliver our  citizens from the danger
lo which they are exposed, by spending the time
of the quarantine, on board of vessels in the neigh- 
 278  YELLOW  FEVER  NOT  CONTAGIOUS.

 bourhood of the marshes, which form the shores
 of the rivers or coasts of quarantine roads. This
 danger is much increased, by idleness, and by the
 vexation which is excited, by sailors and passen-
 gers being detained, unnecessarily, fifteen or twen-
 ty days from their business and friends.

  4. It will lead us to a speedy removal of all the
 excretions, and a constant ventilation of the rooms
 of patients in the  yellow fever, and thereby to pre-
 vent the  accumulation, and further putrefaction of
 those exhalations which may reproduce it.

  5. It  is calculated to prevent the desertion of
patients in the yellow fever,  by their friends and
families, and to produce caution in them to prevent
the excitement of the disease in their own bodies,
by means of low diet and gentle physic, propor-
tioned to the impurity of the  air, and to the anxiety
and fatigue to which they are exposed in attend-
 ing the sick.

  6. It will put an end to the  cruel practice of qui-
 eting the groundless fears of a whole  neighbour-
 hood, by removing the poor who  are affected by
 the fever, from their houses,  and  conveying them,
half dead with disease  and terror,  to a solitary or
 crowded hospital, or of nailing a  yellow flag upon 
    YELLOW  FEVER NOT  CONTAGIOUS.  279

the doors of others, or of fixing a guard before
them, all of which have been practised in Phila-
delphia, not only without any good effect, but to
the great injury of the sick.

   7. By deriving the fever from our own climate
and atmosphere, we shall be able to foresee its ap-
proach in the increased violence of common dis-
eases, in the morbid state of vegetation, in  the
course of the winds, in the diseases of certain brute
animals, and in the increase of common, or the ap-
pearance of uncommon insects.

   8. A belief in the non-contagiousness of the yel-
low fever, and its general prevalence from putrid
animal  and vegetable matters only, is calculated to
lead us to drain or cover marshy grounds, and to re-
move from our cities all the sources of impure air,
whether they exist in the holds of ships, in docks,
gutters, and common sewers, or in privies, gar-
dens, yards, and cellars, more especially during the
existence of die signs of a malignant constitution
of the air.  A fever, the  same in its  causes, and
 similar to it in many of its symptoms, that  is, the
plague, has been extirpated, by extraordinary de-
grees of  cleanliness, from the cities of Holland,
Great-Britain, and several other parts of Europe, 
 280  YELLOW  FEVER  NOT CONTAGIOUS.

    The reader will  perceive, from these facts and
 reasonings,  that I have  relinquished the opinion
 published in my account of the yellow fever  in the
 years 1793,  1794, and 1797, respecting its conta-
 gious nature.  I was misled by Dr.  Lining,  and
 several West-India writers, in ascribing a  much
 greater extenttothe excreted matters in producing
 the disease, than I have since discovered to be cor-
 rect, and by Bianchi, Lind, Clark, and  Cleghorn,
 in admitting even the common bilious fever to be
 contagious.   The reader will perceive, likewise,
 that I have changed my opinion respecting one of
 the modes in which the plague is propagated.  I
 once believed, upon the authorities of travellers,
 physicians and schools of medicine, that it  was a
 highly contagious  disease.  I am now convinced
 this is not the case; but, from the greater number
 of people who are depressed and  debilitated by
 poverty and  famine, and who live in small and fil-
 thy huts* in the cities of the east, than in the  cities
 of the United States, I still believe it to be  more
 frequently communicated from an intercourse with
 sick people by the morbid excretions of the bo-
 dy, than tjie  yellow fever is in our country.   For
 the change of my opinion upon this subject, I  am
   * M. Savary,  in his Travels, says, two hundred  persons live
in Cairo within a compass that  •icconimcd;i-, .■?  Hut thirty persons
in Paris. 
    YELLOW  FEVER  NOT  CONTAGIOUS.  281

indebted to Dr. Caldwell'sand Mr. Webster's pub-
lications upon pestilential diseases,  and to the tra-
vels of Mariti and Sonnini into Syria, and Egypt.
I reject, of course, with the contagious quality of
the plague, the idea of its ever being imported in-
to any country so as to become epidemic, by means
of a knife-case, a piece of cotton, or a bale of silks,
with the same decision that I do all the improba-
ble and contradictory reports of an epidemic yel-
low fever being imported in a sailor's jacket, or in
the timbers and sails of a ship that  had been wash-
ed by the  salt water, and fanned  by the pure air
of the ocean, for several weeks, on her passage
from the West-Indies to the United States.

   In a  former inquiry*, I have taken notice of the
metastasis of error from one medical  subject to
another. It is to be lamented that  a similar trans?
lation of error has taken place from religion to
medicine.  In the close of the 10th century, Pope
 Gregory excommunicated Robert, king of France
 for marrying his fourth cousin. The king disre-
 garded the edict of the pope, and continued to live
 with his queen.  In consequence  of his doing so,
 all his  courtiers  and even his domestics deserted
 him, two of the latter only excepted. But such

                 * Upon the Gout.
VOL.  IV.
2 N 
282   YELLOW FEVER NOT CONTAGIOUS.

was the dread of these two faithful servants, lest
they should be infected with the sin of their royal
master, that they threw all the remains of his meals
to the dogs, and even purified the vessels in which
they had  been prepared.  Let the reader of this
fact, whoever  he  may be, pause and  reflect, that
if he has at any time deserted the sick chamber of
a relation, a friend,  or a neighbour in the plague,
or yellow fever, if he has destroyed the bedding
or clothes of a person who has had either of those
diseases,  or if he  has approved of a law, which
has imposed upon a  fellow citizen, returning in
health from a West-India voyage,  an offensive
fumigation, or a tedious quarantine at a sickly la-
zaretto, in order to destroy their supposed conta-
giousness, let  him be assured, whatever his ta-
lents and  acquirements may be, the  folly of the
domestics of the king of France cleaves to him in
another form,  and will inevitably consign his cha-
racter with theirs, to the pity and  ridicule of fu-
ture generations.

   It gives me pleasure to find the unpopular opi-
nion  of the non-contagiousness of the  plague,
which I have adopted, is not a new one. It was
held by the Faculty of Medicine in Paris, in the
beginning of the eighteenth century, and was ably
defended by Dr.  Pringle and Dr. Pye, about the 
    YELLOW  FEVER NOT  CONTAGIOUS.  283

year 1720 in two very sensible pamphlets which
are to be seen in the library of the Pennsylvania
hospital, written in opposition to Dr.  Mead's
learned and popular tract upon that subject, and
which at once terrified and misled  all the nations
of Europe.  The same opinion of the non-conta-
giousness of the  plague has since been maintained
by Dr. Stoll of Vienna, and Dr. Samoilowitz of
Russia, and several other eminent physicians. Dr.
Heberden has lately called in question the truth
of all the stories that are upon record of the plague
having  been imported  into England in  the last
century, and the researches of Sir Robert Wilson
of the British army, and of Assellini, and several
other French physicians, have  produced the most
satisfactory proofs of its not being  a contagious
disease  in its  native country.  A discovery more
pregnant with blessings to mankind has seldom
been made.  Pyramids of error, the works of suc-
cessive  ages and nations, must fall before it, and
rivers of tears must  be dried  up by  it.  It is im-
possible fully to appreciate the immense benefits
which await this mighty achievement of  our sci- *
ence upon  the affairs of the globe.  Large cities
6hall no longer  be the hot-beds of disease and
death.  Marshy grounds, teeming with pestilential
exhalations, shall become  the healthy abodes of
men. A powerful source of repulsion between na^ 
284  YELLOW FEVER NOT CONTAGIOUS.

tions shall be removed, and commerce shall shake
off the fetters which have been imposed upon it
by expensive and vexatious quarantines.  A red or
a yellow eye shall no longer be the  signal to de-
sert a friend or a brother to perish alone in a gar,
ret or a barn, nor to expel the  stranger from our
houses, to seek an asylum in a public hospital, to
avoid dying in the street. The number of diseases
shall be lessened, and the most mortal of them shall
be struck out of the list of human evils.  To  access
lerate these events,  it is incumbent upon the phy-
sicians of the United States  to  second  the disco-
veries of  their European brethren.  It becomes
them  constantly to recollect, that we are the cen-
tinels of the health and lives of our fellow-citizens,
and that there is a grade of benevolence in our
profession much higher than  that which  arises
from the cure of diseases. It consists in extermi-
nating their causes. 
       A DEFENCE






           OF






   BLOOD-LETTING,






          AS A






REMEDY FOR CERTAIN DISEASES. 
 
DEFENCE  OF BLOOD-LETTING.
     BLOOD-LETTING, as a remedy for fe-
vers, and certain other diseases, having lately been
the subject of much discussion, and many objec-
tions having been made to it, which appear to be
founded in error and fear, I have considered that a
defence of it, by removing those objections, might
fender it more  generally useful, in every part of
the United States.

   I shall  begin this subject  by remarking,  that
blood-letting is indicated, in fevers of great mor-
bid excitement,

   1. By the sudden suppression or diminution of
the natural discharges by the pores,  bowels, and
kidneys, whereby a plethora is induced in the sys-
tem. 
288    DEFENCE  OF BLOOD-LETTING.

  2. By the habits of the persons who  are  most
subject to such fevers.

  3. By the phenomena of fever.  I have attempted
to prove that the higher grades of fever depend
upon morbid  and  excessive  action in the blood-
vessels. It is connected of course, with  preterna-
tural sensibility in  their muscular  fibres.   The
blood is the most powerful irritant which acts up-
on them. By abstracting a part of it, we lessen the
principal cause of the fever.  The effect of blood-
letting is as immediate and  natural in removing
fever, as the  abstraction  of a particle of sand is,
to cure an inflammation of the eye, when it arises
from that cause.

  4. By the symptoms of the first stage of violent
fevers such as a sleepiness and an oppressed pulse,
or by delirium, with a throbbing pulse, and great
pains in every part of the body.

  5. By the rupture of  the blood-vessels, which
takes place from the quantity or impetus of the
blood  in fevers of great  morbid action.  Let no
one call bleeding a cruel or unnatural remedy. It
is one  of the specifics of nature; but in the use of
it she seldom affords much relief. She frequently
pours  the  stimulating and  oppressing  mass  of 
       DEFENCE  OF BLOOD-LETTING.     289

blood into the lungs and brain; and when she finds
an outlet for it through the nose,  it is discharged
either in such a deficient or  excessive  quantity,
as to I*  useless or hurtful.  By artificial blood-
letting, we can chuse the time and place of draw-
ing blood; and we may regulate  its quantity by
the degrees of action in the blood-vessels.  The
disposition of nature to cure violent morbid action
by depletion, is further manifested by her substi-
tuting, in the room of blood-letting, large, but less
safe and less  beneficial, evacuations from the  sto-
mach and bowels.

  6. By the  structure  and use of the spleen.  I
have called it in my lectures  upon  physiology, a
bason furnished by nature to hold redundant blood,
or to afford it a temporary asylum, when the blood-
vessels  are unduly excited.   Now the  spleen is
sometimes too small, and often  so overcharged
with blood, or so obstructed, that it cannot per-
form this office, in which case  blood-letting is indi-
cated.   The  great enlargement and engorgement
of the spleen  in fatal cases of bilious fevers where
sufficient bleeding has not been used, prove  the
truth of this  remark. The relief which bleeding
gives in chronic  and winter intermittents, is pro-
bably occasioned by the spleen being  so much
obstructed,  as not to receive the blood in a pa-
   vol. iv.         2  o 
290
DEFENCE
OF  BLOOD-LETTING.
roxysm of fever.  The lancet here  performs its
vicarious office.

  7. By the relief which is obtained in fevers of
violent action by remedies of  less efficacy (to be
mentioned hereafter), which act indirectly in re-
ducing the force of the sanguiferous  system.

  8. By the immense advantages which have at-
tended the use of blood-letting in violent fevers,
when used at a proper time, and in a quantity suit-
ed to the force of the disease.  I shall briefly enu-
merate these advantages.

  1. It frequently strangles a fever, when used in
its forming  state, and thereby saves much pain,
time, and expense to a patient.

  2. It imparts strength to the body,  by removing
the depression which is induced  by the remote
cause of the fever. It moreover obviates a dispo-
sition to faint, which arises from  this state of the
system.

  3. It reduces  the uncommon  frequency of the
pulse. The loss  of ten  ounces of blood reduced
Miss Sally Eyre's pulse from 176 strokes to 140,
in a few minutes, in the fever of the year 1794. 
       DEFENCE  OF BLOOD-LETTING.     291

Dr. Gordon  mentions many similar instances of
its reducing the frequency of the pulse, in the pu-
erperile fever.

  4. It renders the pulse more  frequent when it
is preternaturally slow.

  5. It checks the nausea and vomiting, which at-
tend the malignant state of fever. Of this I saw
many instances in  the year 1794. Dr. Poissonnier
Desperrieres confirms this remark, in his Account
of the  Fevers of St. Domingo; and adds further,
that  it prevents,  when  sufficiently copious, the
troublesome vomiting which often occurs on the
fifth day of the yellow fever.* It has  the same
effect in preventing the diarrhoea in the  measles.

  6. It renders  the bowels, when costive, more
easily moved by purging physic.

  7. It renders the action of mercury more speedy
and more certain, in exciting a salivation.

  8. It disposes the body to sweat spontaneously,
or renders diluting and diaphoretic medicines more
effectual for that purpose.
* Tvaite des Fievres dc l'lsle de St. Domingue, vol. ii. p. 76. 
292     DEFENCE  OF BLOOD-LETTING.

  9. It suddenly removes a dryness, and gradually
a blackness, from the tongue.  Of the former ef-
fect of bleeding, I saw two instances, and of the
latter, one, during the autumn of 1794.

   10. It removes or lessens  pain in every part of
the body, and more especially in the head.

   11. It removes or lessens the burning  heat of
the skin, and the burning heat in the stomach, so
common and so distressing in the yellow fever.

   12.  It  removes a constant  chilliness,  which
sometimes continues for several days, and which
will neither yield to cordial drinks, nor warm bed-
clothes.

   13. It checks such sweats as are profuse with-
out affording relief, and renders such as are partial
and moderate, universal and salutary.

   14. It sometimes checks a diarrhoea and tenes-
mus, after astringent medicines have been given
to no purpose.  This  has often been  observed in
the measles.

   15. It suddenly cures  the  intolerance of light
which  accompanies  many of the  inflammatory
states of fever. 
       DEFENCE  0* BLOOD-LETTING.     2Vo

  16.  l£  removes  coma.  Mr.  Henry  Clymer
was suddenly relieved of this alarming symptom,
in the fever of 1794, by the loss of twelve ounces
of blood.

  17. It induces sleep.  This effect of bleeding is
so uniform, that it obtained, in the year 1794, the
name of an  anodyne in  several  families.  Sleep
sometimes stole upon the patient while the blood
was flowing.

   18. It prevents effusions of serum and  blood.
Hemorrhages seldom occur, where bleeding has
been sufficiently copious.

   19. It belongs to this remedy to prevent the
 chronic diseases of cough, consumption, jaundice,
 abscess in the liver, and all the different states of
 dropsy which so often follow autumnal fevers.

   My amiable friend, Mrs. Lenox, furnished an
 exception to this remark, in the year 1794. After
 having been cured of the yellow fever by seven
 bleedings, she was affected, in consequence of tak-
 ing a ride, with a slight return of fever, accompanied
 by an acute  pain in  the head, and some of the
 symptoms of a dropsy of the brain. As her pulse
 was tense and quick, 1 advised repeated bleedings 
294    DEFENCE  OF BLOOD-LETTING.

to remove it.  This prescription, for reasons which
it is unnecessary to relate, was not followed at the
time,  or in the manner, in which it was recom-
mended.   The  pain, in the  mean  time, became
more  alarming. In this  situation, two physicians
were proposed by her friends to consult  with me.
I objected to them both, because I knew their prin-
ciples and modes of practice to be contrary to mine,
and that  they were proposed only with a view of
wresting the lancet from my hand.  From this de-
sire of avoiding a controversy with  my  brethren,
where conviction was impossible on either side, as
well as to obviate all cause of complaint by my pa-
tient's friends,  I offered to take my leave of her,
and to resign her wholly to the care of the  two gen-
tlemen who were proposed to attend her with me.
To this she objected in a decided  manner. But
that 1 might not be suspected of an undue reliance
upon  my own judgment, I proposed to  call upon
Dr. Griffitts or Dr. Physick to assist me  in my at-
tendance upon her. Both these physicians had re-
nounced  the  prejudices of the schools  in which
they had been educated, and had coniornied their
principles  and  practice to the present improving
state of medical science. My patient preierred Ur.
Griifitts,  who, in his  first visit to her, as soon as
he felt her pulse, proposed  more bleeding. The
operation was performed by the doctor himselt,and 
DEFENCE OF  BLOOD-LETTING.
295
repeated daily for five days  afterwards.  From an
apprehension that the disease was so fixed as to re-
quire some aid to blood-letting, we gave her calo-
mel in such large  doses as to excite a salivation.
By the use of these remedies she recovered slowly,
but so perfectly as to enjoy her usual health.

   20. Bleeding prevents the termination of malig-
nant, in the gangrenous state of fever.  This effect
of blood-letting will enable us to understand some
things in  the writings of Dr. Morton and Dr. Sy-
denham, which at first sight appear to be unintel-
ligible. Dr.  Morton describes what he calls a pu-
trid  fever, which was  epidemic and fatal, in the
year  1678. Dr. Sydenham, who practised in Lon-
don at the same time, takes no notice of this fever.
 The reason  of his silence is obvious. By copious
 bleeding, he prevented the fever of that year from
 running  on to the  gangrenous  state, while  Dr.
 Morton,  by neglecting to bleed, created  the sup-
 posed  putrid fevers which he has described.

    It has  been common to charge the friends of
 blood-letting with temerity in their practice. From
 this  view which has been given of it, it appears,
 that it would  be more  proper to ascribe timidity
 to them,  for they bleed to prevent the offensive and 
 296     DEFENCE OF  BLOOD-LETTING.

 distressing consequences of neglecting it, which
 have been mentioned.

   21. It cures, without permitting a fever to put
 on those alarming symptoms, which excite con-
 stant apprehensions of danger  and death,  in the
 minds of patients and their friends.  It is because
 these alarming symptoms are prevented, by bleed-
 ing, that patients are sometimes unwilling to be-
 lieve they had been  cured by it, of a malignant
 fever. Thus, the Syrian leper of old, viewed the
 water of Jordan  as too simple and too common to
 cure a  formidable  disease,  without  recollecting
that the remedies for the greatest evils of life are
all simple, and within the power of the greatest
part of mankind.

   22. It prepares the way for the successful use of
the bark and other tonic remedies, by destroying,
or so far weakening, a morbid action in the blood-
vessels,  that a  medicine of a moderate stimulus af-
terwards exceeds it in force, and thereby restores
equable  and healthy action to the system.

   23. Bleeding  prevents relapses.  It, moreover,
prevents that  predisposition  to the intermitting
and pleuritic  states of fever, which so frequently 
       DEFENCE OF  BLOOD-LETTING.     MS i

attack  persons in the  spring, who have had the
bilious remitting fever in the preceding autumn.

  But great and numerous as the advantages of
blood-letting are in fevers, there have been many
objections to it. I shall briefly enumerate, and en-
deavour to refute the errors upon this subject.

  Blood-letting has been forbidden by physicians,
by the following circumstances, and states of t^e
system.

  1. By warm weather.  Galen bled in a plague,
and Araeteus in a bilious fever, in a warm climate.
Dr. Sydenham and Dr. Hillary  inform us, that
the most  inflammatory fevers occur in, and  suc-
ceed  hot  weather.   Dr.  Cleghorn prescribed it
copiously in the warm months, in Minorca. Dr.
Mosely cured the yellow fever by this remedy, in
Jamaica. Dr.  Broadbelt, and Dr. Weston in the
same island, have lately adopted his successful prac-
tice. Dr.  Desportes speaks in the highest terms
of it in all  the inflammatory diseases of St. Do-
mingo. He complains of the neglect of it in the
rheumatism, in  consequence of which, he says,
the disease produces abscesses in the lungs. Dr.
Pugnet says the native physicians of upper Egypt
bleed  in all violent diseases.  They are govern-
    ,VOL.  iv.          2 p 
298     DEFENCE OF BLOOD-LETTING.

ed in their practice by the state of the pulse in the
temples, and when it does  not afford the indica-
tion sought for, they regulate the use of the lancet
by the greater or less  red colour of the body.  I
have  never, in any year of my practice, been re-
strained by the heat of summer in the use of the
lancet, where the pulse has indicated it to be ne-
cessary, and have always found the same advanta-
ges  from it,  as when  I have prescribed it in the
winter or spring months.

   In thus deciding in favour of bleeding in warm
weather, I do not  mean to defend its  use to the
same extent, as to diseases, or to quantity, in the
native and long settled inhabitants of hot climates,
as in persons who have recently migrated to them,
or who live in climates alternately hot and cold.

   2. Being born, and having lived in  a warm cli-
 mate.  This is  so far from being an objection to
 blood-letting in an inflammatory disease, that it
 renders it more necessary.  I think I have lost
 several West-India patients from the  influence of
 this error.

   3.  Great apparent weakness.   This, in  acute
 and violent fevers, is  always from a depressed state
 of the system. It resembles, in so  many partial- 
       DEFENCE OF  BLOOD-LETTING.    299

lars, that weakness which is the effect of the ab-
straction of stimulus, that it is no wonder they have
been confounded by physicians.  This  sameness
of symptoms from opposite states of the system is
taken notice of by Hippocrates.  He describes con-
vulsions, and  particularly a hiccup, as occurring
equally from repletion and inanition, which answer
to the terms of depression, and debility from action
and abstraction. The natural remedy for the for-
mer is depletion, and  no mode of depleting is so
effectual or safe as blood-letting.  But the great
objection to this remedy is, when a fever of great
morbid excitement affects persons of delicate con-
stitutions, and such as have long been subject to
debility of the chronic kind.   In this state of the
system there is the same morbid and preternatural
action in the blood-vessels, that there is in persons
of robust habits, and the same remedy is necessary
to subdue it in both cases. It is sometimes indi-
cated  in a larger quantity in weakly than in robust
people, by the plethora which is more easily induced
in their relaxed and yielding blood-vessels, and by
the greater facility with which  ruptures and effu-
sions  take place in their viscera. Thus it is more
necessary to  throw overboard  a large part of the
cargo of an old and leaky vessel in a storm, than of
a new and strong one. I know that vomits, purges,
sweats, and other evacuating remedies, are prefer- 
 300     DEFENCE  OF  BLOOD-LETTING.

 ed to bleeding in weakly constitutions, but I hope
 to show hereafter, that bleeding is not only more
 effectual, but more safe in such habits, than any-
 other depleting remedy.

   4. Infancy and childhood.  Bleeding is so far
 from being forbidden by these stages of life, that
 it is called for in a greater degree under equal cir-
 cumstances, than in the diseases of adults, by the
 peculiar excitability of the blood-vessels  in chil-
 dren, by the difficulty of reducing their systems by
 means of sweats, and in diseases of the lungs and
 trachea, by their inability under two years old, to
 remove the irritation excited by phlegm and mu-
 cus in those organs,  by expectoration.  Dr. Sy-
 denham bled children in the hooping cough, and
 in dentition.  I bled my eldest daughter when she
 was but six weeks old, for  convulsions brought
 on by an excessive dose of laudanum given to her
 by her nurse; and I bled one of my sons twice,
 before he was two months old, for an acute fever
which fell upon his  lungs and bowels.  In  both
 cases, life appeared to  be saved by this remedy.
I could mention many more instances in which it
has snatched from the grave, children under three
and four months old, by being used from three to
five times in the ordinary course of their acute
diseases. 
              DEFENCE  OF  BLOOD-LETTIFC.      301

         5. Old age. The increase of appetite in old peo-
       ple, their inability to use sufficient exercise, where-
       by their  blood-vessels become relaxed, plethoric,
       and excitable, and above all, the translation of the
       strength  of the muscles to the arteries, and of ple-
       thora to the veins, all indicate bleeding 10 be more
       necessary (in equal circumstances) in dd, than in
       middle aged people.  My practice in the  diseases
       of old people has long been regulated byjthe above-
       facts. I bled Mrs. Fullarton twice in a pleurisy in
       January, 1804, in the  84th year of hei age, and
       thereby  cured her disease.  I drew six ind thirty
       ounces of blood, in the year 1806, at three bleed-
       ings, from Mr. Israel Jacobs  in the 91s:  year of
       his age,  in a bilious fever, in  the course of a few
       days.  He was cured by this remedy, and  at this
       time, July 29th 1809, enjoys good lealth.   I am
       not the author of this bold practice.  Botallus left
       a testimony in favour of it nearly 200 years ago*,
       and it has since  been confirmed by \he experi-
       ence of  Hoffman, and many other physicians. An
       ignorance of, or inattention to this change in the
       state of  the blood-vessels, in persons in the de-
       cline of  life,  and die neglect of the only remedy

         * Magis esse adjuvandos senes, missione sanguinis ium morbus
       postulat, aut corpus eorum habitus malus est, quam idi hsc (quod
       absonum videbitur) juvenibus contingunt.
                        De Cur. per Sang, missionem, cap. 11. § 11.

 i
I 
302    DEFENCE  01  BLOOD-LETTING*

indicated  by it, is probably the reason why disea-
ses often  prove  fatal to them, which in early or
middle life cured themselves, or yielded to a sin-
gle dose of physic, or a few ounces of bark,

  6. The tme of menstruation. The uterus, during
this perioc, is in an inflamed state, and the whole
system is  plethoric and excitable, and of course
disposed to a violent degree of fever, from all the
causes which excite it.   Bleeding, therefore, is
more indicated, in fever of great morbid action, at
this time than at any other.  Formerly the natural
discharge  from the uterus was trusted to, to re-
move a fever contracted during the  time of men-
struation ; but what relief can the discharge of four
or five cunces of blood from the uterus afford, in
a fever which requires the loss of 50, or perhaps
of 100 ounces to cure it ?

   7. Pregiancy. The inflammation and distention
induced upon the uterus by pregnancy, and the in-
flammatory diathesis thereby imparted to the whole
system, render bleeding, in the acute states of fever,
more necessary  than at other times.  I have else-
where mentioned the advantages of bleeding preg-
nant wonen, in the yellow fever. I did not learn the
advantages of the practice in that disease.    I bled
Mrs. PhUer 11 times in seven days, in a pleurisy* 
DEFENCE OF  BLOOD-LETTING.
303
during her  pregnancy, in the month of March,
1783.  Mrs. Fiss was bled 13 times in the spring
of 1783 ; and  Mrs. Kirby 16 times in the same
condition, by my orders, in the winter of 1786, in
a similar disease. All these women recovered, and
the children they carried during their illness, are
at this time alive, and in good health.

   8. Fainting after  bleeding.   This symptom is
accidental in many people.   No inference can be
drawn from it against blood-letting.  It  often oc-
curs after the first and second bleedings in a fever,
but in no subsequent bleeding, though it be re-
peated a dozen times.  Of this I saw several in-
stances, in the yellow fever of 1794.  The pulse,
during the fainting, is often tense and full.

   9. Coldness of the extremities, and of the whole
 body.   This cold state of fever when   it  occurs
 early, yields more readily to  bleeding, than to the
 most cordial medicines.

    10. Sweats are supposed to forbid blood-letting,
 I have seen two instances of death, from leaving a
 paroxysm of malignant fever to terminate itself by
 sweating.  Dr. Sydenham has taught a contrary
 practice in the following case.  " While this con-
 stitution (says the doctor) prevailed, I was called 
304     DEFENCE  OF  BLOOD-LETTING.

to Dr. Morice,  who then practised in London.
He had this fever, attended with profuse sweats,
and numerous petechise. By the consent of some
other physicians, our joint friends, he was blood-
ed, and rose  from his bed, his body being first
wiped dry. He found immediate relief from the
use of a cooling diet and medicines, the danger-
ous symptoms soon going off; and by continuing
this method he recovered in a few days*." In the
same fever, the doctor adds further, " For though
one might expect great advantages in pursuing an
indication taken from what generally proves ser-
viceable (viz. sweating), yet I have found, by con-
stant  experience, that the patient  not  only finds
no relief, but, contrariwise, is more heated there-
by ;  so that frequently a delirium, petechias, and
other very  dangerous  symptoms   immediately
succeed such sweats\."

  Morgagni  describes a malignant fever which
prevailed  in Italy, in which the patients died in
profuse sweats, while their physicians were look-
ing for a crisis from them.  Bleeding would  pre*.
bably have checked these sweats, and cured the
fever.

  * Wallis's edition, vol. i. p. 210
^Vol. i.p. 208. 
       DEFENCE OF BLOOD-LETTING.     305

   11. Dissolved blood, and an absence of an in-
flammatory crust on its  crassamentum.   I shall
hereafter place dissolved blood at the highest point
of a scale, which is intended to mark the different
degrees of morbid action in the system.   I have
mentioned, in the Outlines of the Phenomena of
Fever, that it is the effect of a tendency to a palsy,
induced by the violent force of impression upon
the blood-vessels, rending and  tearing the blood
to pieces. This appearance of the blood in certain
states of fever, instead of  forbidding bleeding, is
the most vehement call of the system for it, Nor
is the absence of a crust on the crassamentum of
the blood, a proof of the absence of great morbid
diathesis, or a signal to lay aside  the  lancet. On
the contrary, I shall show hereafter, that there are
several appearances of the blood which indicate
more morbid action  in the blood-vessels than a
sizy or inflammatory crust.

   12. An undue proportion of serum to crassa-
mentum in the blood.  This predominance of wa-
ter in the blood has often checked sufficient blood-
letting.  But it should be constantly disregarded,
while it is attended with those states of pulse (to be
mentioned hereafter)  which require bleeding.
vol.  iv.          2 q. 
306    DEFENCE OF  BLOOD-LETTING.

   13.  The  presence of petechias on the skin.
These, I have elsewhere said, are the effects of the
gangrenous state of fever.  Dr. Sydenham and Dr.
de Haen have taught the safety and advantage of
bleeding, when these spots are accompanied by an
active pulse.   A boy of Mr.  John  Carrol owes
his recover)- from the small-pox  to the loss  of fifty
ounces of blood, by five bleedings, at a time when
nearly  every pock on his arms and legs had a  pur-
ple appearance.  Louis XIV  was bled five times
in the small-pox, when he was but thirteen years of
age, and thereby probably saved from the grave,
to the great honour and emolument of the single
physician who urged  it against the advice of all the
other physicians of the court.  Dr. Cleghorn men-
tions a  single case of the success of bleeding in the
petechial small-pox.   His want of equal success
afterwards, in similar cases, was probably occasi-
oned by his  bleeding too  sparingly, that  is, but
three or four times.

   Abscesses and sore breasts, which accompany
or succeed fever, are no  objections to blood-let-
ting, provided the pulse indicate the continuance
of inflammatory diathesis.  They depend frequent-
ly upon the same  state of the system as livid effu-
sions on the skin. 
        DEFENCE  OF BLOOD-LETTING.    307

   14. The long duration of fever.   Inflammatory
 diathesis is often protracted for many weeks, in the
 chronic state of fever. It, moreover, frequently re-
 vives after having disappeared, from an accidental
 irritant affecting some part of the body, particular-
 ly the lungs and brain.   I bled a  young man of
 James  Cameron, in the autumn  of  1794, four
 times between the 20th  and 30th days of a chro-
 nic fever, in consequence of a pain  in the side, ac-
 companied by a tense pulse, which  suddenly came
 on after the 20th day of his disease.   His blood
 was sizy. His pain and  tense pulse were subdued
 by the bleeding and  he  recovered.  I bled the late
 Dr.  Prowl twelve  times, in a fever which conti-
 nued thirty days, in the  autumn of the year 1800.
 I wish  these cases to be attended to  by young
 practitioners.   The pulmonary consumption  is
 often the effect of a chronic fever, terminating with
 fresh inflammatory symptoms,  by effusions in tb$
 the lungs. It may easily be prevented  by forget-
 ting the number of the days of our patient's fever,
 and  treating the pulmonary affection as if it were
 a recent complaint.

  15.Tremors and slight convulsions in the limbs.
Bark, wine, laudanum,  and musk  are  generally
prescribed to remove tiiese symptoms; but, to be 
308
DEFENCE
OF  BLOOD-LETTING.
effectual, they should, in most cases, be preceded
by the loss of a few ounces of blood.

  16. Bleeding is forbidden after the fifth or se-
venth day in a pleurisy. This prohibition was in-
troduced into medicine at a time when a fear was
entertained of arresting the progress of nature in
preparing and expelling morbific matter from the
system.  From repeated experience I  can assert,
that bleeding is safe in every stage of  pleurisy in
which there is  pain, and a tense  and oppressed
pulse; and that it has, when used for the first time
after the fifth and seventh days, saved many lives.
Bleeding has likewise  been  limited to a certain
number of ounces in several states of fever. Were
the force of the remote cause of a fever, its degrees
of violence, and the habits of the subject of it, al-
ways the same, this rule would be a proper one;
but, this not being the case, we must be governed
wholly by the condition of the system, manifested
chiefly by  the state of the pulse. To admit of co-
pious bleeding in one state of fever, and not in ano-
ther, under equal circumstances of morbid excite-
ment, is to prescribe for its  name, and to forget
the changes which climate, season,  and previous
habits create in all its different states. 
       DEFENCE OF  BLOOD-LETTING.     309

  17. The loss of a sufficient quantity of blood is
often prevented by patients being apparently worse,
after the first or second bleeding. This change for
the worse, shows itself in some one or more of the
following symptoms, viz. increase of heat, chills,
delirium,haemorrhages,convulsions,nausea,vomit-
ing, faintness, coma, great weakness, pain, a tense,
after a soft pulse, and a reduction of it in force
and  frequency.  They are  all occasioned  by the
system rising suddenly from a state of extreme de-
pression, in consequence of the abstraction of the
pressure of the blood  to a state of vigour and acti-
vity, so great, in some instances, as to reproduce
a depression below what existed in the system be-
fore  a vein was opened ; or it is occasioned by a
translation of morbid  action from one part of the
body to another.

   The chills which follow bleeding are the effects
of a change in the fever, from an uncommon to a
common state of malignity. They occur chiefly in
those  violent cases  of fever which come on with-
out a chilly fit.

   The haemorrhages produced by bleeding are
chiefly from the nose, hemorrhoidal vessels, or
uterus, and of  course arc, for the most part, safe. 
 310    DEFENCE OF BLOOD-LETTING.

   Uncommon weakness, succeeding blood-letting,
 is the effect of sudden depression induced upon the
 whole system,  by the cause before mentioned, or
 of a sudden  translation of the excitement of the
 muscles into the blood-vessels, or some other part
 of the body. These  symptoms, together with all
 the others which have been mentioned, are so far
 from forbidding, that they almost forcibly indicate
 a repetition of blood-letting.

   I  shall briefly illustrate, by the recital of three
 cases, the  good  effects of  bleeding, in removing
 pain, and the preternatural  slowness and weakness
 of the pulse, when produced  by the  use of  that
 remedy.

  In the month of June of 1795,1 visited Dr. Say
 in a malignant fever, attended with pleuritic symp-
 toms, in consultation with Dr. Physick.  An acute
 pain  in his head followed six successive bleedings.
 After a  seventh bleeding, he had no pain. His fe-
 ver soon afterwards left him.  In thus persevering
 in the use of a remedy, which,  for several  days,
appeared to do harm,  we were  guided  wholly by
the state of his pulse, which uniformly indicated,
by its force, the necessity of more bleeding. 
       DEFENCE  OF BLOOD-LETTING.     Oil

  In the autumn  of 1794,1 was sent for to visit
Samuel Bradford,  a young man of about 20 years
of age, son of Mr.  Thomas Bradford, who was ill
with the reigning  malignant epidemic. His pulse
was at 80. I drew about 12 ounces of blood from
him. Immediately after  his arm was  tied up, his
pulse fell to 60 strokes in a minute. I bled him a
second time, but more plentifully than before, and
thereby in a few minutes, brought his pulse back
again to 80 strokes irt a minute. A third bleeding
the next  day aided by the usual purging physic,
cured him in a few days.

   In the month of March, 1795, Dr. Physick re-
quested me to visit, with him, Mrs. Fries, the wife
of  Mr. John Fries, in a malignant fever.  He had
bled her four times.  After  the fourth bleeding,
her pulse suddenly fell, so as  scarcely to be percep-
tible.  I found her hands and feet cold, and her
 countenance ghastly, as if she were in the last mo-
 ments  of life. In this alarming situation,  I sug-
 gested nothing to Dr. Physick  but  to follow his
 judgment, for I knew that  he was master of that
 law of the animal economy which resolved  all her
 symptoms into an oppressed state of the system.
 The doctor decided in a moment in favour of more
 bleeding.  During the  flowing of the blood, the
 pulse rose.  At the end of  three, ten, and  seven- 
312     DEFENCE OF  BLOOD-LETTING.

teen hours it fell, and rose again by three succes-
sive bleedings, in all of which she lost about thirty
ounces of sizy blood.   So great was the  vigour
acquired by the pulse, a few days after the  parox-
ysms of  depression, which have been described,
were relieved, that it required seven more bleedings
to subdue it. I wish the history of these two cases
to be carefully attended to by the reader.  I have
been thus minute in the detail of them, chiefly be-
cause I have heard of practitioners who have lost
patients  by attempting  to raise a pulse  that  had
been depressed by bleeding, in a malignant fever,
by means of cordial medicines, instead of the re-
peated use of the lancet.  The practice  is strictly
rational;  for, in proportion as the blood-vessels are
weakened by pressure, the quantity of blood to be
moved should be proportioned to the diminution
of their strength.

   This depressed state of the pulse, whether in-
duced by a paroxysm of fever, or by blood-letting,
is sometimes  attended  with a strong pulsation of
the arteries in the bowels and head.

   I have mentioned, among the apparent bad ef-
fects of bleeding,  that it sometimes changes a soft
into a tense pulse. Of this I saw a remarkable in-
stance in Captain John Barry, in  the autumn of 
DEFENCE OF  BLOOD-LETTING.
313
1795. After the loss of 130 ounces of blood in a
malignant yellow fever, his pulse became so soft as
to indicate no more bleeding. In this situation he
remained for three days, but without mending as
rapidly as I expected from the state of his pulse.
On the fourth day he had a hemorrhage from his
bowels, from which he lost above a pint of blood.
His pulse now suddenly became tense, and conti-
nued so for two or three days.  I ascribed this
change in his pulse to the vessels of the bowels,
which had been oppressed by congestion, being so
much relieved by the hemorrhages, as to resume
an inflammatory action.  I have observed a similar
change to take place in the pulse, after a third bleed-
ing, in a case of hemorrhoidal fever, which came
under my notice in the  month of  January,  1803.
It is thus we see the blood-vessels, in a common
phlegmon, travel back  again, from a tendency to
mortification, to the  red colour and pain of com-
mon inflammation.

   From a review of the commotions excited in the
 system by bleeding, a reason may be given why
 the physicians, who do not bleed in the depressed
 state of the pulse, have so few patients in what they
 call malignant fevers, compared with those who use
 a contrary practice.  The disease, in  such  cases,
 being locked up, is not permitted to unfold its true
     vol. ivt         2 R 
314
DEFENCE
OF  BLOOD-LETTING.
character; and hence patients are said  to die ot
apoplexy, lethargy, cholera, dysentery, or nervous
fever, who, under a different treatment, would have
exhibited all  the marks of an ordinary malignant
fever.

   In obviating the objections to blood-letting from
its apparent evils, I have said nothing of the appa-
rent bad effects of other  remedies.  A nausea is
often rendered worse by an emetic, and pains in the
bowels are increased by a  purge.  But these reme-
dies notwithstanding maintain, and justly too, a
high character among physicians.

   19. Bleeding has been accused of bringing on a
nervous, or the  chronic state of  fever.  The use
of this remedy, in a degree so moderate as to obvi-
ate the putrid or gangrenous  state  of fever only,
may induce the chronic state of fever; for it is the
effect, in this case, of the remains of inflammatory
diathesis in the blood-vessels; but when blood is
drawn proportioned to the morbid action in the sys-
tem, it is impossible for a chronic fever to be pro-
duced by it. Even the excessive use of blood-let*
ting, however injurious it may be in other respects,
cannot produce a chronic fever, for it  destroys
morbid action altogether in the blood-vessels. 
DEFENCE OF  BLOOD-LETTING.
315
  20. Bleeding has been  charged with being a
weakening remedy. I grant that it is so, and in
this, its merit chiefly consists. The excessive mor-
bid action of the blood-vessels must be subdued
in part in a fever, before stimulating remedies can
be  given with  safety or advantage.  Now this is
usually attempted by depleting  medicines,  to be
mentioned hereafter, or it is left to time and nature,
all of which are frequently either deficient, or exces-
sive in their operations; whereas bleeding, by sud-
denly  reducing the morbid action of the blood-
vessels to a wished-for  point of debility, saves a
great and  unnecessary waste of excitability, and
thus prepares the  body  for the exhibition of such
cordial remedies as are proper to remove the de-
bility which predisposed to the  fever.

   21. It has been said  that bleeding renders the
 habitual use of it necessary to health and life. This
 objection to blood-letting is founded upon an igno-
 rance of the difference  between  the healthy, and
 morbid action of the blood-vessels. Where blood
 is drawn in health, such a relaxation is induced in
 the blood-vessels, as to favour the  formation of
 plethora, which may require habitual bleeding to
 remove it;  but where blood is drawn  only in the
 inflammatory  state of fever, the blood-vessels are
 reduced from a morbid degree of strength to that 
316     DEFENCE  OF BLOOD-LETTING.

which is natural, in which state no predisposition
to plethora is created, and no foundation laid  for
periodical blood-letting. But there are cases which
require  even this evil, to prevent a greater. Thus
we cure a strangulated hernia, when no  fever at-
tends, by  the most  profuse  bleeding.  The ple-
thora and predisposition to disease which follow it
are trifling, compared with preventing certain and
sudden  death.

  22. Bleeding has been accused of bringing on an
intermitting  fever.  This is so far from  being an
objection to it, that  it should be considered as a
new argument in its favour; for when it produces
that state of fever, it converts a latent, and perhaps
a dangerous disease, into one that is obvious to the
senses, and under the dominion of medicine.  Nor
is it an  objection to blood-letting, that, when used
in  an  inflammatory intermittent,  it  sometimes
changes it into a continual fever.  An instance of
the  good effects of this change occurred in the
Pennsylvania hospital, in an obstinate tertian, in
the year 1804. The continual fever, which follow-
ed the loss of blood, was cured in a few days, and
by the  most simple remedies.

   23. It has been said that bleeding, more especi-
ally where it is copious, predisposes to effusions of 
DEFENCE OF  BLOOD-LETTING.
317
serum in the lungs, chest, bowels, limbs, and brain.
In replying to this objection to bleeding, in my
public lectures, I have addressed my pupils in the
following language :  " Ask the poor patients who
come  panting to the door of our  hospital, with
swelled legs and hard bellies, every fall, whether
they have been too copiously bled, and they will
all tell you, that no lancet has come near their arms.
Ask the parents who still mourn the loss of children
who have died,  in our city, of the internal dropsy
of the brain, whether they were destroyed by ex-
cessive blood-letting ?  If the remembrance of the
acute sufferings which accompanied their sickness
and death will permit these parents to speak, they
will tell you, that every medicine, except bleeding,
had been tried to no purpose in their children's
diseases.  Go to those families in which I  have
practised for many  years, and inquire, whether
 there is a living or a dead instance of dropsy having
 followed, in any one of them, the use of my lancet?
 Let the undertakers and grave-diggers bear witness
 against me, if I have ever, in the course of my
 practice,  conveyed the body of a single  dropsical
 patient into their hands, by excessive blood-letting?
 No.   Dropsies, like abscesses  and gangrenous
 eruptions on the skin,  arise, in most cases, from
 the want of  sufficient  bleeding in inflammatory
 diseases. Debility, whether induced by action or 
 318     DEFENCE OF  BLOOD-LETTING.

abstraction, seldom disposes to effusion.  Who
ever heard of dropsy- succeeding famine ? And
how rarely do we  see it accompany the extreme
debility of old age ?"

   " If ever bleeding kills," says Botallus, either
directly or indirectly, through the instrumentality
of other diseases, "it is not from its excess, but
because it  is not drawn in a sufficient quantity, or
at a proper time.*" And, again, says this excel-
lent writer, " One hundred  thousand men perish
from the want of blood-letting, or from its being
used out of time, to one who perishes from too
much bleeding,  prescribed by a physician.t"

  It is remarkable, that the dread of producing a
dropsy by bleeding, is confined chiefly to its use in
malignant fevers ;  for the men who urge this ob-
jection to it„ do not hesitate to draw four or five
quarts of  blood in the cure of the pleurisy. The
habitual association of the lancet with this disease,
has often caused me to rejoice when I have heard
a patient complain of a pain in his side, in a malig-
nant fever.  It  insured to me his consent to the
frequent use of the lancet, and it protected me,

  ' Cap. viii. § 4.
f Cap. xxxvi- § 4. 
        DEFENCE  OF BLOOD-LETTING.    319

 when it was used unsuccessfully, from the cla-
 mours of the public, for few people censure copi-
 ous bleeding in a pleurisy.

   24. Against blood-letting it has been urged, that
 the Indians of our  country cure their inflammatory
 fevers without it.  To relieve myself from the dis-
 tressing obloquy to which my use of this remedy
 formerly exposed me, I have carefully sought for,
 and examined their remedies for those fevers, with
 a sincere desire to  adopt  them ;  but my inquiries
 have convinced me, that they are not only dispro-
 portioned to the habits and diseases of civilized life,
 but that they are far less successful than blood-let-
ting, in curing the inflammatory  fevers  which oc-
 cur among the Indians themselves.

  25. Evacuating  remedies of another  kind have
 been said to be more safe than bleeding, and equal-
ly effectual, in reducing the inflammatory state of
fever. I shall enumerate each of  these evacuating
remedies, and then  draw a comparative view of
their effects with blood-letting.  They  are,

  1. Vomits.
II.  Purges, 
320    DEFENCE OF BLOOD-LETTING.

   III. Sweats.

   IV. Salivation. And,

   V. Blisters.

   I. Vomits  have often been effectual in curing
fevers of a mild character.  They discharge offen-
sive and irritating matters from the stomach; they
lessen the fulness of the blood-vessels, by deter-
mining the serum of the blood through the pores;
and they equalize the excitement of the system, by
inviting its excessive degrees from the blood-ves-
sels to the stomach and muscles. But they are,

   1. Uncertain in their operation, from the torpor
induced by the fever upon the stomach.

   2. They are unsafe in many conditions of  the
system, as in pregnancy, and a disposition to apo-
plexy and  ruptures.  Life has sometimes been
destroyed by their inducing cramp, hemorrhage,
and inflammation in the stomach.

   3. They are not subject to the controul of a phy-
sician, often operating more, or less than was in-
tended by him, or indicated by the disease. 
       DEFENCE  OF BLOOD-LETTING.     321

  . 4. They are often ineffectual in mild, and always
so in fevers of great morbid action.

   II. Purges are useful in discharging acrid feces
and  bile from the  bowels in  fevers.  They act,
moreover, by  creating an artificial weak part, and
thus invite morbid excitement from the blood-ves-
sels to the bowels.  They likewise lessen the quan-
tity of blood,  by preventing fresh  accessions of
chyle being added to it; but like vomits they are,

   1. Uncertain  in their operation ;  and from the
same cause. Many ounces of salts and castor oil,
and whole drachms of calomel and jalap, have often
been given, without effect, to remove the costive-
ness which is connected with the malignant state of
fever.

   2. They are not subject to the  direction of  a
physician, with respect to  the time of their opera-
tion, or the quantity or quality of matter they are
intended to discharge from the bowels.

   3. They are unsafe in the advanced stage of fe-
vers. Dr. Physick informed me, that three patients
died in the water-closet, under  the operation of
purges, in St. George's hospital, during his attend-
ance upon it.  I have seen death, in several instan-
   VOL.  iv.          2 s 
322     OFFENCE OF  BLOOD-LETTINC.

ces, succeed a plentiful spontaneous stool in debili-
tated habits.

  III. Sweating was introduced into practice at a
time when morbific matter was supposed to be the
proximate cause of fever. It acts, not by expelling
any thing exclusively morbid from the blood, but
by abstracting a portion of its fluid parts, and thus
reducing the action of the blood-vessels.   This
mode of curing fever is still fashionable in genteel
life. It excites no fear, and offends no sense. The
sweating remedies  have been numerous, and fa-
shion has reigned as  much  among  them, as in
other things. Alexipharmic waters, and powders,
and all the train of sudorific medicines, have lately
yielded to the different preparations of antimony,
particularly to James's powder. I object to them all,

   1. Because they are uncertain; large and  re-
peated doses of them being often given to no pur-
pose,

   2. Because they are slow and. disagreeable,
 where they succeed in curing fever.

   3. Because, like vomits and purges, they are not
 under the direction of a physician, with respect to
 the quantity of fluid discharged by them. 
       DEFENCE  OF BLOOD-LETTING.    323

  4. Because they are sometimes, even when most
profuse, ineffectual in the cure of fever.

  5. The preparations of antimony, lately employ-
ed for the purpose of exciting sweats, are by no
means safe.  They sometimes  convulse the sys-
tem by a violent  puking.   Even the boasted
James's powder has done great mischief.   Dr.
Goldsmith and Mr. Howard, it is said, were de-
stroyed by it.

  None of these objections to sweating remedies
are  intended to dissuade from their use, when na-
ture shows a disposition to throw off a fever by the
pores of the skin ;  but, even then, they often re-
quire the aid of bleeding to render them effectual
for  that purpose.

  IV.  Mercury, the Sampson of the materia me-
dica, after having subdued the venereal disease, the
tetanus, and many other formidable diseases, has
lately added to its triumphs and  reputation, by
overcoming the inflammatory and malignant state
of fever.   I shall confine myself, in this place, to
its depleting operation, when it acts by exciting a
salivation.   From half a pound to two pounds of
fluid are discharged by it in a day.  The depletion
in this w;ty is gradual, whereby fainting is prevent- 
324     DEFENCE  OF BLOOD-LETTING.

ed.  By exciting and inflaming the glands of the
mouth and .throat, excitement and inflammation
are abstracted from more vital parts.  In morbid
congestion and excitement in the brain, a saliva-
tion is of eminent service, from the proximity of
the discharge to the part affected.  But I object to
it, as an exclusive vacuant in the cure of fever,

   1. Because it is sometimes impossible, by the
largest doses of mercury, to excite it, when the
exigences of the system render it most necessary.

   2. Because it is not so quick in its operation, as
to be proportioned to the rapid  progress of the
malignant state of fever.

   3. Because it is at all times a disagreeabtej and
frequently a painful remedy, more especially where
the teeth are decayed.

   4. Because it cannot be proportioned in its dura-
tion, or in the quantity of fluid discharged by it, to
the violence or changes in the fever.

   Dr. Chisholm relied, for the cure of the Beul-
lam fever at Grenada, chiefly upon this  evacua-
tion. I have mentioned the ratio of success which
attended  it. 
DEFENCE OF
BLOOD-LETTING.
325
  V. Blisters are useful  in depleting  from those
parts which are the seats of topical inflammation.
The relief obtained by them in this way more than
balances their stimulus upon the whole system.  I
need hardly say, that their effects in reducing the
morbid and excessive action of the blood-vessels
are  very feeble.  To depend upon them in cases of
great inflammatory action, is as unwise as it would
be to attempt to bale the water from a leaky  and
sinking ship by the hollow of the hand, instead of
discharging it by two or three pumps.

  VI. Abstemious diet has sometimes been pre-
scribed as a remedy for fever. It acts directly by
the abstraction of the stimulus of  food  from the
stomach, and indirectly by lessening the quantity
of blood.  It can bear no proportion, in its effects,
to  the  rapidity and violence of an inflammatory
fever.  In chronic fever, such as occurs in the pul-
monary consumption, it has often been tried to no
purpose. Long before it reduces the pulse, it often
induces such a relaxation of  the tone of the  sto-
mach and bowels as to accelerate death.  To de-
pend upon it therefore in the  cure  of inflammato-
ry fever, whether acute or chronic,  is like trusting
to the rays of the sun to exhale the water of an
overflowing tide, instead of draining it off imme-
diately, by digging a hole in the  ground.  But 
326     DEFENCE  OF BLOOD-LETTING.

there are cases in which the blood-vessels become
so insolated, that they refuse to yield their morbid
excitement to depletion  from  any outlet, except
from themselves. I attended a sailor, in the  Penn-
sylvania hospital, in 1799, who was affected with
deafness, attended with a full  and tense pulse.  I
prescribed for it, purging, blisters, and low diet,
but without anyT effect. Perceiving  no change in
his pulse, nor in his disease, from those remedies,
I ordered him to lose ten ounces of blood.  The
relief obtained by this evacuation induced me to
repeat it. By means of six bleedings he  was per-
fectly cured, without the aid of any other  remedy.

  Bleeding has great advantages over every mode
of depleting that has been mentioned.

  1. It abstracts one of the exciting causes, viz.
the stimulus of the blood from the seat of fever. I
have formerly illustrated this advantage of blood-
letting, by comparing it  to the abstraction of a
grain of sand from the eye to cure an opthalmia
The other depleting remedies are as indirect and
circuitous in their operation in curing fever, as vo-
mits and purges would be to  remove an inflam-
mation in the eye, while  the grain of sand conti-
nued to irritate it. 
       DEFENCE  OF  BLOOD-LETTING.     J*l

  2. Blood-letting is quick  in its operation, and
may be accommodated to the  rapidity of fever,
when it manifests itself in apoplexy,  palsy, and
syncope.

   3. It is under the command of a physician. He
may bleed when and where he  pleases, and may
suit the quantity of blood he  draws, exactly to the
condition of his patient's system.

   4. It may be performed with the least attendance
of nurses or friends.  This is of great importance
to the poor  at all times, and to the rich during the
prevalence of mortal epidemics.

    5. It disturbs the system much less than any of
 the other modes of depleting, and therefore is best
 accommodated to that state of the system, in which
 patients are in danger of fainting or  dying upon
 being moved.

    6. It is a more delicate depleting remedy than
 most of those which have been mentioned, parti-
 cularly vomits, purges, and a salivation.

    7. There is no immediate danger to life from its
  use.  Patients have sometimes died under the ope-
  ration of vomits and purges, but I never saw nor 
 328     DEFENCE OF  BLOOD-LETTING.

 heard an instance of a patient's  dying in a fainty
 fit, brought on by bleeding.

   8.  It is less weakening, when used to the extent
 that is necessary to cure, than the same degrees of
 vomiting, purging, and sweating.

   9.  Convalescence is more rapid and more  per-
 fect after bleeding, than  after the successful use of
 any of the other evacuating remedies.

   By making use of blood-letting in fevers, we are
 not precluded from the benefits of the other eva-
 cuating remedies.  Some  of them are rendered
 more certain and more  effectual by it, and there
 are cases of fever, in which the combined or  suc-
 cessive application of them all is barely sufficient
 to save life.

   To rely upon any one evacuating remedy, to the
 exclusion of the others, is like trusting to a  pair
 of oars in a sea voyage, instead of spreading every
 sail of a ship.

   I suspect the disputes about the eligibility of the
different remedies which have been mentioned, have
arisen from an ignorance that they all belong to one
 class, and that  they differ only in their force and 
        DEFENCE OF  BLOOD-LETTING.     329

 manner of operation.   Thus the physicians of the
 last century ascribed different virtues to salts of dif-.
 ferent names, which the chemists of the present day
 have taught us are exactly the same, and differ only
 in the manner of their being prepared.

   Having replied to  the principal objections to
 blood-letting, and stated its comparative  advan-
 tages  over other modes of depletion, I  proceed
 next to mention the circumstances which should
 regulate the use of it.   These are,

   I. The state of the pulse.

   The following  states of the pulse indicate the
 necessity of bleeding.

   1. A full, frequent and vigorous pulse without
 tension, such as occurs in the yellow  fever, gout
 and apoplexy. I have called it the synochus  fortis
 pulse.

   2. A full, frequent, and tense pulse, such as oc-
curs in the pulmonary, rheumatic, gouty, phrenitic,
and maniacal states of fever.
vol.  iv.          2 x 
330     DEFENCE OF BLOOD-LETTINg.

  3. A full, frequent, and jerking pulse, without
tension, such as frequently occurs in the vertiginous,
paralytic, apoplectic,  and hydropic states of fever.

  4. A small, frequent, but tense pulse, such as
occurs in the chronic, pulmonary, and rheumatic
states of fever.

  5. A tense and quick pulse, without much pre-
ternatural frequency.  This  state of the pulse is
common in the yellow fever.

  6. A slow but tense pulse, such as occurs in the
apoplectic, hydrocephalic, and malignant states of
fever,  in which its strokes are from 60 to 9, in a
minute.

   7.  An uncommonly  frequent pulse, without
much tension, beating from 120 to  170 or 180
strokes in a minute.  This state of  the pulse oc-
curs likewise in the malignant states of fever.

   8. A soft pulse, without much frequency or ful-
 ness.  I have met with this state of the pulse in
 affections of the brain, and in that state of pulmo-
 nary fever which is known by the name of pneu-
 monia notha. It  sometimes, I have remarked, be-
 comes tense after bleeding. 
DEFENCE
OF  BLOOD-LETTING.
331
   9. An intermitting pulse.

   10. A depressed pulse.

   11. An imperceptible pulse.  The slow, inter-
mitting, depressed, and imperceptible states of the
pulse are supposed exclusively to indicate conges-
tion in the brain.  But they are all, I believe, occa-
sioned likewise by great excess of stimulus acting
upon the heart and arteries. A pulse more tense
in one arm than in the other, I have generally found
to attend a morbid state of the  brain. Much yet
remains to be known of the signs  of a disease in the
brain, by the  states of the pulse;  hence Mr. Hun-
ter has justly remarked, that " In inflammation of
the brain, the pulse varies more than in inflamma-
tions of any other part; and perhaps we are led to
judge of inflammation there,.more from other symp-
toms than the pulse.*"

   The slow,  uncommonly frequent, intermitting,
and imperceptible states of the pulse, which require
bleeding, may  be distinguished from the same
states of the pulse, which arise from an exhausted
state of the system,  and that forbid bleeding, by
the following marks:
* Treatise on Inflammation, chap. iii. 9. 
 332     DEFENCE OF  BLOOD-LETTING.

   1. They occur in the beginning of a fever.

   2. They occur in the paroxysms of fevers which
 have remissions and exacerbations.

   3. They sometimes occur after blood-letting,
 from causes formerly  mentioned.

   4. They sometimes occur, and continue during
 the whole course of an  inflammation of the stomach
 and bowels. And,

   5. They  occur in  relapses, after  the crisis of
 a fever.

   The other stages of the pulse indicate bleeding
in every stage of fever, and in every condition of
the system.  I have taken notice, in another place,
of the  circumstances  which  render it proper in
the advanced stage of chronic fever.

   If all the states of pulse which have been  enu-
merated indicate bleeding, it must be an affecting
consideration to reflect, how many lives have  been
lost, by physicians limiting the  use of the lancet
only to the tense or full pulse! 
       DEFENCE OF  BLOOD-LETTING.     333

   I wish it comported with the proposed limits of
this essay to illustrate and establish, by the recital
of cases, the truth of these remarks upon the indi-
cations of bleeding from the pulse. It communi-
cates much more knowledge of the  state of the
system than any other sign of disease.   Its fre-
quency (unconnected with its other states,) being
under the influence of diet,  motion, and the pas-
sions of the mind, is of the least consequence. In
counting the number of its strokes, we are apt to
be diverted from attending to its irregularity and
force;  and in  these, it should always be remem-
bered, fever ohiefly consists. The knowledge ac-
quired by attending to these states of the pulse is
so definite and useful, and the circumstances which
seduce from a due  attention to them  are so erro-
neous  in their indications, that I have sometimes
wished the Chinese custom of prescribing,  from
feeling the pulse only, without seeing or convers-
ing with the patient, were imposed upon all phy-
sicians.

   To render the knowledge of the indications of
blood-letting, from die state  of the pulse,  as defi-
nite  and  correct as possible, I shall add,  for the
benefit of young practitioners, the following direc-
tions for feeling it. 
334     DEFENCE  OF  BLOOD-LETTING.

   1. Let the arm be placed in a situation in which
all the muscles which move it shall be completely
relaxed; and let it, at the same time, be free from
the pressure of the  body upon it.

   2. Feel the pulse, in all obscure or difficult cases,
in both arms.

   3. Apply all the fingers of one hand, when prac-
ticable, to  the pulse.   For this purpose,  it  will
be most  convenient to feel the pulse of the right
hand  with your left, and  of the  left hand with
your  right.

   4. Do not decide upon blood-letting, in difficult
cases, until yrou have felt the pulse for some time.
The Chinese physicians never prescribe until they
have counted 49 strokes.

   5. Feel the pulse at the intervals of four or five
minutes, when you suspect that its force has been
varied by any circumstance not connected with the
disease, such as emotions of the mind, exercise,
eating, drinking, and the like.

   6. Feel the pulsations of the arteries in the tem-
ples and  in the neck, when the pulse is depressed
:r imperceptible in the wrists. 
       DEFENCE OF  BLOOD-LETTING.    335

  7. Request silence  in a sick  room, and close
your eyes, in feeling a pulse  in difficult cases. By
so doing, you will concentrate the sensations of
your ears and eyes, in your  fingers.

   In judging of the states of the pulse which have
been  enumerated, it will be necessary  always to
remember the natural difference, in its frequency
and force, in old people and children; also in the
morning and evening, and in the sleeping and
waking states of the system.

   Much yet remains to be known upon this sub-
ject.  I have mentioned the different states of the
pulse which call for bleeding, but it  is more diffi-
cult to know when to prescribe it, when the pulse
imparts no  signs of disease. In general it may be
remarked when the disease is recent, the part af-
fected important to life, and  incapable of sustaining
 violent morbid action long,  without danger of dis-
 organization, where pain is great, and respiration
 difficult, where there is redness in  the face, and
 a watery, lively, or suffused eye, the pulse may be
 disregarded in  the use of  the lancet.  To these
 signs, Dr.  Sydenham adds, in the  history of the
 case of a lady in whom the pulse gave no indica-
 tion of the force of the disease, " a red colour in
 the cheeks; drops of blood issuing from the nose, 
 336     DEFENCE OF  BLOOD'LTETING.

 no diminution of the heat of the body after bleed-
 ing and the existence of an inflammatory  consti-
 tution of the atmosphere.*"

   But to return.

   II. Regard should be had to the character of the
 reigning epidemic, in deciding upon blood-letting.
 If the prevailing fever be of a highly inflammatory
 nature, bleeding may be used with more safety, in
 cases where the indications of it from the pulse are
 somewhat doubtful. The character of a previous
 epidemic should likewise direct the use of the lan-
 cet.  The  pestilential  fever which followed the
plague in London, in 1665, Dr. Sydenham says,
yielded only to blood-letting. It is equally neces-
sary in all the febrile diseases which succeed ma-
lignant fevers.

  III. Regard should be had to the season of the
year, and to the state of the weather.  It  is more
copiously indicated in the winter and spring, than
in summer and autumn in middle  latitudes, and
Dr. Hillary and Dr. Huxham both say, it is more
necessary in dry, than in moist weather.
* Waltis's edition, vol. i. p. 134. 
        DEFENCE OF  BLOOD-LETTING.     337

   The words of Dr. Huxham upon this  subject
are as  follow,  " Diseases even of the same species
(as I have constantly observed) require much larger
bleeding, and the sick bear it much better in dry
weather, when the barometer stands  high,  than
when a hot moist air almost  destroys  the tone of
the vessels.  This is constantly observable even in
diseases of the breast.*"  The advantages of co-
pious bleeding in the yellow fever of 1793, when
the weather was uncommonly dry,  confirms the
truth of the remarks of those excellent practical
physicians.

   IV. The constitution of a patient, and more es-
pecially his habits with respect to blood-letting,
should be taken into consideration, in prescribing
it. If he be plethoric, and accustomed to bleeding
in former indispositions, it will be more necessary,
than in opposite  states and habits of the system.
Nature will expect it,

   V. The corpulency of a patient should regulate
the use of the lancet.  A butcher of great observa-
tion informed me, that a fat ox did not yield more
than from one half, to  one third of the quantity of

   * Observations upon the air, and Epidemic  Diseases, preface
page xxviii.
    VOL.  IV.          2  u 
338     DEFENCE OF  BLOOD-LETTING.

blood of a lean one, of the same size of bone, and it
is well known that the loss of a small quantity of
blood, after cutting off the head of a fowl, is always
a sign of its being fit for the table. The pressure
of fat upon the blood-vessels produces the same
effects in the human species that it does in those
animals; of course, less blood should be drawn
from fat, than from lean people, under equal cir-
cumstances of disease.

  VI. As persons have more or less blood in their
vessels, according to their size, less blood should
be drawn, under equal circumstances, from small
than large people.

  VII. Regard should be had to the age of adults
in prescribing bleeding. In persons between fifty
and sixty years of age, for reasons formerly men-
tioned, more blood may be drawn than in middle
life,  in similar diseases. In persons beyond 70, it
will  be necessary to regulate the quantity  to be
drawn by other signs than the pulse, or the appear-
ances of the blood, the former being generally full,
and  sometimes tense, and the latter often putting
on the sign of the second grade of morbid action
formerly described. 
        DEFENCE  OF  BLOOD-LETTING.     339

   VIII. Regard should be had to the country or
place from which persons affected with fevers have
arrived, in prescribing the loss of blood. Fevers,
in America, are more inflammatory than fevers, in
persons of equal rank, in Great-Britain. A French
physician once said,  it was safer to draw a hogs-
head of wine  from a Frenchman's  veins, than a
quarter of a hundred pounds of beef from an Eng-
lishman's, meaning to convey an idea of the differ-
ence in the grades of morbid or inflammatory action
in the  diseases of  the  inhabitants of France  and
England, and of the  difference in the quantity of
blood  proper to be drawn in each of  them.  A
similar difference  exists between the grades of
fever in Great-Britain and America. From a want
of attention to this  circumstance, I saw a common
pleurisy end in an abscess of the  lungs, in a sea
captain, in the city of  London,  in the year 1769,
who was attended  by a physician of the  first repu-
tation in England.  He was  bled but once.   His
pulse and American constitution called for the loss
of 50 or 60 ounces  of blood.  My former pupil Dr.
Fisher in  a letter from the university of Edinburg
dated in the winter of 1795, informed me, that he
had  cured several of his American fellow students
of fevers, contrary to the general prejudices and
practice in that city, by early bleeding,  in as easy
and summary  a way as he had been  accustomed 
 340     DEFENCE  OF  BLOOD-LETTING.

to see them cured in Philadelphia by the same re-
medy. It is not less true, and wvbrthy of the atten-
tion of an American physician, that the diseases
of new comers into the United States from Great-
Britain, Ireland and other European countries, re-
quire more  bleeding  than the natives or old set-
tlers, under equal circumstances of disease. This
fact struck the late Dr. Reynolds in a very forcible
manner, in his extensive practice among his newly
arrived fellow citizens from Ireland. The remark
is founded in reason, and it is to be wished, those
European physicians  who charge their  patients
when they are about  to  emigrate to  America,
" never to be bled," would consider how much
the change which the  stimulating  impressions of
a new climate, diet, company, and often of employ-
ments, make upon the system, is opposed to their
advice.

  IX. Regard should be had to the structure and
situation of the parts diseased with febrile action.
The brain, from its importance to all the functions
of  life, the rectum, the bladder, and  the trachea,
when inflamed, and the intestines, when strangu-
lated, from their  being removed so much out of
the influence of the great circulation, all require
more copious bleeding than the same degrees of 
       DEFENCE  OF  BLOOD-LETTING.    341

disease in the lungs, and some other parts of the
body.

   X. After blood-letting has been performed, the
appearances of the blood should be attended to, in
order to judge of  the  propriety of repeating it I
shall  briefly describe  these  appearances, and  ar-
range them  in the order in which they indicate the
different degrees of inflammatory diathesis, begin-
ning with the highest.

   1. Dissolved blood. It occurs in the malignant
states of fever. I have seen it several times in the
pleurisy, and  have once heard of it in a case of
gout. I have ascribed this decomposition of the
blood to such a violent, or feeble degree of action
in the blood-vessels as to dispose them to a paraly-
tic state. It  is generally considered as a signal to lay
aside the lancet. If it occur in theirs* stage of a fe-
ver, it indicates a very opposite practice. By repeat-
ed bleedings,the vessels recover their natural action,
and the blood becomes resuscitated, or reduced to
its original  texture.  Of this I have had frequent
experience, since the year 1793.  It required three
successive  bleedings to restore the blood  from a
dissolved, to a coagulable state, in Mr. Benton. It
afterwards  became* very sizy.   If this  dissolved
blood appear towards the close ot a malignant fever, 
 342     DEFENCE OF BLOOD-LETTING.

 no other benefit than the protraction of life for a day
 or two, or an  easy death, can be  expected from
 repeating the bleeding, even though it be indicated
 by a tense pulse;  for the viscera are generally so
 much choaked by the continuance of violent action
 in the  blood-vessels, that they are seldom able to
 discharge the blood which distends them,  into the
 cavity  in the vessels, which is created  by the ab-
 straction of blood from a vein.   There  is some
 variety in the appearance of this state of the blood,
 which  indicates more or less violent pressure upon
 the blood-vessels.  It threatens most danger to life
 when it resembles molasses in its consistence. The
 danger is less wlien the part which is dissolved oc-
 cupies the bottom of the bowl, and when its sur-
face is  covered with a sizy pellicle or coat. 1 have
said the blood  is sometimes dissolved  from a  too
feeble  action of the blood-vessels upon it.  We
observe this in the scurvy and in the lowest grade
of typhus fever. It is restored in these cases to its
natural  consistence by means of stimulating re-
medies.   To this account  of the morbid state
of the  blood,  it may  not be improper  to add,
that Dr. Stoll found it coagulated in the  veins of
an epileptic patient, and that Morgagni mentions
the case of a girl in whom the blood was cold.
 She had at the same time no sense of coldness in 
       DEFENCE OF  BLOOD-LETTING.     343

any part of her body.  By means of stimulants, she
was recovered.

   Does not the restoration of  the blood from its
disorganized state, by means of bleeding, suggest
an idea of a similar change being practicable in the
solids, when they are disorganized  by disease ?
And are we not led hereby to an animating view of
the extent and  power of medicine ?

   2. Blood of a scarlet colour,  without any separa-
tion into crassamentum or  serum, indicates  a se-
cond degree of morbid action. It occurs likewise
in the malignant state of fever. It is called impro-
perly dense blood. It occurs in old people.

   3. Blood in which part of the crassamentum is
dissolved in the serum, forming a resemblance to
what is called the lotura carnium, or  the washings
of flesh in water.

   4. Serum of a clear red, or green colour. The
violence and danger of fevers  in which the serum
of the blood assumes the latter colour, is  taken
notice of by Dr. Huxham.*
* On Air and Epidemics, vol. i. p. 129. 
344     DEFENCE OF  BL0OD.-LETTINC.

  5. Crassamentum  sinking to the bottom of a
bowl in yellow serum.

  6. Crassamentum floating in  serum, which is at
first  turbid, but which afterwards becomes yellow
and transparent, by depositing certain red and fiery
particles of the blood in the bottom of the bowl.

  7. Sizy blood,  or  blood covered with  a buffy
coat. The more the crassamentum appears in the
form of a cup, the more inflammatory action is said
to be indicated by it. This appearance of the blood
occurs in all the common  states of inflammatory-
fever. It occurs too in the mild state of malignant
fevers, and in  the close of such of them  as have
been violent.   It  is  not always confined to the
common inflammatory state of the pulse, for I have
observed it  occasionally in most of the different
states of the pulse which have been described. The
appearance of this buffy coat on the blood in the
yellow fever is always favourable.   It shows the
disease to be tending from an uncommon to a com-
mon  degree of inflammatory diathesis. It has been
remarked, that blood which resembles claret in its
colour,  while flowing, generally puts on, when it
cools, a sizy appearance. Blood which assumes a
paler red colour near the edges of the bowl, than 
DEFENCE
OF  BLOOD-LETTING.
345
 that which is in the middle of the bowl into which
 it is flowing, is likewise generally sizy.

   It would seem, from these facts, that the power
 of coagulation in the blood was lessened in an ex-
 act ratio to the increase of action upon the blood-
 vessels, and that it was increased in proportion to
 the diminution of that action, to that degree of it
 which constitutes what I have called common in-
 flammatory action.

  Here, as upon a  former occasion, we may say
 with concern, if bleeding be indicated by all the
appearances of the blood which have been enumer-
ated, how many lives have been lost by physicians
limiting the use of the lancet to those cases only,
where the blood discovered an inflammatory crust!

  It would be a digression from the subject now
under consideration, or I would add in this place
 some remarks  upon what is called the vitality of
the blood. I shall only mention, that I have for
many years  taught  in  my physiological lectures
that the  blood in the healthy state appears to be
like the bones  and tendons, animalized only, and
that like those  parts of  the body, it becomes ani-
mated by the stimulus of disease. The more sizy
it becomes, the more it partakes of an animated
    VOL.  iv.          2 v 
346     DEFENCE OF  BLOOD-LETTINC.

quality. Its cupped appearance indicates its having
assumed a muscular nature.  It is in this animated
state of the fibrin  only, that it forms those mem-
branes which  succeed inflammation  in different
parts of the body.

  The remarks which have been delivered upon
the relative  signs  of inflammatory action  in the
blood-vessels, should be admitted with a recollec-
tion that they are all liable to be varied by a mo-
derate,  or  violent exacerbation of fever, by the
size of the stream of blood, and by the heat, cold-
ness, and  form of the cup into which the blood
flows.  Even blood drawn,  under exactly equal
circumstances,  from both arms, exhibited, in a
case of pleurisy communicated to me by Dr. Mit-
chell, of Kentucky,  very different appearances.
That which was taken  from one arm was sizy,
while that which was taken from the other was of
a scarlet colour. I have known a similar difference
to occur in the appearances of the blood in preg-
nancy. That which was taken from the arm of the
right side, was much more sizy than  that which
was taken from the left.  Blood which is drawn
from a vein in the arm, puts on, likewise, appear-
ances very different from that which is discharged
from the bowels, in a dysentery. These facts were
alluded to in the Outlines of the Phenomena of 
       DEFENCE OF  BLOOD-LETTING.     347

Fever*, in order to prove that unequal excitement
takes place, not only in the different systems of
the body, but in the same system, particularly in
the blood-vessels. They likewise show us the ne-
cessity of attending to the state of the pulse in both
arms, as  well as in other parts of the body, in pre-
scribing blood-letting.  When time, and more at-
tention to that index of the state of the system in
fevers, shall have brought to light all the know-
ledge that  the pulse is capable of imparting, the
appearances of the blood, in fevers, will be regard-
ed as little as the appearances of the urine.

  XI.  Blood-letting should  always be  copious
where there is danger from sudden and great con-
gestion or inflammation, in vital parts. This dan-
ger is indicated most commonly by pain; but there
may be congestion in the lungs, liver, bowels, and
even in the head, without pain.  In  these  cases,
the state of the pulse should always govern the use
of the lancet.  An advantage will arise in  these
cases from drawing blood at the  same time from
both arms. An alarm, Mr. Hunter says, is thereby
excited in the  arteries, which disposes them to
contract  more suddenly, and thus  to relieve  them-
selves of redundant blood.  Eight ounces drawn
» Vol. iii. 
348    DEFENCE  OF  BLOOD-LETTING.

in two minutes in the cases  under consideration,
give more relief than a much larger quantity in a
longer time.  The good effects of a large stream
of blood.in violent inflammatory diseases did not
escape Dr. Sydenham.  The reverse of this prac-
tice should be followed in fevers of weak inflam-
matory action.

   XII. What  quantity of blood may be taken,
with safety, from a patient in an inflammatory fever?
To answer this question it will be necessary to re-
mark,  1. That, in a person  of  an  ordinary  size,
there are supposed to be contained between 25 and
28 pounds of blood; and 2. That much more blood
may be taken when the blood-vessels are in a state
of morbid excitement  and excitability, than at any
other time. One of the uses  of the blood is to sti-
mulate the  blood-vessels, and thereby to assist in
originating and preserving animal life. In a healthy
state of the vessels, the whole mass of the blood is
necessary for this  purpose;  but in their state of
morbid excitability, a much  less quantity of blood
than what is natural (perhaps in some cases four or
five pounds) are sufficient to keep up an equal and
vigorous circulation. Thus very small portions of
light and sound are sufficient to excite vision and
hearing in an inflamed, and  highly excitable state
of the eyes and ears.   Thus too, a single glass of 
DEFENCE OF  BLOOD-LETTING.
wine will often produce  delirium in a fever in a
man, who, when in health, is in the habit of drink-
ing a bottle every day, without having his pulse
quickened by it.

   An ignorance of the quantity of blood which has
been drawn by design, or lost by accident, has con-
tributed very much to encourage prejudices against
blood-letting. Mr. Cline drew 320 ounces of blood
in 20 days from a patient in St. Thomases hospital,
who laboured under a contusion of the head. But
this quantity is small compared with the quantity-
lost by a number of persons, whose cases are record-
ed by Dr. Haller.*  I shall mention a few of them.
One person lost 9 pounds of blood,  a second 12,
a third 18, and a fourth 22, from the nose,*at one
time.  A fifth  lost 12 pounds by vomiting in one
night, and a sixth 22 from the lungs. A gentle-
man at Angola lost between 3 and 4  pounds daily
from his nose. To cure it, he was bled 97 times
in one year. A young woman was bled 1020 times
 in 19 years, to cure her of plethora which disposed
 her to hysteria.  Another young woman  lost  125
 ounces of blood, by a natural hemorrhage, every
 month. To cure it, she was bled  every day, and
 every other day, for 14 months. In none of these
* Elementa Physiologic, vol. iv. p. 45. 
350     DEFENCE  OF BLOOD-LETTING.
 instances, was death the*consequence of these great
 evacuations of blood.   On the contrary, all  the
 persons  alluded to, recovered. Many similar in-
 stances of the safety, and even benefit of profuse
 discharges of blood, by nature and art, might be
 mentioned from other authors. I shall insert only
 one more, which shall be taken from Dr. Syden-
 ham's account of the cure of the plague. "Among
 the other calamities of the civil war which afflicted
 this nation, the plague also raged in several places,
 and was brought by accident from another place to
 Dunstar Castle, in Somersetshire, where some of
 the soldiers dying  suddenly, with an eruption of
 spots, it likewise seized several others. It happened
 at that time that a surgeon, who had travelled much
 in foreign parts, was in the service there, and  ap-
plied  to the governor for leave to assist his fellow-
 soldiers who were afflicted with this dreadful dis-
ease, in the best manner he was able; which being
 granted, he took so large a quantity of blood from
 every one at the beginning of the disease, and  be-
fore any  swelling was perceived, that they were
 ready to faint, and drop down, for he bled them all
 standing, and in the open air, and  had  no vessel to
measure the blood,  which falling on the ground,
the quantity each person lost could not of course,
be known. The operation being over, he ordered
them  to lie in their tents; and though he gave no 
       DEFENCE OF  BLOOD-LETTING.    351

kind of remedy after bleeding, yet of the numbers
that were thus treated, not a single person died. I
had this relation from Colonel Francis Windham,
a gentleman of great honour and veracity, and at
this time governor of the castle.*"

  Again.  An ignorance of the rapid manner in
which blood is regenerated, when lost or drawn,
has helped to keep up prejudices against blood-let-
ting.  A person (Dr. Haller says) lost five pounds
of blood daily from the hemorrhoidal vessels for
62 days, and another 75  pounds of blood in 10
days.  The  loss each day, was supplied by fresh
quantities of aliment, and, where  no aliment is
taken into the stomach, by the blood that is pre-
pared from the chyle which is secreted in the-liver
from the fat of the omentum.  I have supposed
in my physiological  lectures that the omentum
performs the  vicarious purpose that has been
mentioned.  This opinion has been defended and
applied to practical purposes by my son Dr. James
Rush in his inaugural  dissertation  published in
April 1809. One of the inferences drawn from it,
is a caution not to lay aside the  lancet in chronic
diseases with inflammatory symptoms, from a fear
of a penury of blood, in  cases where the resources
• Vol. i. p. 131. 
 352     DFFENCE OF BLOOD-LETTING.

 for its reproduction have failed from the abstrac-
 tion  of food, or a deficiency of the functions of
 the stomach, and where the liver retains the chy-
 lopoetic office he has ascribed to it.

   These facts, I hope, will be sufficient to establish
 the safety and advantages of plentiful blood-letting,
 in cases of violent  fever; also to show  the fallacy
 and danger of that practice which attempts the cure
 of such cases of fever, by what is called moderate
 bleeding.  There  are, it has been said, no  half
 truths in government.  It is equally true, that there
 are no half truths in medicine.  This half-way prac-
 tice of moderate bleeding, has kept up the morta-
 lity of pestilential fevers, in all ages, and in all coun-
 tries*! have combated this practice elsewhere,* and
have asserted, upon the  authority of Dr. Syden-
ham, that it is much better not to bleed  at all, than
to draw blood disproportioned in quantity  to the
 violence of the fever.  If the state of the pulse be
our guide, the continuance of its inflammatory ac-
tion, after the loss of even 100  ounces of blood, in-
dicates the necessity of more bleeding, as much as
it did the first time a vein was opened.  In the use
 of this remedy it may be truly said, as in many of
the enterprizes of life,  that nothing is done, while
* Account of the Yellow Fever in 1793. 
       DEFENCE OF  BLOOD-LETTING.     353

any thing remains to be done. Bleeding should be
repeated while the symptoms which first indicated
it continue, should it be until four-fifths of the blood
contained in the body are drawn  away.  In this
manner we act in the use of other remedies. Who
«ver leaves off giving purges in a colic, attended
with costiveness, before the bowels are opened?
or who lays aside mercury as a useless medicine,
because a few doses of it do not cure the venereal
disease ?

   I shall only add  under  this head, that I have
always observed the cure of a malignant fever to be
most complete, and the convalescence to be most
rapid, when the bleeding has been continued until
a paleness is induced in the face, and until the pa-
tient is able to sit up without being fainty. After
these circumstances occur, a moderate degree of
force in the pulse will gradually wear itself away,
without doing any harm.

   XIII. In drawing blood, the quantity should be
large or small at a time, according to the  state of
the system.   In cases where the pulse acts with
force and freedom, from 10 to 20 ounces of blood
may be taken at once;  but in cases where the pulse
is  much depressed, it will be better .to take away
but a few ounces at a time, and to repeat it three
   vol. iv.         2 y 
354     DEFENCE OF  BLOOD-LETTING.

or four times a day. By this means the blood-ves-
sels more gradually recover their vigour, and the
apparent bad effects of bleeding are thereby pre-
vented. Perhaps  the same advantages  might be
derived in many other cases, from the gradual ab-
straction of stimuli, that are derived from the gra-
dual increase of their force and number, in their
application to the body. For a number of facts in
support of this practice, the reader is referred to
the history of the yellow fever, in the year 1793.
In an inflammatory fever, the character of which is
not accurately known, it  is safest to begin with
moderate bleeding, and to increase it in quantity,
according as the violence  and duration of the dis-
ease shall make it necessary.  In fevers,  and other
diseases, which run their courses in a few days or
hours, and which threaten immediate dissolution,
there can be no limits fixed to the quantity of blood
which may be drawn at once, or in a short time.
Botallus drew three, four and five pints in a day,
in such cases. Dr. Jackson drew fifty-six ounces
of blood at one time, from a Mr. Thompson, of
the British  hospitals, in a fever of great violence
and danger.  This patient was instantly relieved
from what he styled  " chains and horrors."  In
three or four  hours he was out of danger, and in 
       DEFENCE OF  BLOOD-LETTING.     355

four days, the doctor adds, returned to his duty.*
Dr. Physick drew ninety ounces, by weight, from
Dr. Dewees, in a sudden attack of the apoplectic
state of fever, at one bleeding, and thereby restored
him so speedily to health, that he was able to at-
tend to his business in three days afterwards. Un-
der this head I shall remark that bleeding ad deli-
quium animi is often attended with obvious good
effects in the first stage of violent diseases.  By the
total  relaxation it induces in  the blood-vessels, it
enables the stimuli which support animal life, to
impart to them  a  new, and  natural action, and
thereby suddenly to restore their equable excite-
ment,  but this mode of bleeding should  never
be employed in the advanced, or last stages of fe-
ver. I have once known death to be thus induced
by it.  The system requires  all its  resources in
excitability to be restored from a  fainting fit, and
these exist only in the  early or acute stages of dis-
ease. In chronic states  of fever, of an inflammatory
type, small and frequent bleedings, are to be pre-
ferred to  large ones. We use  mercury, antimony,
and diet  drinks as alteratives in many diseases
with advantage.  We do not expect to remove de-
bility by  two or three  immersions in  a cold bath.

  * Remarks on the Constitution of the Medical Department of
>hc British Army- 
356     DEFENCE  OF BLOOD-LETTING,

We persist with patients in prescribing all the
above  remedies for months and years, before we
expect to reap the  full  benefits of them.  Why
should not blood-letting be used in the same way,
and have the same chance of doing good? I have
long ago adopted the alterative mode of using it,
and I can now look around me, and with pleasure
behold a number of persons of both  sexes who
owe their lives to it.  In  many cases I  have pre-
scribed it once in two or three months, for several
years, and in some I  have  advised it every  two
weeks, for several months.

  There is a state of  fever in  wliich an  excess in
the action of the blood-vessels is barely  percepti-
ble, but which often threatens immediate  danger to
life, by a  determination of blood to  a vital part. In
this case I have  frequently seen the scale turn in
favour of life, by the loss of but four or five ounces
of blood.  The  pressure of this, and  even of a
much less quantity of blood in the close of a fever,
I believe, as effectually destroys life as the excess
of several pounds does in its beginning. The ad-
vantage to be derived from the loss of a small
quantity of blood in certain states of the system
is obvious, from the  sudden relief which the dis-
charge of a few ounces of blood by. menstruation 
       DEFENCE  OF  BLOOD-LETTING.     357

affords to the pains which sometimes attend that
monthly disease.

   In cases where bleeding  does not cure, it may
be used with advantage  as a palliative remedy.
Many diseases  induce death in a full and highly
excited state of the system.  Here  opium  does
harm, while bleeding affords certain relief.  It be-
longs to this remedy, in such cases,  to ease pain,
to prevent convulsions, to compose  the mind, to
protract the use of reason, to  induce  sleep, and
thus to smooth the passage out of life.

   XIV. Bleeding from an artery, commonly called
arteriotomy, would probably have many advanta-
ges over venesection, could it be performed at all
times with ease and safety.  Blood discharged by
haemorrhages affords more relief, in fevers, than
an equal quantity drawn from a vein,  chiefly be-
cause it is poured forth, in the former  case, from
a ruptured artery. I mentioned formerly, that Dr.
 Mitchell had found blood drawn from an  artery
 to be what is called dense,  at a time when that
 which was drawn  from a vein, in the same per-
 sons, was dissolved.  This fact  may possibly ad-
 mit of some application.  In the close of malignant
 fevers, where  bleeding  has been omitted  in the
 beginning of the disease, blood drawn from a vein 
 358     DEFENCE OF  BLOOD-LETTING.

 is generally so dissolved, as to be beyond the reach
 of repeated  bleedings to restore it to its natural
 texture.  In this case, arteriotomy might proba-
 bly be performed  with advantage.  The arteries,
 which retain their capacity of life longer than the
 veins, by being relieved from the immediate pres-
 sure of blood upon them, might be enabled so to
 act upon the torpid veins, as to restore their na-
 tural action, and thereby  to arrest departing life.
 Arteriotomy might further be used with advan-
 tage in children, in whom it is difficult, and some-
 times  impracticable  to open  a vein.  Besides
 these advantages, there are several others which at-
 tend this mode of drawing blood. 1.  The arteries
 being more irritable than the veins, the abstrac-
tion of blood immediately from them, removes the
stimulus from the part  which is the  seat of the
most irritation or diseased action. 2. More blood
can be taken from the  arteries without bringing
on fainting, than  from the veins, in  consequence
 of the heart (on the suspension of whose actions
fainting depends) driving the blood which moves it
from the veins. This is of great consequence in
the close of fevers in which bleeding may be ne-
 cessary, but in which fainting is sometimes fatal.
It may be used with  greater safety for the  same
reason in pregnancy, where there is  a disposition
 ?9 faint, the effect of which is sometimes to induce 
       DEFENCE OF  BLOOD-LETTING.     359

abortion. 3. The arteries when opened, are more
apt to assume a morbid action  from the wound
inflicted upon them than the veins, in consequence
of which, a diseased action is more easily translat-
ed from an internal, to an external and less vital
part of the body. 4. More relief is obtained by
the loss of a small quantity of blood, from an ar-
tery than from a vein. These four remarks in fa-
vour of arteriotomy are  taken from Dr. Butler's
thesis, published in Edinburg.  They appear to be
rational, but I can say but little in support of them
from my own experience.

   XV. Much has been said about the proper place
from whence blood should be drawn. Bleeding in
the foot was much used formerly, in order to ex-
cite a revulsion from the head and breast; but our
present ideas of the circulation of the blood have
taught us, that it may be drawn from the arm with
equal advantage in nearly all cases. To bleeding in
the foot there are the following objections:  1. The
difficulty of placing a patient in a situation favoura-
ble to it.  2. The greater danger of wounding a
tendon in the foot than in the arm.  And, 3. The
impossibility of examining the  blood  after  it is
drawn ; for, in this mode of bleeding,  the blood
generally flows into a  bason or pail of water. 
 360     DEFENCE  OF BLOOD-LETTING.

   Under this head I shall decide upon the method
 of drawing blood by means of cups and leeches, in
 the inflammatory state of fever.  Where an inflam-
 matory fever arises from  local  affection, or from
 contusion in the head or breast, or from  a morbid
 excitement in those, above other parts of the arte-
 rial system, they may be useful; but where local
 affection is a symptom of  general and equable fe-
 ver only, it can seldom be necessary, except where
 bleeding from the arm has been omitted, or used
 too sparingly, in the beginning of a fever;  by which
 means such fixed congestion often takes place, as
 will not yield to general bleeding.

   XVI. Much has  been said likewise about the
proper time for bleeding  in fevers.  It may be
used at all times, when indicated by the pulse and
other circumstances, in continual  fevers ; but it
should be used chiefly in the paroxysms of such as
intermit.  I have conceived this practice to be  of
so much consequence, that, when I expect a return
of the fever in the night, I request one of my pu-
pils to sit up with my patients all night, in order to
meet the paroxysm, if necessary, with the lancet.
But I derive another advantage from fixing a centi-
nel over a patient in a malignant fever.   When a
paroxysm goes off in the night,  it often leaves the
system in a state of such extreme debility,  as to 
       DEFENCE OF BLOOD-LETTING.    361

endanger life.  In this case, from five to ten drops
of laudanum, exhibited by a person who is a judge
of the pulse,  obviate this alarming debility, and
often induce easy and refreshing sleep.  By treat-
ing the human body like a corded instrument, in
thus occasionally relaxing or bracing the system,
according to the excess or deficiency of stimulus,
in those hours in which death most frequently oc-
curs, I think I have been the means of saving seve-
ral valuable lives.

  XVII. The different positions of the body influ-
ence the greater or less degrees of relief which are
obtained by blood-letting.  Where there is a great
disposition to syncope, and where it is  attended
with alarming and distressing circumstances, blood
should  be drawn  in a  recumbent posture, but
where there is no apprehension or dread of faint-
ing, it may be taken in a sitting posture.  The re-
lief will be more certain if the patient be able to
stand while he is bled, for by thus opposing  the
"Tavity of the blood, to the action of the heart, the
quantity of it usually sent to the head, is lessened.
 It is diminished likewise in the larger blood-ves-
 sels by the abstraction of that portion of it which
 is necessary to the excitement of the muscles in a
 standing posture, and hence  fainting, and all the
 good effects we  wish from it in the first stage of
     vol. iv.         2 z 
362    DEFENCE  OF BLOOD-LETTING.

diseases, may be more easily obtained, and these
too from the loss of a much smaller  quantity of
blood than in any other  posture of the body.  It
should therefore be preferred, where patients ob-
ject to copious or frequent bleedings. The history
of the success of this practice in the British army,
recently mentioned from Dr. Sydenham, furnishes
a strong argument in its favour.

   I regret that the limits I have fixed to this De-
fence of Blood-letting will not admit of my apply-
ing the principles which have been  delivered, to
all the inflammatory states of fever.   In a future
essay, I hope to establish its efficacy  in the ma-
naical state of fever.  I have said that madness is
the effect of a chronic inflammation in the brain.
Its remedy, of course,  should be frequent and co-
pious blood-letting.   Physical and moral evil are
subject to  similar laws.   The mad shirt,  and all
the common means of coercion, are as improper
substitutes for bleeding,  in madness, as the whip-
ping-post and pillory are for solitary confinement
and labour, in the  cure of vice. The pulse  should
govern the use of the lancet in this as well as in all
the ordinary states of fever. It is the dial-plate of
the system.  But in the misplaced states of fever,
the pulse,  like folly in old age, often  points at a
different mark from nature. In all such cases, we 
        DEFENCE OF  BLOOD-LETTING.     363

must conform our practice to that which has been
successful in the reigning epidemic.  A single
bleeding, when indicated by this circumstance, of-
ten converts a fever from a suffocated, or latent, to
a sensible state,  and thus renders it a more simple
and manageable disease.

   It is worthy of consideration here, how far local
diseases, which  have  been  produced  by fevers,
might be  cured by re-exciting the fever.   Sir
William Jones says, the physicians in Persia al-
ways begin the cure of the  leprosy by blood-let-
ting*. Possibly this remedy diffuses the  disease
through the blood-vessels, and thereby exposes it
to be more easily acted upon by other remedies.

   Havjng mentioned the  states of fever in which
blood-letting is indicated, and the manner in which
it  should be  performed, I shall conclude  this in-
quiry by pointing out  the states of fever in which
it is forbidden, or in which it should be cautiously
or sparingly performed.   This subject is of con-
sequence, and should be carefully attended  to by
all who wish  well to the usefulness and credit of
the lancet.
* Asiatic Essays- 
364    DEFENCE  OF BLOOD-LETTING.

   1. It is forbidden in that state of fever, as well
as in other diseases, in which there is reason to be-
lieve the brain or viscera are engorged with blood,
and the whole system prostrated below the point of
re-action.  I have  suggested this caution in ano-
ther place*.   The  pulse in these cases is feeble,
and sometimes scarcely perceptible, occasioned by
the quantity of blood in the blood-vessels being
reduced, in consequence of the stagnation of large
portions of it in the viscera. By bleeding in these
cases, we deprive the blood-vessels of  the feeble
remains of the stimulus which keep up their ac-
tion, and thereby precipitate death.  The remedies
here should be frictions, and stimulating applica-
tions to the extremities, and gentle stimuli taken
by the mouth, or  injected into  the bowels.  As
soon as the system is a little excited by these re-
medies, blood may be drawn,  but in small quan-
tities at a time, and perhaps only by means of cups
or leeches applied to the seats of the congestions of
the blood.   After the vessels are excited by the
equable  diffusion of the blood  through all  their
parts, it  may with safety be drawn from the arm,
 provided it be indicated by the pulse.

   2. It is seldom proper beyond the third day, in
 a malignant fever,  if it has not been used on the
* Vol. iii- 
       DEFENCE OF  BLOOD-LETTING.     365

days previous to it, arid for the same reason that
has been given under the former head. Even the
tension of the pulse is not always a sufficient war-
rant to bleed, for in  three days, in a fever which
runs its course in five days, the disorganization of
the viscera is so complete, that a recovery is scarce-
ly to be expected from the lancet. The remedies
which give the only chance of relief in this case,
are purges, blisters, and a  salivation.

   3. Where fevers are attended with paroxysms,
bleeding  should be omitted or  used with  great
caution, in the close of those paroxysms. The de-
bility which accompanies  the intermission of the
fever is often so much increased by the recent loss
of blood, as sometimes to endanger life.

   4. Bleeding is forbidden, or should be used cau-
tiously in that malignant state of fever, in which
a weak morbid action, or what Dr. Darwin calls a
tendency to inirritability, takes place in the blood-
 vessels.  It is known by a weak and frequent pulse,
 such  as  occurs in  the  typhus  fever and in the
 plague in warm climates.  I have often met with it*
 in the malignant  sore throat, and occasionally in
 the pleurisy and yellow fever. The remedies here
 ■mould be gentle vomits or purges, and afterwards 
 366    DEFENCE  OF BLOOD-LETTING.

 cordials. Should the pulse be too much excited
 by them, bleeding may be used to reduce it.

   5. It should be used  sparingly in the  diseases
 of habitual drunkards. The morbid action in such
 persons, though  often violent, is generally tran-
 sient.  It may be compared to a soap-bubble. The
 arteries, by being often overstretched  by the sti-
 mulus of strong drink, do not always contract with
 the diminution of blood,  and  such patients often
 sink, from this cause, from the  excessive use of
 the lancet.

   6. It has been forbidden after  the suppurative
 process has begun in local inflammation.  It con-
 stantly retards  the suppuration, when begun, in
the angina tonsillaris, and thus protracts that dis-
ease,  To this rule there are frequent exceptions.

   7. It should be omitted in pneumony, after  co-
pious expectoration has taken place.  This dis-
charge is local depletion, and, though  slow in its
effects compared with bleeding, it serves the same
purpose in  relieving the lungs.   The  lancet  can
only be required  where great pain in  coughing,
and a tense pulse, attend this stage of the disease. 
       DEFENCE OF  BLOOD-LETTING.     367

  8. It may be omitted (except when the blood-
vessels are  insulated) in those diseases in which
there is time to wait, without danger to life, or fu-
ture health, for the circuitous operation of purging
medicines, or abstemious diet.

  9. It  should be avoided, when it can be done
without great danger to life, where there is a great
and constitutional dread of the operation ; also in
persons predisposed to fainting, where  that occa-
sional  effect of bleeding is not desired. In such
cases, it has sometimes done harm to the patient,
and injured the credit of the lancet.

   10. There are  cases in which sizy blood should
not warrant a repetition of blood-letting.   Mr.
White  informs us, in the History of the Bilious
Fever which has lately  prevailed at Bath, that
bleeding, in many cases in which this appearance
of  the blood took place, was useless  or hurtful.
Sir John Pringle says the same unsuccessful issue
attended a second bleeding when the blood was
sizy in the hospital fever. In some of the fevers of
our own country, we sometimes see  sizy blood
followed  by symptoms which forbid the repeated
use of the lancet, but which yield to other deplet-
ing remedies, or to such as are of a cordial nature.
 I have seen the  same kind of blood, a few hours 
368    DEFENCE  OF BLOOD-LETTING.

before death, in a pulmonary consumption,  and
three days after a discharge of a gallon and a half
of blood from the stomach by vomiting.

   11. Even a tense pulse does not always call for
the repeated use of the lancet.  I have mentioned
one case, viz. on the third or fourth days of a  ma-
lignant fever, in which it is improper.  There are
instances of incurable consumptions from tubercles
and ulcers in the lungs, in which the pulse cannot
be made to feel the least diminution of tension by
either copious or frequent bleedings.   There are
likewise cases of hepatic  fever, in which the pulse
cannot be subdued  by this remedy.  This tense
state of the pulse is the effect of a suppurative pro-
cess in the liver. If a sufficient quantity of blood
has been drawn in the first stage of this disease,
there is little danger from leaving the pulse to re-
duce or wear itself down by  a sudden or gradual
discharge  of the hepatic  congestion.  The recove-
ry in this  case is slow, but it is for the most part
certain. I have once known a dropsy and death
induced by the contrary practice.

   12. and lastly. There  is sometimes a tension in
the pulse  in haemorrhages, that will not yield to
the lancet. The man whose blood  was sizyr three
days after losing a gallon and a half of it from hi.^ 
        DEFENCE OF  BLOOD-LETTING.     369

 stomach, had a tense pulse the day before he died;
 and I once perceived its last strokes to be tense, in
 a patient  whom I lost in a yellow fever by a hae-
 morrhage from the nose. The only circumstance
 that can  justify  bleeding in these  cases  is ex-
 treme pain, in which case, the loss of a few ounces
 of blood is a more safe and effectual remedy than
 opium.

   I shall now add a few remarks upon the efficacy
 of  blood-letting, in diseases which are  not sup-
 posed to belong to the class of fevers, and which
 have not been included in the preceding volumes.

  I. The philosophers, in describing the humble
 origin of man, say that he is formed " inter stercus
 et urinam." The divines say that he is " conceived
 in sin, and shapen in iniquity." I believe it to be
 equally  true,  and alike humilating, that he is con-
 ceived and brought forth in disease.

  This  disease appears in pregnancy and parturi-
tion.  I  shall first endeavour to prove this to be
the case, and afterwards mention the benefits of
blood-letting in relieving it,  in both cases.

  In pregnancy, the uterus is always affected with
that grade of morbid action which I formerly call-
    vol. iv.          3  A 
370    DEFENCE OF  BLOOD-LETTING.

ed inflammation. This is evident from its exhibit-
ing all its usual phenomena in other  parts of the
body.  These are,

   1. Swelling, or enlargement.

   2. Haemorrhage.  The lochia are nothing but
a slow and  spontaneous bleeding performed by
nature, and  intended to cure the  inflammation of
the uterus after parturition.

   3. Abscesses, schirri, and  cancers. It is true,
those  disorders sometimes occur in women that
have  never  borne children. In these cases, they
are the effects of the inflammation excited by the
menstrual disease.

   4. A full, quick, and tense or frequent pulse;
pain;  want  of appetite ;*  sickness at  stomach;
puking;  syncope;  and sometimes convulsions in
every part of the body.

    * Dr. Hunter used to teach in his lectures, that the final cause
of the want of appetite, during the first months of pregnancy, was
to obviate plethora, which disposed to abortion. This plethora
should have been called an inflammatory disease, in which absti-
nence is useful. 
       DEFENCE OF  BLOOD-LETTINC.    671

  5. Sizy blood. This occurs almost uniformly
in pregnancy.

  6. A membrane.  Dr.  Scarpa  has proved the
membrana decidua, which is formed during preg-
nancy, to be in every  respect the same in its pro-
perties with the membrane which is formed upon
other inflamed surfaces, particularly the  trachea,
the pleura, and  the inside  of  the bowels.  Thus
we see all the common  and most characteristic
symptoms and  effects of  inflammation, in other
parts of  the body, are exhibited  by the uterus in
pregnancy.

   These remarks being premised, I proceed to
 remark, that  blood-letting is indicated, in certain
 states of pregnancy, by all the arguments that have
 been used in favour of it in any other inflammatory
 disease.  The degree of inflammation in the womb,
 manifested by the pulse, pain, and other signs of
 disease, should determine the  quantity of blood to
 be drawn. Low diet, gentle purges, and constant
 exercise, are  excellent substitutes for it, but where
 they are not submitted to, blood-letting should be
  employed as a substitute for them. In that dispo-
  sition to abortion, which  occurs about  the third
  month of pregnancy, small and frequent bleedings
  should be preferred to all other modes of depletion. 
372
DEFENCE
OF  BLOOD-LETTING.
I can assert from experience, that they prevent
abortion,  nearly with as much certainty as they
prevent a  haemorrhage from the lungs : for what
is an abortion  but a haemoptysis (if I may be al-
lowed the expression) from the uterus ? During
the last month  of pregnancy,  the loss of from
twelve to  twenty ounces of blood has  the most
beneficial  effects, in lessening the pains  and dan-
ger of  child-birth, and in preventing its  subse-
quent diseases.

  The doctrine  I have  aimed to establish leads,
not only to the use of blood-letting in the disease
of pregnancy, when required, but to a more copious
use of it, when combined with other diseases, than
in those diseases in a simple state. This remark
applies, in a particular manner, to those spasms
and convulsions which sometimes occur in the lat-
ter months of pregnancy.  Without bleeding, they
are  always fatal.  By copious bleeding, amounting
in some instances to 80 and 100 ounces, they are
generally  cured.

  Let it not be supposed that blood-letting is alike
proper and useful in every state of pregnancy.—
There are what are called slow or  chronic inflam-
mations, in which the diseased action of the blood-
vessels not only forbids it, but calls for cordial and 
DEFENCE
OF" BLOOD-LETTING.
373
stimulating  remedies. The  same feeble  state of
inflammation sometimes  take  place in the preg-
nant uterus. In these cases cordials and stimulants
should be preferred to the lancet.

  Parturition is a higher grade of disease than that
which  takes place in pregnancy.   It consists of
convulsive or clonic  spasms in the uterus, super-
vening its inflammation, and is accompanied with
chills, heat, thirst, a quick, full, tense, or a frequent
and  depressed  pulse, and great pain.  By some
divines these  symptoms, and  particularly pain,
have been considered as a standing and unchange-
able  punishment of the original  disobedience of
woman, and, by some physicians, as indispensa-
bly necessary to enable the uterus to relieve itself
of its burden.  By contemplating the numerous
instances in  which it has pleased God to bless the
labours and ingenuity of man,  in lessening or des-
troying the effects of the curse inflicting upon the
earth, and by attending to the histories of the total
exemption from pain in child-bearing that are re-
corded of the women in the Brasils^Calabria, and
some parts of Africa, and of the small degrees of it
which are felt by the Turkish women, who reduce
their systems by frequent purges of sweet oil dur-
ing pregnancy, I was induced to believe pain does
not  accompany child-bearing by an immutable 
 374     DEFENCE OF  BLO&D-LETTING.

 decree of Heaven. By recollecting  further how
 effectually blood-letting relieves many other spas-
 modic and painful diseases, and how suddenly it
 relaxes  rigidity in the muscles, I was  led, in the
 year 1795, to suppose it might be equally effectual
 in lessening the violence of the disease and pains
 of parturition. I was encouraged still more to ex-
 pect this advantage from it, by having repeated-
 ly observed the advantages of copious  bleeding
 for inflammatory  fevers, just before delivery, in
 mitigating  its pains, and  shortening its duration.
 Upon my mentioning these reflections and facts to
 Dr. Dewees, I was much  gratified  in being  in-
formed that he had been in the practice, for seve-
 ral years before  his  removal from Abingdon to
Philadelphia, of drawing large quantities of blood
during parturition, and with all the happy effects
I had expected from it.  The practice has been
 strongly inculcated by the doctor in his lectures
upon midwifery, and  has been ably defended and
supported by a number of recent facts, in an inge-
 nious inaugural dissertation, published  by Dr. Pe-
ter Miller, in the year 1804.  It has been generally
adopted by the practitioners of midwifery, of both
 sexes, in Philadelphia.

   I do not mean to insinuate that bleeding is a new
remedy in parturition.  It has long ago been  ad- 
       DEFENCE OF BLOOD-LETTING.    375

vised and used in France, and even by the mid-
wives of Genoa, in Italy, but never, in any country,
in the large quantities that have been recommend-
ed by Dr. Dewees, that is, from 20 to 80 ounces,
or until signs of fainting are induced,  nor under
the influence of the theory of parturition, being a #
violent disease.

   But the advantages of this remedy are not con-
fined to lessening the pains of delivery.   It pre-
vents after pains; favours the easy and healthy se-
cretion of milk; prevents sore breasts, swelled legs,
puerperile fever, and all the distressing  train of
anomalous complaints that often follow  child-bear-
ing.  Dr. Hunter informed his pupils, in his lec-
tures upon midwifery, in the year 1769,  that he
had often observed the most rapid recoveries to
succeed the most severe labours.   The  severity
of the pains in these cases created a disease, which
prevented   internal congestions in  the   womb.
Bleeding, by depleting the uterus, obviates at once
both disease and congestion.  Its efficacy is much
aided by means of glysters, which, by emptying
the lower bowels,  lessen the pressure upon  the
 uterus.

   Let it not be inferred, from what has been said
in favour of blood-letting in parturition, that it is 
 376     DEFENCE OF  BLOOD-LETTING,

 proper in all cases.  Where there has been great
 previous inanition, and where there are marks of
 languor, and feeble morbid action in the system,
 the remedies should be of an  opposite nature.
 Opium and other cordials are indicated in these
 cases. Their salutary effects in exciting the action
 of the uterus, and expediting delivery, are too well
 known to be mentioned.

  I have expressed a hope in another place*, that
 a medicine would be discovered that should sus-
 pend  sensibility altogether, and leave irritability,
 or the powers of motion, unimpaired, and thereby
 destroy labour pains altogether. I was encouraged
 to cherish this hope, by having known delivery to
 take place, in one instance, during a paroxysm of
epilepsy, and having heard of another, during a fit
 of drunkenness,  in  a woman attended by Dr.
 Church, in both of which there was neither con-
 sciousness, nor recollection of pain.

  2. During the period in which the  menses are
said to dodge, and for a year or two after they cease
to flow, there is a morbid fulness and excitement
in the blood-vessels,  which are often followed  by
head-ach, cough, dropsy, haemorrhages, glandular
• Medical Repository, vipl. vi. 
       DEFENCE OF  BLOOD-LETTING.     377

obstructions, and cancers.  They may all be pre-
vented by frequent and moderate bleedings.

   3. It has been proved, by many facts,  that opi-
um, when taken in an excessive dose, acts by in-
ducing  a similar state of the system with that
which is induced by the miasmata which bring on
malignant and inflammatory fevers.  The remedy
for the disease produced by it (where a vomiting
cannot be  excited to discharge  the opium) has
been found to be copious blood-letting. Of its ef-
ficacy, the reader will find an account in four  ca-
ses, published  in the fifth volume of the New-
York Medical Repository.

   4. It is probable, from the uniformly stimulating
manner in which poisons of all kinds act upon the
human body, that bleeding would be useful in ob-
viating their baneful effects. Dr. John Dorsey has
lately proved its efficacy, in the case of a child that
was affected with convulsions, in consequence of
eating the leaves of the datura stramonium.

   5. It has been the misfortune of diabetes to be
considered by  physicians as  exclusively a local
disease of weak morbid action, or as the effects of
simple debility  in the kidneys; and hence stimu-
lating and tonic medicines have been exclusively
    vol. iv.          3  B 
378     DEFENCE  OF BLOOD-LETTING.

prescribed for it.  This  opinion is not a correct
one. It often affects the whole  arterial system,
more especially in its first stage, with great mor-
bid action. In two cases of it, where this state of
the blood-vessels took place, I have used blood-
letting with success, joined with the common re-
medies for inflammatory  diseases.

   6. In intermitting fevers which have long re-
sisted the use of bark, and all the common stimu-
lating and tonic remedies which are employed to
cure them, bleeding is generally a certain remedy.
Many  hundred  instances of its  efficacy in such
cases could be mentioned from the records of the
practice in the  Pennsylvania hospital, as well as
from the private practice of many of the physici-
ans of Philadelphia.

   7. In dislocated  bones which  resist  both skill
and force, it  has been suggested, that  bleeding,
till  fainting  is  induced, would probably induce
such a relaxation in the muscles as to favour their
reduction. This principle was happily applied, in
the winter of 1795, by Dr. Physick, in the  Penn-
sylvania hospital, in a case of dislocated humerus
of two months continuance.  The doctor bled his
patient till he fainted, and then reduced his  shoul-
 der in less than a minute, and with very little ex- 
       DEFENCE  OF BLOOD-LETTING.     379

ertion of force.  The practice has since become ge-
neral in Philadelphia, in luxations of large bones,
where they resist the common degrees of strength
employed to reduce them.

  In contemplating the prejudices against blood-
letting, which formerly prevailed so generally in
our country, I have been led to ascribe them to a
cause wholly political. We are descended chiefly
from Great-Britain, and have been for many years
under the influence of English habits upon all sub-
jects.  Some of these habits, as far as they relate
to government, have been partly changed; but in
dress, arts, manufactures, manners,  and science,
we are still governed by our early associations.
Britain and France have been, for many centuries,
hereditary enemies. The hostility of the former to
the latter  nation, extends to every thing that be-
longs to their character.  It discovers itself, in an
eminent  degree, in diet  and medicine.  Do the
French love soups? the English prefer solid flesh.
Do the French love their meats well cooked? the
English prefer their meats but  half roasted.  Do
the French sip coffee after dinner ? the English
spend their afternoons in drinking Port and Ma-
deira wines.  Do the French  physicians prescribe
purges and glysters to cleanse the bowels?  the 
380     DEFENCE  OF BLOOD-LETTING.

English physicians prescribe vomits for the same
purpose. Above all, do the French physicians ad-
vise  bleeding in fevers ?  the  English physicians
forbid it in most fevers, and  substitute sweating
in the room of  it.   Here then we discover the
source of the former prejudices and errors of our
countrymen, upon  the subject of blood-letting.
They are of British origin.  They have  been in-
culcated in British  universities,  and  in British
books ; and they  accord as ill with our climate
and  state of society,  as the  Dutch  foot stoves
did  with the temperate climate of the  Cape of
Good Hope.

   It is probable the bad consequences which have
followed  the indiscriminate  use  of the  lancet in
France, and some other countries, may have con-
tributed in  some degree to create the prejudices
against it, which are entertained by the physicians
in Great-Britain. Bleeding, like  opium, has lost
its character in many  cases, by being prescribed
for the name of a disease.  It is still used, Mr.
Townsend  tells  us, in this empirical way in Spain,
where a physician,  when sent for to a patient, or-
ders him to be  bled before he visits him.   The
late just theory of the  manner  in which opium
 acts upon the body, has restrained  its  mischief 
       DEFENCE OF  BLOOD-LETTING.     381

and added  greatly to its usefulness. In like man-
ner, may we not hope, that just theories of dis-
eases, and  proper ideas of the manner in which
bleeding acts in curing them, will prevent a re-
lapse into the evils which formerly accompanied
this  remedy, and render it a great and universal
blessing to mankind ? 
 
           AN INQUIRY






              INTO THE






COMPARATIVE STATE OF MEDICINE,






         IN PHILADELPHIA,






       CETWEEN THE YEARS 1760 AND 1766,






           AND THE YEAR 1809. 
 
AN INQUIRY, fcfc.
      IN  estimating the progress and utility of
medicine, important  advantages  may be  derived
from taking a view of its ancient, and comparing
it with its present  state. To do this upon an ex-
tensive scale, would be difficult, and foreign to the
design of this inquiry. I shall therefore limit it, to
the history of the diseases and medical  opinions
which prevailed, and of the remedies which were
in use, in the city of Philadelphia, between the
years 1760 and  1766, and of the diseases, medi-
cal opinions, and remedies of the year 1809.  The
result of a comparative view of each of them, will
determine whether medicine has declined or im-
proved, in that interval of time, in this part of the
world.

   To derive all the benefits that are possible from
such  an inquiry, it will be proper to detail  the
causes, which, by acting upon the human body
    vol.  iv.         3 c 
386
STATE
01 MEDICINE,
influence the subjects that have been  mentioned,
in those two remote periods of time.

  Those causes divide themselves into climate,
diet, dress, and certain peculiar customs; on-each
of which I shall make a few remarks.

  After what has been  said, in the history of the
Climate of Pennsylvania, in the second volume of
these Inquiries, it will  only  be necessary in this
place briefly to mention, that  the winters in Phila-
delphia, between the years 1760 and 1766, were
almost uniformly cold. The ground was generally
covered  with  snow, and  the Delaware  frozen,
from  the first or second  week  in  December, to
the  last  week in February, or the first week in
March.   Thaws were  rare during  the winter
months, and seldom of longer duration than  three
or four days.  The  springs began in  May.  The
summers were generally warm, and the air seldom
refreshed by cool north-west winds.  Rains  were
frequent and heavy, and for the most part accompa-
nied with thunder and lightning.  The  autumns
began in October, and were  gradually succeeded
by cool and cold weather.

  The diet of the inhabitants of Philadelphia, dur-
ing those years, consisted  chiefly of animal  food. 
 BETWEEN 1760  AND 1766, AND  1809.   387

It was eaten, in some families, three times, and in
all, twice a day. A hot supper was a general meal.
To two and three meals of animal food in a day,
many persons added what was then called " a re-
lish," about an hour before dinner. It consisted of
a slice of ham, a piece of salted fish, and now and
then a beef-steak, accompanied with large draughts
of punch or toddy.  Tea was taken in the  interval
between dinner and supper.

  In  many companies, a glass of wine and bitters
Was taken a few minutes before dinner, in  order to
increase the appetite.

  The drinks, with dinner and supper, were punch
and table beer.

  Besides feeding thus plentifully in their families,
many of the most respectable citizens belonged to
clubs, which met in the city in winter, and in its
vicinity, under sheds,  or the shades of trees, in
summer, once and  twice a week, and in  one in-
stance every night.  They were drawn together
by  suppers in winter, and  dinners in summer.
their  food was simple, and taken chiefly in a solid
form.  The liquors used with it were punch, Lon-
don porter, and sound  old Madeira wine. 
388        STATE  OF MEDICINE,

  Independently of these clubs, there were occa-
sional meetings of citizens, particularly  of young
men, at taverns, for convivial purposes.  A house
in Water-street, known by the  name of the Tun
tavern, was  devoted chiefly to  this kind of  acci-
dental  meetings.  They were  often followed  by
midnight  sallies into the streets, and such acts of
violence and  indecency, as frequently consigned
the perpetrators of them afterwards into the hands
of the civil officers and physicians of the city.

  Many citizens, particularly tradesmen, met every
evening for the purpose of drinking beer, at houses
kept for that purpose.   Instances of drunkenness
were rare at such places. The company generally
parted at  ten  o'clock, and retired in an orderly
manner to their habitations.  Morning drams, con-
sisting of cordials of different kinds, were common,
both in taverns and private  houses, but  they were
confined chiefly to the lower class of people.

   From this general use of distilled and fermented
liquors, drunkenness was a common vice in all the
different ranks of society.

   The dresses of the men, in the years alluded to,
 were composed of cloth  in whiter, and of thin
 woollen or silk stuffs in summer. Wigs  composed 
BETWEEN  1760 AND  1766, AND 1809.  389
the covering of the head, after middle  life, and
cocked hats were universally worn, except by the
men who belonged to the society of friends.

   The dresses of the women, in the years before
mentioned, consisted chiefly of silks and calicoes.
Stays were universal, and  hoops were generally
worn by the ladies in genteel life.  Long cloth of
camblet  cloaks were common, in cold  weather,
among all classes of women.

   The  principal  custom under this head, which
influenced health and life, was that which obliged
women,  after lying-in,  " to sit up for company ;"
that is to dress themselves,  every afternoon on the
second week after their confinement, and to sit for
four or five hours, exposed to the impure air of a
crowded room, and sometimes to long  and loud
conversations.

   Porches  were  nearly universal appendages to
houses, and it was common for all the branches of
a family to expose  themselves upon them, to the
evening air. Stoves were not in use, at that time,
in any places of public worship.

   Funerals were attended by a large concourse of
citizens, who were thereby often exposed to great 
390
STATE OF  MEDICINE,
heat and cold, and  sometimes to standing, while
the funeral obsequies were performed, in a wet or
damp church.yard.

   The human mind, in this period of the history
of our city, was in a colonized state, and the pas-
sions acted but feebly and partially upon literary
and political subjects.

   We come now to mention the diseases which
prevailed in our city between the years  1760 and
1766.

   The cholera  morbus was a frequent disease in
the summer months.

   Sporadic  cases of dysentery were at  that time
common.  I have never seen that disease epidemic
in Philadelphia.

   The intermitting fever prevailed in the month of
August, and in the autumn, chiefly in the suburbs
and neighbourhood of the city. In the year 1765,
it was epidemic in Southwark, and was so general,
at the same time, as to affect two thirds of the in-
habitants of the southern states. This fact is men-
tioned by  Dr.  Bond, in a lecture preserved in the 
   BETWEEN 1760 AND I7fi6, AND 1809.   391

minutes of the managers of the Pennsylvania hos-
pital.

   The slow chronic fever, called at that time the
nervous fever, was very common, in the autumnal
months, in the thickly settled parts of the city.

   The bilious fever prevailed, at the same time,
in Southwark.  The late Dr. Clarkson, who began
to practice medicine in that part of the city, in the
year 1761, upon hearing some of his medical bre-
thren speak of the appearance of bilious remittents
in its middle  and northern parts, about  the year
1778, said they had long been familiar to him, and
that he had met with  them  every year  since his
settlement in Philadelphia*.

   The yellow fever prevailed in the  neighbour-
hood of  Spruce-street wharf,  and  near a  filthy
   * From the early knowledge this excellent physician and wor-
thy man had thus acquired of the bilious remitting fever, he was
very successful in the treatment of it. It was by instruction con-
veyed by him to me with peculiar delicacy, that I was first taught
the advantages of copious evacuations from the bowels in that dis-
ease.  I had been called, when a ypung practitioner, to visit a gen-
tleman with him in a bilious pleurisy.  A third or fourth bleeding,
which I advised, cured him. The doctor was much pleased with its
effect, and said to me afterwards, "Doctor, you and I have each a
great fault in our practice; I do not bleed enough,  you do not
purge enough." 
392
STATE OF  MEDICINE,
 stream of water which flowed through what is now
 called Dock-street, in the year 1762. Some cases
 of it appeared likewise in  Southwark.  It was
 scarcely known in the north and west parts of the
 city.  No desertion of the citizens took place at
 this time, nor did the fear of contagion drive the
 friends of the sick from their bed-sides, nor pre-
 vent the usual marks of respect being paid to them
 after death, by following their bodies to the grave.
 A few sporadic cases of the  same grade of  fever
 appeared in the year  1763.

  Pneumonies, rheumatisms,  inflammatory sore
throats, and catarrhs were frequent during the win-
ter and  spring months. The last disease was in*
duced, not only by sudden changes in the weather,
but often by exposure to the evening air on porch-
es in summer, and by the damp and cold  air of
places of public worship in winter.

  The influenza was epidemic in the city in the
spring of the year 1761.

  The malignant sore throat proved fatal to a
number of children in the winter of 1763.

  The scarlet fever prevailed generally in the year
1764. It resembled the same disease, as described 
  BETWEEN 1760 AND 1766, AND 1809.  393

by Dr. Sydenham, in not being accompanied by a
sore throat.

  Death from convulsions, in pregnant women,
also from parturition, and the puerperile fever,
were common between the years 1760 and 1766.
Death  was  likewise common between the 50th
and 60th years of life from gout, apoplexy, palsy,
obstructed livers, and dropsies.   A club, consist-
ing of about a dozen of the first gentlemen in the
city, all paid, for their intemperance, the forfeit
of  tiieir lives  between those ages,  and  most of
them with some one, or more of the diseases that
have been mentioned.  I sat up with one of that
club on the night of his death.  Several of the
members of it called at his house, the evening
before he died, to inquire how he was.  One of
them upon being informed of his extreme danger,
spoke in high and pathetic terms of his convivial
talents  and  virtues, and said, " he had spent 200
evenings a year with him, for the last twenty years
of his life."  These evenings were all spent at pub-
lic houses.

    The colica pictonum, or dry gripes,  was for-
 merly  a  common  disease in this city.   It was
 sometimes  followed by a palsy of the  upper and
     VOL. IV.         3  D 
394        STATE OF  MEDICINE,

lower extremities. Colics from crapulas were like-
wise very frequent, and now and then terminated
in death.

   Many children died of the cholera infantum,
cynanche trachealis, and hydrocephalus internus.
The last disease was generally ascribed to worms.

   Fifteen  or twenty deaths occurred, every sum-
mer, from drinking cold pump water, when the
body was  in a highly excitable state, from great
heat and labour.

   The  small-pox, within the period  alluded to,
was sometimes epidemic, and carried off many ci-
tizens. In the year 1759, Dr. Barnet was invited
from Elizabeth-town, in New-Jersey, to Philadel-
phia, to inoculate for the small-pox.   The prac-
tice, though much opposed, soon became general.
About that time, Dr. Redman  published a  short
defence of it, and recommended the  practice to
his fellow-citizens in  the most affectionate lan-
guage.  The success of inoculation was far from
being universal.  Subsequent improvements in the
mode of preparing the body, and treating the erup-
tive fever, have led us to ascribe this want of suc-
cess to the deep wound made in  the arm, to the
excessive  quantity of  mercury given to prepare 
   BETWEEN 1760 AND 1766, AND 1809.  395

the body, and to the use of a warm regimen in the
eruptive fever.

   The peculiar customs and the diseases which
have been enumerated, by inducing general weak-
ness, rendered the pulmonary consumption a fre-
quent disease among both sexes.

   Pains and diseases from decayed teeth were ve-
ry common between the years 1760  and 1766.
At that time, the profession of  a dentist was un-
known in the city.

   The practice of physic and surgery were united,
during those years, in the same  persons, and phy-
sicians were seldom employed as man-midwives,
except in preternatural and tedious labours.

   The practice of surgery was regulated by Mr.
 Sharp's treatise upon that branch of medicine.

   Let us now take a view of the medical opinions
 which prevailed at the above period, and of the re-
 medies which were employed to cure the diseases
 that have been mentioned.

   The system of Dr. Boerhaave then governed the
 practice of every  physician in  Philadelphia.  Qf 
396
STATE  OF MEDICINE,
course diseases were ascribed to morbid acrimo-
nies, and other matters in the blood, and the prac-
tice of those years was influenced by a belief  in
them.  Medicines were prescribed to thin, and  to
incrassate the blood, and diet drinks were adminis-
tered in large quantities, in order to alter its quali-
ties. Great reliance  was placed upon the powers
of nature, and critical days were expected with so-
licitude, in order to observe the discharge of the
morbid cause of  fevers from the  system.  This
matter was looked for  chiefly in  the urine, and
glasses to retain it were a necessary part of the fur-
niture  of every sick  room.   To ensure  the  dis-
charge of the supposed  morbid matter of fevers
through the pores, patients were confined to their
beds, and fresh, and even cool air, often excluded
by close doors and  curtains.  The  medicines  to
promote sweats were generally of a feeble nature.
The spiritus mindereri, and the spirit of sweet ni-
tre were in daily use for that purpose. In danger-
ous cases,  saffron and Virginia  snake-root were
added  to them.

 Blood-letting was used plentifully  in pleurisies
and rheumatisms, but sparingly in all other diseas-
es.  Blood was often drawn from the feet, in order
to excite a revulsion of disease from the superior
parts of the body. It was considered as unsafe,  at 
  BETWEEN 1760 AND 1766, AND 1809.   397

that time, to bleed during the monthly disease of
the female sex.

  Purges or vomits began the cure of  all febrile
diseases, but as the principal dependence was pla-
ced upon sweating medicines, those powerful re-
medies were seldom repeated in the subsequent
stages of fevers.  To this remark there  was a ge-
neral exception in the yellow fever of 1762. Small
doses of glauber's salts were given every day after
bleeding, so as to promote a gentle, but constant
discharge from the bowels.

  The bark was administered freely in intermit-
tents. The prejudices against it at that time were
so general among the common people, that it was
often necessary to  disguise it.  An opinion  pre-
vailed Timong them, that it lay in their bones, and
that it disposed them to take cold.  It was seldom
given in the low and  gangrenous states of fever,
when they were not attended with remissions.

  The use of opium was confined  chiefly to ease
pain, to compose a cough, and to restrain preterna-
tural discharges  from the body.   Such were  the
prejudices against it, that it was often necessary to
conceal it in other medicines. It was rarely taken
without the ajdvice of a physician. 
 398         STATE OF  MEDICINE,

   Mercury was in  general use in the  years that
 have been mentioned.  I have said it was given to
 prepare the body for the small-pox. It was admi-
 nistered  by my first preceptor in medicine, Dr.
 Redman, in the"same disease, when it appeared in
 the natural way, with malignant or inflammatory
 symptoms,  in order to keep the  salivary glands
 open and flowing, during the turn of the pock.
 He gave it likewise liberally in the dry gripes. In
 one case  of that disease, I well remember the plea-
 sure he expressed, in consequence of its having
 affected his patient's mouth.

  But to Dr. Thomas  Bond the city of Philadel-
phia is indebted for the introduction of mercury
into general use, in the practice of medicine. He
called it emphatically " a revolutionary remedy,"
and prescribed it in all diseases which resisted the
common modes of practice.   He gave it liberally
in the cynanche trachealis.  He sometimes cured
madness, by giving it in such  quantities as to ex-
cite a salivation. He attempted to cure pulmonary
consumption by it, but without success ;  for, at
that time, the influence of the relative actions of
different  diseases and remedies, upon the human
body, was not known, or, if known, no advantage
was derived from it in  the practice of medicine. 
  BETWEEN 1760 AND 1766, AND 1809.  399

  The dry gripes were cured, at that  time, by a
new and peculiar mode of practice, by Dr. Thomas
Cadwallader. He kept the patient easy by  gentle
anodynes, and gave lenient purges only in the be-
ginning of the disease; nor did he ever assist the
latter by injections till  the fourth and fifth days,
at which time the bowels discharged their contents
in an easy manner. It was said this mode of cure
prevented the paralytic symptoms, which  some-
times follow that disease.  It was afterwards adopt-
ed and highly commended by the late Dr. War-
ren, of  London.

  Blisters were in general use, but seldom applied
before the latter stage of fevers. They were pre-
scribed, for the first time, in haemorrhages, and
with great success, by Dr. George Glentworth.

  Wine was given sparingly, even in the  lowest
stage of what were then called putrid and nervous
fevers.

  The  warm and cold baths were but little used
in private practice. The former was now and then
employed in acute diseases. They were both used
in the most liberal manner, together with  the va-
pour and warm air baths, in the Pennsylvania hos-
pital, by  Dr. Thomas Bond.  An attempt was 
400
STATE OF MEDICINE,
 made to erect warm and cold baths, in the neigh-
 bourhood of the city, and to connect them with a
 house of entertainment, by Dr. Lauchlin M'Clen,
 in the year 1761. The project was considered as
 unfriendly to morals, and petitions, from  several
 religious societies, were addressed to the governor
 of the province, to prevent  its execution.  The
 enterprize was abandoned, and  the doctor  soon
 afterwards left the city.

  Riding on horseback, the fresh air of the sea-
 shore,  excursions to mineral springs, and long
journies, were often prescribed to invalids, by all
 the physicians of that day.

  I come now to mention the causes which influ-
ence the diseases, also the medical opinions and
remedies of the present time. In this part of our
discourse, I  shall follow the order of the first part
of our inquiry.

  I  have already  taken  notice  of the  changes
which the climate of  Philadelphia has undergone
since the year 1766.

  A change has of late years taken place in the
dress of the inhabitants  of Philadelphia. Wigs
have generally been laid aside, and  the hair worn 
   BETWEEN 1760 AND  1766, AND 1809.  401

cut and dressed in different ways.   Round hats,
with high crowns, have become fashionable.  Um-
brellas, which were formerly a part of female dress
only, are now used in warm and wet weather, by
men of all ranks in society;  and flannel is worn
next to the skin in winter, and muslin in summer,
by many persons of both sexes.  Tight dresses are
uncommon, and stays are unknown  among our
women.  It is to be lamented that the benefits to
health  which might  have been derived from the
disuse of that part of female dress, have been pre-
vented by the fashion of wearing such light cover-
ings over the breasts and limbs. The evils from
this cause,  shall be mentioned hereafter.

   A revolution has taken place in the diet of our
citizens. Relishes and suppers are generally abo-
lished ; bitters, to provoke a preternatural appetite,
also meridian  bowls of punch, are now  scarcely
known.  Animal food is eaten only at dinner, and
excess in the use of it is prevented, by a profusion
of excellent summer and winter vegetables.

   Malt liquors, or hydrant water, with a moderate
quantity of wine, are usually taken with those sim-
ple and wholesome meals.
*r0L.
rv.
3 F. 
 102        STATE  OF MEDICINE,

   Clubs, for the exclusive purpose of feeding, are
dissolved, and succeeded by family  parties, col-
lected for the more rational entertainments of con-
versation, dancing,  music, and chess.   Taverns
and beer-houses are  much less frequented than for-
merly, and  drunkenness is rarely seen in genteel
life. The tea table, in an evening, has now become
the place of resort of both sexes, and the midnight
serenade has taken place of the midnight revels of
the young  gentlemen of former years.

   In doing justice to the temperance of the modem
citizens of Philadelphia, I am sorry to admit, there
is still a good deal of secret drinking among them.
Physicians,  who detect it by the  diseases it pro-
duces, often lament the inefficacy of their remedies
to remove them.   In  addition to intemperance
from spiritous liquors, a new species  of intoxica-
tion from opium has found its way into our city.
I have known death, in one instance, induced by it.

   The following circumstances have had a favour-
able influence upon  the health of the present inha-
bitants of  Philadelphia.

   The improvements in the construction of mo-
dem houses, so as to render them cooler in sum-
mer, and warmer in winter. 
   BETWEEN 1760 AND 1766, AND 1809.  403

  The less frequent practice of sitting on porches,
exposed to the dew, in summer evenings.

  The universal use of stoves in places of public
worship.

  The abolition of the custom of obliging lying-in
women to sit up for company.

  The partial use of Schuylkill or hydrant water,
for culinary and  other purposes.

  The enjoyment of pure air, in country seats, in
the neighbourhood of the  city.  They not only
preserve from sickness during the summer and au-
tumn, but they render families less liable to dis-
eases during the other seasons of the year.

   And, lastly, the frequent use of private, and pub-
lic warm and cold baths. For the establishment of
the latter, the citizens of Philadelphia  are indebt-
ed to Mr. Joseph Simons.

   The following circumstances have an unfavour-
able influence upon the health of our citizens.

   Ice creams taken in excess, or  upon an empty
stomach. 
404
STATE OF  MEDICINE,
   The continuance of the practice of attending
funerals, under all the circumstances  that were
mentioned in describing the customs which pre-
vailed  in  Philadelphia,  between the years 1760
and 1766.

   The combined influence of great  heat and in-
temperance in drinking, acting upon passions un-
usually excited by public objects, on  the 4th of
July, every year.

   The general and inordinate use of segars.

   The want of sufficient force in the water which
falls into the common sewers to convey their con-
tents into the Delaware, renders each of their aper-
tures a source of sickly exhalations to the neigh-
bouring streets and squares.

   The compact  manner in which the gutters are
now formed, by preventing the descent of water
into the earth, has contributed very much to retain
the filth of the city, in those seasons in which  they
are not washed by rain, nor by die waste water  of
the pumps and hydrants.

   The timbers of many of the wharves of the city
have gone to  decay.  The docks  have not been 
BETWEEN 1760 AND 1766, AND 1809.  405
cleaned since the year 1774, and many of them ex-
pose large surfaces to the action of the sun at low
water.   The buildings have increased in Water-
street,  and with  them there has been a great in-
crease  of that  kind of  filth which is generated in
all houses ;  the stores in this street often contain*
matters which putrefy; from all which there is, in
warm weather, a constant emission of such a foetid
odour, as to render a walk tlirough that street, by
a person  who does not reside there, extremely
disagreeable, and sometimes to produce sickness
and vomiting.

   In many parts of the vicinity of the city are to
be seen pools of stagnating water, from which there
are exhaled large quantities of unhealthy vapours,
during the summer and autumnal months.

   The privies have become so numerous, and are
often so full, as to become offensive in most of the
compact parts of the city, more especially in damp
weather.

   The pump  water is impregnated with many sa-
line and aerial matters of an offensive nature.

   While these causes exert an  unfriendly influ-
ence upon the bodies of the citizens of Philadel- 
406
STATE  OF  MEDICINE,
 phia, the extreme elevation or depression of their
 passions, by the different issues of their political
 contests, now far surpassing, in  their magnitude,
 the contests of former years, together with their
 many new  and fortuitous modes of  suddenly ac-
 quiring and losing property, predispose them to
 many diseases of the  mind.

   The present diseases of Philadelphia come next
 under our consideration.

   Fevers have assumed several new forms since
 the year 1766. The mild bilious fever has gradu-
 ally spread over every part of the city. It followed
 the filth which was left by the British army in the
 year 1778.   In the year 1780, it prevailed, as an
 epidemic, in Southwark, and in Water and Front-
 streets, below Market-street*. In the years 1791
 and 1792, it assumed an inflammatory appearance,
 and was accompanied, in many cases, with hepatic
 affections. The connection of our subject requires
 that I should barely repeat, that it appeared in 1793

   * It appears, from the account given by Mr. White of the bili-
ous fever of Bath, that it prevailed several years in its suburbs, be-
fore it became  general in that city.  It is remarkable, that South-
wark was nearly the exclusive seat, not only of the bilious or break-
bone fever of 1780, but of the intermitting fever in 1765, taken no-
tice of by Dr. Bond, and of the yellow fever of 1805. 
   BETWEEN 1760 AND 1766, AND 1809.  407

as an epidemic, in the form of what is called yellow
fever, in which form it has appeared, in sporadic
cases, or as an epidemic, nearly every year since.
During the reign of this high grade of bilious fe-
ver,  mild intermittents and remittents, and the
chronic or nervous forms of the summer and au-
tumnal fever, have nearly disappeared.

   Inflammations and obstructions of the liver have
been more frequent than in former years, and even
the pneumonies, catarrhs, intercurrent, and other
fevers of the winter and spring  months, have all
partaken more or less of the inflammatory and ma-
lignant nature of the yellow fever.

   The pulmonary consumption continues to be a
common disease among both sexes.  Women are
more subject to it than men, in consequence of
their light dresses, and  particularly  of the  ex-
posure of their upper arms (a part of the body
with which the lungs sympathise in  a peculiar
 manner) to the cold air. The frequency of con-
sumptions from  this cause, has given rise to a
saying that " the nakedness of the women, is the
eloathing of the physicians." 
408         STATE OF  MEDICINE,

   The cynanche trachealis, the scarlatina anginosa,
the hydrocephalus internus, and cholera infantum,
are likewise common diseases in Philadelphia.

   Madness, and several other diseases of the mind,
have increased  since the year 1766, from causes
which have been mentioned.

   Several of the different forms of gout are still
common among both sexes.

   Apoplexy  and palsyr have considerably dimi-
nished in our city.  It is true, the bills of mortality
still record a number of deaths from the former,
every year; but this statement is incorrect, if it
mean a disease of the brain only, for sudden deaths
from all their causes are returned exclusively under
the name of apoplexy.  The less frequent occur-
rence of this disease, also of palsy, is probably oc-
casioned by the less consumption of animal food,
and of distilled and fermented liquors, by that class
of citizens who are most subject to them, than in
former years.  Perhaps the round hat, and the ge*
neral use of umbrellas, may have contributed to
lessen those diseases of the brain.

   The dropsy is now a rare disease, and seldom
seen even in our hospital. 
BETWEEN  1760 AND 1766, AND 1809.
409
  The colica pictonum, or dry gripes, is scarcely
known in Philadelphia.  I have  ascribed this to
the use of flannel next to the skin as a part of
dress, and to the general disuse of punch as a com-
mon drink.

  The natural small-pox is nearly extirpated, and
the puerperile fever is rarely met with in Philadel-
phia.  The scrophula is much less frequent than
in former years.  It is confined chiefly to persons
in humble life.

   I proceed, in the  order that was proposed, to
take notice of the present medical opinions which
prevail among the physicians of Philadelphia. The
system of Dr. Boerhaave long ago ceased to regu-
late the practice of physic.   It was succeeded by
the system of Dr.  Cullen. In the year 1790, Dr.
Brown's system of  medicine was introduced and
taught by Dr. Gibbon. It captivated a few young
 men for a while, but it soon fell into disrepute.
 Perhaps the high-toned diseases of our city expos-
 ed the fallacy and  danger of the remedies  incul-
 cated by it, and afforded it a shorter life than it
 has had in many other countries. In the year 1790,
 the author of this inquiry promulgated some new
 principles in medicine  suggested  by the peculiar
 phenomena of the diseases of the United States, 
410
STATE
OF MEDICINL,
These principles have been so much enlarged and
improved by the successive observations and rea-
sonings of many gentlemen in all  the states, as to
form a new system of medicine. This system re-
jects the nosological arrangement of diseases, and
admits only of a single disease, consisting in dif-
ferent  forms of morbid excitement, induced by
irritants acting upon previous debility. It rejects
further, an undue reliance upon the powers of na-
ture, and teaches, instantly to wrest the cure of all
violent and feeble diseases out of her hands; and
lastly it rejects prescriptions for the names of dis-
eases ; and by directing their application wholly
to their forming  and fluctuating  states,  derives
from a few active  medicines all  the  advantages
which have been in vain expected from the nume-,
rous articles which compose European treatises
upon the materia  medica. This  system has been
adopted  by a  part of  the  physicians of Philadel-
phia, but a respectable number of them  are still
attached to the system of  Dr. Cullen.

   A great change has taken place in the remedies
which are now in common use  in Philadelphia.  I
shall briefly mention such of them as are new, and
then take notice of the new and different modes of
exhibiting such as were in use between the years
1760 and 1766. 
   BETWEEN  1760 AND 1766, AND 1809.   411

   Vaccination has been generally adopted in our
city, in preference to inoculation with variolous
matter.

   Digitalis, lead, zinc, and arsenic are now com-
mon remedies in the hands of most of our practi-
tioners.

   Cold air, cold water, and ice are among the  new
remedies of modern practice in Philadelphia.

   Blood-letting is now used in nearly all diseases
of violent excitement, not only in the blood-ves-
sels, but in other parts of the body.  Its use is not,
as in former times, limited  to  ounces in specific
diseases, but regulated by their force, and the im-
portance of the parts affected to health- and life ;
nor is  it forbidden, as formerly, in infancy, nor in
extreme old age, nor in the summer months, nor in
those cases in  which the blood is dissolved, or de-
void of an inflammatory crust, provided the pulse
be full or tense, nor in the period of menstruation,
where symptoms of a violent,  or of a suffocated
disease, manifested by an active or a feeble pulse,
indicate it to be necessary.

   Leeches are  now  in  general use in diseases
which are removed,  by their seat or local nature, 
412          STATE QF  MEDICINE,

beyond the influence of the lancet.   For the intro-
duction of this excellent remedy into our city we
are indebted to Mr. John Cunitz.

   Opium and bark, which were formerly given in
disguise, or with a trembling hand, are now, not
only prescribed by physicians, but often purchas-
ed, and taken without their advice, by many of
the citizens of Philadelphia. They even occupy a
shelf in the closets of many families.

   The use of mercury  has been  revived,  and a
salivation has been  extended, with great improve-
ments and success, to nearly all violent and obsti-
nate diseases. Nor has the influence of reason over
ignorance and prejudice,  with respect to that noble
medicine, stopped  here.   Cold water, once sup-
posed to be incompatible with  its use, is now ap-
plied to the body, in malignant fevers, in order to
insure, and accelerate its operation upon the sali-
vary glands. But  this  is not  all.   It is applied
locally, and universally  to restrain, or to check a
 salivation, when it  exceeds in  its degree or dura-
 tion, the  exigencies of a disease, or the wishes of
 a physician. 
   BETWEEN 1760 AND 1766, AND 1809.  413

   Wine is given in large quantities, when  indi-
cated, without the least fear of producing intoxi-
cation.

   The warm and cold baths, which were formerly
confined chiefly to patients in the  Pennsylvania
hospital, are now common prescriptions in private
practice.

   Exercise, country air, mineral springs, and the
sea shore, are now universally recommended in
chronic diseases, and  in the debility which pre-
cedes and follows them.

   Great pains are now taken to regulate the quan-
tity and quality of aliments and drinks, by the pe-
culiar state of the system.

   Let us  now inquire into the influence of the
new opinions in medicine, and the new remedies
which have been mentioned, upon human life.

   The small-pox, once the most fatal and univer-
sal of  all diseases, has nearly ceased to occupy a
place in our bills of mortality, by the introduction
of vaccination in our city.  For the prompt adop-
tion of this great discovery, the citizens of Phila- 
414
STATE OF  MEDICINE,
delphia owe a large debt of gratitude to Dr. Coxc,
and Mr. John Vaughan.

   Fevers, from all their causes, and  in all their
forms, with the exception of the bilious yrellow fe-
ver,  now yield to medicine.  Even that most ma-
lignant form of febrile diseases is treated with more
success in Philadelphia  than in other countries.
It would probably seldom prove mortal, did a be-
lief in its being derived from an impure atmos-
phere, and  of its exclusive  influence upon the
body, while it  prevailed as an  epidemic, obtain
universally among the physicians and citizens of
Philadelphia.

   The pulmonary consumption has been prevent-
ed, in  many hundred instances, by  meeting its
premonitory signs, in weakness and feeble morbid
excitement in the whole system, by country air,
gentle  exercise, and gently stimulating remedies.
Even when formed, and tending rapidly  to its
last stage, it has been cured by small and frequent
bleedings, digitalis, and  a mercurial salivation.

   The hydrocephalus internus,  the cynanche tra-
chealis, and cholera infantum, once so fatal to the
children of  our city, now yield  to medicine  in
their early stages. The  two former are cured by 
BETWEEN
1760 and  1766,  and 1809.
415
copious bleeding,  aided  by  remedies  formerly
employed in them  without  success. The last is
cured by moderate bleeding, calomel, laudanum,
and country air.

   The gout has been torn from its ancient sanc-
tuary in error and prejudice, aiid  its acute pa-
roxysms now yield  with as  much certainty to
the lancet, as the most simple inflammatory dis-
eases.

   The dropsy is cured by renouncing the unfor-
tunate association  of specific remedies  with its
name, and accommodating them to the degrees of
excitement in the blood-vessels.

   The tetanus from wounds is now prevented, in
most cases, by inflaming the injured parts, and
thereby compelling them  to defend  the whole sys-
tem, by a local disease.  Where this preventing
remedy  has  been  neglected, and where tetanus
arises from other causes than wounds, it has often
been cured by adding to the diffusible stimulus of
opium, the durable stimuli of bark and wine.

   Death  from drinking cold water, in the heated
state of the body,  is now obviated  by previously
wetting the hands ©r feet with the water; and when 
416
STATE OF MEDICINE,
this precaution is neglected, the disease induced by
it, is generally cured by large doses of liquid lau-
danum.

  Madness, which formerly doomed its miserable
subjects to cells or chains for life, has yielded to
bleeding,  low diet, mercury, the warm and cold
baths, fresh air, gentle exercise, and mild treat-
ment, since its seat has been  discovered to be in
the blood-vessels of the brain.

  The last achievement of our science in Philadel-
phia, that I shall mention, consists in the discovery
and observation of the premonitory signs of violent
and mortal diseases, and in subduing them by sim-
ple remedies, in their forming state.    By  this
means, death  has  been despoiled of his prey, in
many hundred instances.

  In this successful conflict of medicine with dis-
ease and death, midwifery and surgery have borne
a distinguished part. They derive their claims to
the gratitude of the citizens of  Philadelphia from
the practice of each of them being more confined,
than formerly, to a few members of our profession.
It is in consequence of the former being exercised
only by physicians of regular and extensive educa-
tions, that death from pregnancy and parturition 
 BETWEEN 1760 AND 1766, AND  1809.   417

is a rare occurrence in Philadelphia.  For the dis-
covery and introduction of the means of prevent-
ing it from the latter  disease by copious blood-
letting, also for the discovery of the partial inver-
sion of the uterus, and the method of reducing it,
the citizens of Philadelphia are indebted to Dr.
Dewees.

  I should greatly exceed the limits prescribed to
this inquiry, should I mention how much pain and
misery have been relieved,  and  how often death
has been baffled in his attempts upon human life,
by several late improvements in old, and the disco-
very of new remedies in surgery.   I shall briefly
name a few of them.

   In  cases of blindness, from a partial opacity of
the cornea, or from a closure of the natural pupil,
a new pupil has been made;  and where the cornea
has been partially opaque, the opening through the
iris has been formed, opposite to any part of it,
which retained its transparency.

   The cure of fractures has been accelerated  by
blood-letting, and, where the union  of  a broken
bone has not taken place from a defect of  bony
matter, it has been produced by passing a seton
 between the fractured ends of  the  bone, and ef-
    vol. iv.         3  G 
418
STATE OF MEDICINE,
fecting a union thereby between them. Luxations,
which have long resisted both force and art, have
been reduced in a few minutes, and without pain,
by bleeding aftdeliquium animi.

  Old sores have  been  speedily healed, by des-
troying their surfaces, and thereby placing them in
the condition of recent accidents.

  Erysipelas is cured, and external mortifications
are checked, by the application of blisters to the
parts affected.

  The fruidess application of the trepan,  in con-
cussions in the brain, has been  prevented by co-
pious bleeding and a  salivation.

  A suppression of urine has been  cured, by the
addition of a piece of a bougie, to a flexible cathe-
ter.

   Strictures in the urethra have been removed by
means of  a caustic, also, in a more expeditious
way, by dividing them with a lancet

   Hydrocele has been cured by a small puncture,
and afterwards exciting inflammation and adhesion 
   BETWEEN 1760 AND 1766, AND 1809.  419

by an  injection of wine into  the tunica vaginalis
testis.

   The popliteal aneurism and varicose veins have
both been removed by operations  that were un-
known a few years ago.

   For the  introduction of several of those new
surgical remedies,  and for the discovery and im-
provement of others, the citizens of Philadelphia
are indebted to Dr. Physick. They are likewise
indebted to him and Dr. Griffitts for many of the
new and successful modes of practice, in the dis-
eases that have been mentioned.  Even the few
remedies that have been suggested by the author
of these inquiries, owe their adoption  and useful-
ness chiefly to the influence of those two respect-
able and popular physicians.

   Before I dismiss this part of our subject, I have
only to add, that since the cure and extraction of
the  teeth have  become a distinct  branch of the
profession  of medicine,  several  diseases which
have arisen from them, when decayed, have been
detected and cured*.
   * The late Mr. Andrew Spence was the first regular bred den-
tist that settled in Philadelphia.  There are now several well edu-
cated gentlemen in the city of that profession. 
420
STATE OF  MEDICINE,
   We have thus taken a comparative view of the
medical theories and remedies of former and mo-
dern times, and of their different influence upon
human life. To exhibit the advantages of the lat-
ter over the former, I shall mention the difference
in the number of deaths in three successive years,
at a time when the population of the city and sub-
urbs was supposed to amount to 30,000 souls, and
in three years, after the population exceeded dou-
ble that number.

   Between the 25th of December, 1771, and the
25th of December, 1772, there died 1291 persons.

   Between the same days of the same months, in
1772 and 1773, there died 1344 persons.

   Within the same period of time, between 1773
and 1774, the deaths amounted to 1021, making
in all 3,656. I regret that I have not been able to
procure the returns of deaths in years prior to those
which  have been  mentioned.  During the three
years that have been selected, no unusually mor-
tal diseases prevailed  in the  city.   The measles
were epidemic in  1771, biit were  not  more fatal
than  in common years. 
   BETWEEN 1760 AND 1766, AND 1809.  421

  Between the 25th of December, 1799, and the
25th of December, 1800, there died 1525 persons.

  Between the same days of the same months, in
the years 1801 and 1802, there died 1362 persons.

  Within the same period of time, between 1802
and 1803, the deaths amounted to 1796, making
in all 4,883.

  Upon these returns it will be proper to  remark,
that several hundreds of the deaths,  in 1802 and
1803, were from the yellow fever, and that many
of them were of strangers.  Of 68 persons, who
were interred in the Swedes' church-yard alone,
one half were of that description of people.  De-
ducting 500 from both those causes of extra-mor-
tality in the three years, between 1799 and 1803,
the increase of deaths above what they were in
the years 1771 and 1774 is but 727.  Had diseas-
es continued to be as mortal as they were thirty
years ago,  considering the present state of our po-
pulation, the number of deaths would have been
more than  7,312.

  To render the circumstances of the statement of
deaths that has been given perfectly equal, it will
be necessaiy to add, that the measles prevailed in 
422         STATE OF  MEDICINE,

the city, in the year 1802, as generally as they did
in 1771.

   From the  history that has been  given, of the
effects of the late improvements and discoveries in
medicine upon human life, in Philadelphia, we are
led to appreciate its importance and  usefulness.  It
has been said, by its enemies, to move ; but its
motions have been asserted to be only in a circle.
The facts that have been stated clearly prove, that
it has moved, and rapidly too, within the last thirty-
years, in a straight line.

   To encourage  and regulate application and en-
terprize in medicine hereafter,  let  us inquire to
what causes we are indebted for the late discove-
ries and improvements in our science, and for their
happy effects in reducing the number  of deaths so
far below their  former proportion  to the  inhabi-
tants of Philadelphia.

   The first cause I shall mention is  the great phy-
sical changes which have taken place  in the man-
ners of our citizens in favour of health and life.

   A second cause, is the assistance which has been
afforded to the practice of physic, by the numerous
and important discoveries  that  have lately been 
BETWEEN 1760 AND 1766, AND 1809.
423
made in anatomy, natural history, and chemistry,
all of which have been conveyed,  from time to
time, to the physicians of the city, by means of
the Philadelphia and hospital libraries, and by the
lectures upon those  branches of  science which
are annually delivered in the university  of Penn-
sylvania.

   3. The rejection of the supposed healing pow-
ers of nature in all diseases of great, and feeble
morbid action, and the preference  which is given
to the more prompt, and safe method of curing
them by means of artificial remedies, have added
very much to the utility  and credit of medicine in
our city.

   4. The application of reasoning to our  science
has contributed greatly to extend its success in the
cure of diseases.  Simply to  observe  and to re-
member,  are  the humblest operations of the hu-
man mind.  Brutes do both.  But to theorize, that
is, to think, or, in other language, to compare facts,
to reject counterfeits, to  dissolve the seeming affi-
nity of such as are not true, to combine  those that
are related, though found in remote situations from
each other, and, finally,  to deduce practical  and
useful inferences from them, are the high preroga-
tives and interest of man, in all his intellectual pur- 
424
SiATL OF MEDICINE,
suits, and in none more, than in the profession of
medicine.

   5.  The  accommodation of remedies  to the
changes which are induced in diseases by the late
revolutions  in our climate, seasons, and manners,
has had a sensible influence in improving the prac-
tice of medicine in our city. The same diseases,
like  the  descendants of  the same families, lose
their  resemblance to each other by the lapse of
time ;  and the  almanacks of 1803 might as well
be consulted to inform us of the monthly phases
of the moon of the present year, as the experience
of former years, or the books of foreign countries,
be relied upon to regulate the practice of physic
at the present  time, in any of the cities of the
United States.

   6. From  the diffusion of medical  knowledge
among all classes of our citizens, by means of me-
dical publications, and controversies, many people
have been taught so much of  the principles  and
practice of physic, as to be able to prescribe for
themselves in the forming state of acute diseases,
and thereby to prevent their fatal termination. It
is to this self-acquired knowledge among the citi-
zens of Philadelphia, that physicians are in part in-
debted for  not being called out of their beds so 
BETWEEN 1760 AND 1766, AND 1809.   425
frequently as in former years. There are few peo-
ple who do not venture to administer laudanum in
bowel complaints, and there are some persons in
the city, who have cured the cynanche trachealis
when it has  occurred in the night, by vomits and
bleeding, without the advice of a physician. The
disuse of suppers is another cause why physicians
enjoy more rest at night than formerly, for many
of their midnight calls, were to relieve diseases
brought on by that superfluous  meal.

   7. The dispensary instituted  in our city, in the
year 1786, for the medical relief of the poor, has
assisted very much in promoting the empire of me-
dicine over disease  and death.   Some lives have
likewise been saved by the exertions of the  hu-
mane society, by means of their printed directions
to prevent sudden  death; also, by  the  medical
services which have lately been extended to out-
patients, by order of the managers Gf the Penn-
sylvania hospital.

   8thly and lastly. A change,  favourable to suc-
cessful practice in Philadelphia, has taken place in
the conduct of physicians to their patients. A sick
room has ceased to be the  theatre of imposture in
dress and manners, and prescriptions are no longer
delivered with the pomp and authority of edicts.
    vol.  jv.          3 n 
426
STATE OF  MEDICINE,
On the contrary, sick people are now instructed in
the nature of their diseases, and informed of the
names and  design of their medicines, by which
means faith  and reason are made to co-operate in
adding efficacy to them.  Nor are patients left, as
formerly, by their physicians, under the usual ap-
pearances of dissolution, without the aid of medi-
cine.  By thus disputing  every inch of ground
with death, many persons have been rescued from
the grave, and lived years afterwards, monuments
of the power of the healing art.

   From a review of what has been effected within
the last nine  and thirty years, in lessening the mor-
tality of many diseases, we are led to look forward
with confidence and pleasure to the future achieve-
ments of our science.

   Could we lift the curtain of time which separates
the year 1847  from our view, we should see can-
cers, pulmonary consumptions, apoplexies, palsies,
epilepsy, and hydrophobia struck out of the list of
mortal diseases, and many others which still retain
an occasional power  over life, rendered  perfectly
harmless, provided the same number of discoveries
and improvements shall  be made  in medicine in
the intermediate years, that have been made since
the year 1766. 
  BETWEEN 1760 AND 1766, AND 1809.  427

  But in vain will the avenues of death from those
diseases be closed, while the more  deadly yellow
fever is permitted to supply their place, and to
spread  terror, distress, and  poverty through  the
city, by destroying the lives of her  citizens  by
hundreds or thousands  every year.   Dear cradle
of liberty of conscience in the western world! nurse
of industry and arts! and patron of pious and  be-
nevolent institutions! may this cease to be thy me-
lancholy destiny! May  Heaven dispel the errors
and prejudices of thy citizens upon the cause and
means of preventing their pestilential calamities !
and may thy prosperity and  happiness be revived,
extended, and perpetuated for ages yet to come !
PRINTED BY  JANE AITKEN. 
 
 
 
 
 
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