>. v7 V.V4 \% % ■'?"v . 'v -■*'■»' ^^- [THIS little piece was written about trie end of the winter *793'4> on tne occafion of a growing alarm of the yellow fever being again in Philadelphia. Fear began to fpread in the city 2 and, had it extended to the members of the national legiflature, fo as to have occafioned their removal from town, it would have ^ been attended with confiderable difadvantage to the public affairs. Copies were diftributed among the gentlemen of congrefs, and to a few of the city. But it happened that feveral, who could not have been purpofely overlooked, did not receive any: and appli- cations have been made for copies when there were none left. To anfwer thefe, a few copies more, with notes, are ftruck.oi£T^ //^ ((7 rbx YELLOW FEVER*-. u _L HE yellow fever, or tropical endemic caufua, and the fmall pox, are inflammatory in the attack; and are communicated by fpecific contagion. The poifon of the former, as it feems, is conveyed di- rectly to the ftomach with the faliva, or any thing fwallowed, and acts upon it, and upon the pylorus and duodenum, by corrofion; which firft raifing an inflammation on the parts, thefe afterwards become gangrenous. This poifon acts as other acrid poifbns taken into the ftomach. The difeafe is a corrofion of the ftomach, the pylorus, and the duodenum; all elfe of the complaints, are they more than fymptoms confequent of that corrofon ? * The contagious poifon of the fmall pox acts more like that infufed into the blood by the bite of poifon- ous animals, which contaminates the mafs. The conftituent parts of thefe poifons, or by what procefs of nature they are generated, few pretend to know; and though fome may fancy they know them, yet it is beyond the conjecture of moft. ftr*"———-—■ * See an account of diffechons, page 9. [ 3 ] Whilft we are ignorant of the caufe of the yelhw fever and fmall pox, we may however admit that they are infectious, though not alike in all circumftances.* The fmall pox may be communicated in all ftates of the air, but the yellow fever can exift only in a Lot air, as hiftories of it (how : and there are alfo ftrong reafons for believing from thofe hiftories, that frojl kills the infectious matter of it, as furely as it kills certain other exotics. Many people, in the time of the late epidemic in Philadelphia, looked for rain, * The tropical endemic yellow fever is not always conta* gious. It exifts in the Weft India iflands for years together without being notably fo. Strangers from northern climates are very liable to take it on their arrival there; and it goes bard with them. Their being fo very fufceptible, is owing more to their intemperance, and expofure to night air, dews and rains, than to contagion. After fome number of years, it is ufhered in with aggravated circumftances. It thus be- comes very contagious, and is adiftinct and mod fatal difcafe. Such was the yellow fever in Philadelphia in 1793, and in the Weft Indies in 1793 and 1794. The milder or common yellow fever of the iflands can never be conveyed to the con- tinent, becaufe it is not contagious, and the contagious kind feldom exifts in the iflands:—thence the long intervals of its appearance on this continent. All plagues have their periods. When the peculiar circumftances that occafion or admit of the aggravation in the yellow fever give way, the difcafe becomes no longer contagious, but finks into the common and lefs virulent tropical yel!o# fever. It is faid, an excejs of heat or of cold will deftroy certain difeafes. The dreaded Natolian plague (commonly called " The Plague") has ex- ifted, at times, in the higher but miid latitudes, hitherto, without having ever originated any where elfe than in Na- tolia. It is often in northern Egypt and on the coaft of Barbary: but it is faid to be always carried thither from its Natolian fource. M. Savery calls Conftantinople and Smyrna the Foci of it. Was this kind of plague ever known to exift [ 3 ] which they believed would be fatal to the infection.* Others regarded not the coming of rain, otherwife than as it might be attended with or followed by cold; an i they looked only for mere cold, whether attended with rain or not, becaufe hiftories of this fever affured them that cold had always been fatal to the infection. It is admitted that floods of rain, by diluting and waffling off the ftagnant putrid water of a low country, relieve from the remitting, the bilious, and the putrid fevers common to fuch countries. Although the yellow fever originates in countries of perpetual beat, yet it may be brought from thence into this country of both cold and heat, as it hereto- fore has been: there are, however, two particulars efpecially neceffary to that end; that it be in the peculiar air of a large town, and that the feafon be Lot. It may well be prefumed it cannot act, in this country at leaft, but under this combination; becaufe it ne- ver yet has appeared on the continent, unattended between the tropics? It has been earned to England, and other countries of heat and cold, where it raged. Ail the countries of its exiftence are in the temperate climates. Did it ever exift in countries of continual heat? On the other hand, the yellow fever, in its virulent ftate, originates only within the tropics, the lower latitudes of perpetual heat: but it is of a nature to act in the higher latitudes, under a combination of certain peculiar circumftances, when in- troduced from its native fource. There mutl be fuch a combination to produce and fupport thefe contagious and dreadful difeafes. Other circumftances arreft, and in the end annihilate them. * In Granada, " As the change to moijlure was remark- ably great and fudden, much expectation was formed that the virulence of the infection would be done away or abated: but neither happened." Chilholm. [ 4 ] with thofe circumftances. If the matter of this con- tagion fuffers cold, it fuffers death; as may be col- lected from facts uniformly heretofore happening in this country. When it was in Charlefton, S. C. in 1748, it received its death ftroke from cold air on the fourteenth of October; and about the fame time of October it lately experienced the like, on the change of air from an uncommon heat, for that feifon, to the proper degree of autumnal cold. The cool air, efpecially at night, in the laft week of September, 1793, produced fuch a change in the degree of infection and complaints of the fick in Philadelphia, that the phyficians expreflcd an agree- able furprize, on the great abatement of both: but the return of warm clofe weather, with a Ihift of wind from the northern quarters to the fouikern, in the beginning of October, gave fo fatal a malignancy to the difeafe, as occafioned more frequent deaths, for feme days, even after the return of cooler wea- ther; but, it feems it had generally effected too much to admit of recovery, of the then fick, in any flare of the air afterwards. For fupporting the aforegoing principles, we need only be affured that the yellow fever has never been communicated in country places or fmall towns on this continent; and that as often as it has been amongft us, it always appeared to be imported, always vanifhed in the cool feafon of autumn' and never recurred with the enfuing fummer, nor until again ufhered in from the Weft Indies. Re- ports fav in leed, that it has been taCen in country places, in fome few inftances. But on inquiry, it appears there has been a want of knowledge to diftinguifh the yellow fever from difeafes of the ■ I 5 ] country, the fymptoms being partly alike. In other inftances, people have received the infection in Philadelphia, but have pretended they had not been in the city: others alarmed, have imagined they had it, when they have only had a little cold or common complaint, or mere apprehenfion may have induced the fuppofition.* People and merchandife have been continually arriving from the Weft India iflands, the fource of the yellow fever for ages paft; yet the difeafe was never communicated to the people of this city, but in the heat of fummer, and that only thrice in above fixty years; probably the feldomer, from the con- tagious matter having generally fpent itfelf, or eva- porated in the time of performing the voyages. * It feems there (till is a fufpicion in fome phyficians, founded on the narrations of other people, that there were a few inftances of the infection taken in country places. But to afcertain facts of this nature, and diftinguifli them with accuracy, for a phyfician to judge of them with certainty, is not very eafy in common. Difeafes originating in or greatly affecting the ftomach, are attended with fymptoms much alike, from the common intermittent to the yellow fever. Any thing corrofive or acrimonious, acting forcibly on the coats of that bowel, muft immediately affect the nerves, which there abound, and readily communicate fenfations to the very extremities. The beginning of the worft of the yellow fever has been taken, in Philadelphia, for only a cold or obftruSted perfpiration. Perfpiration, by the bye, being refufed a, paffage through its natural outlet, becomes depraved and even acrimonious. It then foon affects the fibres and the nerves, and induces fpafm (whether it be perceptible or not) attended with tremours, head-ach, hea- vinefs, reftleflnefs, anxiety, paine, naufea or vomiting. If haply the perfpirabie matter is driven into the canal, k is [ 6 J To fatisfy the mind that the late epidemic, in Philadelphia, was introduced from a tropical climate, fober reafon requires but to know, that it is a difeafe natural to the Weft India iflands; that it never was known to originate in this country; but has been admitted, without a doubt of any one till now, to have been always brought from thence; that it has been, this year, raging in thofe iflands more than ufual; that there never was before fuch a plenty of means for bringing it from thence, and that it firft broke out in a part of the city near which fhips from thofe iflands, that had unufual numbers of fick peo- ple on board, difcharged their cargoes. From all which circumftances there arifes an irreflftible pre- fumption, that the late contagious fever, called the yellow fever, was imported from the Weft India iflands* thence difcharged in the character of diarrhoea. But, if its ftimulous produces fixed fpafm on the inteftines, whilft the pores of the (kin ftill remain clofed, coftivenefs then occurs, and the perfpirable matter is every way fhut up. It feems, that from the fpafm of the ftomach, extended, arifes the coftivenefs ufual in the yellow fever; which remains, till recovery or putrefaction releafes the fibres from the fpafm. When putrefaction happens to effect this-^then it is that by* ftanders become aftonifhed on feeing the fpontaneous dif- charges, which are immenfe, in fluids that had been accu- mulating, and were imprifoned by the fpafm now fuddenly let loofe on an entire lofs of tone in the fibres. * The introduction of the yellow fever from Boullam, in Africa, into St. George's, in Granada, was by the (hip Hankey, in February, in the year 1793, and it was called the " Boullam fiver" or " Boullam malig- nant peftilential fever." Doctor Chifholm thinks it is |hc fame with that which raged in Philadelphia in that year. t 7 ] It has been inconfiderately imputed to Philadel3 phia, that it is more liable to receive the yellow fever than other large towns of America. It is made by people who had collected from recent hafty pub- lications, that it had been three or four times in this city, without their being informed how often it had been in other towns. This fever, it feems, has been at leaft as often in Charlefton, S. C. and New York. The accurate doctor Lining fpeaks of four times that it was in Charlefton; in the years 1732, '39, '45, and '48. Charlefton being nearer the ocean, the tropic, theHavanna, and the Weft India iflands, feems more liable to receive the infection than a town further from them, and near a hundred miles inland, that in general is remarkably healthful, and which would He illuftrates this idea by the inftance of a veffel, belonging to Philadelphia, introducing the difeafe into St. Pierre, Martinique, in October, 1793, and by a veffel from New London touching at St. Pierre, and carrying the infection to Granada in February, 1794. He adds, that on the fick being put under his charge, he found the difeafe was his old enemy, the malignant peftilential fever, (meaning no doubt the fame with that introduced from Boullam into Granada in the preceding February) which he fuccefbfully treated with mercury. It raged in Granada in 1793, and generally among the Weft India iflands, more or lefs, through that and the next following year.- The Boullam fever, in 1793, February, was imported into Granada from Boullam. In July following, into Phi- ladelphia from the Weft India iflands. In Oclober following, into Martinique from Philadelphia. Being identically the fame in qualities, it was as readily returned from hence to the iflands, as it was at firft brought from thence to the great towns of the continent. A veffel of Philadelphia loft her fupercargo at Granada, who died there of the Boullam fevcf fo early as April, 1793. [ 8 ] probably fcarcely ever recei\ e it, were it not that it is more populous, and therefore has more ot tie air peculiar to large towns, which is fo neceffary, toge- ther with the heat of a fummer, to give action to the contagious matter, on its fpeedy arrival frefh from its tropical fource. It is alfo faid that the yellow fever has been intro- duced into this country in (hips from Rotterdnm and Ireland, crouded with paffengers: but this a great miftake. The hofpital fever has often been intro- duced by them into An erica, but never once the yellow fever, which is not a difeafe of northern climates. The hofpital or gaol fever is thought to arife from animal effluvia. Pnfons, hofpitals and (hips are crouded with men, and abound with excre- mentitious animal effluvia pent up from frefh air. ThcJ gaol fever is peculiar to fuch places, and is very infectious. It is wifhed thofe perfons who are apprehenfivd that contagious matter of the yellow fever is wrapped up in furniture, and they know not what, and that it will break out next fummer, would be at the pains to inform themfelves, from the hiftories of the difeafe heretofore publifhed, of the manner and the time when it ufually arrived or broke out, and when it died away on this continent. It will pacify them. They will efpecially be affured that fome number of years paffed away between the times of its recurring in our country. [ 9 ] THE public is obliged to doctors Thyfick and Cathrall for an account, early given, of their din- fections of perfons who died of the yellow fever which r3ged in Philadelphia in the year 1793; the purport whereof follows, together v.ith remarks thereon bv the editor. B. 1. The brain in all its parts, has been found in a natural condition. Remark. The difeafe is local to the flomach and parts near it. The brain is diflant from the feat of it. The firfl, fs- cond, third and ninth of the folio-wing inftances of dijfeclion were of fuch perfons as died early in the difeafe. Note well the ninth obfervation of the doclors. 2. The vifcera of the thorax are perfectly found. The blood however, in the heart and veins, is fluid; limilar in its confidence to the blood of perfons who have been hanged cr • deftroyed by electricity. Remark. The early death from fpafm of the flomach— aflrokc local that effefls not general difeafe, may account for this: and moreover, in hot -weather coagulation occurs not very foon. 3. The flomach and beginning of the duodenum are the parts that appear the mod difeafed. In two perfons who died of the difeafe on the fifth day, the villous membrane of the ftomach, efpecially about its fmaller end, was found highly inflamed, and this inflammation extended through the pylorus into the duodenum, fome way. The inflammation here was exactly fimilar to that induced in the ftomach by acrid poi- fons; as by arfenic, which we have once had an opportunity of feeing in a perfon deftroyed by it. Remark. Ibis illuftrates the reality of the matter of a fpeci fie contagion ailing immediately on the flomach. Apart •whcr.'of may ten I downward, and here and there attach to the inteflines. If fome of it is, in certain cafes, enveloped in th: paffing excrement, fo as to be carried off at the common outlet, B [ io ] yet enough of it may adh tv, and ail on the bowels to the worfi purpofes. 4. The bile in the gall bladder was quite of its natural colour, though very vifcid. Remark. The fluids ar>- not the immediate fubjeels of ibis dijeafi.-----CCj* ? h~ preceding are in inftances c_/~early deaths, in the fllate of a contraction or inflammation of the ftomach, V he following are of later deaths, where gangrene has oc- curred, after the inflammatory flat e. 5. In a perfon who died on the eighth day of the difcafe, leveral fpots of extravafa/ions were difcovered between the membranes, particularly about the fmaller end of the fto- mach, the inflammation of which had confulerably abated. Pus was feen in the beginning of the duodenum, and the villous membrane of this part was thickened. Remark. The inflammation abates as gangrene approaches. Was not^he produflion of pus owing to an effort of health/' ^The thickening was an indication of putrefaction. 6. In two other perfons who died at a more advanced period of the difeafe, the ftomach appeared fpotted in many places with extravafations, and the inflammation difappeared. It contained, as did ajfo the inreftines, a black liquor, fuch as had been vomited and purged before death.—This black liquor appears clearly to be an altered fecretion from the liver: for, a fluid in all refpects of the fame qualities was found in the gall bladder. This liquor was fo acrid that it induced confiderable inflammation and fwelling on the ope- rator's hands, which remained fome days. The villous membrane of the inteflines, in thefe laft two bodies, was found inflamed mfeveral places. Remark. The ejfetls of the poifon, though mofily local to the flomach and duodenum, fometimes appear in otbtr parts of the bowels ; and they adl definitively vjhere there is the rea- diefi fiufceptibility. The poifon firfi is in contact with the fiomach: and after having effecled. a corrofion and inflammation there, which is followed by a gangrene df that bowel, it or fome part of it may defcend, as it feems, and raife an inflam- mation on the inferior bowels, where it chances to adhere", ever. [ II ] after the fiomach is deftroyed. The general mafs is not imme- diately contaminated by the attack on the fiomach ,* Jo as to be- come gangrenous or putrid: otherwife, could a fubfequent in- flammation be produce J on the other bowels? 0 7. The liver was of its natural appearance, excepting in one of the bft prrfons, on the fuiface of which a very few> diftendcd veins were feen, although other abdominal vifcera were of heaith) appearance. Remark. 7be fpafms an I corrofions of the fiomach are con- fi.lerable. Such as mufi joon indue: g.neral diforder of the bo iy, and extenfive mjrlid iff eels both in the folids and the fluids, tbough not always alike or in the $ame parts. 8. The external furf ace of the ftomach, as well as of the inteftines, was quite free from the inflammation; the veins being diftended with blood, which appeared through the tranfparent peritoneum, gave thern a dark colour. Remark. This is further in favour of the locality of this difeafe. How confined!.—All is effected firfi by contacl with the fibres and nerves of the fiomach. The fymptoms were dif- fuje ; and in the end the fluids with the folids become exten- fivsly morbid. 9. The fiomach of thofe who died early in the difeafe, was always contracted: but in thofe who died in a more advanced period of it, where extravafations appeared, it was difiended with air. Remark. The corrofive poifon early injures the fibres of the fiomach, and occafions fpafm; ;rfi of the minuter parts with •which it comes into contact; and this prefent/y extends fo con- fiderably and fo forcibly as to contracl the whole or a great part of that bowel, during the inflammatory fiate, and until gangrene diffolves the contraction of the fibres. 1 he confquent putrefailion is then attended with a difienfion of the parts. Such fudden, firong, an I extenfive contraction mufi arrefl the natural and necejjary functions : and death comes with fpeed, before time is given for gangrene to effeel it. Mdd.Hist LI 6