fugi ■ &f ■%»:' %> \ ; .,- s&>- •*J< ^u.o^.o ...iA^A'L1'.'1 '' n"".6$S tfc^, a^ c 3 Surgeon Generars Offics %^ao ic e. e acre 6a oogaoQ cr e cn ej^^ A SKETCH ,//y#, OF THE /Ca~~~~~7 RISE AND PROGRESS v" OF THE YELLOW FEVER, AND OF THE Proceedings of the Board of Health, IN PHILADELPHIA, In the Year 1799 : TO WHICH IS ADDED, A Colleflion of Fads and Observations RESPECTING THE At,''" ORIGIN OF THE YELLOW FEVER IN THIS COUNTRY;/^ A^ AND A REVIEW OF THE DIFFERENT MODES OF TREATING IT. Br WILLIAM CURRIE,V FELLOW OF THE COLLEGE OF PHYSICIANS, AND MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, &C. " Though prejudice in narrow minds, The mental eye of reafon blinds; Though wit, which not e'en friends will fpare, Affecl the fneering, laughing air; Though dullness, in her monkifh gown, Difplay the wisdom of a frown; Yet truth will force herfelf, in fpite Of all their efforts, into light." PHILADELPHIA: PRINTED BY BUDD AND BARTRAM, N° 585 NORTH SECOND STREET. —-1 80O. PREFACE. lVxY principal defign in the prefent publi- cation, is to eftablifh the truth reflecting the origin of the yellow fever in this country; and, to communicate what appears to me to be an improvement, in the treatment of that dangerous malady. The intelligent reader will perceive, that the prefent performance contains fome fentiments in fome refpects different from thofe I former- ly entertained, and particularly with refpect to the identity of the yellow fever with that of the typhus gravior or common malignant fever of camps and hofpitals : I therefore beg leave to remind him, that knowledge mull neceffarily be progreffive on newr and intricate fubje&s; and that fince my former publica- tions, additional obfervations and more am- ple and accurate views, have afforded me more correct ideas on the fubjecl:. C IV PREFACE. It is my fincere wifh that all ambiguity mould be removed, and the truth eftablifhed independent of every other confideration : if therefore any material miftakes fliould be difcovered in the following pages, I fhall efteem the correction of them as an act of friendfhip ; for I confider the fituation of a man to be fingularly unfortunate, who, while he is feeking to enlighten others, is walking in the dark himfelf. With thofe fentiments, and this difpoii- tion, the prefent production is dedicated to the candid and intelligent part of the com- munity, By the AUTHOR. A SKETCH, <&V. 1 HE firfl cafes of the peftilential or yellow fe- ver that occurred laft year in Philadelphia, were in the neighbourhood of Meffrs. Willing and Francis's wharf, between Pine and Lombard-ftreets, near the fouthern boundary of the city : and in fouthwark, in the neighbourhood of the ftill-houfe wharf, with- in a few paces of the Swedes church. The firft. cafes that have come to my knowledge in the neighbourhood of the firft mentioned wharf, were the following, viz. A young woman at No. 17, about the 15th or 16th of June; Mr. Afh- mead, a little lower down in Front-ftreet, on the 17th, who died on the 23d. Mr. Thomas, who had been on board a veffel from Curracoa, and came from the quarantine ground the 15th, wa. taken ill with the fever on the 17th. A fhoemakcr's boy, on the 21ft, was moved from Soiithwark to Arch near Seventh-ftreet and there died. Mr. John ( 6 ) M'Donald, who lodged near Meffrs. Willing and Francis's wharf, at No. 17, Pcnn-ftrcet,' direftly back of the wharf, was attacked on the 24th and died on the 29th. The mate of a fnow from Hamburgh, at drat time lying at the fame wharf, was alfo taken with the fever on the 24th and died on the 29th. The next cafes in the order of time that occurred in the neighbourhood of that wharf, were, a young woman at Mr. Samuel Rhoads's, on the 25th, who died on the 30th: Mr. Smith, who had been on board of two veffels at the wharf, on the 27th: Captain Rofs's daughter on the 28th, and his wife about the firft of July : Mr. Thomas Cuthbert on the 27th or 28th of June. Mr. James Smith's fon, in Lombard-ftreet, who had been on the wharf marking calks belonging to the Hamburgh fnow, was attacked on the 28th of June. Several other cafes occurred in the fame neighbourhood a few days later; and from thofe the difeafe gradually fpread into different parts of the city. A fmall (loop called the Molly, prize to the Ganges, had lain at the wharf near the place where the firft cafes of the fever commenced, from the 13th of May. Her cargo, confifting chiefly of coffee, was landed and ftored near the wharf early in June: her hatches were kept fhut till the 21ft of June, at which time they were opened on ac- ( 7 ) count of the ftench proceeding from her, and ac- cording to the account of Samuel Fifher, who had the care of her, 500 buckets of water were thrown into her to clean and fweeten her. The bedding of fome of the feamen that came in her, were left on board: the prize mafter and feamen that brought her in had left her. She was employed trading from Turk's ifland to St. Domingo, at the time of her capture. No perfons were then fick on board, nor did any one become fick while navi- gating her into port. The prize mafter became fick foon after her arrival, but I have not learned what became of him. Near this floop lay a fnow from Hamburgh, the mate and cook, and one of the feamen of which fickened foon after the hatches of the Molly were opened, and two of them died with malig- nant fymptoms, the other recovered. Mr. Smith's fon was near the floop marking calks lefs than a week before his attack: he recovered. During the time the floop lay at Meffrs. Willing and Francis's wharf, the fhip Amiable-Creole, from Havanna, arrived at the city, and came to at the wharf next to Willing and Francis's-, called Nixon's wharf. Refpecting this laft veffel I have been able to obtain no fatisfa the matter of contagion, before the difcafe can be communicated from one to another, or be propa- gated by contagion (which is the only way it can be propagated.) What that precife condition of the atmofphere is, which favours the communica- tion of the difeafe from one to another, has not yet been unequivocally afcertained ; but from the cir- cumftance of the difeafe not being communicated in high, dry, open and airy fituations in the coun- try, during the feafon when it is mofl highly fo in the city, which is a fact, with a few extraordinary exceptions, well eftablifhed, it amounts to a degree of probability almoft equal to certainty, that the atmofphere where the difeafe prevails and is readi- ly communicated from one to another, muft not only be of a certain temperature, but at the fame time calm, confined or motionlefs, and, perhaps contaminated with exhalations from putrefying ve- getable or animal fubftances, or from living animal bodies deprived of frefh and purer air in clofe and confined fituations, which render it a fit conductor for the matter of contagion, at the fame time that the air thus contaminated, by impairing the inhe- rent powers of the body, predifpofes it to be more eafily acted upon by the contagion, not only of pefti- lential, but of fhip, hofpital, jail, or nervous fevers. " A few cafes of the yellow fever have certainly appeared in the lower part of this city already this feafon, amounting in the whole, exclufive of ( '3 ) ambiguous ones, to twenty-one; and of thefe twenty-one, eleven have died. The exifting cafes at prefent are indeed very few; and if we could depend upon the continuance of the pure and fluctuating ftate of the atmofphere in the city which at prefent prevails, there would be no feri- ous caufe of apprehenfion. But as it is impoffible to judge with any degree of certainty, in fo change- able a climate, how long the prefent ftate of the atmofphere, fo unfavourable to the operation of contagion, may continue; and as there is the ftrongeft reafon to expect the revival and propaga- tion of the difeafe with all its complicated horrors, if an unfavourable change fliould take place in the atmofphere, while any of the matter of contagion remains, however fmall in quantity, and however obfcurely it may lurk, or if it fliould by any means be again introduced : and, believing that the fafe- ty of the citizens, and perhaps the future profpe- rity of the city, depend upon the meafures you may devife or adopt for averting a calamity fo awfully diftrefling, 1 beg leave to offer to your ferious confideration the following account of the means employed with the greateft fuccefs, in other countries, for preventing peftilential fevers from fpreading or becoming epidemic. " The magiftrates of the city of Ferrara in Italy, when all the furrounding country was infected with a peftilential fever, obferving the ill fuccefs of the C U ) conduct of their neighbours, who, for fear of lofing their commerce, did all they could to conceal the difeafe, by keeping the fick in their houfes; re- folved, whenever occafion fliould require, to take a different method: accordingly, as foon as they difcovercd that any perfon had died in their city of the difeafe, they immediately removed the whole family to which he belonged, or in which he died, to a fafe diftance from the city." " The example of Ferrara was afterwards fol- lowed by other towns in the fame territory with the fame fuccefs. In confequence of which it was thought expedient to iffue a proclamation for the information of the whole world : " That the only means of preventing peftilential difeafes from fpread- ing or becoming epidemic, is to make the moft early difcovery of the difeafe that is poflible; and as foon as its exiflence is afcertained, to remove without delay, and without refpect of perfons, eve- ry fufpicious cafe thereof, together with the family in which he refides, and every perfon in the fame houfe, with all their goods, furniture and apparel, to a fafe diftance from the city, and to clean and purify the vacated dwellings before any perfon be permitted to reoccupy them." " In addition to the above regulations, Dr. Ruffel, who publifhed an elaborate and voluminous treatife on the plague in the year 1791, advifes, that all ( '5 ) who have had intercourfe with the fick, or who have been expofed to infected articles, whether in- tentionally or not, be alfo compelled to leave the place where the difeafe has begun to appear, for a certain time.—" To permit the infected to remain in a populous city, is to collect magazines of con- tagion, fooner or later to be diftributed into every quarter, and of courfe to convert a whole city into a theatre of difeafe and death." cc By the ftrict obfervance of thofe regulations, Cardinal Gaftaldi, who was appointed commiflary general of health, with difcretionary and unlimited powers, fupprefled the plague at Rome in the year 1657, after the difeafe had made confiderable pro- grefs. The Cardinal's rigorous proceedings at firft excited great popular difcontent and clamour; but as he acted with impartiality, and his proceedings fucceeded, he afterwards received the public thanks. " In the year 1720, the plague was fufpended at Marfeilles by fimilar means for fome weeks, and, no doubt, would have been entirely extinguifhed, if cafes had not been permitted to multiply, owing to this deceitful paufe, a circumftance which gave occafion to the- populace to treat the phyficians and furgeons with indignity, for creating what they fuppofed a falfe alarm.—In confequence of this C 16 ) conduct the difeafe made too great progrefs to be afterwards fuppreffed. " I fliall now conclude with obferving, that if any reliance is to be placed on paft events, unlefs you adopt the moft vigorous meafures for prevent- ing it, the difeafe will revive, and compel the citizens to confult their fafety in flight; an event fo ruin- ous to the intereft and profperity of the city, that it requires no great fagacity to forefee its final de- population, as the inhabitants cannot poflibly fup- port fuch facrifices many years, as they have been forced to make of late. On your management and exertions, therefore, we rely, under Providence, for our prefervation from fo deplorable an event; and I truft we fliall not be difappointed. " The intereft and deep concern I take, in com- mon with.yourfelves, in the welfare of our fellow- citizens, 1 hope, will apologize for the intrufion and trouble which has now, as well as heretofore, been given you, by Your moft refpectful, And very humble fervant, a____________a In the mean time the Board had written and tranfmitted a letter to the Board of Health of Bal- timore, of which the following is a copy. ( i7 ) " HEALTH.OFFICE. " Philadelphia, 7th Mo. 10. 1799. " Gentlemen, " Your friendly communication under date of the 6th inft. is at hand. We are happy in having an opportunity of contradicting the injurious reports regarding the health of this city: reports which fear has induftrioufly diffufed and greatly magnifi- ed. They originated from feveral perfons in one fquare of the city having become fick. Perfons who had no acquaintance or connexion with each other; each of whofe indifpofition can be attributed to diftinct and different caufes fufficient to have produced that effect; caufes which would havq operated fimilarly in every country and fituation equally warm. Their families, nurfes, and attend- ants continue well, neither has any new cafe of ficknefs occurred in the neighbourhood for ten days paft, from which circumftances the alarm has en- tirely fubfided. " We accept your propofal of correfpondence with pleafure, and fliall cheerfully give every informa- tion of the health of our city, together with the probable caufe which may have produced ficknefs, fliould it at any period exift. " Every exertion is ufing among us to avert fo dreadful a calamity •* and we cannot but hope with C you, that, together with yourfelves, we fliall, through divine affiftance, fucceed in our endeavours. " By order of the Board of Health, " EDWARD GARRIGUES, Pref. " To the Board of Health, for ~) the city of Baltimore." $ Examples in other countries of the influence of local and commercial intereft over official duty, are common. No one is willing to believe the deftroyer is at work, left bufinefs fliould be fufpended and the intereft of the city fuffer. Time and temper are wafted on the queftion, " how and whence does " it come ?" Every one endeavours to perfuade himfelf and his neighbour that it is not come, till he difcovers it at his own door. Every one is of- fended with him who pronounces the difagreeable truth. Circumftances are fifted, and the firft vic- tims to the dreaded difeafe are proclaimed to have perifhed by other diforders. The phyficians are looked at with impatience and refentment, and though they are in no danger of being torn to pieces in this country by the populace, as they were in Mofcow in the year 1771, for telling them the plague had got among them, it was propofed to drive them out of the city, or to throw them into the river, not by the populace, but by certain popular characters poffeft of more zeal than know- ledge. ( 19 ) The prize floop already mentioned, was ordered by the Board of Health to the quarantine ground, and fell down on the 29th of June as far as South- ftreet, where fhe remained till the ift of July. She then hauled out and proceeded to her place of deftination. The fever had been dreadfully mortal at the Havanna, before its appearance in Philadelphia, as appears from the letter of Mr. Iznardi, Conful for the United States at that port, publifhed in feveral of the news-papers. The Amiable-Creole from Havanna, lay in the neighbourhood where the fever commenced, as well as the prize floop already referred to. Goods from the fame fickly port were alfo frequently landed at the fame place, by the lighters already mentioned. It is alfo notorious, that the quarantine was re- peatedly violated, by perfons coming up from vef- fels under quarantine in the night, and returning on board before morning. Seven perfons from the city, at a later period, were detected going to the veffels, and were confined fifteen days on State ifland by the Board of Health. Trefpaffes of this nature might be prevented by the eftablifliment of a night watch. I have been affured by a wharf builder of refpectability, that the mafter of a vef- ( 20 ) fel from New England, but laft from the Weft In- dies, eluded the quarantine by fwearing he was lately from New England. A lift of the deaths in the city and liberties was publifhed in one of the papers the i oth of July, from which it appears, that the average number had been for fome time about fix a day. About the 12th of July a few frefti cafes oc- curred in Penn, Little Water, Queen-ftreet, and in the neighbourhood of the ftill-houfe wharf. The alarm which had nearly fubfided began to revive again. The Board of Health, in confequence of this frefh alarm, wrote to the phyficians, requeft- ing a return of all the cafes under their care. On the 15th of July, Harden a Stevedore and a man of the name of Pineyard were known to be dangeroufly ill in different families in Queen near Water-ftreet; Mrs. Arnold and Mr. Rofs's daugh- ter, in Penn-ftreet; Mr. Lawrence, a cooper, bro- ther to the gauger, in Water above Market-ftrect; and Banner Thomas, in Front below Chriftian- ftreet, dangeroufly ill. A frefh cafe of fever oc- curred the 17th, at the corner of Queen and Wa- ter-ftreets. From this time very few frefh cafes were obferved till the 22d ; on this day a lad that lived at Downs's, who had died fome days before, in Little Water-ftreet eaft of Penn-ftreet, was taken ill. C 21 ) There were nineteen funerals in the city and liberties on the 17th, including two from accidents, viz. eight adults and eleven children. From the 17th to the 23d of the month, feveral perfons were attacked in the neighbourhood of Front, Lombard and Penn-ftreets, in the families of Mr. Bridges, Mrs. Woods, Mr. Blackifon and Mr, Thomas. Several perfons were attacked in fuc- ceffion, at fufficiently long intervals to juftify a con- clufion that the difeafe was contagious, efpecially as feveral other families in the fame neighbourhood were entirely exempt, which would not have been probable if the difeafe had arifen from noxious ex- halations floating in the atmofphere. A lady moved from Penn-ftreet to Wilmington early in July, and died there of the fever, but did not communicate the difeafe to any other perfon. A journeyman fhoemaker who refided at Downs's, died of the difeafe in Little Water-ftreet the latter end of July, a few days after Downs's lad. The whole number of deaths on the 29th of July, amounted only to nine, feven of which were at the City-hofpital. The Board of Health received official informa- tion the beginning of Auguft, of the exiftence of the yellow fever in New York. ( 22 ) For the letter of the Board of Health of Phila- delphia to that of Bofton, complaining of their fubjecting the veffels from Philadelphia to quaran- tine, and their denial of the exiftence of a conta- gious difeafe in Philadelphia, I refer to the True American of the 2d of Auguft. I have received affuranees from a refpedtable phyfician in New-York, that he is in poffeffion of unqueftionablc evidences of the importation of the fever into that city in the month of July, by the fhip Gen. Wayne, from St. Domingo. The number of cafes had fo greatly diminiflied in Philadelphia by the beginning of Auguft, that at a meeting of the College of Phyficians on the 6th, only four confirmed cafes were known to ex- ift in the city and liberties, and very few difeafes of any other defcription. A Newbury-Port paper of the 26th of July ftates, that the fever at that time prevalent there, was believed to have been imported by the fchooner Sally from St. Thomas's, which arrived there the 27th of June, as no perfon had been attacked with the fever who had not been on board that veffel, or that did not rcfide or vifit in the vicinity of the lower long wharf, where the veffel was unladen. I: is alfo averted, that no cafe of fuch a fever had occurred, until five or fix days after the arrival of ( ^3 ) the Sally, excepting that of a lad who came from fea in her: foon after which, eleven perfons died in that town, two in Salfbury, and one in Newbu- ry, who had worked on board of her. The above account is confirmed by Dr. James Tytler, in a treatife lately publiflied at Salem in New England, who adds, at page 535—" that of 30 perfons taken with the fever, in the neighbour- hood of the wharf where the Sally lay, 16 died, the majority within the period of feven days." The fever in Philadelphia increafed fo fenfibly after the middle of Auguft, that the College of Phyficians had a fpecial meetmg on the 21ft and made the following laconic communication to the Board of Health. . " Gentlemen, " The College of Phyficians conceive it to be their duty to inform you, that recent events have confirmed the opinion which they lately expreffed to your board ; and they feel it incumbent on them to repeat, that a malignant contagious fever, of the fame nature with the difeafe which rae;cd here in the years 1793, 1797 and 1798, prevails amongft us at this time to a very alarming degree. " Philadelphia, Aug. 21, 1799. " The Board of Health:" ( 24 ) This communication appeared in feveral of the news-papers, a day or two after it was fent to the Board. Confternation feized every one that heard of it; and every part where the difeafe was fufpect- ed to exift, was inftantly deferted. Notwithstand- ing all this, the Board of Health, governed by po- licy that I do not underftand, or mifled by fpecula- tive and miflaken notions refpecting the nature and caufe of the difeafe, did not publicly acknowledge its exiftence, much lefs that it was making progrefs, which was now no longer in their power to con- troul, till the 22d of Auguft. They then, with evident reluctance, acknowledged that a number of perfons had been taken ill the laft fix days, princi- pally in the lower part of the city and in South- wark, fome of whom had died after a few days ficknefs; but that from the few cafes of mortality, and from the favourable change which had taken place in the weather, they were in hopes that a check would be given to its progrefs; and there- fore " they did not think there was fufficient ground for the great alarm which pervaded the city." The citizens convinced of their danger, from the frequent appearance of the herfe and the fick coach, put no confidence in the declaration of the Board, but fled to the country in every direction and from every quarter; fo that by.the ift of September a great part of the city, as well as Soiithwark, was ( *S ) almoft deftitute of inhabitants. Many, however, who had no places provided to retreat to, were forced to remain: and many fell victims to the difeafe, who might have efcaped if the fignal of danger had been given earlier ; and particularly if the line of communication had been cut off early between the infected and the other parts of the city, by removing both the difeafed and the found from that part to a fafe diftance in the country. The difeafe gradually extended to almoft every part of the city eaft of Seventh-ftreet; but very few cafes occurred weftward farther than that ftreet, and not one either on Schuylkill or in Kenf- ington, as far as I can learn. A few nights of fevere froft after the middle of October, deprived the contagion of its power, and put a period to the difeafe fo completely, that the greateft part of the citizens returned to their wel- come homes before the end of the month. The Board did not begin to publifh the daily return of deaths in the city and liberties till the 21ft of Auguft. From this time to the 18 th of October, when they defifted from publifliing them, the number of deaths amounted to 720, including thofe that died at the City hofpital. I believe it may be fafely computed, that the number of deaths in the city and liberties from the 21ft of June to D ( 26 ) the lift of Auguft, on an average, did not ex- ceed 10 a day, including yellow fever cafes, which is lefs than has occurred many years when no yel- low fever prevails; for that period is the moft in- falubrious part of the year td infants and young children in Philadelphia, as September and Octo- ber have always been to adults. According to the return made by the Board of Health to the Governor, the interments from the ioth of July to the laft of October did not exceed 1276. During the laft mentioned period, 324 pa- tients were received into the City hofpital; of thefe 193 died.* The remedies chiefly employed were blood-letting, and mercury, both internally, and externally, for the purpofe of inducing falivation as fpeedily as poflible. In the year 1793, 807 patients were received into Bufh-Hill hofpital (which is fituated in a much more eligible and falutary fituation than the prefent hofpital) from the 22d of September to the 6th of November ; of thefe 448 died. The chief reme- dies employed in 1793, were, occafional but very fparing bleeding, mild laxatives, diluting drinks with vegetable acids, blifters and camphorated ni- trous powders, partial warm bath, &c. * The number of patients with the yellow fever admitted into the Lazaretto or Marine hofpital was 95, of whom 21 died. ( 27 ) In 1797 I do not know the number admitted. Bleeding was feldom employed; but mercury was employed in fmall and repeated dofes, for the pur- pofe of inducing falivation. The proportion of deaths, however, was nearly equal to that of 1799. In 1798, in addition to free blood-letting and the liberal ufe of mercury in recent cafes, active emetics were frequently employed about the fourth day of the difeafe, for the purpofe of " fliaking the gall-bladder;" the quantity and vitiated qua- lity of the bile being at that time fuppofed, by fome gentlemen, to be the principal caufe which kept up the febrile ftate. The proportion of deaths however was greater in 1798, if my in- formation is correct, and I have made a careful inquiry, than in any of the other years that have been mentioned. Some of the nurfes became fick at the hofpital in 1799, but were all well when the patients were difcharged, and the houfe fhut up on the 2d of November. In the courfe of the difeafe, the alms-houfe and Pennfylvania hofpital were fhut; in confequence of which the poor, with difeafes of different kinds, were received for fome time into the City hofpital. ( 28 ) Though the difeafe pervaded different parts of the city, infomuch that it was judged hazardous to hold the election at the ftate-houfe in Chefnut be- tween Fifth and Sixth-ftreets, neither of the banks nor the cuftom-houfe were removed ; and, though they were daily vifited, and bufinefs tranfacted with them by gentlemen from the country there was not an inftance of any one taking the difeafe from that circumftance that I have heard of: a proof that the caufe of the difeafe was not diffufed through the atmofphere. No provifion having been made for the poor, they were reduced to a moft dcftitute and famifh- ing condition ; in confequence of which many were fent to the hofpital, as well as feveral orphan chil- dren. The compaflion of the guardians of the poor being roufed by thefe diflrefling circumftances, they negociated a loan towards the end of Septem- ber, and appointed a committee of humane citizens (of which Dr. Samuel Powel Griffitts was one) to fupply them with neccffaries. A Sketch of the State of the Weather which preceded and prevailed during the existence of the Fever. The preceding winter had fct in early and conti- nued late, and the weather was unufually cold and ( 29 ) wet from April to the 12th of June. It then be- came all at once extremely warm and continued fo (two or three days excepted) till the 26th. On the 24th the thermometer rofe at 2 P. M. to 920 which was as high as it had been at any time for 8 years before, in the fame fituation. No rain or fcarcely any fell from the 12th to the 26th of June.—A thunder-guft came on fuddenly in the afternoon of the 26th, accompanied with tempeft. On the 29th another thunder-guft, fucceeded by frequent fhowers. July 1 ft, it thundered and rained heavily—became fair on the 2d, but continued variable, and the heat moderate with refrefhing wefterly breezes, to the 1 ft of Auguft. The thermometer feldom rofe higher than 82—Rain fell on the 6th, 9th, 13th, 14th, 19th, 20th (the 20th accompanied with ftrong cold windj 26th and 31ft—Loud thunder only 3 days in July. The weather in Auguft was very variable; the thermometer fometimes as high as 86, at others as low as j6 : and a confiderable quantity of rain fell at different times in the courfe of the month, fome- times (repeatedly in the firft week) accompanied with loud thunder. On the 19th the air was un- pleafantly cold. ( 3° ) Sept. i ft Warm and moid. 2d Heavy rain. 3d Rain all day. 4th Overcaft and fo cold as to require fire. 5th Rain—wind N. E. 6th Rain—cold. 7 th Rain—heavy and conftant all day. 8th Rain-—fhowery all night. 9th Rain—heavy all day and night. 10th Cold—overcaft. 11 th Fair—remarkably warm and calm. 12th Do. 13 th Thunder-guft. 14th Cool—pleafant, pure, frefh, and ftrong breeze. 15th Do. 16th Do. 17 th Fair and pleafant. 18th Do.—rain in the night. 19th Rain all day. 20th Heavy rain all laft night and all this day. 31ft Light rain all day. 2 2d Northerly wind—fair, cool. 23d Froft obferved this morning. 24th Froft—wind northerly—cold. 25 th Froft—calm, mild. 26th Wind W.—mild. 27th Do. 28th 29th and 30th—Do. The 1 ft, 2d, and 3d of October, calm and very warm—4th overcaft and fhowery—5th calm and warm.—The weather continued variable, but ge- nerally mild (with heavy rain on the 10th and ( 3i ) fhowers on the i ith, 12th, and 13th) till the night of the 17th when there was a fevere froft.—From the day laft mentioned to the 8 th of November, froft appeared every morning; but the days con- tinued mild, and very pleafant. Very few cafes of the fever appeared this year after the 20th of October, nor did any perfon that I have heard of, take it after their return from the country, though they returned earlier than ufual; and but three or four that have come to my know- ledge in the courfe of the winter, though it conti- nued milder and more moderate, till the end of January, than any winter that has occurred for feveral years: and no attention has been paid by the Board of Health, that I can learn, to purify- ing infected houfes, bedding or wearing apparel. After the thawing of a deep fnow in Decem- ber a catarrhal complaint, or diflreffmg cough, be- came epidemic, which proved mortal to a few chil- dren, and old people. In the winter of 1793, feveral cafes of the yel- low fever occurred which came under the obferva- tion of the writer of this fketch. In thofe cafes the difeafe was of longer duration, and had a greater refemblance to the putrid or common jail fever, than it had been in the fummer and autumn. ( 32 ) In two of thofe cafes, one of which died with hemorrhages and very yellow fkin, (fymptoms com- mon to the jail fever from human contagion, as well as to the yellow fever,) the difeafe was cer- tainly contracted from fleeping on infected beds in a clofe ftove room. OF THE ORIGIN OF THE YELLOW FEVER. A SHALL now proceed to ftate the evidences and arguments, which have convinced me that the yel- low fever has originated from foreign contagion, and not from domeftic caufes, every time that it has appeared in this country: and, as this is not a queftion of amufement, but of ferious import; not between different and contending parties, but a conteft between truth and error, on the eftablifli- ment of which, not only the intereft, but in a great meafure the very exiftence of our cities depend, I truft I fliall meet with a fair and impartial hearing. If the proofs of the foreign origin of the difeafe be convincing, it behoves every one to embrace that opinion: on the contrary, if the weight of the evidences on the other fide of the queftion prepon- derate, it ought to be eftablifhed ; for the know- ledge of truth abftracted from all other confidera- tions, muft eventually be for the intereft of the- community, E ( 34 ) Evidences of the Importation of the Pestilential or Tel' low Fever into this country at different times* The difeafe called in the Englifh Weft India iflands and in America the yellow fever, and in the French iflands the maladie de Siam, is faid by re- fpectable authority to have made its firft appearance at Fort St. Pierre, Martinique, an ifland in the Weft Indies, in the year 1687,* foon after the arrival of a French fleet at that port from the king- dom of Siam in the Eaft Indies.f From Martinique the malady was imported by fome commiflioned fhips into St. Chriftopher's and into Hifpaniola or St. Domingo, where it occafioned great mortality. In Port de Paix and feveral other places it deftroy- ed fuch numbers, that the king of France publifhed an edict, ordering all veffels coming from Martinico to perform quarantine. And in the year 1708, penal laws were made, inflicting the punifliment of death upon any feaman or paffenger from thofe iflands that fliould land in any part of France with- out legal examination and permit. It is related in Hutchinfon's Hiftory of New- England, vol. ii. p. 72,—" that Admiral Sir Fran- * Sauvagc's Nofology. Aftruc de Pefte. Defportes, and Dazille on the Difeafes of the Negroes, &c. . f Hiftory of Hifpaniola, by M. de St. Mery, p. 700. ( 35 ) cis Wheeler 'was fent with a fleet to invade and conquer Martinique, but his men were feized with a malignant fever which deftroyed three-fourths of them; in confequence of this the fleet failed to Bofton and introduced the difeafe into that town, where it occafioned dreadful mortality." From this account, however, it cannot be afcertained whether this was the yellow fever or the common putrid fever. The firft appearance of the yellow fever in Bar- badoes, of which any account is recorded or handed down by popular tradition, was in the year 1691 ; at which time the Rev. Griffith Hughes (Nat. Hift. Barbad.) fays it was called the New Diftemper, and afterwards Kendal's fever, the peftilential fe- ver, and the bilious fever. Dr. Warren, who refided in Barbadoes, and publifhed a treatife on the difeafe in 1739, af- ferts, " that it was introduced into Barbadoes from Martinique by the Lynn man of war, in the year 1723, and from the fame place ten years after by a veffel, the furgeon of which, Mr. Nelfon, was fick on the paffage, and died a few days after his arrival at Barbadoes." Dr. Warren adds, " The fever had broke out, as he was informed by Mr. Nelfon and others, at Port St. Pierre, foon after the arrival of a provencd fleet from Marfeilles." ( 36 ) " This diftemper," fays Dr. Warren, " cannot be reafonably attributed to any corruption of the air that arifes from lakes, marfhes or woods, be- caufe the land in this ifland is the beft cultivated, and entirely free from lakes or marfhes, and, un- fortunately for the inhabitants, there is not a fuffi- ciency of wood on it for fuel; but it is agreeably diverfified with hills and rifings, on the very tops of which the beft canes grow. The air here is al- fo remarkably pure and frefh, and probably more falubrious than in any of the other fugar colonies." Before the introduction of the difeafe firft men- tioned by this author, into the ifland, he fays he had for feven or eight years paid particular atten- tion to the effects produced on health by the dif- ferent feafons and ftate of the weather; during which time fome years had been diftinguiflied for fultry heats and long intolerable droughts, fome by almoft inceffant rains, and feveral by unfettled and tempeftuous weather, and yet no footfteps of this fever did appear in all that time. He has frequent- ly obferved, that a continuation of dry and hot weather has been fo far from giving any aggrava- tion to the contagion, that it has feemed rather to reprefs it, till the returning rains and a moift at- mofphere have renewed its activity. Dr. Warren proceeds, " The reader may judge a5 he thinks fit of this account of the origin of this ( 37 ) difeafe. I am fatisfied that it was introduced among us the two laft times in the manner defcribed ; and that it is not by any means the natural growth of this ifland, but truly a foreign intruder, let the firft caufes of it be what or from whence they may." This author afferts, that " intermitting fevers are rarely, if ever, the product of Barbadoes, let the weather vary ever fo much, though continued fevers upon their going off, fometimes put on the appearance of intermittents, and perfons with agues are often brought here from fome of the other iflands." " In fome of the other iflands, where the har- bours are muddy and the adjacent ground low and wet, the natives as well as strangers, are in an emi- nent degree, fubject to intermittents and remittents, refembling double tertians, which are frequently obftinate and irregular, but which with due pre- paration and precautions fubmit at length to the bark." In another place he fays, " bark did no good in the malignant fever. And that the ifland had not been entirely exempt from the malignant fever from the year 1733 to 1739, the time his treatife was written." And we know from the publications of Drs. Hume and Wright, that it proved deftructive to the crews of Admiral Ver- non's fleet, in the year 1741. ( 33 *> In a pamphlet, entitled, a Difcourfe on *the Plague, publiflied in London, in the year 1721, it is related, that" a peftilential fever was introduced into Virginia in the year 1697, by Admiral Nevill's fquadron, which arrived there from the Weft Indies." The firft occurrence of the yellow fever in Phila- delphia, of which there is any record, or recollec- tion, was in the year 1699. This fever is men- tioned in the Journal of Thomas Story, recorder of the city, who fays, " fix or eight perfons died of it daily for feveral weeks, and fome days ten or twelve." From an anecdote refpecting Roger Gill, a noted preacher of the Friends fociety (who prayed in public that he might be accepted as a facrifice and the people fparedj it appears the fever at that time was moft general and mortal, the laft week in September. And from the regifter of deaths kept by the meeting, it appears to have entirely ceafed before the iff of November. The city at that time contained but about 600 families, of courfe its population muft have been greatly re- duced by the mortality. In a letter from Ifaac Norris, Efq. quoted by Mr. Webfter, dated Auguft 15th, 1699, the difeafe prevalent at that time in Philadelphia, is called the ( 39 ) " Barbadoes diftemper." And John Gough, in his Hiftory of the Friends (vol. iii. p. 516) fays, " the difeafe which raged in Philadelphia, in the year 1699, was the fame as that which has fince been called the yellow fever, which had been very mortal in the Weft India iflands for a confiderable time before it made its appearance in Philadelphia. The difeafe alfo prevailed the fame year in Charlef- ton, South Carolina."* Mr. Story, in the 2d vol. of his Journal, has re- corded, " that 17 perfons lay dead of a malignant fever in the city of New-York, on the ift of Sep- tember (N. S.) in the year 1702." The late Dr. Thomas Bond of Philadelphia, in an introductory lecture to a clinical courfe, in the Pennfylvania hofpital, the 3d of Decem- ber in the year 1766, fpeaking of the effects of cli- mate, in influencing and modifying the appearance and violence of difeafes, delivered the following facts and opinions, viz. " The laft wet fummer, fucceeded by a fliort fpacc of dry hot weather in autumn, caufed fo many in- termittents from the fouthern fuburbs of this city, all the way to Georgia, that I may venture to affert, two-thirds of the inhabitants were not able to do * Hiftory of South Carolina, vol. 1. p. 142* ( 40 ) the leaft bufinefs for many weeks; and fome fami- * lies and even townfliips were fo diftreffed, that they had not well perfons fufficient to attend the fick ; during which time, the city was remarkably healthy. " When I firft came to this city, the dock* wai the common fewer of filth, and was fuch a nuifance to the inhabitants about it every fall, that they were obliged to ufe more pounds of bark than ounces fince it has been raifed and leveled. Ano- ther ftriking inflance of the advantage of cleanli- nefs for the prefervation of health, affords an op- portunity of paying a tribute juftly due to the wif- dom of the legiflature of this province, in framing the falulary laws for paving and regulating the ftreets of this city, and to the /kill and induftry of the commiflioners in executing them, whereby they have contributed fo much to the healthinefs of the inhabitants, that I am confident the whole expenfe will be repaid in ten years by the leffening of phyfic bills alone. " The yellow fever which I take to be exactly the fame diftemper as the plague of Athens, de- fcribed by Thucidides, has been five different times in this city fince my refidence in it. The caufes of three of them 1 was luckily able to trace, and am * A wide muddy canal which crofled three of the princi- pal ftreets, and expofed an extenfive muddy furfacc to the fun during ebb tide. ( 41 ) certain they were the fame that produce a jail fever in other places; and am of opinion, that the difference between the appearance of thefe fevers, arifes from climate, and the different ftate the bo- dies are in when they imbibe the contagion ; if fo, the fame methods that will prevent a jail fever will equally prevent a yellow fever. " It was in the year 1741 I firft faw that horrid difeafe, which was then imported by a number of convicts from the Dublin jail. " The fecond time it prevailed, it was indige- nous, from evident caufes,* and was confined prin- cipally to one fquare of the city. " The third time, it was generated on board crowded fliips in the port, which brought in their paffengers in health, but foon after became very fickly. I here faw the appearance of contagion like a dim fpark, which gradually increafed to a blaze, and foon after burft out in a terrible flame, carrying devaftation with it, which after continu- ing two months, was extinguiflied by the profufe fweats of tertian fevers : but this is not the ordi- nary courfe of the contagion ; it is ufually checked * Thefe caufes, Dr. Shotte, in his Travels, fays, Dr. Bond informed him were a large quantity of putrid filli, thrown into the docks. F ( 42 ) by the cool evenings in September and dies on the appearance of an October froft. " The contagion of thefe malignant fevers, lies in the air confined and corrupted by a neglect of cleanlinefs, about the helplefs fick, and is harmlefs without fuch aid." Extract from hofpital journal. A letter written by the late Dr. John Bard of New-York, and publiflied in the American Mufe- um for 1788, page 453, contains the following information on this fubject, viz. " I have heard from the ancient inhabitants of this city, that fo long ago as the year 1702, a malignant fever little inferior to a plague was im- ported into it, which, from its extreme mortality, was diftinguiflied by the name of the Great Sick- nefs; and that if tradition fays true, was brought here from St. Thomas's, in a fingle bale of cotton." That fatal diftemper, adds Dr. Bard, " called the yellow fever or black vomit, which, about 40 years ago produced its ravages in feveral parts of this continent, particularly in the cities of Philadelphia and New-York, was firft imported from the Spanifh Main into Barbadoes, and from that ifland in the ( 43 ) courfe of commerce, communicated to this con- tinent, " The cities of New-York and Philadelphia, have feveral times experienced the fatal effects of dangerous infections, fome of them refembling the jail fever, from dirty fhips, crowded with dirty paf- fengers, from Rotterdam, which from that caufe took the name of the palatine fever." At that time there was no legal provifion againft thofe dangers: veffels with this load of impurity came immediately up to the wharves and the fick were landed in the town. The legiflature of New- York have fince paffed a law for preventing the in- troduction of difeafes into that city; but laws will be of no avail unlefs they are enforced with rigor and impartiality. We are informed, by Dr. Lind, in his 2d paper on infection, that he had received information from a gentleman in Philadelphia, who had been a fufferer by the difeafe, " that the yellow fever was introduced into that city, in the year 1741, by means of a trunk of wearing apparel belonging to a gentleman who had died of the fever in Barba- does, and that it proved mortal to more than two hundred of the inhabitants." ( 44 ) Dr. Lining of Charlefton, in a letter to Dr. Whytt, publiflied in the 2d vol. of the Phyfical and Literary Effays of Edinburgh, gives an ac- count of the occurrence of the yellow fever in that city, in the years 1732, 1739, 1745 and 1748, and afferts, " that it had been traced to fome perfons or veffel lately arrived from fome of the Weft India iflands, every time that it had occurred there." Dr. Lining alfo adds, " that fome of the feafons in which it had been epidemic or general were more cool and falutary than many that had preceded or intervened, in which the difeafe had not appeared at all." Dr. Mitchel of Virginia, in a letter to Dr. B. Franklin, informs him, " that a malignant contagi- ous fever, (which from his defcription appear!* to have been the yellow fever) was prevalent in cer- tain parts of that ftate, in the years 1737 and 1741, and that it origw*ated *from an infection fui generis, and had been twice brought into thofe parts by fhips of war which failed in thofe feas." From the year 1747, when it was again partially epidemic in Philadelphia and New-York, as appears from letters which have been preferved by fome of their inhabitants, Philadelphia was exempt from it till the year 1762, when, according to the notes of Dr. Redman, prefident of the College of Phyfi- An?. which were communicated to the College in ( 45 ) 17935 it was imported from Havanna, and com: municated by a fick failor to the family with whom he lodged near the New Market, in the lower end of the city, and from that family to others in fuc- ceffion, till it pervaded nearly one half of the city, particularly that part below the great dock and ca- nal, which at that time was neither arched nor drained. It then ceafed of a hidden, about the middle of October, and was no more heard of in any of the ftates, till the year 1793. For an account of the prevalence of the difeafe in Philadelphia in the years 1793, 1797 and 1798, the reader is requefted to confult the late publica- tion of the College of Phyficians, entitled, " Fa&s and Obfervations on the Origin and Nature of the PeftHential or Yellow Fever," &c. in which he will find the importation of the difeafe proved by the moft pofitive and undeniable teftimony. Dr. Monfon, of New Haven, (a phyfician of re- fpedtability and eminence) in his printed account of the yellow fever which occurred in that town in June 1794, and became epidemic, relates, " that Captain Truman arrived there early in June from Martinique, in a floop that was infected with the contagion of the yellow fever, and laid at a wharf within a few rods of Ifaac Gorham's houfe; and that a cheft of wearing apparel, belonging to a man who had died on board the veffel at Marti- ( 46 ) nique, was carried from the veffel to Mr. Auftin's itore, and opened in the prefence of Captain Tru- man, Mr. Auftin, Henry Hubbard and Polly Gor- ham, the three laft of whom were infected and died in a few days after their expofure to the contents of the cheft. No perfon in the town was known to have had the yellow fever previous to the arrival of Captain Truman's veffel." Dr. Monfon afferts, " he could trace every cafe that occurred to conta- gion ; and that, of 64 patients which was the number that died of this difeafe, 44 had black vo- miting." See Webster's Collection. In a fubfcquent letter, Dr. Monfon fays, he was for a confiderable time at a lofs to account for the cafe of a child who took the difeafe, as it could not be difcovered that it had been expofed to any jfource of contagion. But a man, after the termi- nation of the difeafe, who had been employed as a nurfe to thofe in the fever, informed the family that he had taken it up in the ftreet and carried it into the houfe, to prevent it from being hurt, un- perceived by any of the family. By what means the difeafe was introduced into Baltimore in the year 1794, or into Norfolk in the year 1795, I have not been able to collect pofitive proofs; but from its firft appearance at Fell's point, where the (hipping lay, and from its gradual o-roerefs into other parts of the town, there is a ( 47 ) ftrong prefumption it was introduced into Balti- more by one or more infected veffels from the Weft Indies where it had become before that time almoft univerfal. The proofs of the introduction of the yellow fever into New-York in the year 1795, by the brig Zephyr, from Port-au-Prince, publiflied by the Board of Health of that city, though controverted by fome of the medical gentlemen of that place, are fufficiently authentic and valid to convince any impartial and difinterefted inquirer, that it was im- ported that year into New-Tork by that veffel* Thofe proofs may be feen in the Philadelphia Gazette, dated September 24th, 1795. In the year 1796 it appeared and became epi- demic in Bofton, and in the town of Chatham on Connecticut river. From whence it originated in Bofton has never yet been afcertained ; but we are informed by Mr. Webfter in his Hiftory of Epi- demic and Peftilential Difeafes, vol. ii. p. 344, after returning from his refearches among revolv- ing planets, blazing comets, exploding volcanoes and wide-yawning earthquakes, to folid ground; " that the fever at Chatham was traced, in every inftance, to a veffel from a port in Hifpaniola, which was highly infected; and that no perfon was affected without direct intercourfe with the veffel, the clothing or the fick. It was not taken ( 48 ) by paffing along the ftreet, nor from houfe to houfe. It commenced late in September and had no precurfors." Dr. Monfon, in a letter to Dr. Hofack of New- York, afferts, " that the yellow fever was not only decidedly and clearly traced to importation at Had- dam in 1796, but alfo at Newbury-Port in 1797 ; in the latter place by a veffel which arrived there in the month of May, from one of the ports of the Weft Indies, on board of which one or more perfons had died on her homeward paffage." See alfo Med. Rep. vol. i.* The following, among other circumftances, prove that the fever was imported into Philadelphia in the year 1798. The fhip Deborah from Jeremie, a port of St. Domingo, arrived at the quarantine ftation the 8th of July with about 90 perfons on board, including paffengers. After remaining un- der quarantine ten days, flie came up to the city, difcharged her cargo, and proceeded to the vil- lage of Kenfmgton to be refitted. It appears by feveral depofitions, particularly by thofe of Col. Depeyfter, who came paffenger in her, and Mr. * For the account of its introduction into Philadelphia in 1793 and 1797, fee alfo, " Obiervations on the Caufes and Cure of Bilious Fevers," at page 212, &c. ( 49 ) John Boden,* who ferved on board in the capacity of carpenter, " that flie had loft feveral of her * The following is the Depoftion of Mr. John Boden. State of New-Jerfey, Cityi of Burlington. j On the 27th day of Auguft, in the year 1798, before me, Jofeph Bloomfield, Mayor of the city of Burlington, appear- ed, John Boden, fhip carpenter, and freeholder in the fame ; and being duly fworn, depofeth, and faith, that on the firft of December, 1797, this deponent fhipped himfelf as car- penter on board the Deborah, Edward Yard, commander; that faid fhip failed from Philadelphia in February laft, for Cape Nichola Mole, and arrived at faid Cape about the middle of March ; from whence the faid fhip, in April laft, went to Port-au-Prince. While at Port-au-Prince, Henry Philips, one of the failors of faid fhip, was taken very ill with what is called the yellow fever; that during his illnefs, the faid Henry Philips told this deponent, (and feveral times fince) that he had taken the yellow fever in attending on a man of his acquaintance, who had the yellow fever, and died on board an Englifh brig at Port-au-Prince, while the faid Philips was on board faid brig with his faid acquaint- ance. This deponent further faith, that the faid Henry Philips has a wife in Philadelphia, but is now on a voyage to Europe: That this deponent affifted, in nurfing faid Phi- lips, while in the yellow fever aforefaid, at Port-au-Prince, until this deponent was feized on the voyage of the Debo- rah to Jeremie, with the fame yellow fever, which this de- ponent believes he caught of the faid Philips. That while at Jeremie feveral of the crew of the Deborah had the yel- low fever ; that Efdeil, Rofs, and feveral others of the crew died there ; that in June the Deborah left Jeremie : That G ( 5° ) hands with the yellow fever during her ftay at Jeremie, and five on her homeward paffage, and three paffengers including one child." Thefe were reported at the Health Office to have died with fluxes: and it was declared on oath, that there was no perfon fick at the time of her arrival at the quaran- tine ground but one black girl, and that fhe had nothing but a flight fever and lax. But it appears from the books of the Board of Health, that three men were fent from her to the Marine Hofpital the very next day after her arrival, one on the ioth, and two on the nth, with fymptoms of yellow fe- on the paffage to Philadelphia, Miller, the boatfwain, Brown, Smith, and one other failor, and three paffengers died, as was generally believed of the fame fever. That while faid fhip was under quarantine at Fort Mifflin, no perfon of her crew died to this deponent's knowledge ; nor was any per- fon permitted to come on board, or to go on fhore to the deponent's knowledge, while riding quarantine, except the Health Officers and bargemen of the yawl, which brought faid Health Officers on board.—That while faid fhip was difcharging her cargo at Smith's wharf in Philadelphia, George Streeton, fhip carpenter, vifited this deponent, and was about half an hour on board faid fhip: That the faid George Streeton has lately loft a fon, as this deponent has been informed, of the prevailing ficknefs in Philadelphia:— That the faid George Streeton has removed from Philadel- phia with his family, and now refides in the Fall's town- fliip, in Buck's county ; and further this deponent faith not. JOHN BODEN. Joseph Bloomfield,t Mayor of Burlington, j ( 5' ) ver ; and that part of the clothing of the deceafed remained on board. The firft cafes that occurred in the city were traced to perfons that had worked on board or had done bufinefs with the Deborah. And foon after her arrival at Kenfington, which before her arrival was entirely free from the difeafe, feveral perfons who worked on board of her, and others in the neighbourhood where flic lay took the fever; the majority of whom died. The proofs of this are detailed by the College of Phy- ficians at page 41, and are indifputable. To op- pofe fanciful fpeculaltons and arguments drawn from remote analogies, to facts fo clearly and fairly eftablifhed as thefe, is not only trifling with our underftandings, but is an outrage upon common fenfe; and as fuch fanciful fpeculations have a tendency to fupport and perpetuate diftreffmg and unavailing apprehettfions, and to affect the prof- perity of all the commercial towns in the union, it is a grievance that demands the interference of the federal legiflature. Dr. Tilton of Wilmington fays,*' (and Dr. Tilton has been accuftomed to make correct obfervations) " At Wilmington we have no apprehenfion of do- 41 meftic origin. Every medical character in this place takes it for granted that the difeafe was imported from Philadelphia, and no otherwife created. It * Letter to Dr. Miller. Med. Rep. vol. iii. p. 128. C 52 ) appeared to me alfo, that infected houfehold goods and furniture, brought from the city by our flial- lops had more influence in fpreading the contagion than difeafed perfons: for it was very remarka- ble, that the difeafe was not communicated from the firft perfon who died of it, and who came down and fickened in the land ftage. But, when the fever became epidemic, it took its rife at the water edge, and infected all, or with few excep- tions, gradually up to High-flreet. Above this the town is more thinly built, and the cafes were folitary as in the country. ^Although the difeafe made its appearance among us, in the beginning of Auguft, we hoped for our ufual exemption until near the middle of the fame month, when the epi- demic nature of it appeared fo manifeft, that a committee of health was appointed, and a flight hofpital arrangement was conftructed, for the relief cf the poor and neceflitous." Dr. Brackett of Portfmouth (N. Hamp.) in a letter to Dr. Oliver of Salem relates, that " the yellow or peftilential fever made its firft appearance in that city about the ift of Auguft, 1798, eight or ten days after the arrival of a veffel from Marti- nique, on board of which two men had been fick before flie left the ifland, one of whom died on the paffage and the other was on the recovery at the time of her arrival at Portfmouth: at which time there was not, nor had been a cafe of any ( 53 ) kind of fever for a long time in that place. On the ift of Auguft the day the veffel arrived a child of the owner was taken ill with fymptoms of cholera, and died on the 4th. On the 3d of Au- guft his brother, 15 years old, was taken with fimilar fymptoms, but with more inflammation and diftrefs. He was bled freely, took calomel, bark, &c. and died on the 5th day from the attack. Be- tween the 8th and 20th of the month, four or five of the other children and fervants were taken with the fame complaint. One of the daughters, attack- ed on the 17th, and treated with bleeding, mercu- ry, warm bath and bark, died on the 9th day from the attack, She loft a great quantity of blood from her nofe and mouth the three days preceding her death. Many other perfons were taken ill in the fame neighbourhood between the periods juft men- tioned, about one half of whom died. I loft 15 out of 45. If I could procure a forenefs of the fauces by giving mercury in fmall dofes, and by rubbing it upon the gums, or by external frictions, on the third or fourth day, I was fure of the pa- tient's recovery.—The difeafe was confined almoft entirely to the ftreets near to the wharf where the veffel lay, and to the beach where (lie was graved, though thofe ftreets are in the higheft part of the town, are as free from putrid filth as any other ftreets in the town, and have always been efteemed the moft healthy." C 54 ) To the facts which have now been ftated reflect- ing the importation of the yellow fever into this country, and confequently of its being a contagious difeafe, under certain circumftances, I fliall only add one more, lately furniflied by Dr. Bayley, phyfician and infpector of veffels for the port of New York. In a letter from Dr. Bayley to the mayor of New York, publiflied in different papers, it is ftated, " that the fhip General Wayne failed from New York on the 14th of April for Havanna, navigated by 25 men under the command of John Seaman. On the 25th of May, wliilft lying in the harbour of Havanna, John Brown a failor died, and John John- fon the ift of June. During the paffage of the fhip to the port of New York, Jonas Willis fickened, and died on the 14th of June. The fhip arrived at the quarantine ground the 22d of June, at which time James Gardner, a feaman, was fick with the Tellow Fever. He was fent to the Marine Hofpital/. and died the next day. On the evening of the 27 th of June, Mr. John Wright, a paffenger on board the Gen. Wayne, was attacked with the fever, and received into the hofpital on the morning of the 28 th. In the courfe of the difeafe Mr. Wright became very yellow, bled from the mouth, and had exceflive vomiting of matter which was of a dark w colour, but recovered." After remaining at anchor at the quarantine ground 22 days, and having undergone the cere- ( 55 ) mony of waffling and fcrubbing the decks and ven- tilating the hold, without unlading or fhifting the cargo, this veffel proceeded to New York, and came alongfide of Coentie's flip. Soon after her arrival, feveral cafes of yellow fever occurred in the neighbourhood of that wharf which was perfectly healthy before her arrival. This circumftance con- firming the declaration of Capt. Seaman, the maf- ter of the Gen. Wayne, that flie was an infected veffel, which has been ftated by Mr. Watkins, one of the owners, in the New York Gazette, exaf- perated the inhabitants of that neighbourhood to fuch a degree that they compelled her removal. In the year 1793, after an exemption of thirty years, the yellow fever (having firft committed great ravages in Granada, Tobago and Antigua, in the laft of which the inhabitants depend on the clouds for all the water they ufe, according to the ac- count publiflied by Dr. Lettfom, in the Gentleman's Magazine,) entered Philadelphia, and raged with uncontroulable fury ;—but was epidemic that year in no other town in America. In 1794, it prevailed in New Haven, Baltimore, and partially in Philadelphia, while all the other feaports in the United States efcaped. In 1795, in New York, Baltimore and Norfolk. In 1796, in Newbury.Port, Haddam, Bofton, and Ckarlefton. ( 56 ) In 1797, in Norfolk, Baltimore, Philadelphia, Briftol, and Providence. In 1798 it prevailed with unufual mortality in Portfmouth, (N. Hamp.) Bofton, New London, (the latter of which is fituated on a high, dry and rocky fliore, where there is neither marfli nor pond of ftagnant water, and of courfe exempt from putrid vegetable exhalations,) New York, Philadelphia, Chefter, Marcus Hook, Wilmington, (Del.) Peterf- burgh, and Wilmington, N. C.—And in 1799, in Newbury-Port, New York, Philadelphia, Eden- ton, and Charlefton, while Bofton, Dover and Bal- timore, and many other towns furrounded with putrid materials efcaped. If this difeafe originates from the putrid exhala- tions of the ftreets and gutters, can any man poffeff- ed of common fenfe fuppofe, that the flats of Bal- timore and the towns of Charlefton and of Dover could have efcaped in 1798, when the lefs putrid ftreets of Portfmouth, New London, Bofton and Wilmington were thronged with the fick, the dying and the dead ? Reference alone to the dates and facts which have now been ftated, in conjunction with the circumftance of the difeafe appearing only in the commercial towns of the United States; ' one year in the centre, another in the fouth, a third in the north, and a fourth in the eqjj, while intermediate ones have remained perfectly free C 57 ) from its defolating effects, afford an accumulated weight of teftimony in favour of the doctrine of its foreign origin, which it would feem impoflible for any mind, however fubjugated and bigoted to former opinions, to refift. But that no farther ambiguity may remain, reflecting the origin of this dreadful difeafe, the following facts and arguments are added. It is afferted by Aftruc on Peftilential Difeafes; by Sauvages in his Nofologia Methodica; by Def- portes and Dazille, both of whom were phyficians of eminence in St. Domingo; and by Mr. Moreau de St. Mery, in his Hiftory of the French Part of St. Domingo, page 700, " that the yellow fever was not known in the Weft Indies till the year 1689, when it was imported into Martinico by a fleet from Siam in the Eaft Indies, hence called the Maladie de Siam. Hughes fays it was firft obferved in Barbadoes in the year 1691 : and Ulloa in his Voyage to South America, book i. chap. 5. " that its firft appearance on that continent was in the year 1729, and deftroyed the greateft part of the crews of the Guarda Cofta's at Santa Martha." This difeafe has feldom been epidemic in the Weft Indies, excepting in time of war when fleets and armies have been ftationed there: and, if the teftimony of Blane and of other refpectable authors is to be credited, it was {o much confined H ( 58 ) to the harbours and feaports in the year 1782, that very few medical gentlemen who refided in the country had ever feen a cafe of it. This circum- ftance and other facts contained in Blane's work formerly deceived me fo much, that I thought the yellow fever was only a modification of the typhus gravior, or the common malignant fever of fhips, &c. but recent obfervations and more accurate inquiries have convinced me that the difeafes are not the fame; for the contagion of the one operates in winter within a certain diftance of the difeafed, where the air is not frequently renewed, as well or perhaps more certainly than in fummer; where- as the operation of the contagion of the latter is confined chiefly to the latter end of fum- mer and to autumn. From the ceffation of the revolutionary war in America in 1783 to the year 1793, there were no traces of the difeafe in either Granada, St. Domingo or Barbadoes; and I have met with no author that has made mention of it in any other of the iflands between the periods juft mentioned ; if there has, I fliall be thankful for correction, for my fole aim in this account is to feparate truth from error. But early in the year 1793 it made its appearance in the town of St. George, foon after the arrival of the fhip Hankey, with a fickly crew from the coaft of Guinea ; which was on the 17th of February. This fact is eftab- liflied not only on the refpectable teftimony of Drs. Chifliohn and Wright, but by the public ( 59 ) papers of Grenada and Kingfton, and by the Lon- don Chronicle, dated October 12th, 1793. From Grenada the difeafe was fpeedily convey- ed to feveral of the other Weft India iflands in fucceflion, particularly to Tobago, St. Domingo, Guadaloupe, St. Vincents, Antigua, Dominique, Jamaica and Barbadoes; and fince to Cuba, &c. According to Dr. Clark, it did not reach Domi- nica till the 12th of June, which was foon after the arrival of a number of refugees from St. Do- mingo ; a great portion of whom, contrary to what happened in Philadelphia, were the firft affected and the greateft fufferers. In Dominica it was alfo fa- tal to the Negroes lately arrived from Africa, a circumftance alfo contrary to the obfervations of moft of the former Weft India authors.—See Duncan's Annals for 1797. In Barbadoes it muft have been communicated by contagion, and could not have originated there, as there are no fources of intermittents or remit- tents of the mildeft form in the whole ifland, at leaft not fufficient to render the difeafe general.— See Hugh's Natural Hiftory of the ifland publifli- ed in the year 1750.-----Even Antigua which is not only free from marfhes, but has neither fpring nor rivulet on the whole ifland, has not efcaped this ferocious and deftructive difeafe. C 60 ) The immenfe commerce of the United States, and the fhortnefs of the voyage, render the Weft Indies to them the fame fource of contagion that the Levant is to Europe. During the exifting war, though the yellow fe- ver has fucceflively pervaded almoft all the iflands, it has been moft feverely felt in the French iflands Guadaloupe and St. Domingo, which have been the principal fcenes of military operations. With thofe iflands the American commerce has been car- ried on to a greater extent than with any of the others; and as the American veffels neceffarily have had frequent communication with the fleets in the ports of thofe iflands, they could not avoid being infected. When the infected veffels return- ed home early in the fpring or fummer, or late in the fall, the temperature of the air not being fa- vourable to retain or convey the matter of conta- gion, no difeafe or only a few folitary cafes have been the confequence. The reafon that the difeafe occurs more commonly about the end of July or beginning of Auguft, in the United States (though there are many exceptions to this fact, for it has fometimes occurred in the month of May) is be- caufe it is more generally epidemic in the Weft In- dia iflands in that feafon, as we learn from feveral writers of credit, than at any other time of the year, wnich is the moft rainy feafon within the tropics. ( 61 ) In the month of June in the year 1793, a great number of veffels, which were at Cape Francois during the capture of that town by the negroes, took on board and conveyed from thence a great many of the diftreffed inhabitants that had efcaped the fury of the captors, to Philadelphia, as well as to fome of the iflands.—And it is a remarkable cir- cumftance, as recorded by Dr. Clark, that the dif- eafe made its firft appearance in Dominica a few days after the arrival of a number of the fugitives there ;* which was precifely the cafe at Philadel- phia. A few days after the middle of July, feve- ral veffels from Cape Francois arrived at the port of Philadelphia, crouded with paffengers and goods of various defcriptions ; and about the fame time, or a few days later, a French privateer called the Sans-culotte, from Nantz but laft from the Weft Indies, which brought in the fhip Flora of Glaf- gow, captured on her paffage. The difeafe made its appearance the beginning of Auguft, firft in the lodging houfe of Mr. Denny, in the neighbourhood of the wharves where two veffels which had landed fickly paffengers and the Sans-culotte lay. The firft victim to the difeafe was an Englifliman of the name of Moore, who lodged at Denny's. From the fuddennefs of his death and the livid appearance of the dead body, * See Duncans Annals of Medicine for 1797. C 62 ) Drs. Cathrall and Phyfick fufpected he had taken poifon, and obtained permiffion to open his body, but could difcover nothing to juftify their fufpicions. On the 3d of Auguft Dr. Cathrall attended at the fame houfe a female lodger of the name of Parker, who died on the fixth day from the attack. Two French boarders in the fame houfe fickened a few days later, one of whom died. Mrs. Denny, her hufband and two daughters, were alfo taken ill a few days after the death of Mrs. Parkifon—Mr. Denny and wife died : the daughters recovered. Mr. Philips's family, whofe houfe joined Mr. Den- ny's, alfo fuffered about the fame time. Several of the paffengers had refted themfelves on their firft coming on fliore in Mr. Lemaigre's kitchen, which ftands near the wharf, fome of whom appeared in a very fickly condition, according to the teftimony of Mr. Lemaigre and his clerk, and alfo of Major Hodgfon, Mr. Afhbridge, and others, who commu- nicated this account to Drs. Leib, Cathrall, and the writer of thefe pages. Three of Mr. Lemaigre's fervants were attacked with the difeafe on the 2d of Auguft; Mifs Phillips at Major Hodgdon's on the 6th ; two of Mr. Smith's daughters and one of Mr. Andrew Hodge's, all of whom lived in the fame neighbourhood, about the fame time. All thefe were attended by Dr. Hodge (except the Mifs Smiths who were attended by Dr. Carfon) and Dr. Iiodge treated them with mercurial purges. Dr. Carfon alfo prcfcvibed the fame for Mr. Smith's family, ( «3 ) from a fuppofition that they were only violent cafes of the common endemic of the city (the remittent of autumn) and from recollecting that he had once experienced fenfible benefit, when ill of a bilious fever, by taking twenty grains of calomel at one dofe, by the advice of the late Dr. William Smith. Capt. Swartz's veffel from St. Thomas's, which lay a few paces above the veffels that had landed the fick paffengers, was moved up to Kenfington about the 16th of Auguft. The Captain fickened two days after, and two of the crew a few days later: the Captain died, the others recovered. Soon after the arrival of Capt. Swartz's veffel at Kenfington, the difeafe made its appearance in fome of the families there, and foon after became general. For fome time the difeafe was confined to that part of Water-ftreet where it commenced, and al- moft every cafe that occurred for the firft two weeks, could be traced to that particular place. The arrival of a cargo of damaged coffee a fhort time before the fever made its appearance, gave rife to an opinion among fome gentlemen, that the difeafe originated from that fource; but in the opi- nion of others, it might with equal juftice be afcrib- ed to a cargo of millftones which lay in the fame neighbourhood: for though there are many in- ftances on record of intermitting and remitting fe- vers originating from the effluvia of putrid vegeta- ( 64 ) bles, in low, damp, marfliy and unventilated fitua- tions, in the autumnal feafon, when the furrounding atmofphere is moift and impure, there is not a fingle well attefted example to be found of either the plague, or the fever called the yellow fever, which appears to be only a lower degree of the plague, or of any other contagious fever originating from that caufe. The cities of Europe in fimilar climates and fitu- ations are equally fubject to the leffer tribe of fe- brile difeafes with the United States; and fome of them that have much intercourfe with the Weft India iflands, and Cadiz in particular, have been invaded by the yellow fever.* (See Lind on Dif- eafes of Hot Climates, j Many of the cities of the United States have now exifted near 200 years, and Philadelphia more than 100. During this period, by clearing and cultivating the furrounding country, and by drain- ing, paving and arching the refervoirs, and pre- venting the ftagnation of water, and the putrefac- tion of animal and vegetable fubftances to any con- * That it has never been epidemic in London may be ow- ing to the greater coolnefs and purity of the atmofphere in that climate; though I have documents of its prevalence there in the year 1713, and of its being introduced into other parts of England fince ; but it has never fpread fince that time from one family to another. ( 65 ) fiderable degree within their precincts, they have overcome all the natural and ufual difadvantages of new fettlements;' in confequence of which, fe- vers and fluxes, once fo formidable, had almoft difappeared in the cities for fome years before the yellow fever made its appearance, particularly in New York and Philadelphia, as is evident from their bills of mortality, which prove them to be more healthy than any city in Europe in the fame latitude, with a proportionable population. Dr. Monfon (whofe name has already been men- tioned with refpect) in a letter to Dr. D. Hoffack of New York, after affuring him that the yellow fever was clearly and decidedly proved to have "been imported into Haddam on Connecticut river, in the year 1796, and into Providence in the year 1797, remarks, " that the name which has been given to this fever has occafioned the difputes which have arifen about its nature and caufes, both in the Weft Indies and in this country. The fever called the feafoning fever, to which ftrangers are fo gene- rally fubjedt on their firft arrival in the Weft Indies, has been confounded by moft of the Weft India writers with the peftilential fever: and fome of them have confounded it with the bilious or remit- ting fever occafioned by the air of marfhes, or the exhalation's from collections of putrid vegetable fub- ftances; though it is evident it can have no connec- tion with the latter, becaufe the natives are equally I ( 66 ) fubjedt to bilious fevers with ftrangers, and alfo becaufe the bilious fever is not a contagious difeafe in either the Weft Indies or in this country, the reverfe of which is the cafe with both the yellow fever and the common malignant fever of jails and hofpitals.* Thefe unfortunate miftakes have, no doubt, occafioned and kept alive the diverfity of opinion and the unavailing controverfy which fub- fift. This I think clearly appears from the nume- rous accounts publiflied in the news-papers, and in Mr. Webfter's collection; for the gentlemen who have communicated their obfervations, moft of whom had never feen many, and fome of them not a Angle cafe of the yellow fever, have taken its identity with the marfh fever for granted, and of courfe have confounded it with what they are pleaf- ed to call the dock fever of New York, the pond fever of Sheffield, the horfe-neck fever of Montgo- mery, and the cabbage-head fever of Hartford." If the yellow fever, with its dreadful train of malignity and almoft refiftlefs violence, was only a higher grade of the common remitting fever, and originated from the fame caufes, it has been afked, How came it all at once to affume fuch a new and terrific form, as there is no example of fuch a fud- * The malignant fever of hofpitals, however, is lefs con- tagious in the Weft Indies than the yellow fever, but more fo in this country. ( 67 ) den and extraordinary change in the difeafes of any other country ? To extricate themfelves from the dilemma in which they are involved by this queftion, the fup- porters of the domeftic origin of the yellow fever have recourfe to an imaginary change in the confti- tution of the atmofphere, which they fay has taken place of late years, and has become inflammatory : and, that this inflammatory conftitution of the at- mofphere, in conjunction with putrid exhalations, which before this change of conftitution took place occafioned only fevers of a fimple and mild kind in this country, now gives origin to the malignant and deftrudtive yellow fever. In fupport of this doc- trine, its advocates appeal to the feafon of the year when the difeafe begins, progreffes and terminates ; and to the more fpeedy ripening and decay of fruit, increafe of infects, &c. than formerly: and, no doubt, they would have confidered the Heffian fly as an unanfwerable argument in favour of their opinion, if, unfortunately, it had not appeared too early for their purpofe.—Mr. Webfter, with equal reafon, confiders the death of oyflers and large draughts of fhad, as links of the fame chain of caufes which produce earthquakes and yellow fe- ver ! But it furely requires fomething more fub- ftantial, to eftablifh a doctrine fraught with fuch ferious confequences to the welfare and intereft of the community, than the mere fuggeftions of fancy: ( 68 ) And till thofe gentlemen fubject the atmofphere to eudiometrical experiments, and demonftrate that fuch a conftitution does exift, or that fome material change has taken place, it cannot with juftice or fafety be confidered as any thing more than the mere fuggeftions of fancy, and deferves no more refpect than the vifionary opinions which prevailed in the dark ages of Gothic ignorance, when the conjunction or oppofition of certain planets were believed to be the caufe of the plague. The following lines of Fracaftoricus, who pub- liflied his obfervations about the middle of the 16th century, give fome idea of this doctrine : " An hundred years, twice told, have ta'en their flight Since Saturn mix'd with Mars his hated light: Which, by their baneful influence, did infeft The rich and potent nations of the Eaft. Hence rag'd a dreadful peft, before unknown, Which feiz'd the lungs, and made the breafl its throne. Four days it reign'd with dreadful fway, When life burfl forth in purple ftreams and fled away." The ancient doctrine of the influence of certain planets in the production of peftilential difeafes, being the offspring of ignorance and fuperftition, and not of rational and unprejudiced obfervations, is defervedly rejected. This muft eventually be the cafe with the more modern doctrine refpecting the change which is fuppofed to have taken place of C 69 ) late years in the conftitution of the atmofphere, and afligned as the caufe of the converfion of our formerly mild fevers into thofe of a malignant and peftilential kind—For this doctrine is neither fup- ported by obfervations nor direct experiments : on the contrary, it is fo palpably erroneous, that the New York reviewers have given judgment againft it; ift. Becaufe it derives no fupport from eudio- metrical experiments nor any other direcl proof. 2d. Becaufe it feems to be rendered impoflible by the feafon of the year, when thefe malignant fevers are moft apt to prevail; i. e. the latter end of fummer and the autumn, at which time, if at any fea- fon of the year, the relative quantity of the oxygene (or pure portion of the atmofphere,) it would feem probable is mofifcanty. A confiderable pro- portion of vegetable fubftances is then dead, and even the living vegetables, a principal fource of that air, have at this time much declined from the frefh, vigorous and healthy ftate in which they emit it moft copioufly. 3d. Becaufe a greater proportion of the oxygene air, or inflammatory principle, exifts in the winter, fpring and early part of the fummer, than during the remainder of the year, as feems to be rendered probable, by the brighter, and more florid com- ( 7° ) plexions of people, at fuch feafons, and by the nature of the difeafes then moft apt to prevail. 4th. Becaufe if it was owing to an increafed proportion of oxygenous air or an inflammatory conftitution, the difeafe fliould appear among the inhabitants in the country, more readily than in the air of cities. The late experiments of Dr. Carmichael Smyth, alfo appear to militate againft this opinion. The fumes produced according to his directions to de- ftroy contagion,confift, as Mr.Keir afferts, of highly oxygenated nitrous vapour, mixed with a large quantity of oxygenous or pure air. It is a maxim in philofophy, not to admit any thing for the caufe of an effect that is not fup- ported by accurate and repeated obfervations or direct experiments. Therefore, till more fubftantia! proofs than arbitrary affertions or ingenious con- jectures, are offered in fupport of this doctrine, it ought neither to be adopted nor refpected. Equally powerful objections apply to the doc- trine of gazeous oxyd of azote. The doerrine of Mr. Webfter on this fubject, notwithftanding his elaborate refearches, appears ( 7' ) ftill more exceptionable, and to be as much the creature of imagination as the tales of the fairies. Some gentlemen, confounding contagion which arifes occafionally in certain climates and fituations, with that which is permanent and always exifting, have hazarded an affertion, in contradiction to re- ceived opinion and common obfervation, that the yellow fever is not contagious. This doctrine, if erroneous, would be attended with fuch ferious confequences, that nothing but the moft pofitive and unambiguous proofs fliould induce any one to give credit to it. For though many inconveniencies and evils arife from the dread of contagion when it does not exift, there has been no truth more clearly proved, than that ftill greater inconveniencies and injuries are the confequence of believing there is no danger in vifiting and attending the fick, when the difeafe is contagious. Surely, therefore, before the adoption of an opinion which, if falfe, would be attended with fuch ferious and fatal confe- quences, the moft indifputable proofs fliould be exhibited. Notwithftanding the difficulties which attend all inquiries into the nature and properties of conta- gion, and the influence of various caufes on its ope- ration, there are but few fubjects on which people in general are fo well agreed. And if men of eru- dition had trufted to the teftimony of their fenfes, C 7* ) {nftead of the fallacious pictures of their imagina- tions, many countries and cities would have efcaped the dreadful fcourge of the plague, the contagious nature of which, as well as that of the yellow fe- ver, has been openly denied by men who have roved among the planets in fearch of caufes, inftead of at- tending to the phenomena and occurrences before their eyes.—The reafons moft commonly advanced in fupport of this extraordinary opinion, were, becaufe many of the attendants on the fick were not affect- ed, becaufe its progrefs was fluctuating, and it was moft prevalent and mortal among the pooreft claff- es, and might be owing to poverty, unfound food, unwholefome water, and many other fuppofed caufes. That this miftake was eventually the oc- cafion of the moft dreadful calamities, is well known to thofe who have read the hiftory of the plagues which have been imported from the Levant, at different times, into the cities of Europe. Similar opinions have of late been attempted to be revived in this country ; but I hope the recent experience, and the good fenfe of the people, will preferve them from adopting fo erroneous and mifchievous a doc- trine, which has a tendency to relax the vigilance of thofe ftationed at the poft of danger. It is a fact well known to thofe who have hacl the charge of prifon-fliips or tranfports crouded with men, that it is not only from a direct com- munication with the fick that contagious fevers are ( 73 ) occafioned and propagated, but from the perfons and clothes of thofe that have lately been fick, or that have even remained long in an infected atmofphere; that is, in that portion of the atmofphere that fur- rounds the fick, which being received into woollen, cotton, filk, and many other porous materials, not excepting timber and furniture, are capable, after having been conveyed a great diftance and preferved a great length of time in fituations excluded from frefh air, of producing the fame effect as an immedi- ate communication with the fick themfelves: of this fact, the examples on record are fo numerous as to put the matter beyond the poffibility of a doubt. It has alfo been obferved by feveral late writers of diftinguiflied talents and information, that the moft highly contagious fevers, in clear and well venti- lated hofpitals, do not in general affect the patients lodged in the fame ward, but the nurfes only, and thofe patients or other perfons that aflift them in taking them out or putting them into bed, or thofe that lie in the beds contiguous to, or very near them. The fame obfervation applies to private families in large, clean and ventilated apartments; for there it is rare for any perfons but thofe who are under the neceflity of fleeping in the chamber, or of approaching fo near the fick as to be fenfible of the warmth or exhalations from his body, to be infected, efpecially if they guard againft ftand- ing oppofite to the courfe of the wind when the windows are open ; for the matter of contagion, K ( 74 ) like noxious gafes, only operates injurioufly when concentrated and unmixed with pure air, and is harmlefs when diffufed in the unconfined atmofphere. The ingenious Dr. Hunter, who had charge of the military hofpitals in Jamaica in the years 1781, 1782, and 1783, remarks that the typhus gravior* (which is known to be contagious in temperate cli- mates in all clofe, unventilated and uncleanly fitua- tions, crowded with people) was never contagious in the hofpitals of Jamaica, though they were fre- quently crowded with patients with difeafes of dif- ferent defcriptions. Dr. Lind informs us, that this fever, fo extremely contagious on board Chips, was feldom contagious in the clean and airy hofpital of Haflar in England. Both thefe authors, as well as the unrivalled Cul- Ien, are decidedly of opinion, that the contagion of fever received and retained in the wearing ap- parel and bedding of the difeafed, is the moft dangerous mode in which it can be communicated, and is much more certain in producing fever than when it firft iffues from the body of the patient. In fupport of this opinion, Dr. Lind appeals to the circumftance of the naked flaves from Africa efcaping, while the convicts fent to America with dirty foul clothing, generally fuffer by it during. * The common contagious continued fever of camps, hofpitals and prifon fhips, Sec. ( 75 ) their voyage, though much lefs crowded than the unfortunate flaves. It is alfo well known to thofe acquainted with the prefent ftate of medical know- ledge, or that have been employed in military hofpitals or prifon fliips, that the fever which originates in confined and foul fituations crowded with people, is of a continued form, and is con- tagious in winter as well as at other feafons of the year; which we now know is not the cafe in tem- perate climates with either the plague or the yel- low fever, both of which prevail or become epide- mic only in the latter part of fummer and during the autumnal feafon; and which have fo many fymptoms in common, and have their principal feats in the fame parts of the fyftem, as diffe&ions demonftrate, that if there is any dependence on analogy, they originate from the fame caufe and are only different degrees of the fame difeafe, varied in fome refpects by difference of climate. We now know from repeated obfervations, that the contagion of the yellow fever, like that of the peftilence, requires a certain range of temperature, as well as a calm or ftagnant condition of it, to enable it to operate injurioufly on the principle of life. When the temperature of the atmof- phere is above 80, the contagion is volatilized and diffipated : when as low as the freezing point, the caloric or matter of heat by which it is render- ed volatile and active is detached, and it falls harm- ( 7^ ) lefs to the ground.—This is illuftrated by the poi- fonous juice of the Weft India cafhu nut, which in a certain temperature rifes into the atmofphere; and, though imperceptible to the fenfes, when it comes in contact with a tender part of the furface of the body where the cuticle is thin, it occafions a burning fenfation and a painful eruption, which fometimes excites a confiderable degree of fever. I apprehend I have now proved the yellow fever to be a contagious and imported difeafe, by teftimo- ny that can neither be denied nor invalidated, and confequently that the doctrine of its domeftic ori- gin is palpably erroneous. This is a fact of great importance to the true intereft of this country ; for if the erroneous doctrine of the domeftic origin of the difeafe was generally believed, foreign com- merce would fhun our dangerous ports, and the veffels of our merchants would be fubjected to the inconvenience and vexation of a tedious and ex- penfive quarantine in foreign ports. This has al- ready been propofed at Marfeilles, as appears from a pamphlet received from thence by the fecretary of ftate. The induftrious claffes of our citizens, fore vexed by cheerlefs poverty, would feek fome fafer and more favourable fituation, and the ftately edifices of our cities themfelves would foon crumble into ruins:—for few that deferve the name of ra- tional beings, would be found fo prodigal of health and life, however powerful their love of gain, as to ( 77 ) immigrate to, or venture to refide in the feat of peftilence and death. The arguments of thofe gentlemen who contend, that the belief in the doctrine of the domeftic ori- gin of the difeafe would promote the intereft of this country, refemble the arguments of the athe- ifts, who maintain that the caufe of morality would be promoted by the belief that there is no future ftate of accountability; a belief that would take off all reftraint from triumphant vice, and all con- folation from fuffering virtue. My obfervations however incline me to believe, that although the yellow fever is never generated in this country, it is communicated from one to another more readily and certainly when the at- mofphere is replete with putrid exhalations, than when it is more pure or free from fuch exhala- tions. Prudence, therefore, dictates the propriety of removing from the city and its vicinity all putre- fiable fubftances, and to promote coolnefs and ven- tilation during the hot feafon, as far as practicable ; at the fame time, I think our main force fliould be directed with energy and inceffant vigilance to the fource of importation; convinced, if that poft was faithfully and effectually guarded, our health would not be endangered nor our intereft and profperity blafted by the difaftrous calamity of the yellow fever. ( 78 ) Of the Symptoms which distinguijh the Pestilential or Tellow Fever from the Bilious Fever. BESIDES being diftinguiflied from the bilious fever in the circumftance of contagion and the ap- pearances on diffection, the peftilential yellow fever differs from every variety of the bilious fever, in the generality of cafes that prove mortal, in the following fymptoms, which ftrongly indicate that they not only differ in degree but in kind. ift. In the circumftance of the hidden fubfidence or intermiflion of all the moft confpicuous febrile fymptoms in the courfe of the third or fourth day from the attack, and the fpeedy fucceflion of a more diftreffing and dangerous train of fymptoms, viz. inceffant retching, ftraining, and puking of mucilaginous or ropy fluids, but rarely any bile, accompanied with a burning fenfation in the fto- mach, ftricture, anxiety, frequent fighing and reft- leffnefs; and foon after, by a bilious or deep yel- low colour of the whole furface of the body, which firft appears in the eyes, previoufly inflamed and watery and gives them a muddy and dull afpect. The countenance alfo at this period is expreffive of great mifery and diftrefs, contracted and ghaftly. 2d. In the hidden fubfidence of all the preced- ing fymptoms, and return of temporary eafe and ( 79 ) tranquillity, followed by vomiting of dark colour- ed matter refembling coffee grounds, accompanied with bloated and livid countenance, moift tongue, deadly coldnefs of the limbs, difordered and de- luded intellects, apparently renovated ftrength, and finally convulfions. When, however, the chief force of the difeafe is exerted on the brain, inftead of vomiting and reftleffnefs, a deep lethargy per- vades the fenfes, accompanied with hemorrhages and purple fpots and terminates in death. A Review of the Different Methods of Treating the Tellow Fever. SINCE the publication of Dr. Chifholm on the peftilential fever which appeared in Grenada in the years 1793 and 1794, in which he recom- mends producing a falivation as early as poflible by means of mercury, as the moft effectual and certain method of curing the difeafe, the fame method has been adopted by the majority of the phyficians of America: and its fuppofed good ef- fects have been accounted for, upon the fanciful principle, firft taught by Sir John Hunter, of cur- ing one difeafe by creating another. But if my obfervations have not greatly deceived me, mer- cury has protracted the fever and retarded the cure in every cafe where inflammatory fymptoms have predominated, and inflammatory fymptoms do C 80 ) predominate at the beginning of- the difcafe in a confiderable proportion of cafes; except it be giv- en in dofes fufficiently large to occafion copious evacuations from the bowels. Mercury has alfo invariably not only failed in curing, but has in- variably accelerated the fatal event in all the cafes in which I have feen it employed, either in large or fmall dofes, when fymptoms of malignity were evident. In more mild and fimple cafes, milder remedies proved equally effectual and much lefs hazardous. It is true that in moft cafes in which falivation was produced the patient recovered, and generally without any fubfequent bad effect; whereas feve- ral have been reduced to the neceffity^ of com- pounding for life with the lofs of their hair, teeth, and even part of a jaw bone, and fome with con- flitutions fo impaired as to become walking fpec- tacles of wo ! In fome perfons difpofed to gout a fmall dofe of calomel has impaired the digeflive powers of the ftomach and rendered the fufferer hypochondriac. The pain and debility it has fome- times occafioned, have thrown the patient into con- vulfions that have terminated in hidden death. It was feldom poflible to excite falivation in any cafe where fymptoms of malignity were evident; on the contrary, mercury appeared to force out life in rapid flreams, and when falivation was excited in ( 8i ) mild cafes, it was by no means a proof that the mercury occafioned the removal of the difeafe, but more probably that the ceffation of the fever was the caufe of the falivation taking place; for in fimple and mild cafes, a folution of the fever gene- rally takes place without any remedy, on or be- fore the fifth day from the attack. In cafes where mercury has been given or con- tinued after evident marks of malignity have made their appearance, fuch as blue or duiky fpots on the ikin, great depreflion of ftrength, reftleffnefs and haemorrhages from the nofe and mouth, or from the bowels, it has deftroyed life with as much cer- tainty and almoft with as much celerity as light- ning. We are informed by Kramer and Lind, that it once occafioned the fame fatal effects among the Hungarian foldiers in the advanced ftage of the fcurvy. Mercury was once in as much credit in the pre- vention and cure of the fmall pox as it has been of late in the yellow fever; but (with a few excep- tions) is at prefent entirely out of credit in that difeafe, and would foon be the fame in the yellow fever, if we were to judge of its utility from the abufe or mifapplication that has been made of it, abufe which has attached the idea of horror to the very name of mercury. There are circumftances, however, fometimes attending this difeafe, in which L ( 82 ") mercury has done the moft confpicuous fervice, and in which it has moft affuredly refcued many valua- ble lives from the grafp of death. The cafes in which mercury has performed this extraordinary fervice, have been accompanied with evident figns of local congeftion or effufion, and particularly in cafes of coma, in which the dilated pupils indicated compreflion of the brain from congeftion or effufion. Under thefe circumftances, it was given in large and repeated dofes. In the year 1744, falivation was recommended in the plague, in an Inaugural Differtation by Mr. Lowry of Edinburgh, in conformity to the theory which was taught at that time, that all febrile dif- eafes depended on morbific matter in the blood : a doctrine which has fince been demonftrated to be extremely erroneous. The fweating treatment, by the means directed by Dr. Warren of Barbadoes, and by cordial and ftimulating remedies, and the external applications of heat and moirture, whether with or without a load of oppreflive bed-clothes, as far as I have been able to learn, proved not only unfuccefsful, but in the majority of cafes that fubmitted to it was a fpeedy though painful paffport to the grave. When tenfion of the pulfe, with hot fkin, indi- cated inflammatory diathefis, and efpeciallv when. ( »3 ) accompanied with pain in the head, fide or fto- mach, in addition to the antiphlogiftic regimen and frequent purging, by means of a folution of glau- bers falts and tartarized antimony, blood-letting was of fenfible fervice; and in fome extraordinary cafes, where no mercury was ufed, the fymptoms called for it to a fourth or fifth time at the fliort intervals of eight or ten hours. In mild cafes, where mercury was given in fmall dofes fo as to keep up an inflammatory diathefis, bleeding has been employed to an almoft incredible extent, and in many cafes without apparent injury; but as the difeafe was then an artificial one, and not the ori- ginal fever, I leave it for others to determine the propriety of fuch treatment. In general, in the moft inflammatory cafes, three moderate bleedings, when aided by the free ufe of cathartics, were the greateft number neceffary ; and it was for the moft part neceffary to reftria bleeding to the firft three days from the attack of the fever. In cafes where the fever began with great and fudden proftration of ftrength, and the fymptoms continued with great oppreflion and weight about the heart, accompanied with pale or livid counte- nance, low pulfe and moderate heat, and fuch cafes were numerous, bleeding did manifeft and irrepa- rable injury. ( 84 ) In a difeafe, therefore, which varies fo furprif- ingly in different cafes, no precife rules for blood- letting can be laid down ; but the practitioner muft be governed by the ftate of the fyftem, which a careful examination of the leading fymptoms will unfold to his view.—I do not pretend to explain the reafon why the contagion aas as ftimulant in one patient, and as a poifon which expels or diffolves the vital principle in another, and leaves every fibre in his body foft, putrid and powerlefs ; but repeat- ed obfervations warrant me in afferting this to be the faa. In cafes where fymptoms of malignity and great debility in the animal powers made their appear- ance early, or came on in the courfe of the difeafe, I think I have feen the fatal event longer retarded by the liberal ufe of fulphuric acid fufficiently di- luted with water; wafliing the patient's body and limbs at the fame time two or three times a day with cold wine, or brandy and water, than by any other remedies. The body and limbs were wiped dry after every wafliing, and covered from the air for fome time. If fenfible ftrength fucceeded the wafliing, it was encouragement to proceed with it in the fame manner. When that was not the cafe, warm applications were fubftituted. ( 85 ) When that dreaded fymptom, the black vomit- ing,* made its appearance, which was very common towards the clofe of life, accompanied with ceffa- tion of pain, moift tongue, cold extremities, and pulfe flower than in health, no remedies that I have ever feen tried were of much avail—though fome medical gentlemen in New York declare that they have recovered a great many in that condition by means of the free and frequent ufe of fimple lime- water and fweet milk. Some inftances have alfo been recorded, in other places, of the difeafe being cured by the liberal ufe of brandy and water taken cold. The cold bath, as recommended by Drs. Wright, Jackfon, M'Clean and others, was repeatedly tried in the early ftage of the difeafe in the year 1793, in Philadelphia, but without the beneficial effeas that were expeaed from it; in confequence of which it has not been refumed here. In the Weft Indies, thofe gentlemen ftill perfift in declaring it fucceeded, after the early lofs of from 15 to 20 ounces of blood, an aaive cathartic, and previous immerfion in the warm bath, the patient being put to bed immediately after the application of the cold water, and taking mild tepid drinks. This procefs they advife to be renewed, without the bleeding, * The judicious experiments lately made by Dr. I. Cath- rall, decidedly prove that the black matter thrown up by vomiting in the laft ftage of this fever, is neither vitiated bile nor putrid blood. ( 86 ) in a few hours, if the fever does not fenflbly fub- fide and the patient feel relief. In the year 1797, Dr» Hodge employed full vo- miting in the early ftage of the fever, after mode- rate bloodletting, with remarkable fuccefs ; for of feventy patients which he treated in this manner, ho loft but three. Wine, bark and opium, fo frequently beneficial in bilious and typhous fevers, were found decidedly injurious in every cafe of the yellow fever—a fa& which affords an additional argument in confirma- tion of the doarine, that it does not only differ in degree but in kind from the bijious fever of this country. When the febrile fymptoms fuddenly fubfided, and were fliortly after fucceeded by inceffant incli- nation to vomit, with great reftlefsnefs and fighing, which in dangerous cafes generally occurred on the third or fourth day from the attack, moderate and repeated bloodletting, clyfters, and bliftcis to the ftomach and thighs, and the liberal ufe of cool aci- dulated drinks, were the moft fuccefsful remedies, although the apparent debility feemed to contra- indicate tlieir ufe. In the he tcr ftage of dangerous cafes with typhous fymptom,, unconnected with fympioms of inflamed ftomach or congeftions in the brain, liver, or any of the other vifcera, boh Acs of ( 87 ) • volatile falts, inftantly followed by a table fpoonful of lemon juice diluted with cool water, and in fome cafes camphorated vinegar, have been employed with apparent benefit. Port wine and porter, as well as every other remedy that ftiirmlated confi- fiderably or fuddenly, aggravated the difeafe; whereas the diluted juices of frefh vegetables, par- ticularly of lemons, oranges, grapes and currants, bottled fmall beer and mead, were not only fre- quently beneficial but highly grateful to the patient. Dr. Ferriar of Manchefter has found the nitrous acid in dofes of half a drachm, given three times a day, very ufeful in the latter ft ages of the common typhus, or low nervous fever. Dr. Garnet of Glafgow and Dr. J. Currie of Liverpool have found ftill more beneficial effeas from the ufe of the oxygenated muriate of potafli, in dofes of from three to fix grains according to Dr. Garnet, and fifteen grains according to Dr. Currie, who direas it to be increafed according to its ef- feas, and remarks, " Sometimes it feems as inaaive as any other neutral fait, but at olher times it very much increafes the heat of the body." As in malignant cafes of every kind of fever there appears to be an extraordinary deficiency of oxygene, if we may judge from the colour and con- fiftencc of the blood, medicines which contain the ( 88 ) greatcft portion of that material, and part with it inoft eafily, promife to be the moft ufeful remedies. On this principle, the oxygenated muriate of pot- afli will be found fuperior to any other remedy at prefent known; for " about feventy-five inches of extremely pure oxygene gas may be procured by means of heat from one hundred grains of this fait, to which the oxygene is fo loofely attached that it is difengaged even by the light of the fun. It is rapidly difengaged, and combines with combuftible fubftances, as is evident from its detonation with fulphur, and ftill more violently with phofphorus. We may therefore conclude, it will be readily de- compofed by the carbon and hydrogen in the blood, and increafe the proportion of oxygene, and pre- vent any further tendency in the folids to gan- grene."* ' Annals of Medicine for 1797 and 1798. ADDITIONAL FACTS And Obfervations refpecling the Origin of the Tellow Fever in New Tork last Tear, with an Account of the most fuccefsful Method of treating it. Com- municated by Dr. D. Hosack, Profeffor of Botany and Materia Medica, &c* _L HE fhip Gen. Wayne came to Ten-Eyck's wharf (at Coentie's flip on the Eaft river) the 14th of July laft, and began to difcharge her cargo the next day or the day following. Mr. Olmfted (the clerk of Alderman Coles) and F. Barber (the clerk of Meffrs. Duryee and Heyer) vifited the Gen. Wayne on or about the 17th of July while the cargo was difcharging. The former was taken fick the 19th or 20th and died on the 26th of the fame month: the latter was taken ill on the 20th and died on the 27th—(Attefted before Alderman De La Montagnie by Mr. W. Leacraft, infpeaor of the cuftoms.) Michael Galor who alfo vifited the Gen. Wayne while difcharging her cargo, was taken ill with fever the 20th of July and died on the 26th. David Sturgis, who bored fome of the M ( 9<> ) boxes of fu^ar belonging to the Gen. Wayne, was taken with the fever the 21ft of July and died on the -8th.—(Aftelled by Mr. Ch. Duryee.) Brom Johnfon, who aflifted in difcharging the cargo, was taken ill with fever on the 20th of July, but reco- vered.—(Atteiled by Mrs. Winans at whofe houfe he was taken iih) A floop called the Farmer lay at the fame wharf with the Gen. Wayne while difcharging her cargo. About the 20th of July, on her paffage up the North river, Abram Schoonmaker, the mafter of the floop, and John Ploegh, were taken ill on board, and both died, the former on the 26th, the latter on the 27th of July. Dr. Vander Lyn, of Efopus, declares, that he faw John Ploegh the day of his death, that he had the black vomit, and that his eyes and fkin were of a deep yellow. Schoonmaker's tongue was very brown and his ikin confiderably yellow. Jofeph Doughty, merchant, of Dutchefs county, declared before one of the aldermen, that he was taken ill with fever on the 20th of July, foon after leaving Coentie's flip, where he had lodged on hoard Captain North's floop, which lay alongfide or near to the Gen. Wayne while flie was difcharg- ing her cargo. Eleazer Cottrill landed a quantity of fire-wood from on board the fchooner Hypogryph in Coen- ( 9' ) tie's flip while the Gen. Wayne lay there, and on board of which it was proved on oath he had been, and was taken ill with fever foon after, of which he died at Middfetown, New Jerfey. William Schooly, one of the hands belonging to the Gen. Wayne, has alfo given a certificate, pub- liflied in the Argus of Sept. 9th, 1799, in which he declares, that " during the time the veffel lay at the Havanna, two of the hands died of the yel- low fever, and were buried on fliore: the evening after the veffel failed from the Havanna, on her return to New York, one man died of the fame diforder, and on the fecond day another, who were both thrown overboard : and that on or about the 14th of June, when he was imprefled and taken on board a Britifli man of war, nineteen of the crew were ill of the yellow fever, and only four men and the Captain well on board." The declaration of William Schooly, however, appears, from the ma- nifeft taken in the cabin of the veffel on the 2 2d of June, immediately after her arrival at the quaran- tine anchorage at Staten-iiland, to be incorrect with refpea to the number fick at the time of his impreff- ment, though it appears to agree with the manifeft in other refpeas. Dr. Bayley acknowledges,* that fome of the hands had died on board before and after her arri- * See die preceding Sketch at page 54. ( 9* ) val at the quarantine ground. He, however, ftill maintains that the difeafe was not introduced into New York laft year by the Gen. Wayne or any other veffel, but was generated by the mud and putrid materials of Coentie's flip.—In fupport of this opinion, he afferts, that the yellow fever in the years 1797 and 1798 made its appearance on the very fame fpot, in the fame month, and within a few days of the fame time. In addition to this declaration, he afferts, feveral cafes of yellow fever had occurred in New York before the arrival of the Gen. Wayne. That there were a few fpora- dic cafes of the yellow fever in New York is ac- knowledged by Dr. Hofack, who has explained it upon a very different and in my opinion much more fatisfaaory principle than Dr. Bayley, who moft evidently confounds the yellow fever with the com- mon remitting fever of warm feafons and marfhy fituations, to which it bears no more analogy than the fmall-pox or meazles. It muft be acknowledg- ed, however, that Dr. Bayley has fupported his opinion with much plaufibility, and an ingenuity that indicates confiderable talents. For the defence of his opinions, and the circum- ftances on which he refts his belief that the yellow fever is not a contagious difeafe, the reader is re- ferred to the New York Gazette, of the 16th of January laft, printed by Mr. John Lang. ( 93 ) Extracl of a Letter from Dr. G. Blane,a Gentleman of the firft Medical Reputation in England, to an Official Characler at the Britifh Court, from the United States of America, dated London i6ih No- vember, 1798. " THE adopting of meafures for the prevention of difeafe, is one of the moft important duties of a wife and patriotic government, and the difcovery of thefe means, as well as the efficiency of the fteps to be taken, muft depend on a thorough knowledge of the caufes by which it is excited and influenc- ed. My opportunities upon aaual fervice in the Weft Indies, in the late war, when phyfician to the fleet under the command of Lord Rodney and Ad- miral Pigot, and my prefent official duty as a mem- ber of the medical board of the navy, have necef- farily brought to my knowledge a number of faas relating to this fubjea ; and I fliall be extremely happy, if the communication of fome of the moft important of them can throw any light which may prove ufeful to the American government, in checking an evil fo aflliaing and calamitous. " The firft queftion that occurs with a view to preventive meafures is whether this difeafe be infec- tious, and under what circumftances it is fo ? " In thofe fituations in which I obferved it in the Weft Indies it was evidently fo. There was the C 94 ) moft inconteftible evidence of this both on hoard of fhips and at hofpitals, and the doubts which have arifen on this point, feem to have arifen from the effeas of infeaion, being blended with thofe which arofe from other caufes. " But whatever doubts there may be on this fubjea in the Weft Indies there can be none in the climate of North America. This will be the heft proved and illuftrated by an example : " On the 16th of May 1795, the Thetis and Huffar frigates capuircd two French armed fhips from Guadaloupe, on the coaft of America. One of thefe had the yellow fever on board, and out of fourteen men fent from the liuffar to take care of her, nine died of this fever before fhe reached Ha- lifax on the 28th of the fame month, and the five others were fent to the hofpital. Part of the pri- foners were removed on board of the Huffar, and though care was taken to felea thofe in perfea health, the difeafe fpread rapidly in that fhip, lo that near one-third of the whole crew was more or lefs affeaed by it. " This faa carries a conviaion of the reality of in- f-aion as irrefiltible as volumes of argument; and it further a'fords matter of important and inftruaive rnformacion, by proving that the infeaion miv he conveyed by men in health." ( 9S ) Ofy of a Ltttcr from Doctor ILjach, dated New Fork, February 2 id, 1800. " Dear Sir, " I received your favour of the 19th inft. requeft- ing any evidence in my poffeffion, relative to the origin of the yellow fever as it appeared in New Fork during the laft fummer. " In reply to your requeft, I believe there have been two fources of the difeafe of the laft year; the one I believe to have been the remains of the poifon of the preceding year, where care had not been taken to cleanfe or deftroy the clothing and bedding of the fick. It is alfo poflible that goods which may have become charged with infeaion from being expofed in the atmofphere in which the dif- eafe formerly prevailed, may have given origin to fome cafes of the difeafe which appeared the laft fummer. It certainly accords with the obfervations of praaical writers, that infeaion is not totally de- ftroyed in a fingle feafon. Upon this principle I fliould be very much furprifed if the yellov/ fever fliould entirely difappear in one or even two years after the moft rigid quarantine that could be de- vifed. But in my opinion this was not the only fource of the difeafe of the laft fummer. " I enelofe you a copy of the teftimonies relative to the importation of it by the fhip Gen. Wayne. C 96 ) Thefe teftimonies have been colleaed by a very worthy and refpeaable man, Mr. Thomas Storm. Some time after Dr. R. Bayley, our health officer, publiflied fome remarks with the view if poffible to remove the impreffion from the minds of our citizens which they were calculated to produce; a copy of which is alfo enclofed. You will ob- ferve, he premifes a declaration, that the yellow fe- ver appeared in this city before the arrival of the Gen. Wayne, and refers to three or four perfons as examples, and quotes Dr. Miller and myfelf as the phyficians who attended one of them. It is true Mr. Stephenfon died of the yellow fever; but if the foregoing principle be juft, it will account for his cafe, viz. expofure to the latent infeaion of the preceding year revived and rendered aaive by returning heat, which may have been retained in goods, &c. To this I can add the cafe of another perfon whom I vifited, before the arrival of the Wayne*at the New York hofpital ill of this difeafe: this perfon arrived in a veffel from the Havanna. He told me that fome others had been ill on board the fame veffel on her paffage, and had died of the yellow fever. As he had all the charaaeriftic fymp- toms of the yellow fever, I reported him at the health office; he was direaiy conveyed to Staten Ifland, where, I am informed he died a few days after. ( 97 ) " When we thus find perfons ill with this difeafe* or coming from infecled ports, without pqffing through a regular quarantine, permitted to come to the city with their veffels, we Jhould not be furprifed, that cafes of the yellow fever appeared in New Tork be- fore the arrival of the Gen. Wayne. " In the fame letter of Dr. Bayley, he tells you that it appeared precifely at the fame fpot where it had appeared in 1797 and 1798. But, he has omitted to add that it very foon prevailed in Bar- clay ftreet, in Warren, Murray and Chambers ftreets, a part of the city which had been heretofore proverbially healthy. Whether it was not com- municated by contagion to this part of the city you will readily judge.—Thefe ftreets have no re- pofitories of filth, no funken, new-filled lots, no fewers, no dead horfes half buried to poifon the at- mofphere. If it were the produa of the corrupted atmofphere of Coentie's flip, and is not contagious, how did it get into this part of the city ? " Before I conclude I muft add another fa& which, in my opinion, is very much oppofed to the favourite doarine of our home-generating gentlemen. Our infpeaor general of beef, Mr. Edmund Prior, a well-informed and careful obferver, informed me that of 40 perfons whom he had employed during the laft fummer in examining the beef, and in re- moving and emptying fuch barrels as were found N t 98 ) in a putrid state, not one was taken ill with the yellow fever while employed in that fervice ; and what affords ftill farchcr confirmation that this is not of itfelf a fource of yellow fever, 38 of the 40 were feized with a complaint of a very differ- ent nature, the dyfentery.—The remaining two left him and for feveral days worked on board veffels, were feized with the yellow fever, of which they died.—Their fyftems it feems were fufceptible of the poifon of the yellow fever, but the putrid beef produced no other effea than it ufually does in all other countries. You will find in Pringle and fe- veral other writers fimilar faas. " As a proof of my candour and impartiality on this fubjea, and as an apology for my feeming in- confiftency, I muft inform you that in the year 1798, in which the difeafe was afcribed here to the effluvia of putrid beef, having received informa- tion that Mr. Roorbeck, on Long Ifland, had re- ceived the yellow fever, of which he died, from opening and handling a barrel of putrid beef which had floated upon the fhore where he refided, I communicated this faa as 1 then confidered it, to Drs. Lettfome, Pearfon and Marflial of London, and to profeffors Gregory, Duncan and Hamilton of Edinburgh, as an evidence oppofed to the opini- on I had previoufly entertained and expreffed : I alfo added, if that faa fliould be eftabliflied I fliould Dot hefitate immediately to renounce my former C 99 ) opinion of its foreign fource. But I have fince been informed by a gentleman, who at that time refided on Long Ifland, that Mr. Roorbeck, a few days before his illnefs, vifited a perfon ill of yellow fever, who had contraaed it in New York, which at once invalidates the pretended and important faa of his having received it from the putrid beef. In the above expreffion of foreign fource, pleafe to ob- ferve, I do not undertake to trace it to Siam, or any particular climate or country, but confider it as one of the fame myfterious family of difeafes with the fmall-pox, mealies, plague, and many others whofe fpecific caufes are unknown.----Here I muft end for the prefent. Yours fmcerely, D. HOSACK, Dr. Currie. Copy of a fecond Letter from Dr. D. Hofack, dated March 3d, 1800. ** THIS morning I received yours of the 28th Feb. requefting permiffion to introduce my laft, with the documents inclofed, into your publication. Although it was written in hafte and only intended for your own infpeaion, if you fliall judge it wor- thy of being made public, you have my permiffion to make fuch ufe of it as you may think proper. ( ioo ) " I fliall now add a few obfervations on the treat- ment, in addition to thofe contained in the Inaugu- ral Differtation of my brother, reprinted in your city in 1797, by Mr. Dobfon, but muft premife the view of the difeafe which led me to adopt the mode of treatment I purfued, and which may not have been fufficicntly infilled upon in that Differ- tation. " I confider fever to be of two kinds, either arifing from the fenfible changes of the atmofphere, or from a matter of a peculiar quality, introduced into the fyftem : of the firft kind are fimple inflam- matory fever, pleurify, acute rheumatifm, inflam- mation of the brain, ftomach, inteftines, and all thofe difeafes which are purely inflammatory. Of the latter clafs of fevers arc fmall pox, meafles, chicken pox, influenza, hooping cough, fcarlet fe- ver, dyfentery, yellow fever, plague, &c. &c. arifing from certain noxious matters introduced in- to the fyftem, which remain in it a certain length of time, producing more or lefs violent operation in proportion to the virulence of their nature, and at length " wear themfelves out," leaving the bo- dy more or lefs debilitated, according to their du- ration or their violence of aaion. " I have introduced this obfervation to illuftrate the analogy which I fuppofe to exift in a certain degree between yellow fever and all thofe difeafes ( ioi ) which arife from foreign matter introduced into the fyftem. In the treatment of this clafs of dif- eafes, there appears to me but one principle to be purfued: to attend to the different funaions of the body, that the aaion of the poifon may be rendered as moderate as poflible, and that every other fource of irritation be removed, until the caufe producing the difeafe be entirely exhaufted : and that the means of accomplifliiilg this indica- tion be fuch as leaft debilitates the body. " In the management of yellow fever I have ap- plied the fame doarine; in this difeafe there is a peculiar poifon introduced, which like the poifon of the plague, or of a venomous ferpent, produces violent irritation and fever, with a derangement of all the funaions of the body. " When thus introduced, the principles of my praaice have been to moderate its aaion, and to remove every other fource of irritation : both of thefe indications 1 believe may be generally accom- plifhed by the fame means, the chief of which ap- pear to be—firft, to remove from the bowels any matters which may aggravate the difeafe. " Secondly-—To reftore the perfpiration, which is for the moft part obftructed. I make this laft a fe- parate article in the cure of this difeafe, inafmuch as the matter difcharged by perfpiration even in ( 102 ) health is of a noxious quality (as is proved by the late experiments of Mr. Abernethy of London) and if retained muft add greatly to the fever and vitiated ftate of the fluids which take place in this difeafe. As to the medicines I have employed in accompliihing thefe intentions, and the different remedies adapted to the peculiar condition and cir- cumftances of the patient, I can add nothing more to what are detailed in the above mentioned dif- fertation : they are the means I have experienced to be the moft fuccefsful. But that part of the treatment upon which I am difpofed to place the moft reliance, is fweating. Common obfervations have long fince eftabliflied the importance of this remedy in fevers in general: but I was more par- ticularly direaed to the advantages and neceffity of attending to this remedy in the treatment of the yellow fever, by Dr. John Bard of this city, and the writings of Dr. Warren, m his hiftoiy of the yellow fever of Barbadoes. '•' If there is a fpecific in the cure of any difeafe ; if the Peruvian bark is to be relied upon in the cure of intermittent fever, fweating, when induc- ed within the first twelve hours from the commence- ment of the difeafe, I believe I may venture to af- fert is a no lefs certain remedy in the cure of yel- low fever. In ihort, fo ftrongly is my mind im- preffed with the falutary nature of this difcharge in yellow fever, and I have hecn fo rarely difap- ( 103 ) pointed in its effeas, that when I find my patient fweating within a few hours after the attack of the difeafe, 1 congratulate him as fecure from dan- ger, provided it be continued a confiderable length of time, thereby urging him to the diligent ufe of the means prefcribed for accomplifliing it. It is a remedy I moft fincerely and devoutly recom- mend to your particular confideration and atten- tion ; but to fecure its good effeas, I again repeat the remark, that it muft be employed as early as poffible, after attention to the bowels, which fliould be the firft objea of the phyfician's prefcription. " Having been aaively employed in the yellow fever of 1798 and 1799, I had an opportunity of purfuing this mode of treatment upon an extenfive fcale, and am prepared to bear the moft unequivo- cal teftimony in its favour. In the year 1798, Dr. Samuel Bard and myfelf vifited and attended about 550 patients with this difcafe—of this number we loft between 60 and 70.—In 1799 I attended 98 perfons and loft 12.—Although the fa- tality of 1799 is nearly in the fame proportion with that of 1798, there is a very material difference as it regards the praaice we purfued and the con- dition of the patients in thofe different years.— In 1798 we loft many perfons of great refpedtabili- ty, and who were fo fituated as to obtain every comfort which ficknefs requires.—In 1799, except thofe I vifited in confultation with other phyficians, ( 104 ) which cafes are not included in the lift of my pa- tients, I did not lofe more then than four where they had the advantages of good nurfing, com- fortable lodging and pure air. In 1798, upon receiving the Narrative of Bryce on Yellow Fever, in addition to the teftimonies of Dr. Rufli, Dr. Chifliolm and others, in favour of mercury, both Dr. Bard and myfelf refolved to employ it with the expeaation that it would prove a valuable auxiliary to the praaice we then purfued. We accordingly employed it agreeably to the plan re- commended by thofe gentlemen. We gave it in the firft inftance with a view to its purgative effeas, in dofes of ten grains—afterwards continued it as an alterative, in dofes of two grains, and in many inftances in conjunaion with opium, to fecure, if poffible, its operation upon the falivary glands. In this manner we adminiftered it to our patients for the fpace of a fortnight; but that fortnight was a fatal period in our praaice. During that fliort fpace of time near 40 of our patients fell viaims to this mode of treatment. I truft the friends of the deceafed will forgive me for this candid declara- tion, when they reflea upon the motives which in- duced us to make this alteration in our praaice. In every cafe wherein it proved fatal, it appeared to produce its effeas by the irritation it excited in the ftomach. For I rarely introduced mercury in the yellow fever where it did not excite vomit- ing, or at leaft fuch a degree of naufea as prevent- ( i°5 ) cd the ftomach from receiving a fufficient quantity of drink to operate upon the fecretions; but in many inftances vomiting was induced by the firft dofe which was exhibited and did not ceafe until the death of the patient. Salivation was very rare- ly produced by the ufe of this medicine. " Having been thus unfortunate in the ufe of mercury, we immediately returned to our former mode of praaice, which again proved as fuccefsful as the mercurial treatment had been fatal. The laft patient to whom I exhibited mercury was the fifter of Mr. Edmund Prior. Her fituation became extremely dangerous, but fhe recovered after fix weeks illnefs. Compare her fituation with the other members of Mr. Prior's family who were treated by the fudorific plan, as ftated in the ad- vertifement publiflied by Mr. Prior, under the fig- nature of a Citizen, after his recovery from a fe- vere attack of this difeafe. " If it were neceffary I could fubjoin many tef- timonies of a fimilar nature, in favour of the treat- ment by purging and fweating, which has now become very general with our praaitioners. " But it has been objeaed to the fudorific prac- tice by the advocates for the lancet, that it is very difficult to produce perfpiration. I grant that it is in fome inftances attended with difficulty, but I O ( 106 ) have as generally remarked that this difficulty pro- ceeded from the flovenly and carelefs manner with which the remedies for this purpofe are employ- ed : but in the greater number of cafes the per- fpiration immediately follows the operation of the remedies made ufe of to open the bowels. Thefe are falts diffolved in a large quantity of water- gruel, given warm and very frequently until they produce fufficient difcharges by the bowels, aided in their operation by frequent draughts of warm gruel or warm lemonade. I alfo very particularly enjoin it upon my patient to remain in bed during the operation of his medicine, and ftrange as it may appear, I add one or two blankets to the bed covering ufually employed in the fummer fea- fon, that the atmofphere immediately furrounding the body may become warm and thereby relax the excretory veffels of the fkin. Its procefs is gene- rally fucceeded by a very general and profufe dif- charge. Where it is not fufficient, I employ bricks heated and fteeped in vinegar, with fomentations of vinegar and water to the legs. In fome in- ftances I have kept the lower extremities immerfed in a veffel of warm vinegar and water for half an hour or upwards ; at the fame time fupplying my patient with warm drinks until the furface of the body becomes relaxed. One of the moft obftinate cafes which I have met with in praaice occurred laft fummer : the patient C 107 ) was Jonathan Burrell, Efq. of this city, cafhier of the United States branch bank. He was attacked with the ufual fymptoms of this difeafe, pain in the head, back and limbs; countenance fluflied, eyes loaded, fkin hot and dry, pulfe frequent and hard. I immediately prefcribed for him falts and warm drinks in the manner before mentioned. After their operation his fymptoms continued to increafe, at- tended with a great propenfity to fleep, bordering on ftupor—his fkin remained hot and dry, without the leaft appearance of perfpiration. Finding the above remedies were ineffeaual, I immerfed his legs in a veffel of warm water and vinegar, fupplied him largely with warm drinks, at the fame time kept him well covered with his bed-clothes while fitting upon the fide of the bed. In this fituation he re- mained upwards of half an hour, when he became faint, his fkin relaxed and moift, and was followed with a moft profufe perfpiration, which was conti- nued by means of warm drinks for the fpace of three days, when his fever was entirely removed. During the whole of this procefs he remained in bed, without change of bedding or clothing—this I confider a very neceffary regulation during the febrile ftage, and an effential part of the fudorific treatment. Another circumftance of great importance in this mode of treatment, is, to continue the perfpiration without the leaft intermiffion until the fever is en- ( io8 ) tirely removed: for the leaft check that is given to this difcharge is very apt to produce irritation at the ftomach, which, if not fpeedily removed, is fol- lowed by that diftreffing and charaaeriftic fymptom of this difeafe the black vomit. In this ftage of the difeafe I have frequently employed blifters to the region of the ftomach with great benefit; but I have generally remarked, that they were rendered much more effeaual in their operation by the con- tinuance of fomentations to the extremities.—When the heat and burning at the ftomach are not re- lieved by thefe remedies, and black vomit fucceeds, we have little to hope of fuccefs from any fource whatever. 7"east and thefaline mixture have occafion- ally given relief in this defperate period of the dif- eafe ; but there is one fpecies of the black vomit wherein the matter difcharged exhibits the appear- ance of coffee-grounds, in which I have been more fuccefsful in the ufe of lime-water than with any other remedy—but that fpecies of black vomit, wherein the matter difcharged appears in the form of black flakes indicating a deftruaion of the coats of the ftomach, I have never feen removed by lime- water or any other remedy. But in the firft men- tioned fpecies, if it were neceffary I could enumerate more than twenty cafes, wherein this generally fatal fymptom has been removed and the patients reco- vered by the ufe of the lime-water. In the follow- ing advertifement Dr. Bard bears witnefs to its fuc- cefs in thefe cafes; if it were required he could add ( i©9 ) his teftimony that many others were cured by the fame means. " Meffrs. McLean and Lang, " A paragraph appeared in your paper of this morning, recommending various alkalefcent fub- ftances as antidotes to the poifon of infeaion: It may perhaps in fome meafure confirm this doarine, and at the fame time ferve the caufe of humanity to have it publicly known, that lime-water mixed with an equal quantity of new milk has been found by Dr. Hofack of this city not only a fafe and eafy way of exhibiting this remedy, but fo efficacious as aaually to have cured (by this prefcription) three cafes of black vomiting; and that in every inftance in which it has been exhibited (and they are not few) it has relieved the uneafmefs and burning at the ftomach and checked the vomiting, which are fuch painful and alarming fymptoms of the prevail- ing epidemic. Convinced from my own obfervation of the great efficacy of this fafe, cheap and agree- able remedy, I think it becomes a duty to give it all the publicity in my power : and without fuppof- ing my name will prove any greater recommenda- tion of it than that of my fellow praaitioners, I fubfcribe it only in evidence of the faa. SAM1. BARD." Sept. 6th, 1798. ( no ) " I fliall alfo fubjoin the following teflimony of Dr. Charlton, Prefident of the Medical Society. " Dear Sir, " A cafe of black vomit relieved by lime-water, which I at prefent recollea, was that of Weft, whom I attended with Dr. Hamerfley in '98. Laft year, you know, I was out of town. This was a decided cafe, and was attended with haemorrhage from the nofe. The ufe of lime-water was, in this inftance, attended with the happieft effea. Yours fincerely, JOHN CHARLTON, March 4th, 1800. Dr. Hosack." " Many refpeaable praaitioners in this city have informed me that they have exhibited this remedy with great advantage, not only in removing the black vomit, but in allaying the heat, burning* and pain at the stomach, which are the ufual precurfors of the black vomit—but with many other medical gentlemen both in New York and Philadelphia, I find that lime-water has acquired but little reputa- tion. Their want of fuccefs in the ufe of it I afcribe to feveral caufes: the firft is, that it was not em- ployed until every other remedy had failed ; feveral inftances of this fort I have met with, in which it was not adminiftered until the pulfe was fcarcely to be perceived, the extremities cold, and the vomit- ing had been of more than 24 hours continuance, ( III ) in which time the powers of life were nearly ex- haufted. A fecond caufe of want of fuccefs is, the exhibition of other remedies at the fame time that the lime-water is employed. I have frequently ob- ferved thofe gentlemen who are partial to the ufe of mercury, to continue the ufe of that medicine at the fame time the lime-water was given. As the operation of mercury generally produces irritation at the ftomach, naufea and vomiting, it is fcarcely to be expeaed of lime-water or any other remedy to compofe the ftomach under thofe circumftances. I fliould as readily expea that lime-water would allay vomiting at the moment tartar etmtic was exhibited with the view to excite it. ce A third caufe of the unfuccefsful ufe of lime- water is the want of perfeverance in the ufe of it. I was credibly informed, that a praaitioner in this city who ftands high in his profeffion, upon hearing of this remedy, adminiftered a fingle dofe of it, and upon its failure has never employed it a fecond time, but affeas to defpife it as inert and ufelefs. " When I firft employed lime-water in the yellow fever, I generally direaed it to be mixed with an equal quantity of milk, and a wineglafs-full of the mixture to be given every hour. Since that time, I have in feveral inftances given it in porter with bene- fit, where the mixture of it with milk was rejeaed. A Mr. Graham, whom I vifited laft fummer, on Long Ifland, is a ftriking example of the advantage ( ,12 ) of this combination. Porter when given alone ne- ver failed to excite heat and pain at the ftomach, which continued until it was difcharged by vomit- ing ; but mixed with the lime-water thofe fymp- toms were all allayed, and by the continuance of this remedy he was reftored to health. " If the above rude and hafty outline of my praaice in yellow fever may contain any hints which may prove of public utility, you are welcome to make fuch ufe of them a6 you may think proper. I am, Sir, with great refpea and efteem, Yours, DAVID HOSACK." POST-SCPIPT by the EDITOR. My review of the fudorific plan of treating this difeafe was printed before I received Dr. Hofack's account of its fuccefs in New York: and as it only applies to the mode in which it was conducted in a few cafes in Philadelphia, it by no means applies to the mode of conducing it which he fo forcibly recommends on the authority of repeated facts. From the experiments lately made by Dr. Cathrall, it appears that lime-water produces its falutary effects by cor- recting the corrofive acid which is generally contained in the ftomach at the time the black vomiting commences. On this principle calcined magnefia would have a fimilar effect. March 13th, 1800. THE END. WZ. ¥10 \%bo