im:. ii UNITED STATES OF AMERICA WASHINGTON, D. C. GPO 16—67244-1 A SECOND ADDRESS % TO THE CITIZENS of PHILADELPHIA* CONTAINING ADDITIONAL PROOFS OF THE DOMESTIC ORIGIN OF THE MALIGNANT BILIOUS, OR YELLOW FEVER. TO WHICH ARE ADDED, OBSERVATIONS, INTENDED TO SHEW that a belief in that opinion, is calculated! to lessen the mortality of the disease, AND TO PREVENT ITS RECURRE / By BENJAMIN RU PHILADELPHIA .- PRINTED BT BDDD AND BARTRAM, TOR THOMAS DOBSON, AT THE STONE HOUSE, N° 41, SOUTH SECOND STREET. 1799. TO THE Citizens of Philadelphia. JVAOST of the fa&s and opinions contain- ed in the following pages, have been pub- limed in a form which has confined their circulation chiefly to phyficians. They are herein abridged, and fo far diverted of medi- cal terms, as to be intelligible to perfons who have not ftudied medicine. This appeal to your fenfes and reafon has become neceffary, by the unfortunate divifion that has taken place among the phyficians of Philadelphia ° refpe&ing ( hr ) refpe&ing the origin of your annual calamity. You are amply competent to underftand, and determine the controverfy; for it would be a denial of goodnefs to the Supreme Being to fuppofe, he had not endued the common faculties of man, with the means of difcover- ing, and obviating the common phyfical evils of his life. To ad properly, upon the im- portant fubjed before you, it will only be neceflary for you to examine, and think for yourfelves. THE AUTHOR. November 18//&, 1799. A SECOND ADDRESS, &c. X HE partial change, which the events con- nected with the late epidemic have made in the minds of the citizens of Philadelphia refpe&ing its origin, has encouraged me to attempt, by a fecond addrefs, to produce a more general conviction of truth upon this interefting fubject. Two opinions chiefly divide our phyficians and citizens. The one confifts in a belief that it is de- rived from a peculiar, or what is called a fpecific contagion; that it was imported from Siam in the Eafl Indies nearly fixty years ago into the Weft Indies, where it has prevailed ever fince, and that it has been imported from thence from time to time into this city and other fea-ports of the United States. Thofe who deny this opinion, be- lieve it to be the common bilious fever of warm feafons ( « ) feafons and climates—that it is generated from putrid matters by the heat of our fummer and au- tumnal months, and that its late malignity is occa- fioned by the atmofphere having acquired, what has long been known among phyficians by the name of an inflammatory conftitution. If it be derived from the firft fource that has been mentioned, the condition of our city is hope- lefs. It can never be eradicated. Our beds, cloth- ing, and even the timbers of our houfes will retain it till the end of time. The fooner therefore we deflroy our capital, and coniign the fpot upon which it ftands, to paflure grounds, the better. But our epidemic is not the Siam fever. The condition of our city is not hopelefs. The return of our difeafe may be prevented. Its feeds cannot be retained in our beds or houfes from year to year, much lefs can they be imported. As well might a coal of fire be brought from one of the Weft India iflands to this country, or a lump of ice be conveyed from this country to one of the Weft India iflands, in the open air, as the yellow fever be imported from thence fo as to become general in our city. The rare appearance of peftilential difeafes in Europe during the prefent century, has unfortu- nately ( 1 ) nately obliterated much of the knowledge which was formerly collected concerning them. The writers of the laft century fpeak conftantly of the connection between putrid exhalations, an inflam- matory conftitution of the air, and malignant fevers. The animal and vegetable creation bear witnefs that fuch a ftate has exifted in the United States fince the year 1791.—This inflammatory conftitution of the air is fometimes local, but it more frequently pervades whole countries, and fometimes the whole globe. The yellow fever has feldom appeared in one part of America without appearing at the fame time, or foon afterwards in other parts. It was epidemic in Charlefton and Philadelphia in 1699. And again in the fame cities in 1799. It was fickly in the country as well as in the city of Philadelphia in the year 1747. Of this fact: the following extract of a letter from David Palmer to the late Edward Pennington, then in Barbadoes, politely put into my hands by his fon Edward, contains a fatisfadtory document. The letter is dated the 29th of 6th month 1747. " People are exceeding fickly in many parts of the country, and efpecially in the city, where upwards of 20 are frequently buried in a day; the yellow fever being very brief, carrying off healthy people in two or three days." It ( * ) It has been remarked in many publications upon this fubjedt, that the inflammatory conftitution of the air had often been noticed by Hippocrates and Dr. Sydenham. I once believed the knowledge of this elementary fact in the fcience of medicine, to be general, but the publications of fcveral Ameri- can phyficians upon the yellow fever, have convinc- ed me that this is not the cafe. From numerous teftimonies of a belief in the influence of a change in the infenfible qualities of the air, altering the character of epidemics, I fliall felect the following. " It is certain (fays Dr. Mofeley) that difeafes undergo changes and revolutions. Some continue for a fucceflion of years, and vanifh when they have cxhaufted the temporary but fecret caufc which produced them. Others have appeared and difappeared fuddenly; and others have their periodical returns.,, The Doctor afcribes a malignant fever among the dogs in Jamaica (improperly called from one of its fymptoms hydrophobia) to a change in the atmofphere in the year 1783. It was faid to have been imported, but experience, he fays, proved the fact to be otherwife.* " This * Treatife upon Tropical Difeafes, p. 43, 44. ( 9 ) " This latent malignity in the atmofphere (fays Baron Vanfwieten) is known only by its effects, and cannot eafily be reduced to any known fpecies of acrimony." In another place he fays, " It feems certain that this unknown matter difpofes all the humors to a hidden and bad putrefaction."* Dr. John Stedman has related many facts in his eflay upon infalutary conftitutions of the air, which prove, that difeafes are influenced by a quality in it which, he fays, " is productive of corruption," but which has hitherto eluded the refearches of phyficians.f Mr. Lempriere, a Britifh military furgeon, who has publifhed in the prefent year practical obferva- tions upon the difeafes of Jamaica, after mention- ing the unufual mortality occafioned by the yellow fever within the laft five or fix years in that ifland, afcribes it wholly " to that particular conftitution of atmofphere upon which the exiftence of epide- mics at one period rather than another, depend."{ B The * Commentaries on Boerhaave's Aphorifms, Vol. V. p. 226, 230. t Page 135. t Vol. II. p. 31. ( to ) The novelty of a difeafe is no proof of its im- portation. Dr. Sydenham defcribes a fever which appeared with new fymptoms in London in 1685. It was fo unlike all the epidemics he had feen be- fore, that he calls it a " new fever," but he does not upon this account hint at its being of foreign origin.* Dr. Mofeley fays the common " nerv- ous remitting fever changed its type in Jamaica, in 1770. It raged with unufual violence, and car- ried off almoft all the young people who were feized. It returned in the fpring and fummer of the two fucceeding years, but has not been there in the fame form, fince." The Doctor does not de- rive it from another country, nor does he alk, why did it not prevail in former years. A malignant fever has lately appeared in York county in this ftate, which difcovers itfelf firft by a pain in the heel. The inhabitants of that coun- ty have never fufpected it to be an alien difeafe. The hiftories of the firft fettlement of our coun- try contain many accounts of the prevalence of the yellow fever among the Indians. The Creeks loft 600 of their nation by it in the year 1798. Say * Vol II. p. 314. ( II ) Say, ye conjurers who prefide over the health of your tribes, did you ever dream that this difeafe was imported ? The influence of the atmofphere and of other circumftances, has been evinced in the changes which our autumnal fever has undergone fince the year 1760. From that time till 1778 it appeared in the form of a mild intermittent, or a flow nerv- ous fever. After the year 1778 it appeared chief- ly in the form of a mild bilious remittent. Thou- fands were affected by this fever in the year 1780. It was known by the name of the break bone fever. It made its firft appearance in Front ftreet near the Jhipping, and yet no one believed it* though a new difeafe, in fome of its fymptoms, to be of foreign origin. Since the year 1793, both the nervous and mild bilious fevers have nearly difappeared, and an inflammatory intermit- ting, or remitting and malignant fever has taken their place. This change in the character of our autumnal fevers has been acknowledged by all our phyficians. They unanimoufly declare bark to be lefs effectual in them than in former years, and moft of them find it neceffary to ufe blood-letting in a greater or lefs quantity, in order to cure them. It i » ) It has often beena/ked, why was not the yellow fever common before the year 1793 ? If we ad- mit it to be imported, I beg leave to afk, what has become of our nervous and mild remittents ? Both queftions can be anfwered in no other way, than by admitting, the former, to occupy the place of the latter. • It is no new thing for difeafes to vary, not only from changes in the atmofphere, but from the pro- grefs of agriculture and civilization in a country. Mr. Kalm tells us in his travels through North America, that the old Swedes whom he met on the creeks in Weft Jerfey, told him that the bili- ous fever was a modern difeafe among them. Their anceftors knew no other acute difeafe than pleurifies, and fuch other fevers as were produced by the changes in the weather in the winter and fpring months. .In no part of Europe, and in none of the Weft India Iflands, is the yellow fever believed to be fpread by contagion. Admitting it to be pro- pagated in Philadelphia by contagion, the mat- ter, which compofes it muft be fubject to fome laws. . It ought to fpread where it prevails in the greateft quantity, and in the molt con- centrated ftate, agreeably to what is obferved of all ( 13 ) all other contagious difeafes—But this we know is far from being the cafe. The difeafe has often been faid to be communicated through a whole neighbourhood from a fuppofed infected fhip, and to affect a number of perfons at a hundred yards diftance from the fhip, and from each other, and yet the fame difeafe when carried into the healthy parts of the city, and even terminating in death with fymptoms of what is called general putrefac- tion, has perifhed without propagating itfelf in a fingle inftance. To fuppofe it to be contagious under the above circumftances, is to make a fea- ther, outweigh a mountain, or to believe one, to be more than a thoufand. It has been faid in favor of the contagious qua- lity of this fever that it often fpreads through a whole family when introduced into it by an indivi- dual. This is true, and fo does the common inter- mittent in the fouthern ftates, and yet no one has fuppofed this mild ftate of fever to be propagated by contagion. The fame exhalation which pro- duces the difeafe in one member of a family, pro- duces it in moft cafes in them all. Fear, grief, and the fatigue induced by attending the firft per- fon affected, are its ufual exciting caufes in all the reft. There is no inftance of an individual inject- ing ( '4 ) ing a whole family when he carries the difeafe into a dry and healthy part of the country. I fhall here repeat an argument againft the pro- pagation of the yellow fever by contagion, derived from its fudden and general extinction by means of early froft. The operation of cold in this form, is confined exclusively to the atmofphere. It acts long before it becomes fo intenfe as to produce ice in our houfes in which the contagion is faid to be ac- cumulated, and, where the temperature of the air feldom undergoes for many weeks, that degree of cold which is neceffary to deflroy the feeds of the difeafe out of doors. I beg the reader to paufe, and reflect upon this fact. It cannot be contra- dicted. Its evidence, unfupported by others, which opprefs the fubject by their number, is alone fufficient to decide the queftion in favour of the difeafe being derived exclufively from domeftic exhalation, and exifting in the atmofphere during the warm weather. All error is at war with itfelf. It is painful to a citizen of Pennfylvania to meafure the know- ledge of his fellow citizens by the prefent health law. The moft fevere penalties are threaten- ed upon perfons who vifit the Weft India fhips during their quarantine at the fort, even in cafes where there is no fick perfon on board of them, and ( >5 ) and yet the fame law permits phyficians, nurfes, and the members of the board of health to go into any houfe or ftreet they pleafe after attending, or vifitlng patients in the city in every ftage of the fever. But there is fomething much worfe than folly in this health law. By admitting the yellow fever to be propagated exclufively by contagion, it has produced the defertion of the fick by friends, and relations, and fometimes the exclufion of ftran- gcrs to perifh in the ftreet, or in a barn. By thefe means, fo (hocking to humanity, it has added greatly to the mortality of the difeafe. It has moreover impofed a painful quarantine of fifteen or twenty days upon our mariners in a fickly fitua- tion in the hot months, within a few miles of their friends. It is worthy of notice, that quarantine laws have never been adopted by Britain, France nor Spain, in their long and extenfive intercourfe with their refpective iflands, to guard againft the importation of the yellow fever. To none of thofe European countries has that fever ever been communicated by the fhoals of fick, and convalefcent failors and foldiers that have arrived in them, both in peace and war, from every part of the Weft Indies. Their quarantine laws are intended to operate chiefly againft fhips coming from the Levant and other ( 16 ) other fources of the plague. It was becaufe we derived the yellow fever from Weft India contagion in 1793, that the court of London impofed a qua- rantine upon veffels coming from Philadelphia in that year. Our obftinate attachment to this opini- on, has produced a general belief in Europe that our fever is not the fever of the Weft Indies, for this is now known not to fpread by contagion. But further; our quarantine has combined our fifter ftates againft us, by teaching them to adopt our error, as foon as the difeafe makes its appear- ance among us, and thereby to add to the inju- ries which our city has fuftained by the diminution of our European commerce. Accidental coincidence is a frequent fource of er- ror. A peftilcntial fever which accidentally fuc- ceeded the introduction of the potatoe into France, produced an edict againft the cultivation and ufe of that wholefome root by the French court. There was a time in the infancy of medical knowledge in Philadelphia, when the autumnal fever was afcrib- ed to the ufe of the water-melon, a fruit which above all others is calculated to prevent it. In like manner, the arrival of a fhip from the Weft Indies, and the fkknefs or death of a failor induced by the putrid exhalation of our docks and wharves, occurring in the months of July or Au- guft, ( «7 ) guft, (the ufual time of our bilious fevers appear- ing) has unfortunately /connected them together as caufe and effect, by an affociation as unfounded as the two fimilar errors that have been mentioned. It is curious to obferve the relationfhip of the human race eftablifhed in every part of the world, not lefs by the form of their bodies, than by their refemblance in the nature of their errors. There is not a nation upon the face of the earth, that admits the plague to be of domeftic origin. It has been chafed from country to coun- try, until it has been fought for in the planets. Nay, further, from the reluctance which all nati- ons feel to becoming the parents of this difeafe, they have overlooked phyfical or fecond caufes in its generation, and have derived it from heaven itfelf. Whatever may be its defign; it is unnecef- fary to fuppofe a miraculous departure from the ordinary means by which Providence governs our world, to take place in its production. A fimilar relationfhip is eftablifhed between na- tions remote from each other, and differing in a hundred particulars, in adopting certain errors as the means of perpetuating their mifery. 'fhe feeds of the plague have been preferved for feveral C centuries ( >8 ) centuries in Turkey by a belief in predeftination. The feeds of the yellow fever have been preferved in Philadelphia for five years, by a belief in impor- tation. The fraternity of mankind appears ftill further in the folly of the meafures they have adopted to relieve themfelves from their calamities. A pic- ture of the Virgin Mary was fixed upon a gate at Mofcow to flop the progrefs of the plague in that city in the year 1771. The primate of Mofcow was torn to pieces by a deluded mob for an at- tempt to cure their prejudices by removing that picture. Equally abfurd and ineffectual have been our quarantines to prevent the annual return of the yellow fever, and nearly as fuccefsful for a while have been the attacks upon the characters of the phyficians who have attempted to fhew their in- fufEciency for that purpofe, as the outrage was upon the life of the innocent and benevolent Ruf- fian Archbiftiop. It has been faid by fome Phyficians, that intermitting, and mild bilious fevers only, are produced by exhalations from marfhes and other fources of putrefaction. The following facts, moft of which are of a recent date, will furnifh proofs, in addition to many others which have been ( '9 ) been mentioned in former publications, that the moft malignant and fatal epidemics are the off- fpring of the fame obvious and putrid caufes. They are calculated not only to convince, but to alarm every perfon who has fixed his hopes of fafety upon a quarantine law, and lived at eafe amidft filth and danger in our city, and its neigh- bourhood. In the memoirs of the Academy of Sciences for the year 1796, there is an account by Mr. Pitot of a mortal difeafe that prevailed in Languedoc, which was found to be occafioned by ftagnating water. In a town called Ague-morte in the year 1745 out of near 1800 perfons, but ten or twelve efcaped the prevailing fever. Of the children alone there died 200 of thofe who were affected. The town of Frontignan, but three leagues from that healthy city of Montpellier, was nearly depo- pulated, and the village of Baleruc in the fame neighbourhood, loft three-fourths of its inhabi- tants by this fatal epidemic. It was remarkable, fays Mr. Pitot, that it increafed, and declined in its mortal effects according as the waters were permit- ted to ftagnate, or not, in thofe and other adjoin- ing places. In ( *o ) In the- Rev. Mr. Townfend's travels through Spain,* we find the following account of a malig- nant fever produced by putrid exhalations in the neighbourhood of Carthagena, the mortal effects of which were equal to thofe-which have occurred ih 1797, and 1798, from a fimilar caufe in our city.