i

SURGEON GENERAL'S OFFICE
    LIBRARY.
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91
v    V 
 
AN
^^
ON THE DISEASE CALLED
  YELLOW  FEVER;
            WITH OBSERVATIONS CONCERNING

FEBRILE CONTAGION,  TYPHUS  FEVER,
     DYSENTERY, AND THE  PLAGUE,
PARTLY DELIVERED AS THE
<5ul0toiuan  &*ctut*0,
BEFORE THE
IN THE YEARS 1806 AND 1807.
ap
   BY EDWARD NATHANIEL BANCROFT, M. D.
FELLOW OF THE HOYAL COLLEGE OF PHYSICIANS, PHYSICIAN TO THE AIIMY, AND LATE
              PHYSICIAN TO ST. GKORGE's HOSPITAL.

            AND REPUBLISHED, WITH NOTES,

     BFJOHJVB. BAVIBGE, A. M. M. B.

  AND PROFESSOR OF ANATOMY IN THE UNIVERSITY OF MARYLAND.
 M L' ignorance d'une verite en physique pent nous cacher la cause d'un phenomene
oatuiel ; mais I'erreur etablie au lieu de la verite arrete les progres de la science, et
suhstitue des songes et des chimeres aux faits et a la nature.—II est des erreurs et des
verites qui touchent les hnrames des plus pres que les auties, etce sont surtoutcelles
qui regardent la conservation de son individu.—Fontana sur les Poisons et sur les
Cprps Animal, tome i, page 07, 4to#
             ISalttmore:
PUBLISHED BY
            J. Robinson, p;
■ iwRQfiai'Qfc"! • >-^s «mcE
L^
  MAi 29I90Q
;7  o/  ©6. 
  District of Maryland, Set.
  B:  IT IV MEM^KiED,  That on the seventh  day of October, in  the forty-
•*»*******,« fifth year of the Independence of the United Sutes of America,  Joseph
| SE \L.| C.rs.tiNG and Joseph Jewett, of the said District, have deposited in this
*********** office tije title of a Book, the right whereof they claim as proprietors, in^
the words following,  to wit:
  " An  Kssay on  the  disease called  Yellow Fever; with  observations concerning
"Febrile Contagion, Typhus Fever, Dvsenter), and the  Plague,  partly delivered
" a^ the (iulstonian Lectures,  before the College of Physicians, in  the years 1806
"and 1807.   By  Edward Nathaniel  Bancroft, M D. Fellow of the Royal College
" of Physicians, Physician to the Army, and late Physician to St. George's Hospital;
" and republished, with Notes, by John B. Davidge, A.  M. Al.  D. and Professor of
"  Anat irry in the University of Maryland.               -
  " L ignorance d'une  verite  en Physique peut nous cacher la cause d'une pheno-
" mene naturel ; mais I'erreur etablee au  lieu de la verite an ete les pi ogres de la
" science, et substitue  des songes et  des  chimeres aux faits, et  a la  nature il est des
" erreurs et des verites qui touchent les homines des plus presque  les autres, et ce
" sont surtout celles qui regardent la conservatioD'de son individu.  Fontana sur les
" poisons et sur les Corps Animal, tome i. pa^e 97, 4to.
  In conformity  to an act of the Congress of the United States, entitled,  "An
act for  the encouragement  of learning,  by securing  the copies of maps, charts,
ai'd books, to the  authors and proprietors of such  copies,  during the times therein
mentioned."—And also to the act entitled," An act supplementary  to and to amend
the act  entitled,  " An act tor the encouragement of learning, by securing the copies
of ti aps, charts,  and books,  to the authors and proprietors of such  copies during
the times therein mentioned,  and extending the  benefits thereof  to the arts of
designing, engraving, and etching, historical and other prints."
                                                       PHILIP  MOORE,
                                              Clerk of the District of Maryland.
* 
INTRODUCTION.
   Whatever  obstructs the progress of  science, or
throws a shade  over  the research of philosophy,  is a
subject of fair and legitimate criticism.   Truth, phy-
sical, moral, or political, is the common property of so-
ciety; and every member of the literary whole, may, ac-
cording to taste  and ability, enlarge its bounds, or pro-
mote its interests.   Where motive  is ingenuous,  it is
commendable; and manner, though awkward, may be
pardonable.   But  before we  write, we should  think;
and before we publish, we should at  least understand
the nature, if not  the  extent of the subject,  on which
we are about to admonish the world.  The publick,
however ready to learn, is impatient of unprofitable in-
trusion.  Vanity may  invite  derision,  but knowledge
alone communicates information.
   The man  who conceives that the use of writing con-
sists in the multiplication of books, mistakes the adula-
tion of private vanity for the  approval of publick senti-
ment.  It is the  pleasure or the caprice of the many to
write, the good fortune of the few to convey knowledge. 
IV
fNTRODUCTIONi
In the reiteration of what has been said, is not always to
be found the illustration of what is valuable.
  The promotion of science, the encouragement of arts,
the amusement of the curious, or the polish of the social,
appears to be the chief, if not only object for which the
pen is properly used.  And every writer who undertakes
to maintain, with success and understanding, a discus-
sion, or to arrive at any satisfactory conclusion, through
a process of reasoning, must in the first place settle his
principle and define his object.
  Dr. Hosack, by undertaking to write a nosology, prac-
tical he terms it, necessarily pledges himself to throw
additional light on what is already befoie the profession,
or to give something new.   Merely to  repeat what has
been uttered, were to fatigue  himself, and disappoint
his reader.
  The. learned author, in his  preface, offers the most
ample  opportunity  for us to believe that  nosology,  the
science of disease, is not a branch of natural  history;
that it is a thing indeterminate  in form, and mutable in
principle,  k or  he says,  that " in the  details, however,
of the synopsis now. to be submitted,  it will be readily
perceived, that I have been more solicitous  to convey a
distinct enumeration of the characteristick or pathogno-
monick symptoms of diseases, and to form those  associa-
tions  which are connected  with their cure, than to ob-
serve the rigid rules exacted by the the naturalist in the
formation of the genera and species."
See Pref. p. viii. 
INTRODUCTION.
V
  The rigid rules exacted by the naturalist, in the forma-
tion  of genera  and species, can only be  such as an
honest and  faithful history of the distinctive characters
may suggest, by which animals, vegetables, and mine-
rals, can be formed into genera and  species. Any other
rules would be absurd and beside  the subject.   And
these rules  can be derived from  no other  source  than
nature herself, in her varied forms.
  The  formation  of  genera and  species, pre-supposes
distinctive  characters; and to be distinctive, the charac-
ters  must be  regular, otherwise they could not consti-
tute rules to the naturalist, nor would  the  naturalist be
intelligible to his  reader, when he  might speak on his
genera  and species.
  The writer says, " that I have been more solicitous
to convey a distinct  enumeration of the  characteristick
or pathognomonick symptoms of diseases" &c.
  The writer's object clearly appears to be a distinct
enumeration of those symptoms  which are  character-
istick of diseases,  and such as will enable him to " form
those associations"  which  are  connected with  their
cure; and no doubt to be intelligible to his readers, was
a part of his purpose.  And yet he tells us,  that  he  is
not  to be expected to observe the rigid rules exacted by
the  naturalist.
   To the  naturalist there is  no other  rule than that
which is derived from characteristick or distinctive phe-
nomena, nor indeed  can  there be.  The ingenious no-
sologist assures us, that his object is to convey a distinct 
VI
INTRODUCTION.
enumeration of the  characteristick or pathognomonick
symptoms of diseases, tyc.  Then by what rule does the
author attempt to convey a  distinct enumeration  of pa-
thognomonick  symptoms?  If not by the rigid rule ex-
acted by the naturalist, by  what other rule does he at-
tempt  to form  a distinct enumeration  or association  of
symptoms ?
   As the author admits that diseases have their distinc-
tive or pathognomonick signs, and indeed such a conces-
sion is implied in the very attempt distinctly  to enume-
rate the symptoms,  in what does the nosologist differ
from the naturalist? Each is bound, by the ordinary rules
of history and narrative, to give an ingenuous statement
of those characters that are  indicative of the genera and
species, or, in other words, proper to their subjects.
   If a distinct enumeration (what is not essentially regu-
lar,  cannot  be distinctly enumerated,) can be given  of
pathognomonick symptoms of diseases, in the  very ad-
mission itself, disease is allowed to be fixed and deter-
minate in its nature; and of necessity, disease is a  part
of natural history.   It is not presumed that disease is the
production and intention of art, although it may be,  at
times, the result of casualty.
   By what the writer admits, it is conceded, that no-
sology is a science;  and that there  are  other  sciences,
denominated natural sciences, or branches  of natural
history.  It is also suggested by  the necessary import  of
the  assumption, that the sciences of nature, in  objeet 
INTRODUCTION.                 vii
and principle, are fixed; but that the science of nosology
or disease, is v ariable and indeterminate.
   The end  of the  following pages  is to show that no-
sology is a science; that it is, radically and  fundamen-
tally,  fixed and immutable in its  nature and character;
and that it is a physical or natural science, attended by
as few marked or sensible variations as any other branch
of natural history equally  extensive.
   Were disease  mutable in its fundamental laws, it
could exhibit ho  general  or uniform phenomena.   The
doctrine of  disease would become  a  mere  object of
speculation.  In  it there would  be nothing regular or
formal on which the understanding could exercise  its
powers, much less could any gentleman, possessed of in-
tellectual sanity, undertake to give to the world a distinct
enumeration of those signs which should be  pathogno-
monick, and by which future generations are to distin-
guish one kind of disease from another.
   " It is not, indeed, to be contended,"  says Mr. Good,
" that the distinctive signs of diseases are as constant and
determinate as many of the distinctive signs that occur in
zoology  and botany; and so complicated is the animal
machinery,  so perpetually alterable and altered by cli-
mate, idiosyncrasies, and the many accidental circum-
stances by which life is diversified,  that the general rule
must admit of a variety of exceptions, and is here, per-
haps, rather than any  where else,  established by  such
exceptions."
Dr. Hosack's pref. p. viii. 
viii
INTRODUCTION.
   With the opinion, certainly not argument, of this clas-
 sical writer before his eye, the author of the nosology
 undertakes to convey a distinct enumeration of the cha-
 racteristick or pathognomonick symptoms, of diseases;
 constant or determinate signs.
   If the signs be not  constant or determinate, will inge-
 nuity itself explain now a distinct enumeration of symp-
 toms characteristick and  pathognomonick of diseases
 can be given ?
   To say that signs are not  determinate*  and yet are
 characteristick of diseases, is to lay the rational mind
 under a serious contribution, and awaken  sentiments of
 compassion.
   " That the distinctive signs of diseases are not as con-
 stant as the distinctive signs that occur  in  zoology and
 botany; and so complicated is the animal machinery, so
 perpetually alterable and altered by  habit, climate, &c.
 &c." is one of those bold and gratuitous assertions which
 forces us to appeal to the observations and records of
 naturalists, in  regard to animal life.   Alterations  in ani-
 mal life, to be entitled to consideration, must mean funda-
 mental and radical.  If animal machinery be fundamen-
 tally alterable and altered, what preserves the races of
 animals distinct?  How is it that the horse has not de-
 generated into the monkey, and man into the ass?
   Upon  what principle will learned gentlemen explain
how the signs in zoology are constant and distinctive,
and yet the animal machinery so alterable and so altered
as to call for exceptions to general rules? 
INTRODUCTION.
ix
   Either the  animal machinery  is not alterable or al*
tered,  radically,  or  the  signs of the  animal economy
cannot  be distinctive.   What is not constant,  is not
distinctive. And  what is altered, is  not constant.   Does
animal  machinery refer to the human animal only? Is
the brute  an  animal?   Or does zoology treat  of ani-
mals? And if  the reference, by the learned writer, be
to man  only, is the human more alterable than the brute
animal? Or either, than  vegetables?
   It is below the dignity of science, and insulting to the
human  understanding,  to bring such  follies before the
publick eye.   Mr Good may be very classical,  in the
opinion of the gentlemen of New-York, but certainly,
he is neither veiy intelligible, nor philosophical.
   " It is true," says Dr.  Young, " that we must not ex-
pect the same rigid  accuracy in medicine,  that may be
obtained in some of the departments  of  natural his-
tory, since, in fact, many of the distinctions which are
required in a nosological method, are rather established
for the sake of practical  convenience," &c. &c.
   Nothing can be more unintelligible and  inexcusable,
than this confusion of nosology and general medicine.
The subject  before  the  reader, and that to which his
attention is called by Dr. Hosack, is the science of no-
sology—the science of disease.   The  science of medi-
cine involves more extensive considerations.
   Nosology is a discourse on disease, as it is cognizable
by its diagnosticks or more characteristick signs.  In
other words,  it  is  the  science  of pathognomonicks.
This appears  to  be  the  acceptation and import of the
                         2 
X
INTRODUCTION
term,  by all medical  philosophers,  from  the  earliest
periods in which the science has been cultivated.
  Human nosology, then, is that discourse  which treats
of the diseases, in their sensible characters, to which
the human body is liable.
  Disease  is,  essentially, in nature,  in laws and  phe-
nomena, the same, whether art interfere or not.   The
intention of art is  not  to produce, but remove  disease.
Hence it follows,  that the science of disease  must be
viewed apart from that art which human ingenuity and
skill employ for the removal of disease.  No two things
can be more distinct.  The small-pox occurring in the
savage,  at the most remote distance  from professional
aid, is the same in signs and nature, as that which takes
place in  civilized life.   In the eye of science, the dis-
ease, and the art resorted to for the removal of the dis-
ease, are mutually opposed in fact and nature, however
intimately, in  the  views and practice of the profession,
they may be associated.
  The science of  medicine is general, that of nosology
particular.   Nosology refers to nature, incumbered and
disordered in  her functions;  art to  human skill,  ad-
dressing itself as well as it may to the removal of dis-
ease and restoration of health.
  Art, in  its  address  to the  removal of  disease, may
vary, and vary it will, according to experience, to ed-
ucation,  to intellectual ability.   Different intellects,
viewing  the same phenomena, will make  different de-
ductions, as those intellects may be vigorous or feeble;
educated or ignorant; liberal or prejudiced.   But to 
                   INTRODUCTION.                  XI

detain the reader longer in pointing out the incongruity
and absurdity  of extending our views to general prac-
tical medicine, in a discourse professedly on nosology,
were to offend his good sense.  What the  writer  can
mean by a practical nosology, I must leave to  his own
interpretation.
  That nosology furnishes the signs  from which the
rules of practice are deduced is true, for it furnishes
the only means by which the professional man can form
any idea whatever of the particular  condition of the
body against which  art directs its force.   But  yet  it
constitutes  no part of the therapeutrick scheme,  and
hence  can never be, to  my understanding, practical.
But I leave the  solution to the ingenuity of the author.
  Nosology,  or the science of disease, implies three
things:   1st.   There  necessarily must  be  a subject, a
body to be diseased:   2dly.  There must be an agent
or a cause:  And 3dly,  there must be diagnostick signs,
or disease could not be recognised.
  Although nosology has chiefly for its object a  con-
sideration of the phenomena, yet the subject  and the
agent are involved in the general idea of disease.   And
either  the  human body cannot be a subject of nature,
or the agents are not productions of nature,  or  the phe-
nomena can take place without a subject or an agent;
otherwise I expect to show that the science of disease
is a science of nature.
   That science is  said  to  be a natural science, the
scope, object, and tendency of which are, to treat of those
subjects and  agencies  that strictly are physical.   The 
xii
INTRODUCTION.
business of natural history, is to record the things and
operations  of nature.
  A science  is termed a natural science,  in contradis-
tinction to  the science of the mind; to  the  science of
general or  particular  state  polity;  to the mathematical
or demonstrative science;  to the tactical  or maritimal
science.   Tacticks and navigation, however, are rather
arts  than sciences.   To the above  enumeration might
be added the forensick and medical sciences;  as  far
as the latter  has  a  practical interpretation, however, it
is generally styled the " art of  healing "  Although in
a more general acceptation, the medical science is de-
nominated the science of healing;  but not so properly.
For  assuredly, as relates to practice, medicine is an art,
purely tentative;  a matter  of experiment solely.
  It is conceded  on all hands, that if  it can  be esta-
blished that the science of disease is a branch of natu-
ral history, it follows, of course, that in character  and
diagnostick, it is fixed and determinate.
  The laws of animal life, on which depend the struc-
ture and economy of the animal body;  by  which, at
first, the whole organization was laid out, and by which
it  is reproduced and  sustained,  are natural objects; ob-
jects of which the  science of  nature  delights to  dis-
course.  And it  is in these principles  of life that the
susceptibilities reside, on which the morbid agents act.
Can natural  history treat more  properly of any subject
than of the  structure, the life, in  its  sensible  pheno-
mena, and of the susceptibilities of the  human body? 
INTRODUCTION.
Xlll
   This structure, this life, and these susceptibilities, are
intimately concerned in  disease.  And surely, so far,
disease is a  subject  of  a branch of natural history.
And, so far, must be as unchangeable as the principles
of life themselves.
   But  the  principles of life  on which morbid agents
exert their forces and powers, are not more the sub-
jects of  nature than the agents  to the operation  of
which are finally to be traced the  disease.   Nor can
those agents exert their influence,  except through pro-
perties  natural  and  intrinsic!?: to themselves  as agents.
We cannot  conceive a fundamental change in the pro-
perties of an agent,  but with  a radical  alteration of the
thing itself.   And upon such alteration it ceases to  be
an agent.
   Granting that the subject  and agent are the objects
of natural history, I propound the  question, what can
the  result or disease  be?  Can a  subject be acted  on
otherwise than through its own capacities? Or an agent
act  by  other instruments than  qualities  intrinsick  to
itself?  Is not the  disease immediately  and necessarily
consequential on such operation?  But still we are told
that the science of disease is not a science of nature;
that the phenomena of disease are not the  proper ob-
jects of natural history!  If not  the legitimate objects
of natural history, of what history are they the proper
objects?  Diseases have existed from time immemorial,
and we have histories of  diseases.   Shall we  denomi-
nate such histories medical histories? 
XIV
INTRODUCTION.
   Medical histories  are complex, not  simple;  and in
strict propriety, are more annals of the efforts of human
skill and art for the removal of disease,  than of  disease
itself.  Had there been no medical profession, the pen
of the historian would have transmitted down to us the
narrative of disease.
   Nature, in her general scheme, is uniform; otherwise
ruin would invade the universe.   But one part of nature
may fall into collision with another part, and the regu-
larity and uniformity of particular laws be disturbed.  In
lifeless nature, we style sfich disturbance and irregu-
larity disorder, or disarray.  In enlivened nature, we de-
nominate such disturbance of function,  or alteration of
structure, disease.  And although disease be not a part
of the natural  healthy functions of the body, yet it must
be viewed as the natural result of agents acting on  these
functions.
   A  column  of electrick fluid passes  from  a cloud
electrified plus, to one  electrified minus;  or a  column
descends from a cloud to the earth;  the atmosphere is
greatly  rarified; a sudden evaporation  from the cloud
is  produced; and by this sudden evaporation, the tem-
perature of the cloud is depressed, and  a portion of the
water of the cloud is rapidly changed, by the sudden
and great loss of heat,  from a vaporous to a solid  state.
Irregular masses  of  ice are formed, which, partly from
the resistance of the air down through  which they are
precipitated, and partly from laws proper to themselves,
constitute hail, or congealed bodies.   These,  by their
own superior gravity, and the impulse received  from 
INTRODUCTION.
XV
the violence of the wind, in their  descent, injure and
destroy trees, brutes, and men.
  Here, from a simple exchange between the clouds, and
a descent to the earth, of an electrick column, we per-
ceive the most  disastrous  consequences.   The  contu-
sions in  some, and the deaths of other  animals, are
equally with the prostration of the forest, subjects  of
natural history.   And it is natural science, that by  its
lamp,  conducts  curious  inquiry  from the last effect  to
the  first cause,  explaining  to  the  eye of enlightened
intelligence, this awful but  grand phenomenon.   How
simple the philosophy of the formation of  hail,  during
the days of the highest temperature—a sudden evapora-
tion.*
  The marsh effluvium, wherever found, and however
produced, never from animal matter, is an agent brought
into existence by a certain combination of natural atoms
by laws proper to  these atoms.   Or it is an agent from
some simple source and  indecomposable.   Its nature is
inscrutable.  But,  compound or simple,  it is furnished
from nature's stores.
  This effluvium  is poisonous to human  life, and  pro-
duces disease.  And to whatever period of the history
of its operations the eye of observation is directed, the

 * I  wrote an essay on this interesting phenomenon between  ten
and fifteen years ago, for the Maryland Society; in which I  at-
tempted to prove that the formation of hail in  hot weather was
whollv attributable to a sudden passage of electrick fluid from cloud,
to cloud, or to some other body. 
XVI
INTRODUCTION.
 same effects will be perceived under the same circum-
 stances.   Nor in the opinion of the medical philosopher
 is there any fact more certain, or  better established,
 than  that men living within its range, will be effected
 with  diseases  of the  spleen and liver; with diarrhea,
 intermittent, remittent, and yellow fevers.
   How is this fact established, so as to be made a thing
 of uniform belief?   Is it from individual observation, or
 the general history of the effects of this poison? Surely,
 from  general and acknowledged history.
   This effluvium, whether in  the East Indies or West
 Indies,  in Greece or  Italy,  France or America, is the
 same; the human body  and economy are in principle
 and general attribute the same.  Thus it occurs, that
 wherever the poison  is evolved in given  quantities, we
 see the swollen spleen, diseased liver,  bilious  colick,
 morbid secretions of  bile, with all their  consequences;
 sick stomach, diarrhea, dysenterick phenomena;  inter-
 mittent, remittent,  and yellow fever; and these modifi-
 cations under various  incidental circumstances.
   The variety in the effects of this effluvium on the hu-
 man body, is not greater than in the conditions under
 which water is found; sometimes  of ice, or snow,  or
 frost,  or fluid, or vapour,  the productions of incident or
 circumstance.   But yet water modified, as it may be, is
 the same, and an object of natural history.  The effects
 of the marsh poison are equally uniform.   In the same
 intensity, and under the same circumstance, and on the
same  excitability, the phenomena  will be without va-
 riety, and is equally a subject of natural science. 
INTRODUCTION.                XVU
  For a physician to say that disease, in principle and
nature, is  alterable, is to inform the world that he is to*
tally ignorant of the science and history of disease, and
of what he undertakes to speak.
  We at times,  it is true, have a new disease to come
in upon us.   And what is this, but a discovery that our
previous scheme of science  did not embrace a know-
ledge of all the  possible morbid effects, or causes ade-
quate  to  the production of disease ?  Or indeed, that
some new agent or combination had come  into opera-
tion.   But such would be from the  store-house of na-
ture, or her plastick, creative power.  But this is not
change; it is only an  addition  to the old stock, nume-
rous enough already!
  That one and the  same disease can  arise from this
cause  to-day, and  that cause to-morrow, is unphiloso-
phick  and absurd in the extreme,  and in the face of all
the facts of  history, and analogies of nature.  As I have
advanced, I believe, somewhere else, there is nothing
better settled in  science, than that no simple effect can
be produced by any two or more causes distinct in their
nature.   Every  simple  effect must be referred to some
simple cause, aided as it may be, by incident and casu-
alty.
   What  I have said of marsh  effluvium, I might, with
equal  propriety, repeat of the various animal, vegetable,
and mineral poisons.  They are all from the great work-
shop of nature,  and all their effects on the human body,
necessarily  consecutive of their attributes.
                         3 
XVni              INTRODUCTION,

  I might here refer to other irregularities  and disor-
ders in the physical world; the tornado, the earthquake,
the water-spout, &c. &c.  and ask  the  question—are
they more the productions of natural changes and com-
binations than the plague, the small-pox, the influenza,
the canine madness, the mumps,  &c. ? Or are the for-
mer better known than the latter, in their sensible phe-
nomena or ruinous effects? But the  one is said to be a
branch of natural history; the other is a branch of what
science?  Is  the tornado,  the  earth-quake, the water-
spout,  more  constant and  distinctive in their effects,
than the small-pox, siphilis, the  canine madness,  &x.
&c, in their diagnOstick  symptoms?  The former and
the latter both vary in degree.
  The learned professor  has given to the world a no-
sology; but to what end or  purpose,  if disease be not
regular in its sensible signs, the professor has, in so
laboured a manner, spread himself before  the  world, I
cannot conceive.  If the animal machinery, the human
structure, be so alterable and altered, and the symptoms
of disease so irregular and inconstant as to make the sci-
ence of disease a matter of speculation, what benefit or
advantage can accrue to the profession from  any efforts
at distinct enumerations of character?
  The diseases of  the subsequent  year may  not  be
known by the phenomena of the precedent, and those
of New-York may never appear in Baltimore, Philadel-
phia, or Lexington.  Where, and what then are the
advantages derived from spending a great deal of money,
and wasting much more valuable time, by attendance on 
INTRODUCTION.
xix
lectures  in New-York, for two or three seasons ? If dis-
eases do appear,  and they will not fail to annoy the
world, they may manifest themselves under new forms.
How unavailing our knowledge  and our reading!  For-
mer realities have become unreal, and our science va-
nishes  like the  dream of  a feverous moment.  Of all
men in the world, the nosologist  should be the last to
utter a word  against uniformity  and regularity of diag-
nostick and pathognomonick in disease.
  The able and ingenious professor offers to the world
a nosology, and  in the very preface assures his reader,
that the literary performance  to which his attention is
invited, is entitled to but little  consideration   For if di-
agnosticks are not constant and determinate, it may be
insisted that the most laboured writing is vain, and the
most sedulous perusal equally vain.   But the Doctor de-
clares his to be a " practical nosology."  I would much
rather see a scientifick nosology; a nosology founded on
nature and accurate observation.   In my estimation,
those distinctions, in any nosological method, which are
established for the sake of practical convenience, are
slightly to be  valued.  Nosology cannot be supposed to
take its character and form from practical  convenience.
On the other  hand, practice must  always derive its les-
sons from that  order of sensible  characteristick  signs
which nature presents, and, by the aid of which alone,
we can form any rational idea of the condition of parts
or the whole  body.
   Were a physician inadequate to discriminate  a re-
mittent fever from a small-pox,  or a condition of mea- 
XX
INTRODUCTION.
sles from a pleurisy, or an apoplexy from an hydropho-
bia;  or were a surgeon unable to distinguish a wen from
a cancer, or a varix from an aneurism,  he would pro-
voke the contempt of every man who had ever looked
into a medical book.   But yet diagnosticks are not de-
terminate!
  I ask again, if the science of disease or nosology be
not a branch of  which natural history treats, will the
learning  of Dr.  Young,  or Mr.  Good,  or any  other
learned  gentleman,  inform the profession to what his*
tory  it may be referred ? 
ADVERTISEMENT.
In the year 1806, I was appointed to  deliver the Lec-
tures  founded by Dr. Theodore  Gulston ; and having-
chosen the Yellow Fever as my subject, and prepared
myself to  discharge this duty, I  found it would be im-
possible to read what  I had written,  within the time
allowed for these lectures ; and  considerable  parts of
it were, therefore, separated, and laid  aside.  These
have  been since  restored, and some  facts  have  been
added, which had not then  occurred.   I have, more-
over, subjoined  three chapters on Typhus,  Dysentery,
and the Plague, which seemed fit  to be connected or
contrasted with the Yellow Fever, or with each  other.
I have also added eight Appendices, to confirm or illus-
trate  particular positions,  contained in  the Essay  on 
Xxii               ADVERTISEMENT.
Yellow Fever:  and as only the first two parts of th*
Essay were printed, when I determined to embark for
Jamaica, I requested my father to superintend the re-
mainder of the volume.

  There are no diseases which  affect mankind so ex«-
tensively, or  produce so much mortality,  as  some of
those which occupy this  volume  ; and as very opposite
opinions  are  entertained, respecting  their origin and
contagious power, real or supposed ; and as this opposi-
tion  of opinions is disreputable both to the science and
professors of medicine, and incompatible with the best
interests of mankind, I have endeavoured to remove all
doubt and obscurity  from these important questions,
and place them beyond the reach  of future controversy.
How far this  endeavour will  prove successful,  time
must discover.   But in regard to «the Yellow Fever,  I
am persuaded that I shall have done more than enough
to convince every candid and judicious reader, that it
possesses no contagious power ; and that a considerable
part of the facts and arguments which I have employed
for this purpose, might  have been spared, had  I not
been also anxious to convince, even the most prejudiced,
on this subject. 
                   ADVERTISEMENT.             XXiii
  I know, indeed, that many of these  facts, and  argu-
ments, have  been- already noticed ;  some by one, and
otliers by  different writers ; but  as in these  ways, they
have failed to produce that general conviction, which is
most  desirable, I have thought I might render an im-
portant service  to mankind, by so collecting and arrang-
ing the proofs, and reasons connected with this question,
as would  best fit them  to  elucidate, and  support each
other, even  if  I .had not been able to add any  thing
new, and valuable from  my own stock.

   I know, also, that I have been anticipated in several
of my most important conclusions ;  but as I was  led to
them, rather by own train of reasoning, than by  defer-
ence  for the opinion of others, howrever respectable, I
may ill  regard  to these, say with Montaigne, " Que la
verity et  la raison sont  communes a un chacun,  et ne
sont pas plus a qui les a dites premierement, qu'a celui
qui les a dites apres."  I have, however, commonly
m* ntioned those'writers, by whom conclusions similar
to mine were first advanced,  (so far,  at least,  as they
are known to  me) for  the purpose  of giving them  all
due credit, and also to confirm my own opinions, by
th-°ir authority ;  and, in my  quotations,  I  have, with
two or three unavoidable exceptions, always referred 
XXIV              ADVERTISEMENT.
to the particular pages of the several works whence my
extracts were taken ; so that  my readers may be  able
to ascertain the accuracy with which they have been
made. 
AN ESSAY
                        ON THE

DISEASE CALLEB YELLOW FEVEft, %cK
PART  I.
         APPELLATIONS  OF THE  YELLOW FEVER.

The Fever which is to form the chief subject of my inquiry,
has been called Typhus icterodes,  by Sauvages, and Typhus
cum flavedine cutis, by Cullen; it is generally known, in this
country, by the name of Yellow Fever; among the French,
by the names of Maladie tie Siam, and Fievre Matelotte; and
among the Spaniards, by those of Yomito Prieto, and, accord-
ing to Coreal and Ulloa, Chapetonada.
  The title bestowed  by Sauvages is improper, because the
Fever in question (independently of any discolouration of the
skin) does not accord with his own definition of Typhus, and
also because, as will be proved hereafter, it is not connected,
at least not generally, with any morbid state either of the liver
or of the bile, nor with any permanent obstruction to the pas-
sage of that fluid into the duodenum,—causes to which icterus,
or jaundice, is commonly  referred.  Dr. Cullen  may  have
been, in some degree, aware of the latter objection;  and  he
may,  on that  account, have been  induced to  lay  aside the
epithet  of " Icterodes," used by Sauvages, and  to  substitute
for it the words " cum flavedine cutis," in his designation ef
                            4 
26
  the disorder:  but even these, as well as the English epithet of
  " Yellow" Fever,  are objectionable,  because  they  draw the
  character of the Fever from a  symptom which is very often
  wanting,  even in the most severe cases  of the disease,  and
  which certainly is not always of high importance when it does
  occur, very many  persons  having recovered after  being re-
  markably yellow.
    The term of " Vomito prieto," or " black vomit," is likewise
  objectionable, because this  symptom does not occur in a very
  large proportion of the persons who are attacked by the Fever
  now spoken of; it is, moreover, certain,  that neither*  th%
  yellowness of the skin, nor the discharge! of a dark-coloured
 matter by vomiting, nor even the existence of both these symp-
 toms^: in the same patient, is peculiar to that disease.

   ♦ Dr Lind mentions (at pages 188, 198, &c. of his Essay on the health of
 Seamen) the existence of a fever at Portsmouth, on board of several ships of
 war lately returned from Louisbourg and Quebec,  " which went commonly
 under the denomination of the Yellow Fever, from the sick often becoming
 yellow."  This was clearly a different disease from the Yellow Fever of hot
 climates.
   f See page 30,  of " Surgical Observations on the constitutional origin and
 treatment of local Diseases," by John Abernethy, Esq for an instance of black
 vomit in another disorder.
   * One instance  will suffice to show, that those two symptoms are some-
 times combined in other diseases.   Dr. William Stark, respectable for his
 accuracy, and  zealous  pursuit of knowledge, in his valuable Clinical and
 Anatomical Observations, (" the materials of which," as he tells us, " were
 collected at a great hospital," which it is well known was St. George's Hos-
 pital, London,  where it will not be suspected  that cases  of Yellow Fever
 were to be found) relates, at ch 1, §. 2, the case of a man who died from
 " inflammation of the smaller intestines, with effusion of blood," and whose
body he examined after death.  From this case the following lines are ex-
tracted : " A man aged thirty, unknowing of  any  cause,  was one evening
suddenly seized with retching and vomiting, which were  frequent, day and
night, ever after." " His skin became yellow on the fourth day, and what
he vomited was observe;, on the  eighth,  to be of a coffee-colour."  " He
died on the thirteenth day." 
27
  Several writers on the Yellow Fever, who have been sensi-
ble of the impropriety of the above appellations, have adopted
others, taken from among the names given to fevers  by the
ancient Greek physicians.  In the works attributed to Hippo-
crates,  mention is  made of violent  febrile disorders, which
                                                             4
sometimes proved fatal  on the fourth day, and even sooner,
and wei'c attended with incessant vomiting, sometimes of black
matters, yellowness of skin, and other affections so similar to
those which are frequently observed in the Yellow Fever, that
I am disposed to believe that they could be no other disease.
These fevers are described  under various names, such as
* «.eiva-of  kuvtu^vs  To<po$, 'Iktcpot  teizrvpi)], <Qpev7ris-. vowi/acc wit%u &C.
but as the descriptions are either very loose or very brief, and
as each  of these  names is also applied to other very different
diseases, it is evident that no precise meaning can be aflixed to
them, and that confusion would  result  from employing any
one of them to  designate the Yellow Fever.
    It is unquestionably of great moment, both for the advance-
 ment of science, and the prevention  of dangerous errors  in
 practice, that disorders should not be arranged under impro-
 per titles:  and of all titles,  none can be more improper,  or
 tend more to embarrass inexperienced practitioners, than such
 as are borrowed from certain symptoms, which, like the yel-
 lowness  of skin, and the black vomit, besides being wanting
 in the great majority of patients, do  not, in  general,  make
 their appearance, when present, till  towards the close of the
 disease.   I hope, therefore,  that the disorder,  of which I am

   ♦ For y.Zo<ro$, see Lib. de judicat page 54, line 54 of Foesius's Hippocrates,
 Geneva, 1657 ; and Lib. 1, de Morb. Vulg. Sect. 7, p. 954. O.: for »mvtuS,ih,
 Lib. de Affect, p. 519, 1. 21 : for Tityo*, Lib- de intern. Affect, p 551, 1. 6.:
 for txleeoi. Lib. de Morbis, p. 490, 1. 6; and Lib. de intern.  Affect, p. 551,
 1. 8: for Xuvvetv. Lib de Morb. p. 467, 1. 10 : for Qpenris, Lib. de Affect;
 p. 518, I. 81. and for varyiAX ifaW) Lib. de intern. Affect, p.  559, 1. 14% 
                            28
 to treat, will, ere long, receive a more appropriate name than
 any yet bestowed upon  it; but I must leave to others  the
 task of proposing one, and content myself with that of Yellow
 Fever, since it is, at present, in general use.  I beg, however,
 to observe, that if it be allowable to apply to a disease, affect-
 ing the whole system, a name which designates only one of its
 symptoms, the terms of causus, or of ardent Fever, seem to be
 the most eligible of all the appellations that have been bor-
 rowed from the ancients, and given to the Fever here treated
 of; because the excessive heat of the  skin, and indeed of  the
 whole body,^s a symptom  which occurs not only very gene-
 rally, but also very early in the disease, and requires particu-
 lar notice for the successful treatment of the malady :  so that
 either of the above names, especially the latter, is well adapted
 to direct the  attention of the practitioner, however inexperi-
 enced, to an important point of practice, and is not liable to
 mislead him  in other respects, or to occasion uncertainty or
 delay as to the management of the patient in the first stages
 of the Fever. It appears to have been upon similar grounds
 that Dr. Towne, M. Poissonnier Desperrieres, Dr. Moseley,
 and Dr. Fowle, have  applied the one or the other, or both, of
 those  names to the Yellow Fever.
  Before I proceed to describe the  appearance of this disease,
 I shall briefly notice  the indiscriminate mode in which  the
 term Yellow Fever has been employed; a  subject not unim-
 portant in itself, since it  is probably owing to a want of pre-
 cision in the use of that term, that so  much ambiguity has
 prevailed, even to the present time, concerning the nature of
 the disease.  The  truth is, that in those countries in which
 the temperature  of the atmosphere is usually heated, during
 certain seasons, to 85°, or more of Fahrenheit's thermometer,
in the day time, all febrile affections, however produced, have
 a tendency, in consequence of the action of heat on the human
body, to assume the  violent and  dangerous  form which is 
29
generally considered as characteristic of the Yellow Fever.
Thu.-, the fevers which sometimes originate from intoxication,
and other excesses, from taking cold, or from fatiguing exer-
tions  of body, while exposed to the sun, or strong agitations
of mind, are, in those hot seasons liable to be accompanied
with the same severe and fatal symptoms which occur  in the
terrible Fever that occasionally attacks  a great  part  of the
population  of certain towns situated  in warm  latitudes  ;
and from this resemblance, the term Yellow Fever has been
equally applied to Fevers, which are strictly sporadic,  and
comparatively rare, and to Fevers truly Epidemic*  But,
although the same symptoms be observed in the Sporadic, and
the Epidemic Yellow Fever, the course of these is not exactly
similar, and their causes are totally different.  The Sporadic
Fevers are always, I believe, of the continued type, and are
brought on by certain  affections of the body and mind, operat-
ing only upon a few individuals ; whereas the Epidemic Fever
almost always  manifests  a disposition to remit, unless the
speedy death or recovery of the patient precludes a second
paroxysm;   and it arises from causes of a general nature,
such as are  capable of operating on a  considerable number of
persons at the same time.  The causes of the Sporadic Yellow
Fever are so well known, that it is in the power of almost
every  individual to preserve  himself  from its attack;  but
those of the Epidemic Fever are  still  involved  in so much
obscurity, and placed  so little within our power, that neither
huihan ingenuity, nor  patriotick zeal, with their  most perse-
vering efforts, have as yet been able to hinder its appearance,
or perhaps materially  to check its  ravages.   This is,  there-
fore, the most formidable and interesting to mankind;  and it
will, for this reason, form the  chief object of my present in-
  * By the term Epidemic,  I understand simply a disease prevailing  in  an
extraordinary degree, without any reference to contagion, which I do not
consider as being essential  to an Epidemic. 
30
quiry.   A great part of the subsequent observations, however,
concerning the symptoms  and the treatment of the  Yellow
Fever, will, I think, be found  equally applicable to the Spo-
radic and to the Epidemic disease.  Both  have,  indeed, been
described by so many writers  of great eminence, that it will,
I hope, not be deemed improper in me to abstain  from giving
a minute account of all the various symptoms of this Fever in
its several  forms, and to confine myself to those only which
are of most importance, as indicating  the nature of the dis-
ease, and the parts principally affected by it, together with the
proper means of obviating, or  removing those affections.

                       SYMPTOMS.

The progress and violence of the Yellow Fever differ great-
ly,  according to the force of its cause, the vigour and excita-
bility of the patient, and  the season of the year.   When it
prevails  epidemically in hot climates,  and attacks young and
robust men, lately arrived  from temperate regions,  the disor-
der commonly  appears in its most aggravated form.  In this
the patient first complains of lassitude,  restlessness, slight
sensations of cold and nausea, which  symptoms  are soon suc-
ceeded by strong arterial action, intense heat, flushing of  the
face, redness of the eyes, great pain and throbbing in the head
and  in the eye-balls, uneasiness and pain in the stomach,  op-
pression of the prsecordia, a white fur on the tongue, and a
dry, parched skin, with a quick, full, tense,  and generally
strong pulse, though it is sometimes oppressed and irregular.
These symptoms are speedily  accompanied by frequent efforts
to vomit,  especially  after swallowing food or drink,  with
discharges, first  of such matters as the  stomach happens to
contain, and  afterwards  of  considerable quantities of  bile 
31
 appearing first- yellow,  and then  green,*  sometimes  tinged
 with blood, but,  in the progress of the disorder, with matters
 of darker colours ; an increase of pain, heat, and soreness at
 the prsecordia, also occurs, with constant wakefulness, and, fre-
 quently, with delirium, more or less violent.  This paroxysm,
 or  exacerbation, which has  been  called  the  inflammatory,
 or the  febrile stage,  generally lasts thirty-six hours,  but is
 sometimes protracted for seventy-two hours,  and even longer,
 probably  in consequence of either general or local inflamma-
 tion, (particularly in the brain or stomach), or of  irregularity
 in the circulation, which are known  to prolong the paroxysms
 in Fevers of Type.
   A  remission then occurs,   in which many of the  symptoms


  * The green colour of the bile, which is very frequently brought up by vomit-
 ing, has been attributed, by some  writers, to a morbid  condition, or action
 of the liver, or gall-bladder  It would probably, however, be more just to
 attribute it to a spontaneous, and, as it may be called, chemical change, which
 the bile itself undergoes in the duodenum and stomach, while these viscera,
 being debilitated by disease, or by the operation of  certain medicines, and
 particularly of emetics, no longer possess the power of preventing the matter
 which  they contain from acting chemically on each  otner, and forming de-
 compositions and new combinations. This power of the stomach, which has
 been called by Dr. Fordyce its governing power, will be particularly noticed,
 at page 13, &c. in treating of the symptoms which denote a putrescent state
 of the fluids.   It is well known, that the faeces of  infants, although yellow
 when voided, (which is the proper  colour of  the bile  mixed with them) fre-
 quently become green after some  time; and, in addition to this, 1 may ad-
 duce the following fact from page 206, of Dr. Heberden's Commentarii de
 morborum historia & curatione.  " Cujusdam icterici urina saturrime fusca,
 paucas boras servata, viridem  colorem  induit; quemadmodum  interdum fit
 in vomitu  bilis flavae, cujus color  post aliquam moram in viridem mutari
 solet."  As acids, when added to bile, change  its colour from yellow to
green,  it is, probably, from a mixture with acescent  matters that  the bile
becomes green within the intestines : and this is the  opinion which the late
Dr John Hunter also entertained on the subject—See page 129 of his Ob-
servations on the diseases of the Army in Jamaica. 
                            32
 subside, so as often to induce a belief that the Fever is at an
 end, and recovery about to take place.  Frequently, however,
 the foundations of  irreparable injury to the brain or stomach
 have already been laid in the former paroxysm, and in such
 cases the remission is short and imperfect.   During these re«,
 missions the pulse often returns apparently to the condition of
 health, the skin feels cool and moist, and the intellect, if pre-
 viously disturbed, sometimes becomes clear; sometimes, how-
 ever, the patient remains in a quiet and stupid state, a symp-
 tom generally denoting great danger.   Another sign of dan-
 ger, as denoting a  very morbid condition of the stomach, is
 the renewal of  the  efforts to  vomit when pressure is made on
 that organ, or food is swallowed.  After  a certain interval,
 this remitting stage is succeeded hy  another, which may be
 called the second paroxysm, and which probably would appear
 as a renewed exacerbation,  if the  violent effects of the first
 had  not almost exhausted the patient's excitability, and in
 conjunction with the extreme  depression of strength which
 usually attends inflammation of the brain or stomach, rendered
 him nearly  unsusceptible of those morbid actions  which are
 necessary for that purpose.  In this latter stage, then, instead
 of great febrile heat, and strong arterial action, the warmth of
 the body,  and the frequency  and strength of the pulse,  are
 often  less than when the patient was in health ;  but frequent-
 ly the pain and heat in the stomach become excruciating, with
incessant strainings to vomit, which, in most of the fatal ca-
 ses,  are followed by  hiccough, and  repeated discharges of
matters resembling  turbid coffee,  more or less diluted, or the
grounds of  coffee,  and also  by evacuations  of  similar dark
matters from the bowels.  Here it is to be observed, that when
these symptoms occur, (indicating a violent affection of  the
stomach and bowels,)  the patient is, in general, sufficiently in
possession of his  intellects to know those about him, and to
give distinct answers to questions made to him,  although  his 
ss
excessive weakness often renders him incapable of mental ex-
ertion, and his inability even to raise his head, may induce the
appearance of coma.   In those cases,  however,  in which the
brain has suffered greater injury than the stomach, the retch-
ing and the  black vomit, just described, do not so commonly
occur, but instead of  them,  low muttering,  or coma,  with
convulsions  of the muscles  of  the face, and the otter parts
of the body,  supervene.   About this time, also, the tongue and
teeth are covered with a dark brown fur; yellowness of  skin
and petechias make their appearance; the urine,  when passed
has a putrid smell  and dark  colour ;* the faces likewise be-

  * Of the many authors who have treated of putrefaction in fever, the late
Dr. George  Fordyce seems, in his investigation of that subject, to have ap-
proached most  nearly to the truth.   His reasoning thereupon, which will be
found at length at page  71 of the first  part of his third  Dissertation  on
Fever, and at page 151 of his Treatise on Digestion, may be,summed up as
follows :
  The Creator, as one of the means of destroying and removing the remains
of the  successive races  of animals and vegetables as they become extinct,
which otherwise must have accumulated on the  surface  of the globe so as
to afford no space for new generations, has ordained that dead animal and
vegetable matter  should be subject to certain processes  called fermenta-
tions, and terminating in putrefaction.  Now every circumstance which would
cause a rapid putrefaction to take place in the dead body of a man, is con-
stantly applied to the living  body; viz. a warmth of nearly 100 degrees of ■
Fahrenheit's thermometer, the contact of atmospheric air, and motion;  and
although no  chemical circumstance has been discovered in the  body of a
living man that is capable of hindering such putrefaction from taking place,
nevertheless the body of  a living man  has no appearance of putrefaction :
and hence he concludes, necessarily, that  there is in the life, independently
of all other  circumstances, a power of preventing putrefaction.   Thus en-
dowed, the living body is able to preserve, from the fermentations above-
mentioned, not only its own solids and flu ds, but also, when  in health, t£e
extraneous matters, as aliment, which it contains ; and thus, when the living
power of the stomach is  strong, the food thrown into  that viscus will be
perfectly digested; but, when the organs of digestion are weak or disordered,
or when food is given to an animal which  is not adapted to its organs ef di*
                                5 
34
come most offensively  putrid ; haemorrhages sometimes take
place from the nostrils, gums,  and various other internal sur-
faces ; there is, in some patients,  a suppression of urine,  in
others an involuntary discharge of  it,  and of the faeces : the
pulse becomes feeble and intermits; the breathing is laborious,
portions of the skin assume  a livid  colour,  the  extremities
grow cold ; and life  is gradually extinguished.
   This is a general outline of  the Yellow Fever,  when it ap-

gestion, agreater or less portion of that food is not governed by the stomach,
but runs into the fermentations which would arise, if it had been in the same
chemical circumstances, out or" the  body.  It seems to be upon the same
principle (viz. the defect of the governing power, as Dr. Fordyce  has not
inaptly styled it, of the organs,  or vessels, of the body over the substances
the) contain) that we are to explain why, in certain morbid conditions, the
faeces, the discharges from the vagina and from wounds or ulcers, and also
pus, in the lungs, or other parts, the  urine, and even the  blood,  which has
beer, itself supposed to possess  a living power, become putrescent.   " The
putrescency of the blood," (says Dr. Fordyce, at page 285 of the 1st volume
of the Transactions of a Society for the improvement of Medical and Chirurgi-
cal knowledge) "is the effect of the depression of strength ; for it happens only
when there is great depression of strength ; and when such depression arises
in any other case, the same progress towards putrefaction is always ob-
served."   It is a confirmation of the above opinion, that,  in most of those
cases of injury to the spine, or disease of the bladder,  in which this viscus
loses the power of contraction,  it also soon loses  its governing power, and
the urine is voided in a putrescent state, like that voided in severe cases
offever.
   Two distinguished modern physiologists have stated it as their belief, that
the stomach and intestines  had, under certain circumstances, a power  of
secreting air; but even their authority has not removed  the  objections  to
that opinion which appeared to me to exist; and the generation of  the air
in question will, perhaps, be more satisfactorily explained by supposing that,
under such circumstances, the governing power of those viscera is, in a cer-
tain degree, impaired, in consequence of which chemical decompositions of
the matters contained in them begin to take place, and air is thereby evolved-
It is  not necessary to remind  the reader of the volumes of various gazes
which can be extricated by chemical agencies, from even small masses  of
most of the substances usually  existing  in the alimentary canal. 
                            35

pears in its most violent form ; and in this form  it somer
times proceeds  with  so  much rapidity  as  to  destroy  the
patient  on  the third or fourth day,  or  even sooner.  But
the disorder frequently appears  in  a milder form at first ;
the course being  protracted  into several paroxysms,  shor-
ter at first, and  followed by more  distinct remissions,  but
afterwards increasing in violence and in duration,  when  the
disease terminates fatally.   In these cases, death  usually hap-
pens between the seventh day and the fifteenth.
   The features, which are  the most remarkable  in  this  dis-
ease, are the'affections of the head, of the stomach, and of the
skin ; and I therefore propose to offer  some observations on
each  of them.  There is  great reason to believe,  both from
the  symptoms,  and  from  the frequent examinations which
have been made after death, that most of  those, who die of
the Yellow Fever, are destroyed in consequence of some irre-
parable injury having occurred either in the brain,  or in the
stomach.   It seldom happens, however, that these organs are
both  mortally injured in the same subject ; more commonly,
one of them only is dangerously affected.   I do not here mean
to affirm, that there have been cases of the Yellow Fever, in
which a fatal  affection of the head had supervened, without
any disorder of the stomach ; or cases in which  the  stomach
was much diseased,  while the brain continued in a sound or
healthy state ;—for I believe, on the contrary, that these or-
gans jointly suffer more or less in  every  case and species of
Fever ; but, according to iny experience,  and that of several
very respectable practitioners, with whom I have  conversed on
the subject, those patients in the Yellow Fever, who die from
an affection of the head, generally perish early in the disease,
and with less vomiting, especially of blackish, or dark-colour-
ed matters ; whereas, on the other  hand,  those  in whom this
last symptom greatly predominates, are usually found to have
their mental  faculties  clear, though often much weakened ; 
36
and they seldom expire before the end of the fourth,  or the
beginning of the fifth day.

                      DISSECTIONS.

When the bodies of patients, in whom the affection  of the
head formed the principal feature of the  disorder, have been
inspected after death, the integuments of the brain have gene-
rally been found  more or less inflamed,  especially near the
temporal bones; the vessels of the dura mater, and of the pia
mater, were not unfrequently observed to be very turgid with
blood,  which moreover was  sometimes extravasated.   Effu-
sions of a watery  fluid also have occasionally been seen over
the surface of the brain,  or in vesicles between the pia mater
and the tunica araclmoidea.   In some cases, the  integuments
have been so firmly  attached to eacb other, and to the  brain,
that, in attempting to raise, or  separate them, a part  of the
substance of  the brain has been torn up.  The  volume  of the
brain is often increased,  and the substance of it is, in  some
instances, more firm than usual; when cut, the vessels distri-
buted through it,  have been so distended with blood, that the
medullary part  has  immediately become thickly  spotted with
red points, owing to the oozing of  blood from the divided ves-
sels ; and it was not rare to find that some of those vessels had
been ruptured,  and that blood had escaped into the substance
of the  brain.  The ventricles have usually contained  water,
frequently of a yellow colour, and were, in some cases, quite
filled with it.  The plexus choroides has often  been  loaded
with blood.
   Such is the disorganization which careful dissectors have
uniformly detected, in a greater or less  degree,  in those ca-
ses of the Yellow Fever in which the predominant symptoms
indicated a severe affection of the head.   It accounts  suffici-
ently for the occurrence of those symptoms, and for the  fatali- 
37
 ty which so often attends  them, as well as  for the derange-
 ment of mind,  the loss of  memory,  the impaired state of the
 sight, and other senses,  and  the extreme feebleness of the
 limbs, which are the frequent consequences of this disorder in
 those  who escape with life; and from which they sometimes
 recover very slowly.
   Those cases  of the Yellow Fever, in  which the stomach is
 principally affected, are next to be  considered.  This organ
 appears to be .the most universal and important of all the vis-
 cera,  and that  which is the  most indispensably necessary to
 animal life.   Some animals are organised with so much sim-
 plicity as to have no visible brain, heart, or lungs; other ani-
 mals, with cold blood,  which are endowed with these organs,
 will live, and even  move,  for  a considerable time after being
 deprived of them : but'no animal is formed without a stomach,
 nor would any one be capable of supporting life, perhaps for
 even a very short time, after  that  viscus was destroyed.—
 There is, indeed, no other animating viscus discoverable in
 Zoophytes, Hydatides,  Polypi, &c. though they are all capa-
 ble of muscular motion and self-propagation.  In the more
 perfect warm-blooded animals,  which possess other vital or-
 gans  besides the  stomach,  this last always sustains a  distin-
 guished part in the general  system, by its important functions
 and associations.  When it is in its healthy state, every other
 part of the body feels its salutary and invigorating influence;
 and when, on the other hand, it languishes or suffers, they all
 participate  in  its  derangement.  Ardent spirits,   Opium,
 iEther, &c. when swallowed, produce powerful effects  in eve-
 ry part of the body,  long before they can have passed beyond
 the stomach; and a few ounces of strong Laurel-Water* occa-

  * Fontana, sur les  poisons, vol. ii.  p. 125. "Si on donne cette eau (de
 Laurier-Cerise) en  grande quant it 6 aux animaux,  ils meurent presque dans
I'instant sans convulsions, toutes les parties ck leurs corps ciant relachees,
^ dans 'laffaisement.                          * 
38
 sion almost instant death, upon reaching that viscus, without
 any struggle or  appearance of re-action.   But this  intimate
 and extensive  connexion of the stomach with other  parts of
 the body, and its great irritability, subject it also to be injur-
 ed and disorder by every thing which occasions injury and dis-
 order to thent.   Thus it exhibits marks of inflammation in an-
 imals  killed by the bites of  venomous serpents,  and  of  rabid
 animals, and by other poisons externally applied ; and it is al-
 ways, in some degree,  affected by attacks of Fever, in which
 loss of appetite, aversion from food, and inability to digest it,
 occur  with not less certainty than any other febrile symptom.
 But the Yellow Fever is almost invariably  attended by marks
 of disorder-in the stomach,  much more decided  than these,—I
 mean nausea, followed by frequent vomiting, even in the early
 part of the  disease, and by the discharge of considerable quan-
 tities of bile,—a discharge  which  appears, in these cases, to
 be caused solely by the efforts to vomit, in the same manner
 as in  sea-sickness, and other affections, in which the evacua-
 tion of bile, and even the  increased  secretion  of that  fluid,
 (which violent vomitings  are believed  to occasion) are merely
 a consequence,* and not a cause, of the disorder.  These indi-

  * Dr. G. Fordyce has  properly noticed, in his valuable  Dissertation on
 Simple  Fever,  (page 94,) the  error of a  common opinion, viz.—that " re-
dundancy of bile constitutes an essential part of the  attack of Fever," which
 opinion has been formed, because bile is " conspicuous from its colour, taste,
and smell; while the gastric, pancreatic," and other juices, as they are not
very conspicuous for their sensible qualities, have not been taken into the
 account." "  If the pancreatic juice had been  blue, (continues he,) and had
 any particular taste or smell, and the bile had been colourless, insipid, and
inodorous, or as much so as the pancreatic juice now is; in that case, what-
ever has been said of the redundancy of bile, as being an essential part of
 the attack of Fever, would have been said of the pancreatic juice.—See also
 the JSote,  at page 467, of Dr. Clarke's Obseivations  on the Diseases of Long
 Voyages.  The idea of an increased secretion of bile  in the Yellow Fever, p.r 
39
eations of a morbid affection of the stomach in the Yellow Fe-
ver, are accompanied with others,  affording similar evidence
of the state of that organ, particularly excessive thirst, acute
pain, and burning heat in the stomach, with so great a degree
of tension and soreness over  the epigastric region, that exter-
nal pressure  cannot be  endured.  As the disease  advances,
these symptoms become more violent, the strainings to vomit
are incessant; and when the termination is fatal, hiccough and
the black vomit usually supervene.
   When the bodies of those who have died with the preceding
symptoms  have been dissected, the stomach has, in every in-
stance, as far as either my  knowledge or my information ex-
tends, exhibited very evident signs of inflammation.  In some
cases, almost the whole inner surface was inflamed; very often
portions of the villous coat were abraded, and not unfrequently
observed floating among the contents of that viscus.   Marks
of inflammation, but less violent than these, have also been
often seen in the small intestines, especially  near the pylorus.
The inflammation observed on these viscera, seems to be of
the kind denominated erythematic, which is found to affect
the villous  coat of  the intestines more frequently  than any
other.  This  kind of inflammation is apt to spread wherever
there is a continuity of membrane or of structure; and as
such continuity exists through the alimentary canal, the vis-
cera, nearest to the  stomach, must be liable ,to  participate in
the inflammatory affection of the latter.

                    THE BLACK VOMIT.
As erroneous opinions have been entertained concerning both
the origin and nature of what is called the Black Vomit, it

in persons living in warm climates,  is opposed by Dr John Hunter, upon
grounds which appear to be just, at page 128 and 316, of his Observations
on the Diseases of the Army in Jamaica* 
40
may be proper to state, in this place, some facts and observa-
tions relating to it.
  From the time of Galen, bile was supposed to be the prin-
cipal agent in  producing intermittents; and as  soon as we
became acquainted with  the  Remitting Fever of the West
Intlies, it was generally ascribed to that cause.  Dr. Towne,
who, in 1726, published an account of the Yellow Fever, under
the name  of " Febris Ardens Biliosa," considered it  as  a
truly bilious disorder; so did Hillary, who called it  a " Pu-
trid Bilious Fever."   This idea has been since very generally
adopted,  and the  matters which  constitute  what  is termed
Black  Vomit have, accordingly, been deemed, by many per-
sons, to be the product of a morbid secretion of the Liver, or
else  of a morbid change in the bile.   That neither of these,
however, is the case, has been clearly ascertained, by late
examinations made upon the bodies of great  numbers of per-
sons who have died of the Yellow  Fever, particularly by Dr.
P. S. Physick,* in Philadelphia.   In these dissections, the
Liver was very rarely found diseased, and even when in that
state, the  disease seems  almost  always to  have  been  of a
chronic nature.  The  alteration from the usual  appearance
of this organ most frequently observed, was  a greater or less
degree of paleness.  The stomach, however, was constantly
diseased, if the symptoms, which  I have lately mentioned as
denoting, inflammation in that organ, had previously existed.
The matter of Black vomit (which is commonly found in the
stomach, but is also found in the intestines when they have
partaken of the inflammation) was never discovered in the
Gall-Bladder, the Liver, or any other viscus or cavity.  The
Stomach has sometimes been loaded with this black matter,
  * For more satisfactory information to the reader, the paper of Dr Phy-
sick, which is alluded to, is given in the Appendix,  (No 1.) and there is
also added the substance of another memoir concerning the Black Vomit,
written by Dr. Isaac Cathrall, of Philadelphia. 
41
while, in the same subject, not only the Liver was free from
disease, but the bile in  the Gall-Bladder was in its natural
healthy state;  and  this has been seen  in several  cases, in
which a contraction of the pylorus had completely obstructed
the passage from the duodenum into the stomach.   The matter
of Black Vomit is, besides, essentially different from bile; it
differs from it in colour; for, however dark the bile  may ap-
pear in its  most concentrated state, it always displays  a yel-
lowish,  or greenish yellow tinge, when spread  on a  white
surface, or when diluted; and this is never observed with the
matter of Black Vomit.   It has also been found that an addi-
tion  of bile to the latter altered its nature so much as to give
it an appearance different from that  which it had before; nor
could the Black Vomit be imitated by any mixture of various
proportions of dark-coloured bile, with the fluids found in the
stomach.   It differs likewise,  most decidedly, in taste; the
Black Vomit being always  insipid, when freed from other
foreign matters, whereas bile can never, by any means, be
deprived of its intense biterness.  In many cases, portions of
the inner surface  of the  stomach have been covered  with a
coat of thick blackish matter, and upon  removing  this coat,
the parts beneath it, and no other, were found inflamed.  The
substance thus obtained, was exactly similar to that of  Black
Vomit, and, like it, incapable of being made to adhere again,
when applied to the same or to any other parts.   Hence there
is reason to believe, that the matter  forming this  black cover-
ing, must have been derived from the vessels of the inflamed
part, especially as  it  could  not of itself have produced the
inflammation, since it  is so perfectly bland,  that it has been
frequently dropped into the eye without exciting any greater
sensation than pure water.  Neither can it be supposed, that
it could have come from the gall-bladder, or from the biliary
ducts, (in which, as I have remarked, nothing like it has ever
been found) or from any part of the alimentary canal, and
                             6 
»
                            42
have  attached itself afterwards to  the stomach, in the  man-
ner in  which it  is seen adhering,—first, because  it has no
adhesive quality  when  it has been  once detached from  the
surface on  which  it was found;—and,  secondly,  because,
in some subjects,  no  such  matter  was  found loose in  the
stomach or  intestines,  although a very  great part of  the
inner surface of the stomach was, at the same time, covered
with  a coat of it.   At  those  spots, moreover,  where  the
villous  coat  had been  abraded, the  extremities of arteries
have been frequently seen filled with this dark-coloured mat-
ter ; and collections of  the sanie matter  have even been dis-
covered immediately under the  villous coat,—a situation to
which it is impossible that any foreign  matters, which had
passed into the stomach, could have found access.   To  these
facts, which render it incredible that the  liver has any  share
in producing the matter of Black Vomit, I may add that this
vomiting of dark matters never accompanies Hepatitis, or any
other affection of the liver; and that it has seldom appeared,
so far as I can learn, in any case of the Yellow Fever, in which
there  was not reason to believe that the stomach was, or had
been inflamed. It may, therefore, be concluded, that when this
symptom occurs in  the above disorder, it is  usually a conse-
quence-of inflammation in that viscus.
   Some authors, who had adopted a similar conclusion, were
inclined to consider the matter of Black Vomit as a particular
morbid secretion, by the inflamed vessels or  glands of  the
stomach; but this opinion, if  I understand their meaning, does
not accord with fact; for it is to  be supposed that the villous
coat,  and  the glands beneath  it, are the only parts of  the
stomach by which  secretion can be performed; and proofs
have"have just been adduced, that the matter in question may
be formed without the co-operation  of that membrane, or the
glands connected with it, since it has  been found in the extre-
mities of arteries, and lying beneath the villous coat itself. 
4S
   The  least objectionable, and, in all probability,  the true
 explanation of the  most  common  formation  of this  sub-
 stance, and of  the phenomena attending  it, seems to be, that
 it is merely blood which has  been effused from  some  of the
 small arteries,  ruptured  in consequence of the  separation of
 certain portions of the villous  coat, and has coagulated within
 the general cavity of the  stomach, or on the surface over which
 it was  effused; and having been  afterwards detached, and
 triturated by  the violent and frequent contractions of that
 organ,  in the  efforts  to vomit, has  had  its appearance as a
 coagulum of blood  altered, and its  colour* darkened by the
 gastric juice,  or  by some  chemical decomposition,  either

  * Dr. Henry Warren, at page 39, of his Treatise concerning the Malignant
Fever in Barbadoes, (1740,) says, " I ought here to observe, that  the fatal
black stools and vomitings are vulgarly supposed to be only large quantities
of black bile, or choler; which false  notion seems to be owing to that fixed
unhappy  prejudice that the fever is purely bilious.  But let any one only
 dip in a bit of white linen cloth, he will soon be undeceived,  and convinced
 that scarce  any thing but mortified blood is  then voided, for the cloth will
appear tinged of a deep  bloody red, or purple, of which I have made many
experiments."
  Dr. Cullen, treating  of Hacmatemesis, (See Art.  1017 of his first lines of
the Practice of Physic,) mentions the " black and  grunious appearance" of
the blood thrown  out from the mouth, as one of the signs by which "  the
blood may be certainly known  to proceed from the stomach ;" and in Vrt.
1029, Treating of Melaena, or Morbus niger, which  consists " in  an evacua-
tion either by vomiting or by stool, and sometimes  in both ways, of a bLck
and grumous blood," he says, " it is highly probable that what gave  occasion
to the notion of an atrabilis among  the ancients, was  truly the appearance
of the blood poured into  the alimentary canal in  the  manner I have men-
tioned ; which appearance we  know the blood always puts  on, -when it  has
stagnated there for any length of time."  Blood acquires a dark colour also,'
though in general more slowly, when it happens to  be effused in other parts
of the body; and the  brownish tinge, which the fluid in  Hydothorax and
ascites frequently exhibits, seems to  be derived from a similar change of
colour induced in the red globules of blood that had been  effused  into  the
thorax and abdomen, together with serum and coagulable lymph. 
44
spontaneous, or produced by the action of the air, or  other
matters contained in the stomach.
   That blood is really poured  out into the stomach  in the
manner just stated, will  scarcely be doubted,  many respect-
able* authors having affirmed, from their own  observation,
that blood,  sometimes red, as  if very  recently  effused,  and
often grumous, is frequently vomited in the Yellow Fever.  It
seems,  indeed, impossible  that any portion of the villous coat
could be destroyed, or separated from the other coats, without
occasioning a rupture of the  arteries which conveyed blood to
it, or that  an effusion of  blood  should not  immediately take
place from  the  ruptured  arteries, and continue until some of
the blood thus poured out had coagulated, either within their
cavities, or over the  adjoining surface, so as to prevent the
effusion of more blood.  This is the usual operation  of nature
in all other hsemorrhages, and, we may presume, that it must
unavoidably be performed in the case before us.

  * Thus Dr. Rush, at p. 4G, Edinb. edit, of his account  of the bilious Yel-
low Fever in Philadelphia, in 1793, says, " there was  frequently discharged
from the stomach,  in the  close of the disease, a large quantity of grumous
blood, which  exhibited  a  dark colour  on its outside, and which, I believe,
was frequently mistaken for what is commonly known by the name of the
black vomiting ;" which last Dr. Rush had conceived to be " bile in a highly
acrid state"
  On the same subject, one of the latest of the authors alluded to, M. I N,
Berthe, Professor in the School of Medicine, at Montpellier, (who was joined
with two other Medical  Professors of that University, Mess P. Lafabrie and
V. Broussonet, in a commission sent by the French Government into Spain,
in 1800,  to observe and report upon the Yellow Fever,  then prevalent  in
many parts of that country, and who has since published the result of the
information collected by that commission, under the title of " Precis Histori-
que de la Maladie qui a r€gn€  dans I'Andalousie in 1800,"  printed at Paris
in 1802) has  stated at  p. 87,  as follows, viz. : " On observait e"galement a
cette epoque le hoquet, le vomissement noir : les malades rtjetaient tantot
du sang, et tantot de l'atrabile;  et plus  souvent ces deux matieres melees et
en meme temps fetides." 
45
  There is another mode by which the vomiting of black mat-
ters in the Yellow Fever has been explained. Sir John Pringle,
treating of this symptom, at page 197, of his Observations on
the diseases  of the  Army,  states his  belief that  the blood,
" by oozing into the stomach, gives that blackish cast to what
is  then  thrown up;"  and he  attributes  this oozing to the
blood's  being " here so much resolved.""  Dr. John Hunter
entertained a similar opinion ;  " the blood," says he, " being
frequently in a dissolved  state, is forced into the stomach and
thrown  up, forming, what is  called by  the  Spaniards, the
black vomit." See page 64 of his Observations on the diseases
of the Army in Jamaica.   Dr. Blane, however,  apparently
with greater justice, thinks that " this happens, more probably,
from a relaxation of  the vessels on the surface of the alimentary
canaU than from a dissolved state of the blood."  " The black
matter," adds he,  " that is vomited, and the black colour  of
the fseces  and urine in the last and hopeless state of this dis-
ease, seem to be owing  to the propensity to haemorrhage  in
the internal surfaces."   See page 410-1, of his Observations
on the Diseases of Seamen.  It has been ascertained by Sau-
vages, and other physicians, that in Meloena, blood in various
gradations of change, from  a red fluid to a matter resemblmg
the grounds of coffee, has been sometimes vomited by patients,
whose stomachs were found,  on dissection,  free from any
abrasion or rupture of the blood-vessels ; and it is also known,
that a vomiting of similar dark-coloured matters has occasion-
ally happened suddenly to women in labour, especially in cases
of rupture of the uterus, without being preceded by a vomiting of
any other matters, and in patients, the coats of whose stomachs
were observed  to  be perfectly sound upon examination after
death.  A relaxation of the  vessels on  the  surface of the
stomach,  (which may be,  and perhaps often is, accompanied
with some degree  of inflammation) appears to be the cause to
which the effusion of blood  in  such instances ought  to be re- 
4b
ferred :  and if such relaxation may take place in the affections
just mentioned, it is to be presumed, that it may also take
place in a disease of so debilitating a nature as the Yellow
Fever, which is sometimes seen to occasion hemorrhages from
many other internal surfaces.   On these grounds, therefore, it
seems not improbable, that a relaxation of the vessels of the
stomach had existed in most, or all of those cases of this fever,
in which the black vomit occurred with little or no previous
vomiting, or in which the coats of the stomach were entire.  I
must, however, remark, that in the accounts of dissections of
patients dead of the Yellow Fever, which have come to my
knowledge, I have found the cases just described, to bear only
a very-small proportion to the number of those in which injury
had been done to that viscus ;  and I  am, therefore, inclined to
believe, that the black vomit is much less frequently the conse-
quence of a relaxation of vessels, than of a separation of some
portions of the internal coats of the stomach.
  I must not omit to mention among the appearances on  dis-
section, that the lungs and pleura have sometimes been  found
to have  undergone some degree of  inflammation during the
course of the Yellow Fever; but, although the sufferings of
the patient must have been greatly increased from such an
affection, it does not appear that the inflammation was often so
considerable as to warrant  the supposition that it had caused
his death.

                AFFECTIONS OF THE SKIN.

The connexion between the skin and the alimentary canal Is
well known, and, perhaps, results, in a  considerable degree,
fi'om the identity of their membranes.   This connexion  may
contribute to  some of the appearances observed on the surface
of the body in Yellow Fever, which generally begins with more
moderate  sensations  of  cold than other Fevers, but soon pro- 
47
duces strong arterial action,  during which the skin becomes
excessively dry and parched, with  an intensely burning or
pungent  heat.  Sweats  are in this stage a very rare  occur-
rence, and when they do appear, no relief is afforded by them.
A feeling of general soreness of the skin also takes place in
many patients.  But the most remarkable symptom affecting
the skin in this Fever,  is a yellow  suffusion;  which, though
far from being a constant  symptom, occurs often enough to
have given occasion for  the name by which the disorder is now
commonly distinguished.   The  yellowness begins  in  a few
cases, within  the  first  forty-eight hours;  sometimes on the
third day, and frequently not until the fourth or fifth.   It is,
indeed,  sometimes observed but a few minutes before,  or  a
little after death.  I believe that in  many  instances it might,
with attention, be  first discovered on the eyes ; but it is com-
monly first observed on the cheeks,  extending  towards the
temples, and about the angles of the nose  and mouth;  about
the lower jaw and on the neck, along the course of the jugu-
lar veins, whence  it afterwards spreads in stripes and patches
along the breast and back downwards, so as at  last to become
universal in some patients,  though in others it remains partial.
The yellowness is  sometimes of a dingy or brownish hue, some-
times of a pale lemon, and at others of a full orange colour.
 When the yellowness appears only in patches or spots, and of
a dingy or brownish hue, these are frequently intermixed with
other spots of a florid red,  or a purple, or livid colour.
   A considerable difference of opinion has subsisted respecting
the cause of this symptom; some physicians having ascribed
it to serum, which has been rendered yellow either by a colli-
quation, or dissolution  of the red globules, or by a peculiar
action of the vessels, and afterwards effused under the cuticle :
 and some to  an eiror loci  of the globular part of the blood,
 which, as they conceive, might occasion yellowness, by getting
 into the smaller order of vessels, in consequence of their great 
48
 debility and  relaxation,  or  into the cellular membrane ; as
 happens after Ecchymosis, from external contusion ; in which
 the skin, though at first livid, becomes yellow, when a part of
 the red globules is removed by absorption or otherwise.   The
 late Dr. George Fordyce, in his fourth dissertation on Fever,
 (page 74) attributes the yellowness in question to the sebaceous
 matter, which he supposes to be then secreted more copiously
 by the sebaceous glands  of the skin; he contends that, " the
 colour is very different from that which takes place in Jaun-
 dice,"  supposing,  erroneously,  that  " the secretion  irom the
 kidneys has  not that deep  yellowish brown, nor that thick
 sediment, which have almost always been seen in those per-
 sons, in whom bile has got into the blood."   Another author
 again,  the late Dr. John Hunter, (whose authority on this sub-
ject is  entitled to greater weight, from his experience in the
 Yellow Fever, and who had found, as every other person must
 have done, who has really made the trial, that in this disease,
 " the  urine is of  a very deep colour,  and stains linen rags
 yellow, like that of a person in the Jaundice," See page 72 of
 his  Observations on the diseases of the Army in Jamaica) be-
 lieved it " probable that the inflammation in the coats of the
 duodenum and stomach, and the violent contractions they suffer
 from repeated vomiting and  straining, may produce  a spasm
 of the gall ducts, sufficient to interrupt the course of the bile;"
 (See page 157 of the same work)  the  consequence of which
 was, as he states at pages  135 and 137, that the bile was
 " absorbed and carried by the lymphatic vessels into the ge-
 neral mass of circulating fluids," and thus became " the cause
 of the yellowness."  And lastly, Dr. William Saunders thinks
 that, in the more aggravated species of the Yellow Fever, this
 symptom " depends rather upon a particular state of the lymph
 in the cellular substance of the parts, than upon the absorption
 of bile into the circulating mass :"  (See page 104, of his valu-
 able treatise on the structure, ceconomy, and diseases of the 
49
liver, 3d  edition); but that in " the ordinary," i. e. " the
Endemic Fever of the West Indies," " the Jaundice seems to
depend upon a redundant secretion," the quantity of bile being,
perhaps, so very  considerable in this  disorder, as  he states
farther  at page 233,  " that though the greatest part of  it
escapes into the primse vise., the whole may not readily find a
passage;  and the surcharge thus occasioned, may give rise to
regurgitation and  absorption."
  I was once inclined to adopt one of the latter opinions, be-
cause it seemed difficult to  conceive by what other means, or
from what other cause bile should be introduced into  the blood
vessels in this Fever so as to render the skin  yellow.  That
fluid is naturally intended to perform  all its offices in the ali-
mentary canal, and to  be all conveyed thither: and  it is only
when its  passage  through the ductus communis choledochus
into the duodenum is obstructed, that nature is believed to have
provided means for its escape into the  blood vessels, in order
to obviate the mischief which  might result from an excessive
accumulation of bile in the gall-bladder, and  biliary  ducts.
But no such obstruction appears to exist in the Yellow Fever;
the alvine fasces being commonly dark-coloured, so as to de-
monstrate  the admixture of bile; and the quantities of that
fluid which are discharged from the stomach during the whole
course of the disease, being such as to obviate all suspicion  of
an obstruction in the duct, and all probability of an accumula-
tion of bile in the liver, or gall-bladder.  These, however, and
other objections against the existence of bile in the blood, as a
cause of the yellowness in question, were overcome in my mind
by further consideration and inquiries;  and I am now disposed
to think that, with perhaps one partial exception to be here-
after mentioned, the yellowness of the skin, which is frequent
in this Fever, is derived from the bile.
  In the action of vomiting, the abdominal  muscles contract
strongly,  while the diaphragm is forcibly drawn downwards :
by these motions the liver, from its situation immediately be-
neath the diaphragm, and its large bulk and inelasticity,  suf-
                             7 
5a
 jfers a certain degree of compression.  When this compression
 is moderate  and gradual, as it appears to be in most cases of
 ordinary vomiting,  it is probable that some portion of the bile
 contained in the biliary ducts is thereby propelled into the du-
 odenum,  whence it passes into the  stomach, and is  thence
 throw up with other matters.   When, however, there has been
 very frequent and  violent vomiting for some length of time,
 the stomach, diaphragm, and  abdominal muscles, are apt to
 become irritable to an extreme degree, so that,  at each effort
 of the former to discharge its contents, the latter (whose pow-
 er, as Mr. John Hunter has observed, at page 158 of his work
 on  the Animal (Economy,  is  " often capable of forcing the
 bowels themselves  out of the abdomen, producing rupture")
 will frequently be thrown instantaneously into strong spasmo-
 dic contractions, and the liver together with the gall-bladder,
 will be,  as it were, suddenly caught and tightly squeezed in a
 powerful press, the  necessary  consequence of which pressure
 seems to be,  that  all the fluids  contained in that viscus  will be
 driven towards both extremeties, backwards as well  as for-
 wards, in  those vessels which are not provided with valves to
 prevent their retrograde motion.   Under such circumstance it
 can scarcely  be doubted, (after the experiments of* Haller, con-
 firmed by others,  demonstrating the facility with which fluids
 may pass from  the  biliary ducts through the pori biliarii into
 the hepatic veins) that the bile  will be forced to regurgitate in
 this manner, and pass from those ducts into the  vena cava, at

  * " Altera certissima anastomosis est ex ductibus biliariis in venam cavam,
quam  cl- ante  me viri viderunt, &  mea experimenta confirmant.  Elem,
Phisiolog. Corporis humani. Tom  6. p. 509. 4to.
  " "Baron Haller observes, that a subtile injection thrown in by the hepatic
duct will escape readily by the hepatic veins. This is a fact; and I know
from experiment, that water injected in the same direction, will return by
the veins in a full stream, though very little force is used.  From the facility
 with which water takes this retrograde course, a probability arises that, if
from any cause the natural direction of the bile be obstructed, it will readily
obey the same (retrograde) direction."  Dr. Wm. Saunders, Treatise on the
 Structure, &c. of the Liver, page 108. 
51
 each  violent compression of the liver; and that by continued
 and  strong  spasmodic contractions  of the before-mentioned
 muscles in vomiting, a  considerable quantity of bile may be
 carried  into  the circulation,  and a yellow suffusion,*  exactly
 resembling Jaundice, be, even very speedily, produced.   It is
 in this manner that  we must account for the universal yellow-
 ness of the skin which even in the time of Galen, has been ob-
 served to follow the  bite  of the viper,f when the poison was  of

   * As the liability of the  liver to such compression  depends on circum-
 stances  varying in different individuals, and  principally on  its  situation,
 form,  and size, and also on the suddenness and force by which the surround-
 ing muscles happen .to  contract upon it, we can hence understand why
 Jaundice may be more readily produced in one person than in another,  al-
 though the symptoms might seem to be equally violent in both.  We may
 likewise hence understand why infants, in whom the liver is, proportionably,
 much  larger than in adults, and who are subject to numerous  indispositions
 inducing strong convulsive contractions of the diaphragm and  abdominal
 muscles, should be so frequently affected by Jaundice ;  the cause of which
 affection, however, appears to have been overlooked, and mistaken by Haller,
 (Elementa Phisiologix corporis humani  Tom. 6. page 590) for curdy mat-
 ters obstructing the common duct, and  by others for viscid  bile imparted
 therein, or other gratuitous  suppositions.  The only  authors  within my
 knowledge who have expressed a belief, that the bile might be driven into
the blood vessels by the violent action of the diaphragm and abdominal mus-
cles, and thus occasion Jaundice, are,  Haller (in his work  entitled, " Her-
mann! Boerhaave Praelectiones academics," § 348,) and Van Swieten (in his
 " Commentaria in H. Boerhaave Aphorismos Sect.  631 and 950) ;  these very
learned Physicians, however, do not appear to have thought, that the Violent
action of  those muscles  simply could produce a Jaundice, for they suppose
the pre-existence of gall-stones, or of some other obstruction in the cystic
or common duct, by which  the excessive vomiting that precedes the Jaun-
dice in such cases, is  always  produced as a salutary effort of nature : but
this supposition does not accord with  the well-ascertained  facts,  that gall-
stones may obstruct the common duct, and produce Jaundice, without ex-
citing any vomiting, even when  they are attended with  excruciating pain,
and that Jaundice frequently occurs, although a free passage of the bile into
the duodenum exists.
  ■j- Fontana was led to suppose, that the yellowness of the skin in persons
bitten by vipers  is derived from the bile, which is carried into the circulation
in consequence of the common duct being closed by some crisping or irrita-
tion in the duodenum, arising from convulsive vomitings; but he  offered no 
52
 sufficient force to  produce  the usual symptom  of convulsive-
 vomiting, and for the similar  effects that have likewise been
 observed to ensue from the  bites of some other venomous ani-
 mals.   In these cases a deep yellow colour of the skin has been
 observed within  even a  single hour after  the accident, (as
 Dr.  Mead affirms, at page 9 of his mechanical account of poi-
 sons, 3d edition) and consequently too  soon to have been the
 result of any thing but a regurgitation of bile as before explain-
 ed : for in regard to absorption, it is scarcely credible that the
 lymphatick vessels of the liver could ever, under any circum-
 stances, take up and convey into the circulation such a quanti-
 ty of bile as would suffice to produce Jaundice in that short pe-
 riod of time :  neither is it readily to be perceived why, or how,
 in persons bitten by vipers, or in those labouring under certain
 affections to be presently mentioned,  in whom a yellowness of

opinion concerning the means by which the bile is conveyed thither.  " Con-
venons done," says he, at page 68, vol- 1, of his work sur  les poisons, " que
si les sujets attaques par le venin deviennent jaunes, il faut que la cause
qui produit cet effet  ait intprcep'e" le cours de la bile, apres qu'elle est se-
pAr6e dans le foie, sans avoir auparavant  nui en rien a cette secretion  Je
croirois volontiers qu'elle ne se repand ainsi dans la masse des humeurs, que
pare que son cours est intercepte dans le canal choledoque avant qu'elle se
degorge dans le  duodenum  Les convulsions de 1'es.tomac et des intestins,
qu'eprouvent ceux qui out et£ mordus par la vipere, peuvent tres bien irri-
ter, et ensper le duodenum, et boucher ainsi cet orifice.   Ne nous etonnons
pas non plus de voir la  meme jaunisse se manifester chez ceux qui ont pris
d'autres poisons, puisqu'ils eprouvent aussi  de semblables convulsions, un
tiraillement douleureux dans le creux de I'estomac, des vomissemens bilieux et
convulsifs, une contraction autour de l'ombilic ct d'autres accidens dans le bas
venvre."   Fontana probably borrowed his gratuitous notion of a crisping of
the duodenum from Morgagni, (de Sedibus and Causis morborum. Epist. 37.
n. 35.); and Dr  John Hunter appears to  have taken his idea of " a spasm of
the gall-ducts."  as mentioned at page 36, from Fontana, combining  with it,
thai of the bile being absorbed by the lymphatic vessels  of the liver,  and
employing both to explain the occurrence of Jaundice in the Yellow Fever.
Toe bite of the  rattle-snake does not cause excessive and convulsive vomit-
ing as that of the viper; and it seems reasonable to suppose that the poisons
of diffwnt  >nak?s may be endowed, each with peculiar properties, and pro-
duce different effects. 
55
the skin is speedily induced, a particular system of vessels in a
particular viscus,  i. e. the lymphatics in the liver, should  have
their functions at once changed, and should on a sudden be ex-
cited to  absord bile  copiously,  and this while there is a ready
exit for the passage of  that fluid into the intestine,  as is mani-
fested by the matters discharged in such  cases from the stom-
ach and rectum.*   In the same way yellowness of the skin, to

  * It may yet be doubted whether Jaundice be produced by absorption of
the bile in any instance, even in a complete obstruction of the common duct
by a gall-stone, although this  is the mode in which it is now by most  per-
sons supposed to  be always produced in that case.  A justly eminent  physi-
cian relates an experiment made  by himself, which, as he  thinks, " evinces
that the absorbents take up the bile from the interior part of the liver, and
convey it by th<- thoracic duct into the mass of blood."  He tied the hepatic
duct in a living dog, and two  hours  after, the animal being strangled, he
examined the parts.   " On inspection," says he, '* it appeared that the ab-
sorbents  had been very  active, for they were very much distended with  a
fluid of a bilious colour, and their course, which was very conspicuous, could
be traced with the greatest  ease to the thoracic duct, the contents of which
seemed  only moderately bilious.   The bilious colour was. in a great mea-
sure, concealed by the  red particles of blood, which had been  extravasated
by ihe injury, taken up by the absorbents, and conveyed into that canal  It
is probable, however, that the bile was only just entering the blood vessels,
as on a vt-ry careful inspection of the eye, the tunica conjunctiva did not
betray the slightest appearance  of Jaundice "  From this experiment the
author draws the  following conclusion.  " It seems then,   that, during the
space of two hours, the secretion of the liver had been sufficient in quantity
to distend its ducts,—to stimulate the absorbents to relieve that distension,
and to allow of a small portion  of their  contents  to be conveyed into the
blood vessels "
  This conclusion, however,  notwithstanding my great deference for the
opinion* of this author, does not  appear to me sufficiently supported  by the
preceding facts.  It is, indeed,  mentioned that the contents of  the thoracic
duct were " bilious ;"  but they are admitted to have been " only moderately'*
so; it is moreover acknowledged, that "  the bilious colour was, in a great
measure, concealed by the red  particles of blood;" and as' it was by the eye
alone, that the result of this  experiment was determined,  I think  that a
slight yellow tinge, which confessedly was almost "  concealed by red," is
not of itself of sufficient evidence to decide a doubtful point of great physio-
logical, as well as pathological, importance.   The presence of bile  in the 
54
 a remarkable degree,  attended with yellow sweats (which,  as
 well  as the urine, gave to  linen a  yellow tinge,  have been
 sometimes  produced  by  the excessive vomitings, and  violent
 spasms, which ensue from eating some species of mushrooms in
 Europe, and  certain poisonous fishes* in the East and West

thoracic duct, would probably have been determined with greater  certainty
by tasting the matters contained therein.
  "When the circumstances attending an obstruction of the common duct,
by a gall-stone or other cause, are fairly considered, it seems highly probable
that some regurgitation of the bile must happen, which, if continued for a
sufficient length of time, may produce Jaundice :  for,  in such  a case of ob-
struction, the bile will still be secreted as copiously as before, and must accu-
mulate in the ducts, and distend the liver considerably beyond its usual size«
and it does not seem possible, that in this state the latter can avoid suffering
 almost perpetually some degree of compression by the mere actions of the
muscles  in  respiration ;  nor probable that, when thus turgid, it  could be
compressed without some portion  of the  redundant bile  being  each time
driven into  the hepatic veins.  Besides these, other stronger actions of the
thoracic and abdominal muscles  are  likely to be very  frequently excited by
the general uneasiness, or looal  pains, accompanying this morbid  condition
of the liver, as in sighing, coughing, &c. which may also force bile into the
hepatic  veins.  In these ways regurgitation appears to be  of  itself ade-
quate to  the production of Jaundice ; and  if it be so, to recur to the doc-
trine of absorption, as another source of that disease, without any decisive
proof that the bile is  really absorbed, would only multiply causes without
necessity.
  * Several authors of undoubted credit,  as  Kampfer, Frezier,  Sloane,
Catesby,  Ulloa, Osbeck, Forster, &c  have given accounts  of various species
of fishes  found in the seas of warm climates, which frequently act as poisons
upon those who have eaten them.   The morbid effects  produced by such
food have been described by Dr Robert Thomas, now of Salisbury, but who
formerly  resided  nine years in the West Indies, (at page 586 of his  " Modern
Practice  of Physic, 3d edition) ;  and among these, besides " severe vomiting
and purging," he stages the following " In the advanced state of the dis-
ease, I observed  that the whole surface of the body acquired a deep yellow
hue  as in Jaundice, and that the urine was likewise tinged  of  the  same
colour  Even the perspiration gave a deep yellow tinge to the linen  These
appearances  took place, in a very high degree, in one  or two  cases,  but
more particularly in my own, as I was so  unfortunate as once to experience
the deleterious effects of a poisonous rock  fish," (perca marina)
  As the fishes in question are poisonous at some times and situations   and 
55
•Indies, and also from swallowing a violent dose of arsenic,  or
other poisonous substances.  And if the vomitings and spasms,
arising from these causes,  are found in a multitude of instan-
ces,  to produce general yellowness of skin,  with such excre-
tions, by urine a*nd sweat, as manifest the presence of bile, we
may surely infer that the severe vomitings, which occur in the
Yellow Fever, may produce the like effects, and that they also
may cause the  introduction of  bile into the blood-vessels, and
thus induce the yellow suffusion of the skin under our consid-
eration.   In  like  manner,  temporary jaundice  is  sometimes
found to arise from Spasmodic  colic,* Hysterics, and, as Hal-
ler,! Lind,  and other highly respectable physicians have de-
clared, strong passions of the mind.
   The exception to the yellow  suffusion being generally deriv-
ed from the bile, to which I  lately alluded, refers to those cases
in which the yellowness of skin occurs partially, i. e. in patch-
es or spots, previously to, or shortly after, death, or  in which
the patches are of an  obscure  or dingy hue, and intermixed

not at others, it is not improbable that their  poison is  acquired  by feeding
on certain noxious submarine plants or other substances.   They are said to
be rendered innocent by being laid for some hours in salt-
   * Dr William Saunders,  whose opinions  concerning the origin of the
yellowness of the  skin in the two supposed species of Yellow Fever have
been  lately  stated, attributes the Jaundice, that sometimes follows  the
affections here mentioned, to the same cause which Fontana believed to pro-
duce the yellow suffusion  in  persons bitten  by vipers. "  When Jaundice
has arisen from very acrid  emetics, or griping purgatives, or colic,  or
hysteria, the resistance to the free passage of the bile, is either at the very
extremity of the ductus communis, or during its oblique course through the
substance of the duodenum, at which part it is liable  to compression from
the muscular action of that intestine."—See page 243, of his Treatise on
the Liver.
   • Nascitur enim icterus, et bilis adeo retrograda in sanguinem  refluit plu-
rimas ob causas, quarum aliquze  vix corporese sunt,  ut ex  ira."  " Hue
mxror profundior, terror," &c—Haller Elem. Physiol-  Corp. Human- Tom
vi. p- 592.
   " A violent fit of anger or grief will immediately produce a Jaundice-"—
Lind- page 177, on his Essay on the Diseases of Europeans in Hot Climates. 
56
 with petechia;  the yellowness may,  perhaps, in these instan-
 ces, be produced by a cause  similar to that which  produces
 the yellowness  that follows  Ecchymosis; and  this  cause  is
 probably connected with that particular state of the blood, and
 of the vessels, which occurs in the worst cases" of the disorder,
 and gives rise to Haemorrhages from various parts of the body,
 external and internal.  It seems admitted by all practitioners,
 that these yellow patches on the skin indicate extreme danger;
 but a general yellow suffusion, such as I suppose to arise from
 bile, which is forced into the blood vessel by the  temporary
 compression of the liver, is, according to my own experience,
 and that of many practitioners with whom I have conversed, a
 symptom of little real importance in the Yellow Fever; the bile
 so introduced being in all probability, incapable of doing any
 more  considerable mischief than it is observed to do in those
 cases  of Jaundice,  which  have succeeded  to a* colic, or  a
 strong hysteric fit, &c.   It has, indeed, been associated  with
 extreme danger  in the Yellow Fever,  by most writers on that
 disease, but only, as I believe, because the excessive vomiting,
 which had produced it, had also produced other  more destruc-
 tive effects.

                          DIAGNOSIS.

 Having thus stated, and endeavoured to account for, the prin-
 cipal symptoms of the Yellow Fever, I shall conclude this part
  * When a Jaundice is produced by the affections  here mentioned, it will
gradually  disappear without any aid from medicine ;  if  the  suffusion be
slight, it will vanish in a few days ; but if deep, and approaching to an or-
ange colour, it will generally require from four to six weeks for its removal.
The kidneys seem to  be the principal means by which the bile,  and most
other unnecessary  ingredients, are extracted from the circulating mass, a
portion of bile,  corresponding with the quantity thereof existing in the
blood-vessels, being voided in every discharge of urine.  An infinite number
of remedies are recorded, by which the Jaundice is stated, and was believed,
to have been cured ; and the above explanation may serve to point out the
real degree of their  respective virtues, as well as their modes  of operatbn
in such  cases. 
57
uf my subject with noticing some of the diagnostics, by which
it may be distinguished from the distemper properly called the
Pl-.;gue, and from that fever which is now known, in this counr-
try, by the name of Typhus,—two diseases with which it has,
by some writers, been, even lately, assimilated and confounded.
  The Yellow Fever  prevails only in those countries, and in
those seasons,  in which the heat is,  or  has recently been  so
great as would destroy,  or stop the progress of,  the Plague;
and it is for this reason that the latter disease has never been
known to exist  in intertropical countries, the temperature of
which, however,  is eminently suited to the existence of the
Yellow Fever.   The latter disease is not accompanied with the
glandular and cutaneous affections, called Buboes and Carbun-
cles ; some of which, especially the former, always accompany
the Plague ; for although, patients are sometimes cut off by the
latter disease,  before Buboes appear above the surface of the
adjoining parts, their germs may nevertheless, as I believe, be
always felt, after death,  in the glands near the groin or axilla*
It is true,  indeed, that the parotid glands are occasionally af-
fected in Yellow  Fever; but this is  not a common affection,
and it differs greatly  from the glandular tumours which occur
in the Plague.   The Yellow Fever is moreover, always atten-
ded by a  violent febrile paroxysm:—this is essential to its
character; but it is admitted by several writers on the Plague
and I have myself witnessed the fact, that persons have been
attacked by the latter disease without having the least febrile
affection,—an occurrence which has also been observed in the
Small-Pox, in the Scarlet-Fever, and in the Measles.  Final-
ly, Blacks are  very rarely seized  with the yellow Fever,
and when seized, they  are much less violently affected by it
than Whites living under the same circumstances; but I had
occasion to observe, in Egypt, that Blacks were not at all less
susceptible of the Plague than Whites, and that they died of it
in a far greater proportion.
   Yellow Fever differs from Typhus in the following circum-
stances, viz. it prevails, as I have  already mentioned, only
                             S 
58
 during, or immediately after, very hot seasons, in which Ty-
 phus is soon extinguished; and  it is, in its turn, completely
 extinguished upon the accession of cold weather, in which Ty-
 phus is commonly most prevalent; it attacks most readily and
 most violently the young and robust, over \\ horn  Typhus is
 allowed to have the least power;—it begins with much greater
 exertions  of the living power than Typhus,—is attended with
 many different symptoms, and terminates much sooner;—it is,
 besides, disposed to remit,  and it frequently changes into a
 regular remittent, and sometimes even  into an intermittent
 fever, which true Typhus is never observed to do.  There are
 some other very important circumstances in which the three
 diseases differ from each other, but these  are  reserved  for
 another place.

                        PROGNOSIS.

 Having already stated all that I had to  submit in regard to
 the prognosis in the Yellow Fever, I  must beg permission to
 refer the  reader, who  desires farther information upon that
 subject, to the treatises of former authors.

                       TREATMENT.

 In offering some observations concerning the cure of the Yel-
 low Fever, it is not my intention to recommend any particular
 indiscriminating  mode of treating the disease, in its several
 forms and varieties, being persuaded that none which I could
 devise would be found adequate to all cases  of the disorder;
 but my sole aim will be to point out the general principles by
 which, as  I conceive, the most  urgent symptoms may be  re-
 relieved, and the  violence and fatality of the  fever lessened.

                       BLEEDING.

The  remedy which first presents  itself to our  notice is
bleeding, as being proper only in an early stage of the disease. 
59
 Concerning this evacuation, the most opposite opinions have
 been delivered, some considering it as an indispensable remedy,
 and others alleging that nearly all who were bled  had died.
 The number  of persons  who have  survived, after  copious
 bleeding, in this disease, among whom I may he included, are
 a sufficient proof that this evacuation is not necessarily fatal;
 and, therefore, we can only account for  this  contrariety  of
 opinion,  by supposing that, where bleeding has proved hurt-
 ful, some important mistake must have been made  as to the
 necessity of that evacuation, or as to the quantity of blood re-
 quired to be drawn.
  It has already been observed, that the Yellow Fever, espe-
 cially the violent forms of it, seldom occur among  any other
 persons than  strangers recently arrived from temperate cli-
 mates, the greater part of whom will commonly be found  to
 be young, robust,  and vigorous.—Hence we might  be led, a
priori,  to believe, that these persons would be most liable  to
 that inflammatory disposition, which is well known  to be a
 very frequent  concomitant of the intermittent  and  remittent
 fevers  common in  Europe; but we can have no hesitation  in
regarding the  Yellow Fever as a disorder frequently, in its
first stage, accompanied with a very considerable  degree  of
general inflammation, (a  degree which is,  perhaps,  greater
than occurs in any other  kind of fever)  if we attend to the
leading symptoms  which are visible at the commencement  of
the disease,—I mean the  hard, full, and strong pulse,—the
distressing sense  of universal distension, the  red,  starting,
watery eye, and the parched skin.  Dissections, moreover,  of.
persons, who were victims of this disease, have very generally
exhibited signs of considerable inflammation in various organs,
and especially in the head and stomach. Now experience has
 clearly demonstrated that  general  inflammation  always in-
 creases the duration of the  paroxysm, whenever it supervenes
in a fever of an intermittent or a remittent type,  (as the Yel-
low Fever is) without being  removed, and that  it likewise
augments the  severity of all the febrile symptoms; the consc- 
60
 craertce of which is either that the patient is often destroyed
 during the  paroxysm, though he  might otherwise  have sur-
 vived; or, at least,  that extreme weakness, with all those
 symptoms called putrid,* which are its usual effects,  is more
 speedily induced.  To avoid, therefore, the mischiefs arising
 from  such  superadded  violence, no means appear to me so
 certain or beneficial as bleeding; but, that it may  prove ad-
 vantageous, it ought to be performed copiously ;  and from a
 large orifice,  as early as possible  after general inflammatory
 action is perceived; it being sufficiently ascertained that such
 action is more speedily and completely  subdued by taking
 away  a large quantity of blood  at once, in this manner, than
 by a larger evacuation at two or  more bleedings; and  that,
 although the  patient may be much debilitated at first by the
 former, his strength  will, in the  end,  be less exhausted than
 by the latter.  Those physicians, who have found the  greatest
 benefit from  this remedy in the  Yellow Fever, insist  most
 strongly upon the necessity  of bleeding early, (as within twen-
 ty-four hours, and even twelve if possible, from the attack) to
 the amount of twenty-four or thirty ounces in the more violent
 cases; but in mentioning these quantities, it  is not my inten-
 tion to recommend that all patients should indiscriminately be
 bled to such an extent:  the  necessity of this evacuation, and
 the quantity in which  it is to be  performed, can only be  indi-
 cated by the vigour of the patient's constitution, and  the pre-
 sence of inflammatory symptoms, and their degrees of violence
 and previous duration ;—and doubtless, in  some patients,
 bleeding may be superfluous, or detrimental.
  + It is not uncommon, in hot climates, for the symptoms denoting putri-
dity, to supervene within  two or three days after the commencement of
fever; and this has led several systematic medical writers, the greater part
of whom have never been out of this island, to believe, and assert, that the
fevers of hot climates are usually putrid, and very seldom inflammatory. These
writers, however, seem either not  to have been aware of the violence, and
exhausting nature of the symptoms, which precede the appearances of pu-
tridity, or not to have been acquainted with the true causes of those ap-
pearances. 
61
                        COLD  WATER.

One of the least tolerable  among the  earlier sufferings of
the  patient in  this disorder, is a sensation  of burning heat
through the whole body, which is far from being imaginary,
as bis general  temperature frequently rises four degrees,  or
more, of Farenheifs thermometer, above the natural standard.
Happily we have a remedy for this most uneasy and formidable
symptom,  in  the external use  of cold water,—the safe and
efficacious operation of which has been very ably explained by
the late Dr. Currie.  The modesty  and generous delicacy of
this estimable  man, have led him to do  injustice to himself,
that he might perform what he thought an act of justice to the
supposed discovery of a contemporary writer, from whose prac-
tice, in a distant country, as  reported to him, he  had first de-
rived the idea of employing cold bathing in fevers.  In doing
this, however, he could  not  have been fully acquainted with
the claims which several physicians,  ancient as  well as mo-
dem, had to acknowledgments  of the same nature, for having
recommended,  or mentioned,  the external application of cold,
by bathing, or  otherwise, in febrile disorders ; and especially
Hippocrates,*  who, in  several  parts of his works, has given

  * A multitude of instances might be cited from the works of this great
physician, shewing the extensive use which he made of cold and of warmth,
especially in external applications,  towards the cure or relief of general or
local affections ; but I shall content myself with referring to only a few  such
instances, observing that his practice appears to have been grounded upon the
general principle of restoring the due temperature of parts, by cooling those
which he conceived to be too much  heated,  and of comforting, by warmth,
those which were  either too cold or debilitated ;—a principle which,  after
some experience, I am inclined to consider as the  best practical rule  upon
this subject that he could have followed. And Hippocrates had, in this re-
spect, so judiciously adapted  his practice to the suggestions of nature, as
to have discovered that heating and cooling applications might be usefully
employed, at the same time, with the same  patient, for the purpose of cor-
recting the deficiencies and  excesses, of heat in different parts,  Some pas- 
                                 62

 particular directions for the employment of cold water, which
 are almost as judicious as Dr. Currie's.   If, however, as Mal-
 pighi  says concerning  Harvey, " in  arts and  sciences  he is
 properly to be deemed the discoverer, who, by a proper inves-
 tigation, unravels  nature's  perplexities, and calls  in reason

sages, it is true,  may be found, which seem to contradict the above-mentioned
principle ;  but these are comparatively few, and might justly, perhaps, be
included among the interpolations with which the -writings, commonly as-
cribed to Hippocrates, are, on good grounds, believed to abound.—See the
treatment directed in the disorder termed Distension  of the  Lungs  from
Inflammation, in the third book de Morbis, (page 489. line 29 to 53. of the
edition of the Works of Hippocrates, byFoesius's, printed at Geneva, in 165?;)
in Ilei, also in the third book de Morbis, (page 491, line 34 to 46;) in Cau-
sus, in the book de Affectionibus, (page 518, line 41 to 50;)  in Tertians
and Quartans, (page 520, line 48 ;) in Typhus, in the book de Internis Affec-
tionibus, (page  553, line 25 to 38;)  in Ulcers, in the book de L.quidorum
Usu, (page 426, line 45 to 47.)   See also the Cases, in the fifth book of Epi-
demics, of the woman in Larissa, ill of Puerperal Fever, cured by water very
cold, (page 1144. F.) ana of another woman, who, being in appearance dead,
was  recovered  by throwing thirty amphora of cold water over her,  (page
1153. B. C.)  Hippocrates had likewise successfully employed effusions of
cold water in Tetanus  and  Opisthotonus,—(See the third book de Morbis,
page 491, line 30 to 33,  and the book de Liquidorum Usu, page 427, line 34,
the latter of which two passages  is repeated  in the fifth book of his \pho-
risms, 21. j and even in the Gout, as appears from the twenty-fifth Aphorism
of the last-mentioned book,  and from the book de Affectionibus, (page 524,
line 23,  24.)
  It is not improbable  that Hippocrates borrowed his modes of using cold
water from similar uses, which  he might have observed in the course of his
travels through rude nations, among whom that natural and simple remedv
for excess  of heat was  likely to  be much  employed, especially in Fevers.
The two following passages will prove the existence of a like practice among
very unenlightened people in other and opposite parts of the world.
  The first is taken  from a manuscript letter, (preserved in the library of
the British Museum, and marked in Ascough's catalogue, 4432. 71.) which
was written by Dr. Oliver Coult, at Calcutta, to Dr. Mead, and is dated the
25th of November, 1718.  " I am credibly told, (says Dr. Coult) that, upon
the coast of Sumatra,  Pegu, and Siam, the natives, in fevers of all kinds,
whether continued,  intermitting,  or eruptive, also in diarrhoeas and  slow
dysenteries, wash frequently in the rivers, which are very cool, in the season
of rains," (from June to November.) 
63
 and experience to support, and facts to confirm, what he as-
 serts," then  will Dr.  Currie doubtless be esteemed the dis-
 coverer of this remedy.
   It is only when the heat of the body  is above the  healthy
 standard, that cold water should be applied externally; and
 the patient's feelings will sometimes best direct  how long and
 how frequently the application should be made; but we ought
 always to recollect that, if he should become chilled by it, not
 only mischief may be caused by driving a considerable quan-
 tity of blood from the surface to  the internal parts, especially
 the brain, but also a violent re-action of the system might  be
 produced, winch  could scarcely fail of protracting and aggra-
 vating the paroxysm.
   As the usual modes of applying cold water to the surface of
 the body, viz. by placing the patient in a bathing-tub, filled
 with water, or pouring water over him, or washing him with
 wet sponges, while  sitting on a stool, may sometimes cause
 serious disturbance and fatigue to him, and are often attended
 with difficulty or inconvenience enough to deter both  patient
 and attendants from persisting in their use  for  a sufficient

  The second will be found  in a well-written tract, composed by a Mr*. Bour-
geois, Secretary of the Board of Agriculture at the Cape in St Domingo, in
1755, entitled " Memoire sur les maladies les plus communes a  Saint Do-
mingue ; leurs remedes," &c. and contained in a volume of "Voyages in-
teressans dans differentes colonies Francaises, Espagnoles, Anglaises, &c a
Paris, chez Jean-Francoise  Bastien, 1788."  " L'habitude des Negres qui
veulent guenr des fievres est de se jeter dans l'eau la plus froide, de s'y
baigner, & de se mettre sur  la t€te des herbes fraiches  qu'ils arrachent au
fond des ravines ou des rivieres. J'en ai vu l'essai sur des blancs,  qui con-
venaient que cela leur otait  l'ardeur de la fievre, que le  mal de tete cessait
presque  aussi-tot, & qu'ils se sentaient soulages.  Plusieurs m'ont meme
dit en avoir ete gu€ris. Ces herbes se changeut d'instant en instant, and se
ret 1 rent toujours aussi chaudes que si on les eut fait bouillir: elles procu-
rer  de fortes transpirations, & debarassent surtout la tete.  J'ai eprouve ce
recede sur moi-meme.  Mais pourquoi douterait-on de son efficacite' ? qu'on
se  •ppelle  ce que rapporte Chardin, de la maniere dont la fievre se guerit
en n'if-'ques lieux de l'Onent, ou l'on ne connait d'autre cure, que de se
faire  jeter sur le corps des seanx de l'eau la plus fratche"—P. 483. 
64
 length of time, a safe and useful substitute may be procured,
 by covering the patient, as he lies in bed, with a single sheet
 wetted* with cold water, which, by evaporation, will gradually
 reduce the temperature of his body to a proper standard.
   The addition  proposed by two or three writers  of distilled
 spirit,—as rum,—to the water which is employed as a bath,
 would, indeed, contribute to cool the patient more speedily;
 but it may be disagreeable,  if not injurious, to the patient, to
 inhale the spirituous vapours; and it is probable that the pro-
 Cess of cooling by water only in the management just mention-
 ed will be sufficiently quick  and effectual in most cases.
   Besides  the external application of cold water, there is an-
 other use of  it, I mean the  drinking  of it in small quantities
 frequently, which, as I have good reason to  believe from per-
 sonal observation, will be found of great efficacy, in  moderating
 the excessive heat of the body, as well as the violence of general
 febrile action; also  in disposing the  skin to  perspire gently;
 and in preventing inflammation of the stomach, or diminishing
 and removing it after it has been excited.  The utility of fre-
 quent draughts of the coldest water in the cure of ardent fevers,
 and likewise in various other inflammatory disorders, was very
 generally known among the ancientf physicians, as is evident
   * The mode here proposed of carrying off the superabundant heat  of the
 body in fever, may be used in this country during warm weather ; but, during
 cold weather, if the patient's room be not too much heated,  he may, in ge-
 neral, be sufficiently cooled, by merely diminishing the quantity of his bed-
, covering.
   \ It  is true that these ancients differed among themselves about the proper
 time of administering cold drinks  in fevers ;—Celcus, Galen, and most of the
 other Roman and Greek physicians, deeming it dangerous to administer them
 before the fourth day, or before those appearances, which they regarded as
 the signs of concoction, had taken place ; while the Arabian Physicians gave
 cold drinks in the  beginning, without waiting for such signs ;  the latter
 practice, however, has been proved by more modern experience, to be safe
 as well as advantageous ; we cannot, therefore, wonder that  some sanguine
 physicians should have pushed it  to an extrf me. and emploved it alone in
 the treatment of febrile disorders, as in the  diata aquea of certain Italian
 Physicians.                          • 
65
  fi'om  the writings  of most  of those whose  works have  been
  banded down to us;  and it has been so fully established by the
  experience of many of the most considerable  medical writers
  on the Continent during the last two or three centuries, espe-
  cially in Italy and Spain,  that it  is a matter of no less sur-
  prise than regret, that this beneficial remedy should have been
  so little employed by British* and American physicians in the
  cure of the  Yellow Fever.  It is scarcely  necessary to add,
  that in places where ice or snow is preserved  during  the hot
  season, water-ices, made with acidulous fruits, will be found a
  safe and very pleasant mode of diminishing  febrile heat.

                          PURGATIVES.

  The state of the primse vise likewise demands early attention.
  Costiveness  frequently precedes, and  generally accompanies,
  the Yellow  Fever; and as an accumulation of fsecal matters
  usually  produces morbid  irritability  in  the whole intestinal
  canal, but  more especially in  the  stomach,  and  aggravates
  other  symptoms, it is highly expedient  to employ a cathartic
  without delay.   The medicine, which should be given for this
  end, ought,  for reasons which I shall  immediately explain, to
  be such as will not offend or irritate the stomach by its bulk or
  quality ; and unless there  be considerable determination to the
  head,  the dose ought not to  be very powerful, lest the patient
  should be too much reduced  by excessive evacuations,  and a

    * Dr. John Williams, of Jamaica, and Dr. Rush,  are two of the few exceptions I
  have met with to this remark.—" Large draughts of cold water, (says Dr. W7illiams)
  or other cool liquors, have occasioned profuse  sweats,  when all the sudorificks in the
  shop would not have had the same effect."  He adds,  " I  have often observed that
  those persons who had this  (the Bilious or Yellow) Fever on board of the vessels in
  the harbour, who seldom drank any thing but cold water, no beds to lie on, or clothes
  to cover them, with a free admission of air, frequently recovered "—See pages 16 and
T 27 of « Essays on the Bilious Fever, containing the different  opinions of those eminent
  physicians, John Williams, and Parker Bennet, of Jamaica." London, 1752.
   Dr. Currie has made some useful  observations on cold drinks in the llth chapter of
  vol. i. of his Medical Reports on the Effects of Cold Water,
                                9 
66*
 prolongation of the paroxysm,  or a diarrhoea be  the conse-
 quence.   Calomel,  with   Scammony,  Jalap,  Gamboge,  and
 similar purgatives,  will  best  answer the above purpose; and
 it will  be  proper to  repeat them as may be  requisite, in order
 to  procure  two evacuations  daily during  the  continuance of
 the fever.

                              EMETICS.


 Emetics have  been recommended in the begining of this dis-
 ease by some,  but reprobated, and as I think,  very justly,  by
 other writers,  in no respect  inferior to the former, either in
 discernment or  experience.    My reasons  for condemning the
 use of emetics  are,—first,  that they commonly  fail in their
 principal object of removing nausea, which is very  apt to con-
 tinue,   and  even in a  greater degree  than before; for this
 symptom  rarely proceeds from any load of undigested food,*

  * It is, perhaps, only for the purpose of removing such undigested food, and thereby \
preventing the injurious effects which its continuance in the stomach would occasion,**
that vomiting  can be beneficially employed in the  Yellow Fever; and, in cases of this
 description, the above purpose may be sufficiently  attained, if not by draughts of tepid
water silone, to aid the stomach in discharging its offending contents, at least  by a
moderate  dose of Ipecacuanha, which is a more certain emetic than any of the prepara-
tions of Antimony in use, and is also preferable to the latter for other reasons presently
to be explained.
  The practice of giving emetics in the beginning of fevers, has probably been rendered
 more  general by the opinion first advanced, as I believe, by Sir John Pringle, (See
page 290, of  his Observations on the Diseases of the Army) and afterwards adopted
and maintained by Dr James Lind, who, in his Dissertation on Fevers and Infection,
chap. 2, says, that  " if a person be seized with chills or sickness, after examining a
prisoner, visiting a prison, or being in a crowded Court of Judicature, where prisoners,
suspected of  infection, have been tried, a vomit taken immediately seldom or never
fails to prevent the future  mischief;"—(See page 346 and also 248  and 257, of his
Essay on Preserving the Health of Seamen, second edition ;) but I am persuaded, by
numerous facts which have  fallen under my observation, to be stated  in another part,
that in all the instances adduced by Dr. L'md to support his opinion,- no one of the per-
sons, whom he supposed to have been infected, and to have been  preserved in this
mode from fever, was really infected ; and I am likewise persuaded by other facts, also
 to be stated, that when a person has imbibed a dose of contagion sufficient to produce
fever, a vomit will not oply not prevent, but, on the contrary, assist  its production. 
67
or bile,  or phlegm in the stomach, but seems rather to proceed
from other causes,  such  as  sympathy with the morbid state
of the brain, or of the surface of the body, or else from an in-
flammatory affection of the  coats of the  stomach itself; and
these are causes which emetics have but little power to re-
move.   Secondly, the patient  cannot vomit  without making
violent  efforts, which will exhaust his strength,  increase the
circulation, and propel a large quantity of blood into the head
where it may occasion the  most serious  mischief.  Thirdly>
there is a peculiar tendency in a warm temperature, to render
the stomach  and intestines relaxed,  irritable, and liable to
inflammation ;  hence the great prevalence of Cholera Morbus
and Dysentery, in all countries, towards the end of Summer
and in  Autumn ; and this natural effect of heat is,  in no dis-
ease, more perceptible than in the Yellow Fever, in which a
disposition to vomit is usually a very early symptom,  and one
of  the most difficult to allay, as well as one of the most fatal
if not allayed ;  for  what is properly understood by the term
of  the Black Vomit, rarely occurs except as  the sequel to fre-
quent  vomitings, nor can we be surprised at the remarkable
frequency of this disposition to vomit,  since we learn, from
very numerous dissections, that the stomach is more or less
 inflamed in  most of those who have died of the Yellow Fe-
ver.  Instead,  therefore,  of prescribing emetics in this disor-
der, it soon became my chief anxiety, while attending the sick
in military hospitals, in  the West Indies, to calm the irrita-
tion of  the stomach by every possible means;  and I had full
employment  in this occupation; for  the  greater part of my
patients, in the Yellow Fever,  were persons  to whom emetics
had already been administered before they were  sent into the
hospitals.  The mode which proved most successful towards
effecting this intention, wheu patients, with constant vomiting,
came under  my care, was to give small doses of Opium, as
 half a grain, at intervals, at first of half an hour, and after-
wards of one or two hours; to procure sufficient alvine eva-
cuations, where the bowels had been torpid, by  clysters, and 
68
  also by combining moderate doses of the more powerful purga-
  tives,  as Calomel, Scammony,  Jalap, fcc.  with the Opium,
  such evacuations being highly useful towards checking the
  vomiting, by promoting the natural propulsory  action of the
  stomach and intestines ; to apply a large blister or  sinapism
  over the epigastric region, and to forbid the patient from swal-
  lowing food  of any kind, liquid or solid,  as the presence  of
 even a very small quantity in the stomach always renewed the
 strainings  to vomit.   The patient was,  however,  directed  to
 rinse Ms mouth  frequently with  lemonade, or  some other
 pleasant and acidulated liquid.
   When this treatment had been persisted in for eight, ten,
 or twelve hours, I generally found that the vomiting had sub-
 sided,  and that the patient was able  to retain a  little food,
 which I then allowed him to take, at first in  small portions,  as
 a tea spoonful or two, and gradually* in larger:  and  I  have
 the satisfaction of knowing, that very many persons were en-
 abled to take sufficient nourishment, and in the quantity of half
 a pint  or more at once, within a day or two after this simple
 plan of treatment had been  adopted, and that they finally re-
 covered; when it seemed highly probable  that they would
 have been carried off in the same space of time, if, according
 to the mode which some authors have advised, and many prac-
 titioners have pursued,  I had kept the stomach in a perpetual
 state of irritation, by  forcing the patient,  who had rejected
 one potion, immediately to swallow another, perhaps possess-
 ing even a more stimulating quality than the former, f

  * I have very often found that patients, in the condition here described, were able to
retain, and relished, small quantitieSjOf spruce beer, cooled as much as possible, when
almost every thing else disgusted them, or was rejected by the stomach.
  f Although Dr. Cullen and Dr. George Fordyce, two ofmir greatest modern teach-
ers of medicine, have been partial to the use of emetics, and have recommended them
in the commencement of  Fevers, the weight of their recommendation, so far as it  re-  ■>«$
gardsthe treatment of the Yellow Fever, is considerably lessened by recollecting, that
neither of  them was personally  acquainted with any  but the Fevers of this country*
which are  much less viole't in their symptoms,  and less rapid or dangerous in their
course, than the Fevers of hot climates, and in which it is certain, that emetics are 
                                      69

    Though opium, as I have found, given in the manner  above-
 mentioned, may be  of great service towards putting a stop to


 given with greater safety than  in the latter: yet the following passages  from their
 works will sliow, that both these experienced physicians were aware of the bad effects
 which emetics are capable of producing.
   Cullen.  First lines of the Practice of Physic, paragraph CLXXVIII.  " It is sel-
 dom that vomiting is found to produce a fi :al solution of Fevers ; and, after they are
 once formed, it is commonly necessary to repeat the vomiting several times; but this
 is attended with inconvenience, and sometimes with disadvantage.—The exercise of
 vomiting is often a debilitating power; and therefore, when the vomiting does not re-
 move  the atony and spasm very entirely, it may give occasion to their recurring with
 greater force."
   Fordyce. Third Dissertation on Fever, second part, page 73.  " It happens some-
 times, when an emetic is employed, that, with every precaution, the sickness will con-
 tinue,  and the patient shall  pass a restless and distressing night, more so  than  wouid
 probably happen if no emetic had been exhibited."
   Id.  Fourth  Dissertation on Fever, page 80.  " Preparations of antimony, ipeca-
 cuanha, and other medicines, which produce symptoms similar to those  which take
 place in the ordinary crisis of Fever, and especially Dr. James's powder, have  frequent-
 ly been  employed in this  very violent disease (the Yellow  Fever).   The patient's
 stomach very soon becomes so extremely irritable,  that any dose of such medicines
 which might be expected to be at all efficacious, has produced vomiting ; which, when
 it takes place in any great degree,  has hardly ever been got over, but  has  destroyed
 the patient.'"
   Sir John Pringle was also aware of the disadvantages of emetics in the advanced state
 of Fever.  See page 308 of his Observations on the diseases of the Army.
  Some useful instruction concerning the injuries that may be caused by emetics, and
 particularly by antimonial ones, in the treatment of Fevers,  is to be derived from the
 account given by M. Le Cat, M. D. (and published in  the 49th vol. of the Philosophical
 Transactions, part 1, page 49)  of a " malignant Fever that raged  at Rouen, in the
 winter of 1753-4," where " the havoek it made gave them the reputation throughout
Europe of having the  plague."  This was the contagious Fever to which Dr. Cullen
 has applied the name of Typhus; a disorder, in  a  great measure, peculiar to the
British Isles, and but little known to French physicians; for which reason it appears to
 have been very unsuccessfully treated by them  whenever it has been introduced  into
Brest,  or other ports or towns in France by English prisoners of war.  The treatment
pursued by M. Le Cat on the above occasion was, " after a bleeding or two," a vomit,
the formula of which was " four grains of emetic tartar dissolved in a quart of water,
 the fourth  part of which is given at a time; after this had worked either by vomit or
Stool, another fourth was taken, and so on, till the patient was supposed to have vomited
or purged  enough."  This remedy sometimes produced  " a small flux of five or six
stools a day." and is thereby said to have effected a cure, as it might do. in slight cases;
" but when this success did not follow, the putient was again bled, first in the arm, then
 i« the foot, and every two or three  days there was given some cassia, quickened by an 
                                70
excessive vomiting, ntuch caution  is nevertheless required in
the use of it; for if it be given freely, and in a larger quantity
than is necessary for quieting the stomach, delirium and coma
may be brought on, affections not less to be dreaded than that
which the  opium was  intended to  remove.   And,  indeed,  it
will be found of the greatest consequence, throughout the dis-
ease, to pay unremitting attention to the state of the brain, and
to moderate,  as far as possible, every  action which threatens
mischief to that most important organ.
   If, therefore, the patient  should, after having been suffici-
ently bled, complain  of  very severe pain  in  the head,  or
be delirious,  or comatose, it would be proper to support him
in bed, so  that his head  may be raised,  to  apply a blister at
the  nape of  the neck, or between his shoulders, and to keep
cloths wetted  with  cold  water  wrapped  round  his  head:
and if  these should not have procured  the  desired  relief, to
have the head  shaved, and fix a large  blister over it, by which
emetic, in a decoction of tamarinds."  From vomitings and purgings thus reiterated,
the reader will not be surprised at the following appearances  having been discovered
in the stomach and intestines on examining the bodies of " many" of those who died,
viz. " In some, part of the villous coat of the stomach, and of the small  guts was in-
flamed, and the rest of these organs were filled with an eruption of the miliary crystal-
line kind, except that it was larger/'  " In others, a strong inflammation had seized
the whole stomach, and a small portion of the cesophagus, but the intestines were free."
  In those cases where the delirium had continued long and violent, we  found either
ulceration on the stomach, or its villous coat separated, together with a great inflamma-
tion, and even some gangrenous spots on the other coats of that organ."
   " The manner of recovery from this disease, adds M. le Cat, deserves a place in the
history of it.  There were but few who recovered of it in the usual wav, that is to say,
who only wanted the restoration of their strength, exhausted as well by sickness as by
the medicines.  Almost all of them, even those who had it in the first and second de-
gree, (the mildest degrees) still felt some remains of the  symptoms of the disease ;"
" others who  escaped the mortality of this dangerous poison, carried about with them
for several months and still feel, its terrible effects."
   M. Le Cat appears to have had no  suspicion that the above appearances, and slow
or imperfect recoveries, were the consequences of his mode of treatment; for, in men-
tioning that treatment,  he styles it  " the most successful," which it might have been,
 compared with other modes then in use;  but to have (erroneously) considered them
 •-<s characteristics of an unusual and peculiar distemper. 
71
sleep is frequently soon induced,  and severe pain in the head
greatly mitigated or removed, after other  usual means have
failed.

                       SUDORIFICS.

Sudorific s have, as  well as emetics,  been frequently com-
mended, and employed in the treatment of the Yellow Fever :
I cannot, however, join in this commendation, for the follow-
ing reasons; 1st.  They do not seem to be at all necessary,
because a natural perspiration will  readily ensue  as soon as
the excess of heat above  the standard  of health has been re-
moved, which  'can  be accomplished with  certainty by the
proper application of  cold water to the surface of the body.
2dly.  The means by which a perspiration is to be  excited are
not altogether  innocent.   Small doses of such sudorific medi-
cines as, when given in large quantities, prove emetic, tend to
increase that disposition to vomit, from  which, as I have just
mentioned, the greatest danger is always to be apprehended;
and of this class of sudorifics none are  so detrimental in the
Fevers of hot climates as preparations of  antimony, because,
aided by the natural operation of heat, they usually leave be-
hind them an extreme degree of irritability in the primse viae,
 which but too  often resists all our  endeavours to  appease it.
 Again, if the sudorifics be composed of medicines of the above
class, combined with opium, as Pulvis Ipecacuanhas composi-
 tus,  some share  of that irritability will still be produced,
 though less, indeed,  than in the former case; and  the first
 effects of this combination will generally be a morbid increase
 in the heat of  the body, and a greater determination of  blood
 to the head, which may soon be followed by delirium or coma.
 Moreover, medicines of this description do not always succeed
 in causing perspiration ;  and if they fail in this respect, they
 will probably  produce other effects very injurious to  the pa:
 tient, such as aggravating the existing  symptoms, and length-
 ening the paroxysm. 
72
               PERUVIAN BARK AND CORDIALS.

By the means above-mentioned, joined  with mild febrifuge
remedies, as saline draughts in an  effervescent state,  and  oy
such others as will mitigate the sufferings  of the patient,  we
may confidently hope, either that the termination of the first
paroxysm will also terminate the disease, or at least, that the
brain and the  stomach will  have been so far protected as to
obviate the dangerous consequences of the succeeding stages;
and in this  expectation we  may begin, as  soon as the  febrile
commotion subsides, to administer the Peruvian Bark, in such
form  of preparation,  and in such  quantity, as will  best suit
the state of the stomach,  in  order* to restore that organ to
its proper functions, to strengthen the system, and to prevent
any return of the  Fever.   It  should, however,  be  a rule  not
to give bark in this disorder till the  period just mentioned;
for if it be given when there is a parched skin, a hard pulse, a
dry tongue, great  heat and  pain at the stomach, or delirium,
it will generally he found to increase and prolong these symp-
toms.
   When the patient begins to sink in strength,  lie should be
supported by combining aromatics with the bark, and also by
wine more  or  less  diluted, or even brandy, which is often more
palatable and more easily retained by the stomach than wine;
and these cordials should afterwards he continued, or increas-
ed according to the state of his stomach,  and the degree of his

  * Dr. John Clarke, after a review of the practice in Fevers, as contained in  the
journals of the Surgeons of the different ships in the service of tlte East India Company,
between the years  1770 and 1785, has given the result thereof in the following words,
at page 468 of his valuable work on the diseases of long voyages. " Upon the whole of
the evidence it appears that, when Fevers of any consequence prevailed in the  ships,
either at sea, or at the different stations in India, mortality was al most invariably  the
consequence of bleeding, and the continued use of purgatives and  antimonials.  That
under a cordial regimen, and moderate evacuations, succeeded even by a late use of
the hark, many recovered; and that under the early, liberal, and contimied use of this
medicine, not one instance of death is recorded." 
73
 debility.  If the extremities grow cold, they should be warmed
 by artificial means.

                         MERCURY.

 It will  doubtless he expected that I should speak of saliva-
 tion by  Mercury' in the Yellow Fever,  which some writers
 have so highly extolled; and, indeed, I  should  have done it
 earlier, if the results of my former experience, or a satisfac-
 tory  explanation of its mode of operation, had  relieved me
 from the doubts and difficulties which  I have  felt on this
 subject.
   Dr. Henry Warren, in his " treatise concerning the Malig-
 nant fever in Barbadoes," (for so he  called the Yellow Fever)
 first printed in 1740,  after condemning what he designates as
 ie a very odd, and unwarrantable practice which had obtained
 for many years among several of the plantation practitioners
 in that island,  of giving calomel in Inflammatory  Fevers,"
 says, (at page 36) " I have yet never heard of mercury being
 given in this malady, (Yellow Fever) and I hope I never shall;
 as, no doubt, it  would here act an  uncommon  mischievous
 part."   It was  not then foreseen that,  in the year 1793, a
 medical  practitioner in Grenada would  be found boldly ad-
 ministering mercury in this Aery disease, even so as  to excite
 copious  salivation,  because  he supposed, erroneously,* that
 " the liver was the most diseased part," and had heard of two
 Surgeons of the army who, some years before, gave calomel with
 success in the Yellow Remittent Fever, not indeed to salivate, but
 to produce evacuations btj stool;  and  also, because he thought
 that " it was, at all events, better to  try a doubtful one,  than
 remedies of no efficacy."  Although I should not have thought
 these motives sufficient to warrant an innovation so extraordi-
 nary, yet if it has really preserved even a few of the lives said

  * S<:e pages 351 and -i'J3 of Vol. 1, of Dr. Chisholm's Essay on the Malignant Pesti*
!(ntial Fever, &c.
                             10 
74
  to have been saved thereby, I shall most readily excuse the
  acknowledged " temerity" of that new practice, and sincerely
  rejoice at the practitioner's good  fortune in thus stumbling
  upon an efficacious remedy for a disease commonly productive
  of so much mortality.  I must, however, acknowledge, that I am
 not yet convinced of the supposed benefits of this new practice ;
 for,  should it even be true, as is pretended, that the patients
 labouring under Yellow Fever, in whom a salivation  can be
 excited, generally recover, I  do not perceive that we could
 thence fairly infer, that their recovery was effected by the sali-
 vation. It is well known that, in many cases of that disorder,
 more than 500, and, in some, more than  1000, grains of calo-
 mel  have been given  internally to  a single patient without
 producing any sensible effect on the salivary glands, or even
 on the intestines; and although, to explain this inactivity of
 the mercury, it has been supposed, that in  such cases the ab-
 sorbents alone were in fault by not taking up the mercury,
 this  explanation cannot be admitted,  because the  intestines
 have commonly been as little excited by  the calomel thus in-
 troduced as the salivary glands; and it seems, therefore, pro-
 bable that a general torpor, or defect  of excitability, and of
 vital energy, existed in such patients,* and that the mercury
 proved inefficacious in them  only,  because they had already
 made considerable approaches towards the condition of a dead
 body, in which it is obvious that no quantity of that medicine,
 however large-*could exercise a stimulant power.  If this rea-
 soning be just, there will be room to suspect at least, if not to
 conclude, that, when  patients  die of Yellow Fever, after all
 attempts to excite salivation in them have  failed, their deaths

  * Dr. Chisholm, after mentioning (at page 429 of Vol. 1, of his Essay) that there are
 some habits which, under the influence of disease, resist the action of mercury even
 when more than 2000 grains have been given, while there are others in which saliva-
 tion is excited by less than ten grains, adds, " hence it may not be irrational to conclude,
 that the susceptibility of, or resistance to, the action of mercury in habits, in which ths
 morbid action of the cause of the Malignant Pestilential, and Yellow Remittent Fevers
 has already taken place, are in the direct ratio of their excitability ,•" a conclusion tha
1s in conformity with the explanation which I have above given. 
75
liave resulted, not from the want of any good effect which sali-
vation may be thought capable of producing, but because^.the
condition of their living, or sensorial power, and of the func-
tions depending thereon, had already become so morbid as to
render their recovery impossible;  and, on the other hand, that
where persons have  recovered from the Yellow Fever, after
having been salivated, their recovery was not occasioned by
the salivation, but was the consequence of such a condition of
the powers of life, and of the functions connected therewith,
as induced a mitigation of the disorder, for the same  reason,
and perhaps, cseteris paribus, in the same degree, as it favour*-
ed the operation of mercury upon such persons ; and therefore
that, although recovery has not unfrequently followed, or ac-
companied salivation, the latter was not a cause of the former.
There is, indeed, no source of error more common or produc-
tive,  than that of supposing  an  event which closely follows
another to have been occasioned by it; and it may be doubted,
whether a great number of the advocates for mercurial saliva-
tion in the Yellow Fever have any other, or better, foundation
for their conviction of its efficacy.
   Besides the uncertainties in the operation of mercury, which
depend on the different conditions, or degrees of the general
excitability,  there are  others, arising from certain constitu-
tional peculiarities not well  understood, which give occasion
to excessive salivations by the taking of only  a few grains of
calomel; and this effect constitutes a serious  objection to the
use of mercury, in a disease so rapid and dangerous, without
manifest necessity.
   In order,  however, to attain the truth upon this important
subject, it is not sufficient for us  to discover, that recovery
generally follows salivation in Yellow Fever, though even this
is contradicted by many very respectable authorities; but we
must ascertain  whether those practitioners who excite saliva-
tion in as many of their  patients as may be susceptible of it,
under that disorder, do  in fact lose a smaller proportion of
 them, than those who purposely abstain from all endeavours to 
                               76
  produce that discharge : and on this point I must declare that,
  after some experience, assisted by no  ordinary portion of in-
  quiry and information, I  have not been able to  discover that
  the salivators were more  successful than the others.   And, if
  not more successful,  their practice has certainly been hurtful;
 because, in most of the persons who have recovered, the (per-
 haps  useless) salivation had retarded  the convalescence, and
 produced very troublesome affections of the tongue,  mouth,
 and throat, with other ill consequences ; as is well known and
 acknowledged, even by its advocates.  Dr.  Chisholm (at page
 357, of vol. i. of  his Essay,) warmly acknowledges his "obli-
 gations to Dr. Rush for supporting in a masterly manner,"
 and "pursuing the mercurial mode of treatment," and express-
 es both " admiration and respect" for his " fortitude" in doing
 so.  But Dr. Rush, notwithstanding this support and this for-
 titude, has candidly stated, that " in the City Hospital, (of
 Philadelphia)  where  bleeding was sparingly used and where
 the physicians depended chiefly upon salivation, more than one-
 half died of all the patients who were admitted."—(See page
 128, of vol. v.  of his Medical Inquiries and  Observations.)-—
 But great  as this mortality was,  it fell vastly short  of that
 which occurred in a detachment of the Royal Artillery, placed
 under the  care of Dr. Chisholm, when  of twenty-seven re-
 cruits for that corps, who arrived in Grenada, in July, 1793,
 twenty-six were seized with the Fever, and  of these,* twenty-
 one  died before the middle of  August ensuing, that is, in six
 weeks.   (Seepage 133, of  vol. i. of Dr. Chisholm's Essay.)—
 Upon the subject of this occurrence, Dr. John Hunter has ob-

  * Among the cases given by Dr. Chisholm, in his first Appendix, the four which are
 numbered 9, 13, 14, and 15,  (See pages 371, 383, 386, and 387, of vol. ii.) seem to be
 the cases of four out of the five survivors of the twenty-six men in question ; and it is
 remarkable  that in the two first of those  cases very little mercury was administered,
but the Peruvian Bark,  with some opium, wine, &c  was chiefly relied upon for  the
cure;  and that in  the two last, ho mercury whatever was given.  The twenty-five
cases, therefore, before us, and their results, appear by no means to correspond  with
 Dr. Chisholm's high commendation cf, or professed confidence  in, the mercurial treat-
 ment. 
77
 served, (at page 328, of his  work on the Diseases of the Army
 in Jamaica,) that although   "Dr. Chisholm had satisfied him-
 self of the great virtues of  Mercury, at least four months be-
 fore, yet this is a mortality never exceeded in any Fever."*
   To one  who is sincerely desirous of  discovering and adher-
 ing to the truth,  it is extremely difficult to reconcile, or ac-
 count for,  the very opposite testimonies given on this subject;
 and the doing it would moreover be too invidious for me to at-
 tempt  it.  This, however,   appears certain, that the good ef-
 fects of the  mercurial treatment  have  been greatly exaggera-
 ted  by persons  who either  were deceived,  or were willing to
 deceive others ;  that many persons have died of the Fever in
 question, although mercury, administered externally or inter-
 nally,  had produced a copious salivary discharge ; and that,
 in  very many others who have recovered,  this discharge did
 not beginf until after a solution, or a great mitigation, of  the
 disease had evidently taken place, which solution,  or mitiga-
 tion, therefore, could not have been the effect of salivation.—
 I cannot,  with  an eminent  and respectable  physician,^: who
 treats of this practice, "aver that, although I have been called
 in to attend  many under such circumstances, not one survived,


  • Dr. Chisholm, who was likewise attacked by the same Fever in the same year, was
himself more fortunate ; for though he had recourse, at first, to the same remedy,  he
became convinced of its inefficacr, in his own case, early enough to call for the advice
of Dr. William Munro, then of Grenada, and now of Demerary, under  whose care  he
 recovered, but, as I have been well informed, by a very different mode of treatment.
  Dr. Chisholm, at page 237-9, of his second volume, mentions the great success of the
mercurial treatment in the hands of his former partner in Grenada, Mr. W. Campbell;
yet, as I have been assured from respectable quarters, this gentleman refused to take
Calomel, when he was afterwards attacked by the Yellow Fever, of which he died.
  •J- " Mercury seldom salivated until the fever intermitted or declined.  I saw several
cases in which the salivation came on during the intermission, and went off during  its
exacerbation; and many n which there was no salivation until  the morbid action had
ceased altogether in the blood-vessels, bv the solution of the  fever."—See Dr. Rush's
Account of the Bilious Yellow Fever of Philadelphia, in 1794, in the 4th vol. of his
Medical Inquiries and Observations, page 94
  * See the " Essay o» the Yellow Fever of Jamaica, by David Grant, M. D."
page 51. 
78
 and that they became more victims to the mercury  than even
 to the Fever;" but I can aver, that I had not a few opportuni-
 ties of observing the effects of mercury given in this disease,
 while I served,  in  1796 and  1797, as physician to  the army,
 under Sir  Ralph Abercrombie, in the West Indies; and that
 I  saw nothing, which, to my understanding,  could afford a
 proper encouragement to continue the mercurial practice ; and
 this, I have great reason to believe, may be said of most of
 the other physicians and medical officers, who were then,  or
 have  been subsequently, employed with the British forces in
 the West Indies; and therefore, though  I have adopted no in-
 vincible, nor, as  I hope, unreasonable,  prejudice on the sub-
ject, I cannot venture to recommend the use of mercury  to
 excite salivation in  Yellow Fever,  without farther evidence of
 its utility.   At the same time, I consider the use of it, in this
 disorder, as a purgative, to be highly beneficial.
   Of mercurial  frictions,  which have been largely employed
 in the Yellow Fever, it may also  be observed,  that they do
 not seem likely to prove altogether innocent in those cases in
 which  they may happen to do no good;  for,  besides the sali-
vation which they may  produce,  when  the patient lives long
enough, and which is to be added to the number of his suffer-
ings, already sufficiently abundant,  the very act of rubbing-in
the mercury tends greatly to disturb his  body and mind, when
his only wish is to  remain unmolested;  while the covering a
large portion of the skin with a greasy  ointment produces a
considerable  accumulation of heat therein, by which the gen-
eral  heat  of the body, and with it many of the other febrile
symptoms,  will be increased.
END OF PART FIRST. 
PART  SECOND
Having given some  account of the symptoms and treatment
of the Yellow Fever, it seems expedient, as far as possible, to
ascertain its  cause:  but in attempting to do this, I  find the
natural course and progress of  my inquiry obstructed by cer-
tain doctrines, taught by authorities highly respectable, and
almost generally adopted, though, as I think, without sufficient
evidence; and I  am, therefore,  induced to enter upon a pre-
vious examination  of these doctrines, in order to remove the
obstruction  occasioned  by them, and clear a path which will,
I hope, lead towards the truth.
  To render this examination the more methodical and satis-
factory, I beg leave to propose, for discussion, two problems,
to which the doctrines in question seem to be referable, viz.—
First, Are all fevers naturally  contagious, or capable of ex-
citing fever in other persons not predisposed thereto ?
   Secondly, Can a fever, strictly contagious, be generated by
an accumulation of filth, or  of putrifying, or putrid matters,
or by the crowding of  healthy  persons into confined, or ill-
ventilated, and unclean  places ?
   The  affirmative  of the first of these problems has been as-
serted by Dr. Cleghorn,* Dr. Robert Hamilton,!  Dr. John
Clarke,^ and more especially by the late Dr. George Fordyce.
The last of these authors, in his Dissertation on  Simple Fever,

  * Observations on the Epidemical diseases of Minorca, third edition, page 132, Sec.
  | Observations on Marsh Remittent Fever, page 39, &c.
  * Observations on the Diseases which prevail in Long Voyages to Hot Countries.
vol.i. page 151,  8cc. 
80
 (page 113 and 114, second edit.) endeavours to maintain, that
 " by repeated experience, it is now known  that, although it
 very frequently happens  that  a man coming near  another
 afflicted with fever, is not  afterwards affected with the disease,
 yet of any number of men, one-half of whom go near a person
 ill of this disease, and the other half do not go near a person
 so diseased, a greater number of the  former will he affected
 with fever, than of the latter, in a short period afterwards.  In
 some instances, the proportion is not very different;  in others,
 the author has known seven out- of nine, who went near a per-
 son afflicted with fever, seized with the disease, in the space
 of three weeks  afterwards.  There is, therefore, (adds he) a
 perfect ground, from experience,  for believing, that coming
 near a person afflicted with fever is a  cause  of the disease."
  This  general indiscriminating  assertion, if it were true,
 could only prove that some fevers are contagious,—not that
 all are so.—But the assertion  is  manifestly founded  upon a
 supposed probability, or presumption, that such effects would
 result from the  causes here described;  for no one can believe,
 that an actual experiment was ever made by selecting a cer-
tain number of persons,  and sending  one-half of them into
 close communication with a febrile patient, and  afterwards
 contrasting what happened to these, with the condition of those
 who were not allowed to approach  any person labouring under
fever.  Nor would a single experiment afford  any conviction
on this subject, for reasons too obvious to require explanation.
 Much also would depend on the species of fever to which the
individuals in question are supposed  to  have been exposed,
 which is not mentioned by  Dr. Fordyce.  Few persons, if
 any, doubt of the contagious  quality of what  is called Jail
 Fever, and  few believe that  intermittent fevers possess that
quality.
  The same author, at page 116, inculcates  that " a peculiar
matter is probably generated in the body of a man  in fever,
which, being carried by the atmosphere, and applied to some
part of the body of a person in health, causes a fever to take 
81
]place in him."   This matter having no  sensible properties,
" its existence (says he) is only known by its effect in pro-
ducing the disease."   And in the next page he  asserts, that
" this infectious matter is produced by  all fevers whatever ;"
but immediately adds, that, " as far as he knows, no person
has been seized with fever, in consequence of  coming near
another person  afflicted with it, where  the fever consisted of
one paroxysm only;" and he thereby, in effect, admits that he
has gone beyond his knowledge, and  contradicted his own
uniform experience, in asserting that " this  infectious matter
is produced by all  fevers whatever."  And probably, if he
had examined facts with  sufficient accuracy and caution, he
would have discovered that other fevers,  beside  those  of  one
paroxysm, had  occurred, which were not known to have ever
re-produced fever in any other person.
  In the same page, Dr. Fordyce declares, " that Intermittent
Fevers produce this matter, or, in other  words, are infectious;"
and that he " knows this from his own  observation, as well as
that of others."
   Here again the author seems to have  hazarded an assertion,
for which it  is hardly possible that he could have had  any
certain foundation, because it is now known, as will be more
fully  stated hereafter, that the  ordinary,  and  perhaps  sole
cause  of intermittents, i. e.  Marsh* miasmata, may remain
inactive for several months after having been imbibed by a
person in health, and, finally, produce  fever, notwithstanding
such  long inactivity;  and therefore,  although  Dr. Fordyce
majihave known persons to be attacked by intermittents, after
having communicated with others labouring under that disor-
der, he could  never have  been certain that they had not, with-
in the preceding six  or  eight months been exposed to these

  * I beg to state, in this place, that, in joining the epithet marsh, or marshy, to the
terms miasmata,  exhalations, effluvia, &c. and in considering these as a cause of fever,
I do not mean to intimate that such miasmata, &c. are emitted solely by marshes, (it
being certain that they frequently arise from soils in a different state,) but o.ily to  desig-
nate the quality 4>f those vapours, which are eminently the product of marshy grounds.
                             11 
                            82
miasmasta, existing, as they do, in a variety of unsuspected
places.  He seems, indeed, to have been less confident in re-
gard to these than in regard to other fevers, for he immedi-
ately subjoins the following concession, viz.—" But intermit-
ting fevers  are  not nearly so apt  to produce  it, (the conta-
gious matter,) or at least, to propagate it, as continued fevers;
and the more violent the continued fever is in its febrile symp-
toms, the greater quantity of infectious matter is produced."
  This general assertion of the contagious nature of all fevers
without exception, is so important in the conclusions deduci-
ble from it,  and so much at variance with the general experi-
ence  of mankind,  more especially in  regard to those fevers,
which so  frequently follow any considerable exposure to the
exhalations  of marshy,  or damp,  soils during, or soon after,
very hot seasons, that I  feel it incumbent on me to contest this
assertion;  anil in doing so, I beg  leave  to observe, that the
kinds of evidence, which would be sufficient to produce convic-
tion in a Court of Judicature respecting the ordinary transac-
tions  of our lives,  would often prove fallacious in regard to
medical facts, and especially those which relate to the exist-
ence  and effects  of contagion ;•—the former being cognizable
by some of our senses,  we are enabled to  ascertain and testify
the truth concerning them; but  this rarely happens in regard
to the latter ; of which our belief frequently depends upon sup-
posed causes and effects, whose existence  and relations  are
not capable of being either seen, heard, or felt; and yet men
will frequently imagine  they have seen, heard, or felt, all that
is necessary to warrant their belief; and will, in such ceases,
even  assert  what appears to them to be true as confidently as
if their judgment had not been, in any degree liable to error.
  Hence the works of  medical writers abound with supposed
facts, which are now known to  have been more or less falla-
cious ; and to this source of error, all proofs of the existence'
of contagion are particularly liable;  because the matter,  of
which it consists, is not distinguishable by any of our senses;
and we can, therefore, only presume its existence and agency 
83
by certain effects or events, which may be suspected, but can
hardly ever be absolutely proved, to have resulted from it.—
Aware of this difficulty, Dr. II ay garth has very properly made
adistinction between facts  adduced  to shew the existence of
contagion, from the circumstance  of certain persons having
been attacked by a particular disease, which last he names af-
firmative proofs ; and other facts shewing the non-existence of
contagion, from a number of persons having escaped the disor-
der, who had been fully exposed to the action of effluvia,  sup-
posed to he infected; these he calls negative proofs.   " Obser-
vation,  or experiment," says he, " can determine with much
greater  certainty what does not,  than what does, give infec-
tion ;" whence  he justly concludes, that the negative proof is
 capable  of being established  by incomparably stronger  evi-
 dence than the affirmative, and is therefore, in  all cases, much
 better entitled to credit."*
   Indeed, Dr. Fordyce maintains, page 110, of his first Dis-
 sertation, that, " in treating  of Fevers,  nothing is to be ad-
 mitted as a cause, the knowledge  of the action of which does
 not depend upon experiment;" and he observes, at page 112,
 that, " of the number of causes to which  fever has been ascri-
 bed by the practitioners who have treated of this disease, few
 will bear the  test of any strict  inquiry:"—an observation
 which will I think, hereafter appear applicable to more than
 one of the causes of fever, which  have been supposed by Dr.
 Fordyce himself,  notwithstanding the great merit of his wri-
 tings in many other respects.  If contagion be a quality natu-
 rally belonging to all sorts of fevers, without distinction, they
 ought all to manifest this property in circumstances favourable
 to, and upon persons susceptible of, its action.   That there are
 fevers,  however, which do not manifest this property, or qua-
 lity, in circumstances highly favourable to its operation, and
 upon individuals  who  must have  been fully exposed  to, as

   * See his letter to Professor Waterhouse, at page 296, of his " Plan for exterminat-
 ing the Small Pox." 
                            84
 well as susceptible of, its impressions, if such contagion had
 existed, may be demonstrated by hundreds, and probably by
 thousands, of well-authenticated facts, capable of infinitely
 overbalancing  the supposed evidence derived from occurren-
 ces, in most of which it was easy to mistake, for the effects of
 personal contagion, those produced by morbid causes existing
 in the atmosphere, and derived from very different sources.
  It will,  however, be sufficient to adduce a few only of these
 facts at present, especially as I shall have  occasion hereafter
 to mention a variety of others, of similar import, though for a
 different purpose.
  Dr. James Lind, in his Essay on the Diseases incidental to
 Europeans in Hot Climates,  (p. 27,  fifth edition,) states the
following fact,—viz.
  " In the month of August, 1758, Admiral Broderick, in the
 Prince ship of war, anchored in the Bay of Oristane, (in Sar-
 dinia)  where  twenty-seven of his men,  sent ashore on  duty,
were  seized  with the epidemical distemper  of this  island;
 twelve of them in particular, who had slept on  shore, were
brought on board delirious; all of them laboured under a low
fever,  attended with great oppression on  the breast,  and at
the pit of the stomach,—a constant retching, and sometimes a
vomiting of bile, upon which a delirium often ensued.   Those,
fevers changed into Double Tertians, and afterwards termina-
 ted in obstinate Quartan Agues.  It is worthy of remark, that
 in this ship,  which lay only two miles distant from the land,
 none were taken ill but such  as  had been on shore, of whom
 seven died."
  The same  respectable  author, at page  221,  mentions ano-
 ther similar fact in the following terms,—viz.
  " In  a  voyage to the Coast of Guinea,  performed  in the
 year 1766, by the Phoenix ship of war, of forty guns, the offi-
 cers and ship's company  were perfectly healthy,  till, on their
 return home,  they touched at the Island of  St. Thomas.—
 Here  the  captain,  unfortunately, went on shore, to spend a
 few days in a house belonging to the Portuguese governor  of 
85
that island.  This happened during the rainy, or sickly, sea-
son.  In the same house were lodged the captain's  brother,
the surgeon, some midshipmen,  and the captain's servants.—
But in a few days after their being on shore, the captain, his bro-
ther the surgeon, and every one, to the number of seven, who had
slept in that house, were taken ill; and all of them died except
one, who returned to England in a very ill state of health.—
The ship lay at anchor there twenty-seven days, during which
time three  midshipmen,  five men,  and  a boy, remained on
shore, for twelve nights,  to guard the water casks, under pre-
tence that the islanders would steal them; all of  whom were
likewise  taken ill,  and two of them only escaped  with life.—
At that island, only those who slept on shore were taken ill; no
other man of  the ship's company was seized with  any distem-
per during their stay there.  Even during the whole voyage,
if we except these  unfortunate persons,  only one man died,
and he  was  killed by an accidental  blow upon the head—
None of  those who slept on shore escaped the sickness, and
of them only three survived it."  And, at page 225, he adds,
"In the year following,  the Phcenix made another voyage to
the Coast of Guinea, and happened again to touch at this isl-
and in the sickly season,  where she lost eight men out of ten,
who had impri'dently remained  all night on shore.  At the
same time,  the rest of the ship's company continued in perfect
health, who, after  spending the greatest part of the day on
shore,  always returned to their  ship before night.  On board
the Hound sloop, then in company with her, only one man
died during the whole voyage; the  officers having  been  parti-
cularly careful not to permit any of the people to  continue all
night on  shore in that place.  This man was cut off by an ob-
stinate intermitting fever, with which he had  been first seized
at Sheerness."
   The same  author, in his " Essay on the most effectual
means of preserving the health  of Seamen," had previously
observed, at page 57,  "that the fever of the Island of St.
Thomas, is, to a proverb, in that part of the world?  deemed 
86
the most malignant and fatal species of  any African or Ame-
rican Fever ;"* and consequently,  if Dr. Fordyt-c's doctrine
were true,  that all fevers  are more contagious  according as
their  symptoms are more violent,  this fever ought to have
been  communicated to great numbers on board  the Phoenix,
whose intercourse with the  sick  in that ship must have been
sufficiently near and frequent.   The same want  of contagion
has, however, attended this fever on other, and,  so far as I
know, on all other occasions.
  Dr. Trotter,  late physician to the Royal Navy says, (See
Medicina Nautica, vol. i. page 456,)  " In a voyage down the
Coast of Guinea, in the Assistance, in the year 1762, we had
scarcely a man indisposed.  We wooded  and watered at the
Island of St. Thomas, and  with  a view to expedition, a tent
was erected on shore,  in which the people  employed on these
services were  lodged during the night.  On the middle pas-
sage, every man who slept on shore died, and the rest of the
ship's company remained remarkably healthy."
   Of a similar nature are the facts which occurred in regard to
the Ponsborne and Nottingham East Indiamen,  at the Como-
ra Islands; (See Medical Observations  and Inquiries, vol. iv.
page 156,) atone of these islands, viz.  Mohilla, a great part
of the crew of the former ship,  after sleeping on shore in  Au-
gust, 1765, were attacked by a violent  fever, which, in a few
weeks, proved fatal to more than seventy of them ; and, on the
 16th of July of the following year, the Nottingham having an-
 chored to the leeward of Johanna, (another of the Comora Isl-
 ands,)  and a considerable part of her  crew having been sent,
 and allowed to sleep, on shore, they were attacked, soon after
 the ship had put to sea, by  a severe remitting fever, of which

  * Of the Island of St. Thomas, Dr. Robertson, Physician to Greenwich Hospital,
observbs, page 32, of his Meteorological and Physical  Observations, &c. 4to. that " the
 town is built on the leeward-most part of the island,  which is not at all cleared of the
 woods, nor the marsh drained ; the consequence of which is, it is generally peopled
 frot>. Portugal every second year, it proves so fatal to Europeans."  For another proof
 of the danger of sleeping on shore on that island, see pages 33 anil 98 of the same work. 
87
 several died.   Of this fever, Dr. Badenoch, then surgeon of
 the  Nottingham, observes,"it infected only those that slept on
 shore, and having gone through them, the fever ceased."  And
 this  he adds, " was  likewise the case with those on board the
 Fonsborne, in regard to the Bilious Fever,  which prevailed in
 that ship, at the island of Mohilla."
   A similar occurrence is related by Dr. John Clark,  in  the
 first volume of his Observations on the Diseases which prevail
 in Long Voyages to Hot Countries, page 124;  after descri-
 bing the low place, " covered with impenetrable mangroves,"
 at North Island, near the Streights of Sunda, where most of
 the East India ships take in  wood and water  for their home*
 ward voyage, he adds, that " a Danish ship, in 1768, anchor-
 ed at this Island, and sent twelve of her people on shore to fill
 water, where they only  remained two nights.  Every  one of
 them were seized with a fever,  of which  none recovered ; but
 although the ship went out to sea, none, except the twelve who
 slept on shore, were  attacked  with  the complaint."   Here
 again was a fever so violent as  to kill every one in whom it
 was excited, and from a cause so powerful as to affect every
 one who was exposed to  it,  which,  notwithstanding, did  not
 reproduce itself in a single instance.
  Many facts and occurrences, of a similar nature, might ea-
 sily be added to the preceding; but they are all rendered su-
 perfluous by the notorious and unfortunate events, which have
 recently happened among the British officers and soldiers em-
 ployed in Zealand, among whom, though near thirty thousand
 of them were attacked by fever, which proved  fatal to nearly
 one-sixth of the whole number of sick, I have  not been able,
 after much inquiry, to discover a single case,  in which there
 has been reason to suppose,  that any one  person caught  the
 fever from  another.  But,  on the contrary, it appears to he
 the  unanimous  opinion of  the army physicians employed on
 that service, (with most of whom I have conversed on tlic sub-
 ject,) and also of the other medical officers, best qualified to
judge of such matters, that no contagious quality accompanied 
                           88
tiie fever in question, either upon the island  of  Walchercu,
or among the sick removed to this  country. And  I shall
hereafter  adduce the  most convincing evidence,  that in fact,
these fevers were not of a contagious nature; and we may,
therefore, consider ourselves  as  abundantly warranted in
concluding, that all fevers are not endowed with a contagious
quality, which conclusion is all that I propose to establish at
present.
  Problem II.   Can a Fever, strictly contagious be generated
by an accumulation of filth, or of putrefying,  or putrid, mat-
ters,  or by the crowding of healthy persons into  confined, or
ill-ventilated, and unclean places ?
  Most writers on the subject of Contagious Fever have ei-
ther inculcated or believed, that it might be generated,—first by
an accumulation of those disgusting  matters, commonly de-
nominated filth ;—secondly, by the offensive vapours  emitted
by  corrupting dead bodies, or by other matters in  a putrid
state;—and, thirdly, by crowding persons,  even when heal-
thy, in ill-ventilated and unclean places.
  I have no desire to weaken any of the prejudices which  tend
to promote  cleanliness in civilized nations, any further  than
is absolutely necessary for the manifestation of truth,  on a
question of  great importance to mankind ;  and  I flatter my-
self that we shall all find within ourselves  sufficient  motives
to  remove or avoid  filthiness, even when convinced that it
does not produce  contagious fever.  Whence the belief of its
doing so was derived, I am unable to explain; but it has pro-
bably been confirmed by the frequent co-incidence of  such fe-
 ver,  with  nastiness  and offensive  smells in  the dwellings of
 indigent people.  There is, however, no necessary, or natural
 connexion between the former and the latter.
   Dr. Fordyce asserts, (first Dissertation,  page 115,) that he
 has known persons to be ill of the most infectious fevers, and
 to communicate fevers to others by infection,  when there was
 no peculiar  smell nor taste, nor  any thing perceptible to the
 senses in the atmosphere  surrounding them; and similar as* 
89
scrtions have been made by Dr. Lind, and others, which I be-
lieve, are in conformity with the experience of all physicians.
I know, indeed, that masses of animal and vegetable matters,
and  especially the former,  while undergoing putrefaction,  or
other modes of decomposition, as in privies, &c. may give out
vapours  so condensed and noxious as to cause asphyxia, and
sometimes almost immediate  death, to those  by whom they
are inspired.  But  such mischiefs have no relation to fever;
nor are those who recover from them, afterwards affected,  in
consequence  thereof, by any  febrile disorder.  This is also
true of the dangerous, and often fatal,  effects produced by the
fumes of charcoal,  and the mephitism of mines, long-neglect-
ed w ells,  &c. which are not known to  have ever produced  fe-
ver ; these do not however, properly relate to our present in-
quiry.
  Every thing which I have been able to discover,  or ascer-
tain,  respecting the nature and properties of  contagion,  in-
duces me to   consider each of its several species as a  peculiar
morbid quality, or power, imparted to certain  animal  secre-
tions, in consequence of some particular, though unknown, ac-
tions excited in the living body, when  actually disordered, by
the very  same species of contagion previously,  and in like
manner, elaborated in another body, whilst labouring under a
similar disorder from a similar cause;  and therefore, though
we are unacquainted with the origin of any one species of con-
tagion, yet, considering  the properties   manifested by all,
ever  since they have been known to exist,  we  may conclude,
that being thus produced, exclusively by,  and within, the liv-
ing body, each is capable of exciting,  in other living bodies,
the same morbid action, or disease,  which occasioned its own
production,  and of thus maintaining  and propagating  itself in-
definitely ; and consequently, that though contagion be a mor-
bid and morbific  secretion or production,  it is also a natural
one, wholly, inimitable,  either by accident or art.  If this be
true, it must follow that, though noxious vapours should result
from those fortuitous, and ever varying, collections oi unclean
                             12 
                            90
 or putrefying matters commonly denominated filth,  which, as
 in the instance of marsh effluvia, may produce diseases, inclu-
 ding fever, vet the diseases  so produced will be incapable oi
 exciting simi'lar diseases in other persons,  and will, therefore
 be  destitute  of  the most essential property of contagion.
  Indeed,  if it were true that vegetable or animal matters,
'while decomposing or putrefying, could de novo generate con-
 tagion properly so called, the species or varieties of contagion
 ought necessarily to have become  as numerous and various as
 the matters so  decomposing, and  also as various as their re-
 lative proportions ;—every dunghill, every collection of  rub-
 bish and filth,  ought to be capable of generating the cause of
 a new disease, and that disease ought to be capable of repro-
 ducing itself in other persons ; and human existence, with  such
 additions  to the other dangers which surround us,  ought to
 have become the most precarious, transient, and deplorable,
 of all the works of creation.
   No  person,  who is even moderately acquainted with the
 subject, can believe that a  disorder resembling Small Pox,
 (for instance,) and possessed of the  same properties,  could be
 created by any accidental collection,  or even by the most ar-
 tificial and scientific  combination,  of either organic or inor-
 ganic matters,  not impregnated by the specific contagion of
 that disease.   On the contrary, we have the strongest reason
 to believe  that neither human ingenuity, nor any co-operation
 of natural means, could even alter the nature of variolous con-
 tagion ; and that, in fact, it has continued,  without any last-
 ing  change  in its properties, ever since that unknown sera
 when its  morbid  action was first exerted upon mankind;
 though, having been successively transmitted through the bo-
 dies of, perhaps, several hundred thousands of individuals  of
 different   colours and temperaments,  many  of them probably
 contaminated at the same time by scrophula, syphilis, cancer,
 or   other  morbid taints, or infections,  (and  this, during the
 prevalence  of numerous ep:domical or  pestilent  diseases,)
 these ought, if any thing could, to have produced every de- 
91
gree of deterioration, of which the original virus was suscepti-
ble, and some permanent varieties, at least  in this species of
contagion.*  We  know, however,  that its specific properties
are invariably the same, and that the differences which are ob-
served in  its effects, depend  upon causes connected  with the
individuals to whom it is  respectively applied;  the disease,
cseteris  paribus,  proving no worse,  when   communicated by
one  dying of  it  in  the  most confluent  and malignant  form
than it would have been,f if communicated by one recovering
from the mildest product of inoculation.   And we have  simi-
lar reasons  for  believing that  Measles, Chicken  Pox, and
other specific contagions, are equally permanent and unaltera-
ble.   If then  the powers of life,  and the  organs  by which


  * Dr. Adams, physician to the Small Pox Hospital, observes, at page 21 of his work
on morbid poisons, in 4to. that,  from  the great affinity, or analogy between the vario*
Ions and vaccine  contagions, " we might even expect that the characters ot the two
might be altered, by applying both at  the same time, and also that the  phenomena of
one might imitate the phenomena of the other, in such a manner as to render the dis-
tinction between them doubtful.   It is, therefore, a matter of  surprise, that the distinc-
tion should be so regularly observed, and the laws which separate other morbid poisons
be so rarely infringed."
  He also remarks, at page 398, that " Small Pox and Cow Pox, contrary to the law of
all morbid poisons, which are different in their nature, will  proceed together in the
same person without the smallest interruption of each other's course.  If  inserted
nearly at the same time in the same person,  each proceeds  in the same course as if
they were in two distinct subjects; if inserted nearly in  the same spot, the two form
one common areola, but the vesications are distinct, and each  preserves its own charac*
ter till that of Small Pox becomes purulent from suppuration," Sec.  In this case, he
adds, " you may take Small Pox matter from the pustule, which, by the adhesive  in-
flammation, will  remain distinct from, though seated in part of the Vaccine Vesicle;
and from the  other parts of the Vesicle you may take vaccine matter, and each will
perpetuate its respective morbid poison."
  Thus we find that, by the simultaneous association of two infections, so nearly alike,
that the action of the one renders the body insusceptible to the  action of the other, the
energies of the constitution cannot produce even an intermediate, or hybrid contagion.
   f At page 10, vol. i. of the Transactions of a Society for improving Medical and Chi-
rurgical knowledge, Dr. G. Fordyce says, « I have the greatest reason to believe, that
it is not of the smallest consequence, (in inoculation) whether the matter be of the mild
or the confluent kind.  I never  knew of an instance of any other disease beiDg eoiamu
sweated by inoculation of the Small Pox." 
                           d2
 these contagions are successively renewed and perpetuated,
 cannot ev.n alter the qualities or effects of the latter, by any
 of the changes which may be supposed to have taken place in
 their actions and in the fluids of the human body, from a  va-
 riety of morbid, and other,  causes excited in so many differ-
 ent individuals,  it is credible, that putrefaction,  which is but
 a natural separation of organised matters, previously held
 together only by animal or vegetable life, should be capable of
generating a new contagion ? Such matters spontaneously de-
 composing,   and returning to their natural inorganic  and
 harmless combinations, necessarily obey their respective che-
 mical attractions; and the products resulting from this sort of
 obedience are as certain and constant as the formation of Sea-
 salt, by combining  soda with  muriatic acid.  There is no
 chance, therefore, nor even possibility, of thus generating  any
 thing so wonderful,  and so immutable, as contagion, which,
 resembling animals and vegetables in the faculty of propaga-
ting itself, must,  like them, have been the original work of
 our common Creator, and must have been  continued in exist-
 ence by the energies  of a living principle, exerted successively
in the different bodies, through which it has been transmitted
from one generation to  another.  As well might w~e revive the
 for-ever  exploded doctrine of equivocal generation, and be-
 lieve, as formerly, that insects, reptiles, &c. are the offsprings
 of mere  corruption,  as to believe that a substance so analo-
 gous to them, in that most mysterious and essential function
 of self-propagation,  could originate  from that cause, or form
 any  operation of chemical agencies alone.
  As this reasoning, however, may not of itself produce gene-
 ral conviction, especially on strongly prejudiced minds, let us
recur to matters of fact, and let these decide whether, in re-
ality, any, and  more especially a febrile, contagion has been
produced  by putrefaction.   In former ages, when ignorance
and credulity, which  always accompany each other, were pre-
valent,  many surprising aad alarming stories were reported,
and believed, of widely-spreading diseases  produced by  this 
93
cause, and more especially by the putrefaction of animal sub-
stances.  Fortunately, the truth, or falsehood, of such reports
may be easily ascertained by facts within our own knowledge;
for, as the same causes, cseteris paribus, must always produce
similar effects,  we have  a right to expect that,  if putrefying
carcasses, fish, &c. were ever able to generate contagious,  or
other, fevers,  they should still be  able to  do  it,  especially
when collected in the largest masses, and when the impres-
sions, to be made by their  effluvia, are assisted by the most
favourable circumstances.
  Many writers of celebrity, and among them the great Lord
Bacon,  have thought that no effluvia were so infectious, and
pernicious to mankind, as those which issue from putrefying
human bodies;  and, although a century and a half has elapsed
since  Diemerbroeck* attempted to  convince  physicians that,
at least, such effluvia could not produce the Plague, yet the
old opinion has kept its ground; and it is still believed, that,
in their milder state, they  may cause putrid fevers,  and in
their  more concentrated state,  a true pestilence.   There are
facts, however, on  a large scale,  which completely decide
this question :—two of these deserve particular notice.—The
first relates to the exhumations made in the church-yard  of
»S7. Eloi,  at  Dunkirk, in the year 1783;  and the other to
those made  three years afterwards,  in  the  church-yard  of
the Saints  Innoccns, at Paris.  As the undertakings  and
results  were similar in  both instances, I shall, to avoid  re-
petition,  here  describe  only the  latter, which I  have pre-
ferred,  because the corpses here  taken up were  much more
numerous than at  Dunkirk,  and  probably constituted  the
greatest mass of  putrefying  animal  matter,  of  which  we
have  any  accurate information.    The  church-yard  of  the
Saints  Innocens,  at Paris, situated in one  of the most  po-
pulous  quarters of the city, had been made the  depository
of  so many bodies, that,  although  its area enclosed more
* Tractatus de Peste, Lib. I. Cap. viii. p. 41 
94
 than  1700 square toises,  or  near  two  acres,  yet  the soil
 had  been  raised by  them  eight or  ten feet higher  than the
 level  of  the adjoining  streets;  and  upon  the  most mode-
 rate calculation, considerably more than six hundred thousand
 bodies had been buried  in  it,  during  the last  six centuries;
 previous to which  date,  it was  already  a very  ancient burial
 ground.*   Numerous complaints having been made  concern-
 ing the offensive smells,  which arose from this spot, and some-
 times penetrated into  the  adjoining houses,f  and the public
 mind  being greatly  alarmed, it was  at last  determined  to
 forbid all future burials  there, and to  remove so  much of the
 superstratum as would reduce the surface to the  level of the
 streets.  This work  was undertaken in 1786, under the super-
 intendance of M. Thouret, a physician  of eminence in Paris,
 and in two years he  accomplished the  removal  of that super-
 stratum, almost the whole  of which was impregnated, or in-
 fected, as M. Thouret styles it, with the remains  of carcasses,
 and of quantities  of filth and  ordure,  thrown upon it  from
 the adjoining houses.

  * In less than 30 years,  more than 90,090 corpses had been deposited here  by the
last grave-digger.  The poor inhabitants were buried in coffins made of very thin deal
boards, and were regularly stowed as closely as possible, upon and beside each other,
in large pits about thirty feet deep, and capable of receiving each from twelve to fifteen
hundred coffins.  These pits were gradually filled with coffins, and then covered over
with earth about one foot in depth, and the bodies  left to  putrefy.  But as the same
space was commonly wanted in fifteen or twenty years for other bodies, this mass of
animal corruption  was then dug up, and a like number of recent corpses deposited in
the same pit; and this operation was  successively repeated through nearly the whole
extent of the church-yard, from  generation to generation, until the earth itself  had
been so completely supersaturated with human putrefaction, as to have no longer  any
action, or decomposing influence,  upon bodies buried therein.
  + According to a Memoire on this subject, read at the Royal Academy of Sciences,
by M.Cadet de Vaux, in the year 1781, " Le mephitisme qui s'etoit degage d'une des
fosses voisines du  cimetiere, avoit infecte toutes les caves: on comparoit aux poisons
les plus subtils, a ceux, dont les Sauvages impregnent leur fleches  meurtrieres, la terri-
ble activite de cette emanation.  Les murs baignes de l'humidite dont elle les pene-
troit, pouvoit communiquer,  disoit on, par le seul attouchement, les accidens  les plus
redoubtables."----See " Memoires de la Societe Royale de Medecine," torn,  viii-
p. 242;  also Annales de Chimie, torn. v. p.  158. 
$5
  " The exhumations," says this gentleman, (in the narrative
of them* which he published in the Journal de Physique, for
1791, page 253) " were principally executed during the Win-
tei', but a considerable  part of  them  was also carried  on
during the greatest heats of  Summer.  They were begun with
every  possible care, and with every known precaution; but
they were afterwards continued, almost for the wJwle period
of  the  operations, without employing, it may be said,  any
precaution whatever;  yet no  danger  manifested itself in the
whole course of our labours,—no accident occurred to disturb
the public tranquillity."*  This account is authentic,—and
was read  before the Royal Academy of Sciences at Paris.   Ii
is  moreover confirmed  by  the  report  of M.  Fourcroy, who
was joined  in this commission with  M. Thouret for certain
chemical objects, which report was also read at the Academy,
and is printed in the sixth  volume of the Annates de Chimie.
If  this result from taking up nearly twenty thousand bodies,
in different stages of putrefaction, be insufficient alone for my
 purpose, there is another almost equally conclusive in its na-
 ture and extent.
    It is well known that M. Berthe,  Professor in the School
 of Medicine, at Montpellier, and two of his colleagues in that
 University,  were  sent,  by the  government of France, into
 Spain, to examine, and report upon,  the nature of the Yellow
 Fever, which had proved so fatal in several towns of Anda-
 lusia,  in  1800.   M. Berthe has published  the report of the

  * It does not appear, after the fullest inquiry, that any febrile disorder was ever
produced by this immense mass of corruption, during the removals made in 1786, &c.
 or while it was suffered to remain as a burying ground.  The grave diggers were, in-
deed, sometimes thrown down suddenly, and, for a time, deprived of sense and motion,
 (as in what is termed Asphyxia,) by the concentrated vapours which escaped, upon
 accidentally breaking open, by their spades, the abdominal viscera of bodies, in an early
 stage of putrefaction.  These vapours also, in a more diffused state, are said to have
 sometimes produced nausea, loss of appetite, and, in a course of years, paleness of
 countenance, debility, tremors, &c.  But fever of any kind, and much less contagious
fever, does not appear to have been noticed,  as resulting from the offensive, or putrid
 matters of this church yard, either to the grave diggers, or to the neighbouring inhabi-
 tants.*—'See Annales de Chimie, torn. v. p. 154, &c 
90
  commission, of which he was a member, and in it has men-
  tioned  that, being at Seville  only a  few months after the
  epidemic had ceased, he frequently visited the burying places
  just without the  city,  in  which the victims  of the fever had
  been interred; that, in these excursions, he  was accompanied
  by the French  Consul at that city, and had  occasion to con-
  verse much  with the  guards stationed at these places, and
  with the grave-diggers still employed in them: and he states,
  that, besides these, many thousands of the inhabitants of Se-
  ville also came thither, some  from  curiosity,  and others in
  processions, to testify their sorrow and respect for their de-
  parted  friends.   In one of these grounds, south-westward of
  the city, ten thousand bodies had been buried; in two others
  seven or  eight thousand; and in that of Triana about four
  thousand.
    "The heats of the Spring," says M. Berthe, (which, I need
  not observe, are considerable at Seville) " were, at this time,
  beginning to he felt, and  the ground of these burial places,
  being clayey, was already cracked  into wide  and deep cre-
  vices, through which a foetid odour was exhaled, the  result of
  the decomposition which was going on among  these  heaps of
  bodies."*
    Filled with  alarm  at  the calamities which  might be pro-
  duced by  such masses  of putrefaction, M. Berthe,  and  his
  colleagues, represented these supposed dangers to the Spanish
  government; and then went to Cadiz, where they found  the
  churches more or less filled with  putrid emanations  from  the
  same cause: but as they did not discover that these supposed
  fomites of infection  were productive  of  any mischief,  their
  fears concerning them seem at length  to  have subsided com-
  pletely ; for, in their reply to the President and  Members of
  the Board  of Health, who had requested  a  statement of their
  opinions,  they  expressly declare  their belief, that  " if  the
  Yellow Fever could he produced  by the effluvia arising from
   * See pa^e 28 of " Precis Historique de la Maladie qui a  regn.6 dans I'Andalousie,
'  en 1800, par I. N. Berthe, Professour de I'ecole de Medecine de Montpellier," &c 
97
putrefying bodies, it was evident that such a misfortune must
already have taken  place, through  the  imperfect manner in
which  the tombs and vaults, pointed out by them,  had been
closed,—a defect which they had observed even in the church-
es that they were most frequented."*   Thus it appears that
the putrid emanations from the bodies of many thousand per-
sons, who had recently died of the Yellow Fever, did not, and
therefore could not, produce that disorder.
   To the preceding facts I may add another, which is related
by a man whose veracity is as little to  be questioned,  as  his
exalted philanthropy,—I mean John Howard, in his work on
Lazarettos, page 25.
   " The governor, at the French Hospital  at Smyrna,  told
me, (says Mr. Howard) that, in the last dreadful plague there,
his house was rendered almost intolerable by an  offensive
scent,  especially if he opened any of  those windows which
looked toward the great burying ground, where numbers were
left, every day, unburied; but that it had no effect on  the
health of himself or his family.  An opulent merchant, in this
city, adds he, likewise told me that he  and his family had felt
the same inconvenience without any bad consequences."
   If the exhalations from piles  of bodies  destroyed by  the
plague itself, and corrupting in the open air, were thus inca-
pable of generating the contagion either of fever or of plague,
even during the prevalence of a pestilential constitution of the
atmosphere, (if any state of the atmosphere ever deserved that
title) it may, I think, be safely affirmed, that there are no cir-
cumstances under which putrid animal matter can be supposed
ever to produce febrile contagion.
   I have now before me  a great number of similar facts, well
authenticated; but  those which I have just stated will, proba-
bly, suffice to convince most of my  readers,  that if putrefying
animal matters are  not completely harmless,  they are,  at
least, innocent of the charge of  producing contagious fevers;

            • •  * See  page 331 of M. Berthe's work,
                            13 
98
 and, therefore, I shall content myself with referring those who
 may desire further evidence on this point, to Appendix, No. 2,
 where they will, I believe, find rather a  redundancy,  than  a
 deficiency, of such proofs.
   Whatever variety of sentiment  may have been  entertained
 with respect to the supposed generation of infection  by  filth,
 or by putrefying bodies, it appears to have long been an uni-
 versal opinion, at  least  among those who have admitted the
 existence of  any infectious fevers, that, to  use  the words of
 Dr.  Cullen,  (first  lines of the Practice of Physic,  Sec. lxxxi.)
 " the effluvia constantly arising from the human body, if long
 retained in the same place, without  being diffused in the at-
 mosphere,  acquire  a singular virulence; and  in that state,
 being applied to the bodies of men, they become the  cause of
 a fever, which is highly contagious."
   This opinion is  become so familiar, that few  persons hesitate
 to adopt it,  however difficult it  be  to comprehend  by  what
 means these  effluvia can acquire  such contagious properties.*

  * Dr. Chisholm, in his  Essay on the Malignant Pestilential Fever, kc.  page 281, of
vol. i. includes, among the causes of that disease, " the product of animal substances
of every description, deprived of life, and in a state of putrefaction, which, exhaling
azote and oxygene chemically combined, and diffusing through the atmosphere to a
certain extent the basis  of pestilential infection,  are equally capable of producing
contagious and pestilential diseases."  The same author has again  recently delivered
this doctrine in several parts of his  letter to Dr. Haygarth, (8vo.  1809,) particularly
at page 133, where he mentions,  as  a  " most important fact in medical  physics,
that the vapour, or exhalation, arising from animal  matter, accumulated in a  putrid
state, and rendered stationary by the  neglect of ventilation, is universally  the cause of
the fever of infection,—the Typhis, which annually diminishes the population of thesrf
cities," &c.  "The same causes,  (he adds,) probably gave origin to the Plague:'
Ver> soon after this, however, (i. e. in October last,) Dr. Chisholm, with laudable
candour, thought  proper, in a great degree,  to retraet this doctrine, by  asserting,  '
  " That the effluvia from dead animal bodies, passing through the natural  process
o£ putrefaction, and unrestrainedly  diffused  through the atmosphere, is injurious  to
living animal bodies exposed to their action, no more than inasmuch as their fcetor
is offensive to the olfactory nerves;  that, when confined to a very limited space, and
their principles, instead of entering into new  combinations, are concentered,   a d in
that state applied to, or received  i, to,  the  bodies  of living animals,  these effluvia
may :.ct as a poison, producing in the  living animal frame  fever perhaps, but  in-
communicable, or incapable of propagation by contagion ; or instant Jleath by a sud- 
99
   We can all understand that if a person under an infectious
disorder be confined in an  ill ventilated  room, the infectious
effluvia, when they are of a  powerful  nature,  will, with the
other emanations from his body, be  gradually accumulated,
and the atmosphere of that room may thus, at length, become
loaded with infection; but, that the emanations from a person
who was not ill of an infectious disease, should ever undergo
so remarkable a change in their nature, as from being innoxi-
ous, to acquire not only the power of producing a disease, but
a  contagious disease,  capable of regenerating itself in  other
persons, seems to me incredible.
   I have already  remarked, particularly  in  regard  to the
Small Pox, that the human body has no  power even to alter,
in the slightest  degree,  a contagion already existing therein;
and that  it must be infinitely more difficult for it to generate
one entirely new.   If  it were otherwise, with what certainty
would it not be effected  in  a variety of places, which are en-
tirely exempted from  it.  Take, for instance, those in  which
the natives  of Kamstchatka  dwell constantly during  seven
months of the year, and which are called yourts; these are
sunk seven or eight feet  below the surface of the ground, and
are covered with a thatched  roof, in the form of  a truncated
cone, open at the top; they  consist of one small apartment,
which  usually contains  six families with their utensils, and
stock of provisions for the winter, the chief part  of  which is
dried fish almost putrefied.
   If the  combination of personal pastiness, with the most

den exhaustion of the living principle."—See his paper in the Edinburgh  Medical
and Suigical Journal, Oct. 1810, page 389.
  But though Dr. Chisholm has  so far returned towards what I believe to be  the
path of truth, he still adheres to the commonly received opinion of the generation of
contagious fever, by crowding, and  deficient ventilation.  "The cause, in fact,
(says he,) of Typhus, is, I  believe, an undefined  change in  the atmospheric air,
brought about by" its confinement in a very limited space, and incapacity,  in a great
degree, of renewal, and the  respiration of an effluvia,  (effluvium) emanating from
the persons inhabiting the wretched close dwellings in which the fever is found."—
Sec Note to page 391, of the Edinburgh Medical and Physical Journal, Oct. 1810. 
100
 putrid smells and foul air, were capable of creating the con-
 tagion of fever, cvcvy yourt would necessarily be a fomcs ol
 infection.  " Here they eat, drink,  and  sleep, crowded pro-
 miscuously together; and satisfy all the calls of nature with-
 out modesty  or restraint, and never complain of the noxious
 air that prevails in these habitations.*  Yet, instead of being
 generally  attacked by  contagious fevers every  winter, they
 seem to enjoy as good health  during this season of confine-
 ment as any other people ; and fevers arc not even mentioned
 in the list of diseases,  which  that  respectable traveller,  M.
 Lessep, either observed, or heard of, as existing  among them.
  The people of the island of Oonalaska, also, " inhabit jourts,
 or subterraneous dwellings, each common to many families,
 in which they live in horrible filthiness ;"—(Pennant's xlrctic
 ^oology, vol. i. page cliv.) and the Samoiedes live  in sub-
 terraneous dwellings, equally filthy, for  almost  nine  months
 in the year, who yet  are reported by travellers  to be strong,
 active, and healthy.   In addition to all  this filth, crowding,
 and want  of ventilation, the food of these people may be con-
 sidered as little better than putrefaction itself.  Mr. Pennant,
 describing that of  the natives  of Kamstchatka,  says,  " their
 ambrosial repast is the  Huigal, or fish flung into a pit until
 it is  quite rotten,  when  it is served  up in a  state of carrion,
 and with a stench that  is insupportable to every  nose but that
 of a Kamschatkan."   But these people, notwithstanding, are
 seldom attacked by any other  disease than scurvy, for which
 they seem to possess a remedy in the Allium  Ursinum, or
 Wild Garlic, and in the Pinus Cembra.j
   The Greenlanders  and Esquimaux appear, by the accounts
 of those  celebrated  navigators,  Davis, Frohisher,  Baffin,
 Henry Ellis, 6cc. as well as of Bishop Egede and Crantz, to
 live, during  the greater part of the year,  in very close,  ill-

  » See Lessep's Travels, page 230, &c. also Pennant's Arctic Zoology, vol. i.
page exxxii. also  Voyage to the Pacific Ocean, &c. vol. iii. puge 374.
  f Arctic Zoology, vol. i. page cxix. also Lessep's Travels, page 90- 
101
ventilated,  and  crowded  habitations,  (without chimneys)
which, notwithstanding  the  great  severity of the cold, they
keep extremely warm by their  numbers  and breath,  assisted
by a single burning  lamp in each,  and by excluding fresh air
so completely, that any other people would think themselves
in danger of being suffocated by the offensive vapours con-
tinually exhaling from the lungs and bodies of the inhabitants,
and which involve them as a thick  fog;  and yet fever of any
kind is a rare disease among these people, though, like  those
of Kamstchatka, &c. they are much disposed to scurvy.
   Dr. Matthew Guthrie, Physician at St.  Petersburgh, in a
letter  to  Dr. Priestley,  on the Antiseptic Regimen  of the
Natives  of Russia,  inserted in the  sixty-eighth volume of the
Philosophical Transactions, mentions, at page 623, that " the
Russian boor lives in a wooden house,"  " caulked with moss,
so  as to be snug  and close.  It is furnished  with an  oven,
which answers the triple purpose of heating the  house, dress-
ing the  victuals, and supporting,  on its flat top, the greasy
 mattrass on which he and his wife  lie."
   " During the  long severe winter season, the cold prevents
 them from airing  this habitation,  so that the air cannot be
 very pure, considering that four, five, or  six people eat and
sleep  in  one room, and undergo,  during  the night,  a most
 stewing process  from the heat and  closeness of their situation,
 insomuch that they have the appearance  of being  dipped  in
 water, and raise a  steam and smell in the room, not offensive
 to themselves,  but scarcely supportable  to the  person  whom
 curiosity may lead  thither."
   " Now, if it  be  considered that this  human effluvium must
 adhere to every thing in the room,  especially to the sheep-
 skins, or mattrass on which they sleep,  the moss in the w alls,
 &c. and that the apartment is never ventilated for six months
 at least; at the same time that  these people are living upon
 salt-fish," &c. " and the whole time without fresh vegetables,'*
 kc.   "  If it be a fact that they are, in spite of all these pre-
 disposing causes, strangers to putrid disease, it will sufficiently 
                            102
Justify my first assertion, that the regimen, nature has dictated
to these people, is highly antiseptic."
   Dr. Guthrie had, in  a preceding  part of this letter, stated
that, notwithstanding  this mode of life, " the Russian  boor
enjoys a state of health that astonishes an  inhabitant  of a
country  where the  dreadful consequences are so well known
of bad air within, excessive cold without, joined to a want of
fresh vegetables for a length of time."
  Dr. Guthrie has stated these facts principally to shew the
supposed beneficial effects of the Russian drink  called Quass,
&c.; but I am entitled to avail myself of them for the purpose
of demonstrating, that long confinement in close unventilatcd
houses, without chimneys, in an atmosphere replete with human
effluvia,  and in very cold weather, when Typhus or Contagi-
ous Fever is commonly most prevalent, does not produce that
disease,  it being, as will hereafter  appear, unknown  in  that
part of the world.
  Dr. Charles de Mcrtens, an  eminent physician  who  had
resided many  years in Russia,  writes, in a  letter  from Vi-
enna, dated January 14, 1778, and printed in the same volume
of the Philosophical Transactions, page 661, &c. that " the
common people (at Moscow J  live  in  small wooden houses,
generally very low, in which they crowd together both night
and  day, during three parts of  the year,  on account  of the
great cold.   There  is little air in the room, the windows of
which are very small.   Here they stew together in humidity
and  nastiness; for  except the  bath, which they use  once  a
week, they are extremely nasty."  These people, he observes,
enjoyed, notwithstanding, a much better state of health  than
the higher classes of society at Moscow, who were frequently
attacked severely by scurvy.*

  » From the description given by Dr. Orrseus, (Politi» Petropolitanse Medicus,)
the habitations of the Russian and Polish  peasants seem, at least, to equal those of
the poor of any other country, in accumulated filth and foul human effluvia. His
words are as follow, viz.—
  " Eccui ignota es pauperculorum vivendi ratio ?  Degunt cumulatim in domun- 
. 103
   Having stated these facts in regard to the supposed effects
 Of crowding human beings in small unventilated habitations,
 in northern countries, let us see what effects result from simi-
 lar  causes  in  the  warmer regions.  And here the African
 slave ships  most obviously present themselves  for examina-
 tion.   Until within a few years these vessels notoriously con-
 veyed human beings across the Atlantic  in a state of closer
 compression, and in an  atmosphere more offensively impreg-
 nated with  human exhalations,  excretions,  and excrement,
 than could  probably  be found in any other place of confine-
 ment.   " The poor wretches  (says Dr.  Lind, in his treatise
 on the jail  distemper)  are  crowded together below the deck,
 as close as they possibly can lie, with only a small separation
 between the men and women;  every  night they  are shut up
 under close  hatches, in a sultry climate, barred down with
 iron  to  prevent  an insurrection;" "  and though some have
 been suffocated by the close confinement,  or  foul air, though
 they are subject to the flux, and suffer from a change of tli-
 inate, yet an infection is scarce known among them; or if an
 accidental Fever, occurring from the change of climate, should
 become infectious, it is generally much more mild than in the
 opposite situation,"—i. e. that  of ragged felons under trans-
 portation.  It will be here observed, that Dr. Lind, influenced
 as he was by the commonly-received opinions, mentions an
 infection  (meaning of Fever)  as being  " scarce known,*9 in
 the slave ships, instead of asserting,  as he might  have done
culis depressis, angustis, humidiusculis;  esculenta & potulenta sua, partim jam cor-
rupta & fermentantia  in  iisdem, vaporibus empyreumaticis obnubilati, apparent;
quisquilias raro everrunt; illuvies varias, negligentius  quaquaversum profundunt;
ut alias immundities ex  infantibus & propriis excretionibus provenientes, taceam.
Mephitidi hinc products assueti, de renovando aere vix cogitant. Uti Jassise, sic
etiam in Polonia, ubique  fere inter  Judseos pauperiores, sordide omnino &  arete,
uti notum  est, viventes, prima pestis quasi incubatio fiebat-  Medici, qui Moscus,
in officinam pannorum, ad examinandum infectos, repetitis vicibus mittebantur, de
foetore in habitatiunculi&operariorum, cui vix per  aliquot minuta perferendo pares
essent, conquerebantur."—Vide " Gustavi Orroei, M. D  Descriptio Pestis quae anno
MUCCLXX  in Jassia,  &  MDCCLXXI in Moscua grassata est.  Petropoli,
1784."—Page $1. 
104
with truth, that it is never known: for after very extensi\e
inquiries, I am fully  convinced that Fever of any kind rarely
occurs on  board these vessels, and contagious  Fever vever;
though  great mortality has frequently happened  from  other
diseases, and more especially from Dysentery.*  Dr.  Trotter,
who was formerly surgeon  to a  slave  ship,  after  noticing
what I have just  stated from  Dr. Lind, adds, " The confine-
ment of so many wretched creatures in a small space, deserv-
edly attracted the animadversion of a physician investigating
the sources and progress  of  contagion.   But Contagions  Fe-
vers we find are not  their diseases."  See Medicina  Nautica,
vol. i. p. 184.f
 * I could  readily accumulate proofs in confirmation of the
preceding  statement, concerning slave ships ; but the truth in
regard  to  it is now so generally known and acknowledged,
that they must he unnecessary ; and there certainly is nothing
in  the  constitutions of Negroes,  which exempts  them from
Typhus or  Contagious  Fever; on the  contrary, they have
been found as  susceptible of it as Whites,  and considerable
numbers of them, who were sent from this country, and from
Nova Scotia, to  the new colony of Siena  Leone, died of it
on  their passage thither, as will be more fully related in
another place.
  An instance of the crowding of Europeans on  ship board,
which  approaches very  nearly to  that  of  Negroes  in slave
ships, may be found in the '• Narrative of the  deportation to
Cayenne," of J. J.  Job  Aime, and  one hundred and ninety-
two other  persons,  on board the  Decade  frigate, in conse-

  *  See Lind on preserving the health of Seamen, page 317, 318, Second edition.
 f  lh> Garden, in a letter to the Rev. Stephen Hales, D. D dated Charlestown,
South Carolina, March 24,  1756,  after mentioning the Guinea slave ships arriving
there, adds, " I have often  gone  to visit those vessels on their first arrival, in order
to make a report of their  state of health to the governor and council ;  but ! ne-
ver  yet was on board  one, that  did not smell most  offensive  and noisome : what
from filth, putrid air,  putrid dysenteries, (which is their common disorder)  it is- a
wonder th.t any escape with life." See Dr. Hale's Treatise on Ventilatois, seconu
part, page 95 
105
quence of the revolution (in France)  of the 18th Fructidor,
(Sept.  4th,)  1797,  written by himself,  and printed for J.
Wright,  Piccadilly,  1800.  In  this narrative the writer
says, (page 78)  " we were placed in  the between-decks, be-
fore the  fore-mast  and  main-mast,  occupying  nearly one-
fourth  of the superficies of the vessel, having about four feet
and a half in height, and receiving no light but by the scut-
tles ; that is to say, by two openings of three feet square."—
" Partitions had been made in this part of the between-decks,"
&c. " In this  place, the door  of which  was  locked, were
crowded  and squeezed together 193 individuals, mostly aged
and infirm.  We lay in two rows one  over the other, forming
as it were, two stories, in hammocks of coarse cloth,  and ex-
tremely narrow."  " Those above could not raise their heads-
without hitting those above; neither could any of us make the
smallest motion without disturbing his neighbours ;  for we all
touched  each other, and,  not having the least spare  room,
 formed, as it were, but one mass."  " And that nothing might
be wanting to increase the horror of our situation, as we were
 not permitted to go out for fourteen hours together," (i. e.
 from 6, P. M. until 7h A. M.) " and sometimes more, tubs had
been placed in the midst of us, where we might  satisfy the in-
 dispensible wants  of nature ;  and to get to  these sorry re-
 ceptacles, we were obliged to creep, on our bellies, beneath
 the hammocks.  How insupportable then must have been the
 infection of such a close  confined place, which was already
 poisoned  by  our own exhalations!  Indeed,  the  air,  which
 passed from this hole,  was so hot and foetid, that the centi-
 ncls,  placed at the hatchways as our guard, demanded that
 the time  of their duty, at so dangerous  a post,  might be
 shortened."
    In  addition to this morbid atmosphere, the exiles, most  of
 whom had been " accustomed to the elegance  of life," were
 condemned to subsist upon the coarsest, the most disgusting,
 half-putrefied food, in the taking of  which, says Aime, •« we
 resembled a flock of animals who eat their  food  out  of one
                             14 
                           106
common trough,"  and  were,  besides, made " a  subject of
mirth," by " the officer who superintended the distribution of
our meals," which were also too scanty to satisfy the cravings
of hunger,—(page 82 to 85.)   They were also condemned to
endure the greatest and most offensive personal filth, swarm-
ing with lice, &c.   " If it be recollected, (says the author)
that we were obliged to sleep in our  clothes, and when it is
known that  several of  us had not taken off our lesser gar-
ments during the voyage, it may be  easily conceived that it
was not our  linen alone, into which these horrible vermin had
introduced themselves."—(Page  81.)  " Our blood,  it is
true, was not shed, (says he,) but there  was not one of us,
who would  not have a thousand  times preferred  a speedy
death,  to  the miserable state  in which we  existed."—(Page
85.)  But though they were kept in this state during ninety-
six days,  and,  to use the words of Aime, " there  was every
reason to expect, that  one  half of us would have been the
victims of such inhuman treatment;  nevertheless, astonish-
ing as it must appear,  under these circumstances,  not one
of its perished."—(Page 85.)  They  were,  indeed, as might
well be  supposed, attacked by scurvy and other disorders,
some of which  are called fevers,  though the latter appear
to have been so slight, and  of so  short a  continuance, as
hardly to deserve that name;  but certainly nothing  like
contagious fever existed among them, or could have exist-
ed in such circumstances without extensive mischief.   Indeed
there was only  one  person lost during the voyage,  and he (a
sailor)  accidentally  fell overboard.   And yet here  was every
thing likely  to  generate febrile contagion, (if it could be ge-
nerated by  crowding,  want  of ventilation, filthy clothing,
and unwholesome,  corrupting food, together with anxiety and
dejection  of  mind, &c.)  to a much greater extent than in
any gaol  within Great Britain.
  In Dr. Lind's Essay on preserving  the Health of  Sea-
men, page 195, I also  find the following statement, viz.
  "During  the month of  October, (1759)  the squadron 
•107
arrived from  the West Indies,  after the reduction of Gua*
daloupe, so  over-run with the  scurvy,  that, when in the
channel, ten  or a  dozen  persons  usually  died  of it every
day.   Out of  three hundred and fifty scorbutic patients,
"who were sent ashore from those ships,  there was not one who
had a fever.   This  I mention, (says Dr.  Lind,) for the sake
of the  following remark:  The  surgeon  of the  Panther"
{of sixty-four guns) " told me, that forty of her men had died
of the scurvy in their passage home ; and, during that time,
there were usually  ninety  patients in  the  sick apartment.
The place  appropriated for the sick, was in the bay of the
ship, (which Dr. Lind calls " the most damp and unwhole-
some part of a ship," page  133)  "and had no pipe from
the ventilator,  nor  any scuttles cut through its sides, for the"
admission  of  the  fresh air.   A number  of patients, thus
closely crowded together, rendered the place so disagreea-
ble  and suffocating,  that the sick were in  a manner stifled
 or want of air.  The surgeon, .when visiting, could scarce-
ly breathe in it, or remain  for any  length  of time, without
being obliged  to have recourse often to the fresh air upon
deck,  and sometimes to  spirit  of  hartshorn, or to a glass
of wine, for his immediate relief.  He observed,  that both
the  virulence and  mortality of the scurvy  were heightened
by the unventilated  air of the  place, in which the sick, for
several weeks, had been confined; yet,  out of above an hun-
dred patients, sent to the hospital by this surgeon, not one
was remarked to have any symptom  of contagion generat-
ed in that  apartment."
   Another fact, which  deserves mentioning, relates to  the
prisoners taken out of the memorable  Spanish galeon, cap-
tured, by  Commodore Anson, in the Centurion, on the 20th
of June, 1742, and is recorded at pages  492 to  496,  15th
edition, of the  Account of the  Commodore's Voyage round
the World, published by  Mr. Richard Walter,  who had  ac-
companied him as his Ghaplain, 
108
   "The galeon had five hundred  and fifty men at the begin-
 ning of the action,"  of whom *•« sixty-seven were killed, and
 eighty-four wounded."  All  the  prisoners  were  "scut  on
 board the Centurion before night, except such as were thought
 the most proper to be retained to assist in navigating the ga-
 leon."  The prisoners were " placed, all but the officers and
 the wounded, in the hold, where to give them as much air as
 possible, two hatchways were  left open."  " The sufferings of
 the poor prisoners, though impossible to be alleviated,  were
 much :o be commiserated ;  for the  weather was extremely hot,
 the stench of the  hold loathsome  beyond all conception,  and
 their allowance of water but just sufficient to keep them alive.
 All this considered,  it was wonderful that not a man of them
 died during their  long confinement,"  (from June the 20th to
 July  the 28th,) " except three of  the wounded, who expired
 the same night they  were taken."
   An additional proof of the like import may be derived from
 the dreadful catastrophe,  in the black-hole, at  Calcutta,  on
 the 20th  of  June, 1756,  in which,  out of  one hundred and
 forty-six  persons, one hundred and twenty-three perished by
 suffocation.   And  a further reason with me for noticing it is,
to correct the misrepresentations thereof, which I have heard
 and seen; for it has been  asserted, that the  twenty-three sur-
vivors were afterwards seized  with Typhus Fever, as, indeed,
they ought to have been, if crowding,  with an accumulation of
human  effluvia, and want of  ventilation,  could produce  it
But whoever will read the narrative of this occurrence, given
by Mr. Holwell, the  chief officer of the British factory at Cal-
cutta, (which none of the  medical  writers I  allude to seem to
have perused, or, at least,  not  with due attention,) will, I am
sure,  be convinced, from all the subsequent events, that not
one of the survivors in question was attacked by any disease
which could, with propriety, be called a fever.   It was impos-
sible indeed for men,  who had undergone such extraordinary
sufferings,  and had  preserved their existence with  so much
difficulty,  not to feel exhausted and  indisposed, when  they 
109
were released from their dungeon the next morning; and it
seems that, within forty-eight hours, every one had a consi-
derable  eruption of boils over his body,  which was  probably
caused by the excessively profuse  perspiration,  which each of
them had undergone,  and is not a rare consequence of  very
copious  sweating.   But, as I shall demonstrate in the Appen-
dix, No. 3, a fever did not ensue in a single individual among
them;   and, therefore, no  febrile contagion  was  generated,
even in  an atmosphere  rendered  pernicious  to life, and  not
only loaded with effluvia perspired from the living body,  but
also with the most offensive smells from those who expired in
the course of the night, and whose bodies had  fallen into rapid
putrefaction, as soon as life was extinguished.
   The  Lord Chancellor Bacon seems to have been strongly
impressed with  a belief of the existence of contagion in pri-
sons,  and of its being, at least, greatly augmented,  if not ge-
 iterated, by filth and deficient ventilation.   " The most perni-
 cious infection,  (says he,)  next to the Plague, is the smell of
 the Jail,  where prisoners have been long,  close,  and nastily
 kept; whereof we have had, in our time, experience twice or
 thrice,  when both the judges that  sat upon the Jail,  and num-
 bers of  those who  attended the business, or were present, sick-
 ened upon it,  and died."*—(In  Sylva Sylvayum,  Cent.  104
 Num. 914.)

  * Mr. Anthony Wood, in his " History and Antiquities of the University of Ox-
ford," published by John Gutch, M.  A. Oxford, 1790, after mentioning the  Rlack
 Assize  in that city as one of the "Mortalities," which Lord Bacon must have con-
templated in the passage just quoted, adds,  "where the  other happened I am not
certain; however, that the like was  at Cambridge, at the Assize kept in the Castle
 there, in the  time of Lent, 13th of Henry VIII. Ann. Uom. J521-2, is evident; for
 the justices there, and all the gentlemen, bailives, and all resorting thither, took such
an  infection,  that many of them died; and almost all that  were present fell des-
 perately sick, and  narrowly escaped with their lives."—Vol.  ii. page  188, &c
 This seems to have been the earliest instance of what, perhaps, may be  considered
 as jail infection, communicated  in a Court of Justice, of which any information has
 been transmitted to us; but Lord Bacon could not,  with propriety,  have men-
 tioned it,  as occurring in his time;  it having happened forty years before his birth. 
110
   One of the instances here alluded to, doubtless, was that of
 the memorable Black Jlssizc at Oxford, in the month of July,
 1577, which I  shall more particularly notice in the Appendix
 No. 4.  The other instance seems to have been that mentioned
 by Holinshed,  as Occurring at Exeter, during  the Assizes
 there, in  March, 1586, of which a further account will be
 found in the same Appendix.
   From that time I  can discover no instance of any remarka-
 ble mortality or sickness,  supposed to have been produced by
 Jail infection, until the year 1730, (an interval of one hundred
 and fifty-three years,) when, at the Lent Assizes, some pri-
 soners,  who had been removed from Ilchester Jail,  to take
 their trials at Taunton, were believed to have infected a part
 of the Court, and produced a contagious disease, of which the
 Chief Baron Pengally, with some of his officers and servants,
 and Sir James Shepard, Knight,  and Serjeant at Law,  died
 afterwards, at Blandford, in Dorsetshire.  John Pigot,  Esq.
 High  Sheriff of Somersetshire, also died, as was  supposed, of
 the same disease, which spread considerably at Taunton,  and
 proved fatal to several hundreds.—(See Gentleman's Maga-
 zine, for May, 1750.)
   Twelve years after,  viz. in April,  1742, according to Dr.
 Huxham, (de Aere, &c. vol. ii. p. 82,) a fever,  which he calls
 putrid, contagious,  and highly pestilential,  (" febris putrida,
 contagiosa ac pestifera valde,") appeared at, and in the neigh-
 bourhood of Launceston,  occasioning great mortality there,
 This fever, he adds, was generated in the prisons, and widely
 disseminated by means of  the County Assize,—(" genita hsec
 in carceribus  febris et per  comitia provincialia  disseminata
 longe lateque.")*

  * At  page 83, Dr. Huxham makes this addition, viz.—" Perfrequen.s est utique
 generatio febris pestilentis in angustis immundisque carceribus ; etiam ipse aer conclu-
 sus in fodinis, speluncis, puteis, tandem evadit exitialis admodum idque longe citius,
 si accedunt quoque plurima animalium effluvia, quse et ipsa porro magis magisque  in
 horas violeiita fiunt, brevique pestifera maxime."—(Here  he  refers to Lancisi de
-repentinis mortibus, L. i. C. 6) " Atmosph»ra stagnans, frcquentia hominum polluta,
 mox valde rancet & ad respirationem inepta est prorsus ;  imo aqua dulcis balneum 
Ill
   The  next  remarkable  occurrence of this  sort happened at
the Sessions  of the Old Bailey, in the spring of 1750, which
proved  fatal  to the  Lord Mayor, and two of the Judges, with
several eminent and other persons, who, as was asserted, and
is now  generally believed,  were infected by the contagion of
Jail Fever brought into the Court from Newgate.  With how
little reason  or truth this assertion was made, I shall endea-
vour, by a minute  examination of facts, to ascertain, and de-
monstrate, in the Appendix, No. 4.   And this task I have the
more readily undertaken,  by reason of the very important
conclusions respecting febrile contagion,  which have been, as
I think, erroneously deduced from the  melancholy events in
question.
   It was in  consequence of, and immediately after, this me-
morable  transaction, (viz.  in  May, 1750,)  that  Sir John
Pringle published his " Observations on the nature  and cure
of  Hospital  and Jail Fevers," from pages four and five of
which the following extract is made,  viz.
   " The hospitals  of an army,  when crowded with  sick, or
when the distemper's are of a putrid kind, or at any time when
the ail'  is confined, especially in hot weather, produce a fever
of a malignant nature,  always accounted fatal.  I have ob-
served  the same sort of  fever to take  its rise in crowded bar-
racks, and in transport ships, when filled beyond a due num-
ber,  and detained  long  by contrary w inds, or when the men
were kept at sea, under close hatches, in stormy weather."
   " The cause seems plainly to arise from a corruption of the
air, pent up, and deprived of its elastic parts by the respira-
tion of a multitude; or  more  particularly  vitiated  with the
perspirable matter, which, as it is the most volatile part of the
humours, it  is also the most putrescent."
   As soon as I  became acquainted with this fever in the hos-
pitals abroad, I suspected it to be the same with what is called

sorde cutanea fcedatum putrescit atque putet brevissime.  Nee mirum est hoc utique,
quandoquidem a  qtiolibet  adulto  homine  unci» 40 feri rancidi  vaporis qiiotidie
rxhalant," 
                          112
here the Jail Distemper, which I had  never seen;  and was
confirmed in my opinion,  by having an opportunity of com-
paring them, which was furnished by the following accident."
  Here the author relates the means by  which two hundred
men, of Brigadier Houghton's  regiment, were,  in 1746, at-
tacked by a " fever, which came directly by contagion from
the true Jail Distemper," communicated in a manner which he
describes: and these men, he adds,  "being under my care, I
had the best opportunity of examining the distemper, which 1
found differed  in nothing  from  the  usual Hospital Fever, in
cither symptoms, violence, or cure."  And on this foundation
he proceeded to  " consider the  two diseases as one," and to
describe  them  accordingly;  having,  as  he  observes,  "met
with no author who has treated them  in so clear and full a
manner, as to  enable  a physician  either to know,  or cure
them."—Page 7.
  When this was written, external putrefaction was believed
to produce highly morbid and  malignant effects upon,  and
within,  the living human body; and both Dr.  Huxham  and
Sir John Pringle,  prepossessed by this belief, were  thereby,
probably, induced to promulgate their  doctrines and  opinions
on this subject with less consideration, and more confidence,
than men of their superior talents and  understanding, would
otherwise have done.   Indeed,  Sir John Pringle (and proba-
bly Dr. Huxham)  was ignorant of an  important fact, which,
if known, might have  altered his opinion on this subject;  for
he was manifestly convinced,  that  warm,  or hot weather,
would  promote the activity  and force  of Jail contagion,  (as,
in truth, it ought  to do, were,  that contagion generated by
filth, putrefaction, and deficient ventilation ;) and in the pub-
lication just mentioned, he expresses his belief, that the fever,
supposed to have  been recently produced  by infection from
Newgate, would " be, in a great  measure, confined to those
who were present  at the trial, especially if the weather  con-
tinued  moderately cool;" n<•*  suspecting, what is now ascer-
tained, that the contagion of Typhus, or Jail Fever, is always 
113
 rendered most virulent and morbific by severe frost,* which,
 by increasing the density and purity of the air,  renders ven-
 tilation least necessary,  and completely arrests  the  progress
 and influence  of putrefaction and  of its products;  while,
 on the contrary, this  contagion is  soon enfeebled,  dissipat-
 ed,  and  destroyed  by  hot  weather,  in which putrefaction
 proceeds most  rapidly,  and crowding  with deficient venti-
 lation is most hurtful.
   The opinions, however,  of these  celebrated physicians are
 now generally prevalent in this country, and more  especial-
 ly in regard  to prisons,  which  are  considered as  eminent-
 ly the parent as well as the fomes  of the contagion of Typhus
 Fever.  That  this  fever often exists  in  them cannot be de-
 nied ; but this circumstance can afford no  evidence  of its
 having been generated  therein,  any more  than the multi-
 plication of vermin in  such places  could demonstrate the
 spontaneous generation  of these, and other insects, by the
 nastiness which favours the  deposition, and hatching of their
 eggs.  It must, indeed, be  impossible  to  adduce any suffi-
 cient affirmative proof on this subject; for, as the contagion
 of Jail Fever,  though commonly inactive  during the hotter
 part  of the summer, always exists in this country; and, as
 it frequently remains  dormant in the human body several
 months after being  received  therein, the breaking out of this
 fever in a prison can  never afford  any evidence of its  hav-
 ing  been  generated,  where it  first  appears.  For,  even if
 the person first attacked should have been so long imprisoned,
 as to make  it  incredible that he  was infected previously to
 his imprisonment,  there must  always have been so many
 ways  and means, by which the contagion might have been
 introduced  from without, (e. g.  by  infected persons,  gar-

  « The benevolent  John  Howard, in his  work on Prisons, (page 467,)  observes,
that « the Goal Distemper is always observed to reign more  in our prisons du-
ring winter  than summer; contrary, I presume, (adds he,) to the nature of other
fmtrid diseases." Similar,  but stronger, testimonials will hereafter be adduced.
                             15 
                           Ill
ments,  bedding,, &c.) that its having been  so introduced
will always be much  more probable than  the spontaneous
generation of contagion; an operation,  or process,  of which
we have  no example, and  which,  if it  really took place,
would  to  me seem miraculous.
  I have  already proved, that crowding,  filth, and  deficient
ventilation,  do not, in a variety of other situations, pro-
duce any  thing like  contagious  fever;  and I might fairly
conclude,  therefore, that these causes  would  not be  more
efficacious or noxious  in jails, than  they  are found to be in
the places already  mentioned.   But least any persons should
imagine that there may  be  some circumstances in a prison
peculiarly  suited  to the generation of what is called Jail
Fever, I will,  in regard to  this particular, undertake  what'
I have already performed  in regard to  the putrefaction of
animals,  &c.   and instead  of requiring affirmative  proofs
from those who assert the generation of febrile contagion
by such causes, will take upon myself to refute these unsup-
ported assertions by decisive negative evidence : and for this
purpose I  will resort to  the  observations and testimony of
Mr. Howard,  than whom no  man ever  took more pains to
ascertain  the  truth concerning prisons,  or stated  it with
more exactness and candour; and the result  of all that he
either heard or saw is, that the Jail Distemper is not known   j
in the  prisons abroad.
  In his work on  Prisons,  he informs us, (page 125,) that
on  conversing  with Dr.  Tissot, at Lausanne, the latter ex-
pressed his surprise at our Jail Distemper; said, " I should
not find it jn  Switzerland;"  and added, that "he had not
heard  of  its being any  where but in England."   "I did
not," continues Mr.  Howard, (as the  Doctor said,)  " find
the Jail Fever in  Switzerland."
  In  regard to the prisons at Venice,  Mr. Howard  says,
(page  106,) of the same work, "the  chief prison  is near
the  Doge's Palace,  and it is  one  of the  strongest I  ever
saw.—There were between three and  four hundred priso- 
115
ners,  many of  them confined in loathsome and  dark cells
for life; executions here being  very rare.   There  was no
fever or prevailing disorder in this close prison."
   At  page  117  of the same work, Mr. Howard, describing
the great prison of Naples, La  Vicaria, says, " it contain
ed, when I was  there,  according to  the gaoler's account,
nine hundred and eighty prisoners.   In  about eight large
rooms,  communicating  with one another,  there were five
hundred  and forty sickly objects, who had access to  a court,
surrounded  by buildings so high as  to prevent the  circula-
tion of air.  In seven close offensive  rooms, were thirty-one
prisoners almost without clothes,  on  account of the great
heat ;  and in  six dirty  rooms, communicating with one
another,  were fifty women."  Here he  adds the following
note,  viz.  " In visiting the prisons of Italy,  I observed, that
in general great attention was paid to the sick;  but I could
not avoid remarking, that too little  care was  taken to pre-
vent sickness.  From the heat  of  the climate,  one might
imagine  the Jail Fever  would be very likely to prevail; but
I did not find it in any of the prisons."
   Sir John Pringle, in  a discourse delivered by him to the
Royal Society, as their president, the 30th of November, 1776,
says,  " the late Dr. Mounsey, (F. R. S.) who had lived  long
in Russia, and been Archiater under two successive sovereigns,
acquainted  me that, happening  to be  at Moscow, when  he
perused  my observations on the Jail and Hospital Fever, then
lately published, (1750,) he had been induced to compare what
he read in that treatise, with what he should  sec in the several
prisons of that large city.  But to his surprise,  after visiting
them  all, and finding them full  of malefactors, (for  the late
Empress at that time suffered none, who were  convicted of
capital crimes, to be put to death;) he could discover no fever
among them, nor learn that any  acute  distemper, peculiar to
jails, had ever been known there.  He observed,  that some of
these places of  confinement had a yard into which the prison-
ers were allowed  to come for the air; but that  there were. 
                                116
 others witlimt that advantage, tjet not sickly."  " He conclud-
 ed with  saying,  that, upon his return to St. Petersburg, he
 had made the same enquiry there, and with the same result"*
   After  adverting  to this part of Sir  John Pringle's  dis-
 course, Mr. Howard, in his Account of the  State of the Pri-
 sons in  England and Wales,  (page 94,) adds,  " in this  an-
 cient capital of Russia, (Moscow,)  I found  no  trace of  any
 such prisons,  or dungeons,  as were common formerly  in the
 castles of England, and in several foreign countries." " That
 cruel mode of confinement, in many of our prisons,  has been.
 and still is, a principal cause of the Jail Fever;  no symptoms
 of which fever did I see in Moscow, or any part of Russia.f
 He had, however, previously described (at pages 87, 88, 92,
 93 and 94,) prisons  and hospitals in Russia, which he found
 in a very apt state for generating febrile contagion,  according
 to the  generally received opinion  on this subject;  they being
 very foul and close.  Near the end of his work on Prisons,
 (viz. at  page 467,) Mr. Howard brings the result  of his ob-
 servations  and enquiries,  concerning the cause  of the  Jail

   • See Dr.  Kippis's  Edition of Sir John Pringle's Six Discourses, &c. 8va
 page 168.
   f This has been confirmed by the  Reverend William  Coxe, M. A. 8*c. who,
 in his Account of the Prisons and Hospitals of Russia, &c. (page 25,) says, " I
made particular enquiries whether  there have been any  signs of Jail Fever, or
Epidemical  Distemper, ever discovered among the prisoners in Russia, but could
 not hear of the least tendency to such disorders."  This fortunate  exemption cer-
tainly cannot be ascribed to any peculiar advantage in the  construction of the Rus-
 sian prisons, or any superiority of cleanliness,  because the late Empress Catharine,
in the answers which she dictated  to her secretary, and sent to Mr. Coxe on that
 subject, declares, that " there has been hitherto no general plan for the construc-
tion of prisons, nor  rules for their distribution and situation."—And that  " there
is no more  regulation  for the cleanliness of the prisons than  for  their construc-
tion and  situation.  By an abuse (she adds)  favourable  to the prisoners,  they are,
in many  places, permitted to go to the baths."—But, she  thinks, " it is probable,
that the cold atone prevents epidemical disorders.—Travels  inte Poland, Russia, &c.
vol iil- page 133, 8vo.  Cold, however,  is now certainly known not to produce  any
such effect,  in regard to the contagion of  Jail or Typhus Fever,  which,  as has
been already stated, (at page 124, &c.) is equally unknown in the habitations of the
Russian peasants- 
117
Fever, to  this pointed couclusion.   " If it were asked,  (says
he,) what is the cause of the Jail Fever ?  It would, in general,
be readily replied, the want of  fresh air and cleanliness :  but
as I  have found, in  some prisons  abroad, cells and  dungeons
as offensive and dirty as any I have observed in this country,
where, however, this distemper was unknown, I am obliged to
look out for some additional cause for its production."  Mr.
Howard's further experience,  in  his subsequent tour over a
great part of Europe, and into Turkey, in (1785, 6, and 7,)
being in conformity with his preceding statement, he repeated
it in the same words,  in his work on  Lazarettos.—Page £31.
  This " additional cause," which Mr.  Howard thought  it
necessary to look for, in order to explain the production of
Jail Fever, can be no other than the contagion thereof,  which,
however prevalent  in this kingdom, has no existence in most
other countries, and where it does  not exist, there is good rea-
son  to  conclude that the true Jail or Typhus Fever never
occurs, though other fevers have been frequently mistaken for
it; this is,  doubtless the reason why all those accumulations
of filth, in close crowded places,  do not occasion febrile con-
tagion in prisons abroad,  though in this country, where that
disorder always exists,  they contribute  greatly to its reten-
tion, concentration, and virulence.
  The  frequent  intercourse between the subjects  of  Great
Britain and those of France,  by reciprocal  captures at sea,
has been  a  cause of  introducing the Typhus  Fever into the
ships, and among the seamen of the latter.   But, as Paris  is
at a  considerable distance from the sea coast,  there is  good
reason to believe that this fever has been rarely, if ever, know n
in that  metropolis;  and that,  when it has occasionally exist-
ed at any sea-ports, or in the interior parts of France, (as at
Rouen, see page 71, note,) it has,  in general, been originally
derived from British prisoners.   And it was, doubtless, for
the reason just given, that an eminent and justly-celebrated
physician, Professor Sauvages, of Montpellier, when he ad-
mitted  the Jail Fever (which he denominates Typhus Carce- 
118
rum)  into his Msologia Metliodica, relied solely on the au-
thorities of two English physicians, Huxham and Pringle,
adopting exclusively their descriptions of the disease, which
he has mentioned in several parts of his valuable work, but
always with references  to the same English physicians only,
which probably he would not have done,  if, with his very ex-
tensive reading, he had found any other sufficient authority
for the  existence of this fever,  (which,  indeed,  he does not
appear to have ever seen,) and for  its characteristic symp-
toms.
  A further proof of the rarity of this fever, in the interior of
France,  seems to  present itself in  the  ninth  volume of the
Memoires of the " Societe Royale de Medecine," of Paris, in
which it appears that this  society, in  November, 1790, pre-
sented to the National  Assembly, a plan of a new  Medical
Constitution in France,—(page  102 ;) and at the fifth section
of the second part of this plan, which relates to the " fonc-
tions du Medecin dans les Depots de  Mendicite ou Maisons de
travail,  et dans  les prisons,"  the following  observation is
made, viz.  " On sait que faute de proprete et de soins, et par
l'entassement des hommes, ou le mauvais traitement des ma-
lades, les prisons ou depots ont souvent ete le foyer d'Epi-
demies redoutables.  C'est surtout en Angleterre qu'on en a
eprouve  les funestes efftts; c'est la qu'on a vu la plus expan-
sive des  contagions s'elancer de ces maisons pour infecter au
loin les flottes par la presse; les armees par les recrues faites
dans les Bridewells, (ou maisons de  correction;) les villes et
les  campagnes par les Sessions des Comtes, &  les possessions
Anglaises dans les iles par la transportation des criminels."
I ought here to  observe,  that four or five  years before this
plan was presented to the  French National Assembly, Mes-
sieurs Tenon and Coulomb, two  of the commissaries, nomina-
ted by the  Royal Academy of Sciences,  for matters relating
to hospitals,  had been sent by the French government to En-
gland, to obtain information on that subject;  and  were here
most  favourably received, and  made  acquainted with every 
119
thing likely to render their mission beneficial.   And, among
other acquisitions of knowledge, they were informed of, and
persuaded to adopt, the opinions prevalent in this country, re-
specting the supposed generation of  febrile  contagion by
crowding,  filth, and  insufficient ventilation, which opinions
appear to have greatly  influenced the Royal Medical Society
of Paris, in that part of their plan which has been just cited.
But those  who have had opportunities of seeing and compar-
ing the conditions of the poor, as well as of the streets, houses,
prisons,  and hospitals, of Paris and of London, must be con-
vinced,  that if the causes just mentioned,  had  been sufficient
to produce the supposed effect. Typhus Fever would have pre-
vailed in the former,  at least as often, and as long ago, as in
the latter.   And that it could not have been proper or justifia-
ble in this society, to select  and represent England  as the
country  in which, above all  others, the pernicious effects of
pontagion  so produced, had been oftenest, and  most  fatally
manifested.
   That there may, however, be no doubt on the subject of this
comparison, I  shall extract,  and place in  Appendix No. 5,
certain parts of a large volume in quarto, entitled " Memoires
sur les Hopitaux de Paris, par M. Tenon, Professeur Roy ale
de Pathologie,  &c. imprimes par ordre du  Roi," (1788;) by
which it will appear that the Hotel Dieu, of Paris, is not only
the largest, but the most crowded and filthy hospital on earth;
that a single building thereof, called " Batiment Meridional,"
generally contains two thousand six hundred and twenty-se-
ven patients, crammed together, Jfrom four to six in each bed,
with every circumstance and degree of nastiness, and deficient
ventilation, so that if such causes could have generated conta-
gious fever, it must have been there generated, nearly two cen-
turies ago; and being once generated by them, it must,  from
their continual aggravation, have been constantly maintained,
and spread to a greater extent, and with increasing virulence.
   Believing, as I do,  that  any additional evidence on this
subject would be superfluous, I  shall content myself with ob- 
                           120
serving, that the respectable Dr. James Lind,  though he had
allowed himself to adopt and maintain the common opinion,
that Contagious  Fever might be  generated  by  the means
which have been so  often  mentioned,  has,  notwithstanding,
upon several occasions, stated facts, which, with proper at-
tention, might have led him to a different conclusion.  In his
chapter on the Jail Distemper, at page 315, of his Essay on
preserving the  Health of  Seamen,  (second edition,)  are the
following  paragraphs, viz.
  "The origin of the jail infection is a point, at present, en-
tirely unknown.  No person has given us the least satisfac-
tory account how or where it is generated.  It does not seem
to originate in air,  and there are many prisons abounding
with filth  and impurities, perfectly free from it.
  " In ships also, an infection is generally imported from the
land, and  many that have been long in a very dirty condition,
at sea, bring their men quite  healthy into the harbours.—
Indeed, I  have  always observed,  that the most healthy ships
were such as arrived from a long foreign voyage,  the scurvy
being the  chief, and  almost the only complaint among them.
Whereas  ships of war,  especially when fitted  out in the
Thames,  even in times of peace,  very often received this in-
fection from London."
  And, finally, at page 227 of the same volume, we find this
assertion,  viz.  " I never heard of any ship which, after hav-
ing been carefully and properly smoked,  did not immediately
become healthy: And if,  afterwards,  they turned sickly, it
was easy  to trace that sickness, from other  infected ships,
jails, and the like places."  Certainly this would not  have
been the case, if it were possible that contagion should be ge-
nerated, de novo, as has been supposed, by the causes in ques-
tion.
  From the preceding facts  and considerations,  I think it
may be safely  inferred,  that filth, crowding,  putrid human
effluvia, and deficient ventilation, though  favourable to the re-
tention and accumulation of febrile contagion,  where Typhus 
m
Fever exists, or has existed, and consequently, to its activity,
do not of themselves  either generate, or enable the  human
body  to  generate, that  contagion;  and that fevers  are not
contagious,  nor liable to become so, unless produced by con-
tagion.
  Assisted by these inferences, I shall next proceed to ascer-
tain,  as far  as I may be able, the causes of the Yellow Fever,
together with the truth or fallacy of  those reasonings which
ascribe either its origin or propagation to contagion*
END OF PART  SECOND.
i'6 
PART THIRD.
         OF THE CAUSES OF THE YEXIOW FEVER.

 The  Creator  of the world,  for purposes which .it  is our
duty  to  respect as  wise and good,  has so constituted the
surface  of the  earth, that,  in a  great  part of it, the soil,
when moistened and assisted by  suitable degrees of  solar
heat,  is  naturally disposed to produce certain vapours or
exhalations, technically  denominated marsh miasmata,  and
possessing a specific power of exciting  fever in the human
body, which fever,  though  most  frequently intermitting or
remitting,  is a great cause of mortality, especially in hot
climates.
  This  important truth is  now   so  well ascertained,  and
so generally admitted,  that  many proofs in support  of it
will   scarcely  be  deemed  necessary.   Several  remarkable
instances  of fevers  produced  by  this cause, have been  al-
ready stated between pages  82  and  88  of  this  volume,
and to these it may suffice to add the following.
  Dr. John Hunter, in his Observations  on the Diseases
of the Army  in  Jamaica, informs  us, that the place in
Kingston  Harbour in that island, at which " the  ships of
war  take in their water, being  wet and swampy,  it com-
monly happens that  the men  employed in filling the wa-
ter-casks  are  taken  sick, either  at the time,  or a few days
after ; and there are examples where, out of sixty or seven-
ty men sent on that duty not one has escaped a fever. 
122
  Dr.  Blane also,  in his interesting " Observations on the
Diseases of Seamen,"  alluding to the same service,  at the
same place in Jamaica,  says,  (p.  92.)  that "it was the
practice  of many  ships  of  war) to leave the water-casks
on  shore  all night, with  men to  watch them, and as there
is a land-wind in the  night,  which  blows over  some ponds
.and marshes, there were hardly any  men  employed on that
duty who  were not seized  with a fever of a  very  bad sort,
of  which  a great  many  died."  Afterwards,  at p.  392,
when  treating of  "the bilious remitting fever,"  the same
author observes,  that  it "may generally be traced to the
air of woods  and marshes; and in our fleet hardly any
men were attacked with  it,   but  those who  were employ-
ed  in  the  duties of wooding and watering."
  Dr.  Lind, speaking of the unfortunate  attempt to  make
a settlement at the Island of Balambangan, near Borneo,
where  scarcely one in  ten of those  sent  thirther survived
the first  six months, says, " from October till April, during
the north-east  monsoon, the  wind comes  from the sea, and
the settlement is perfectly healthy;  but from April till Oc-
tober,  during the south-west  monsoon, the wind blows over
the  marshes,  both of  this  Island  and Borneo,   and pro-
duces  fevers of the most malignant  nature, which  frequent-
ly  cut off the stoutest men  in twelve  or fourteen hours."
See his Essay on  the Diseases incidental to Europeans  in
Hot Climates, p. 99, 5th  Edition.
  And finally,—Nicholas Fontana,  who  went  out as sur-
geon to an  Italian East India  ship, in  November,  1776,
in  which  service  he continued five  years,  and afterwards
published  some judicious  observations  concerning the dis-
eases of Europeans in  hot climates in the  Italian  language,
informs us, that "  the ship having arrived at  the Bay del
Agoa,  on  the  Eastern Coast of Africa,  in March,  1777,
some  tents were pitched  along the  bank  of the river Spi-
rito Santo, which is low and swampy, to accommodate the
sick of the scurvy, and those who were employed  in wood- 
                            124
 ihg and watering, and that, of  forty-seven sailors who had
 slept  on  shore,  there  was  not one  who escaped  a  vio-
 lent  fever, which proved  fatal to  twenty  of  their  number.
 —■" Observazioni intorno  alle  mallattie die  attaccano  gli
 Europi ne' climi caldi."  P.  11. also p. 76.
   If  more proofs  of the specific power  of  marsh, miasmata
 to produce fever should be  desired, they  may be found in^
 the treatise " De noxiis paludum effluvis,  corumque reme-
 diis," by  "Jo. Maria  Lancisius  Archiater  Sanctmi-  Pa-
 tris  Clementis XL ;" and in the works of Sir John Prin-
 gle,  Dr. Lind,  Dr.  John  Clarke,  and. several other medi-
 cal writers of eminence, as well as of  undoubted credit.
   Assuming,  then, that these  miasmata are a most power-
 ful and  frequent  cause of fever, it seems  expedient to en-
 quire concerning their origin, nature,  and  constituent  prin-
 ciples.
   The exhalations from marshy grounds may be presumed
 to consist, either of pure aqueous  vapour alone,  or of this
 vapour, combined or intermixed  with other vapours,  or par-
 ticles resulting  or extricated from  some  of the various mat-
 ters,  which naturally constitute the soil,  or  have been su-
 peradded  to it; and  we ought, therefore, if possible, to as*
 certain  whether the noxious effects of these exhalations are
 produced  by  pure  water  only,  either dissolved or diffused
 in the atmosphere, as some respectable  authors have assert-
 ed, or  whether they  are  solely or principally  occasioned
 by any other matters  extricated from  the earth ?
  There are  two  modes  or forms in which water may ex-
 ist  in the  atmosphere; one  is  that of  a complete  dissolu-
 tion  by the air, so as to  be rendered  invisible to  the eye,
 and  sometimes  insensible  even  to  the  nicest  hygrometers;
 the other  is that of very small  globules, commonly  percep-
tible  to  the eye,  and disturbing  the  transparency of the
 atmosphere, as  in  what is  called mist  or fog.
  If pure  aqueous vapour in the former of these states  were
 really a cause of  fever, we should uniformly discover that 
123
sailors are, and have been, more liable to that disorder on the
ocean than when on shore, or in harbour; since it may safely
be affirmed that the atmosphere at^sea is more saturated  with
aqueous  vapour,  than it  can be on  shore, because a much
greater evaporation must necessarily take place  from a vast
expansion of water, than ever occurs from an equal surface of
land, not covered, or not nearly covered, by water.  It is,
however,  notorious, that if vessels are not sent  to sea in an
improper  condition, their crews are generally  much more
healthy on  the wide ocean than  in any other  situation.  Dr.
Lind,  in  his Essay on  Preserving  the Health  of Seamen,
(p. 218,) states,  as a general proposition,  confirmed by  long
experience,  "that persons  at sea are less subject to fevers
than  those  at land." .  Dr. Blane, also, in  his work on the
Diseases of Seamen, says,  (p.   252,) " The air  at  sea  in
those climates, (West Indies) as well as every where else,  is
extremely pure and wholesome, and there is  no where  that
seamen are  more healthy  or comfortable." He had previous-
ly  made a similar, and,  in regard to " violent fevers of hot
climates," a more  pointed assertion at p. 204.
   To these testimonies may be joined that of  Dr. John Hun-
ter, who (at p. 14  of his Observations on the Diseases of the
Army in Jamaica states,)  that " simple moisture  is harmless,
at least as far as relates to the production of fevers, of which
the two last mentioned places  (Fort Augusta and  Port Royal)
may likewise be given as examples,  for they arc nearly sur-
rounded w ith  water on  all sides."  He adds,  " It is true the
air is perfectly  clear, yet it must he  loaded with moisture in
consequence of the great heat  of the sun  acting  upon the
water."  And finally, not to tire my  readers w ith superfluous
testimonies, I shall  content myself with adding  that of Dr.
Gillespie, who,  in his  Observations  on  the  Diseases of his
Majesty's Squadron on the  Leeward  Island Station, between
1794 and 1796, states,  (page 20) as  the general  result of his
experience,  that " a ship of war is rarely  affected  with a
sickly crew  at sea,  in the  West Indies, and as rarely  con* 
                           126
tinues a fortnight in port without some of the seamen  being
attacked with fevers and fluxes."
  It seems  probable,  however, that the morbid influence,
which was attributed by the  late Dr. George Fordyce, to pure
water, in exciting fever, was principally intended to he under-
stood of aqueous vapour merely diffused  through the atmos-
phere,  in the form of mist or fog ; and  as his Dissertations
on  Fever,  which promulgate  or  assert this  doctrine, are
amongst the most valuable  medical works  produced in this
country, it may be expedient to examine this part of the sub-
ject  more minutely, in order,  if his opinions respecting  it
should be erroneous,  to obviate that extensive  adoption  of
them, which his high authority might otherwise obtain, upon a
question of great importance.
  The following are Dr. Fordyce's reasonings  and state-
ment on this subject, at page 146 of his Dissertation on Sim-
ple Fever, viz.  " A  man going into water of a moderate
temperature, and remaining in it for some time, has not been
found more frequently afterwards affected with fever,  than
after standing,  walking, or  any  other indifferent circum-
stance.  It  is  certainly, therefore,  not the application  of
the water to the body that gives occasion to  the disease;. but
if the air has  particles of  water floating in it, and a man
has continued for some time in such an air, fever has ensued
much more  frequently than when he  had lived in a dry air."
Hence the author is led to conclude, that moisture must be a
cause of fever;  and that he may persuade his readers to adopt
the  same conclusion, he assumes the  following unsatisfactory
proposition, p.  151.   " If those, who contend that the  appli-
cation of water suspended  in the atmosphere, in the form of
moisture, does not produce fever, were to live a year or two in
Batavia,  they  would be convinced, by fatal experience, that
men living in a moist atmosphere are more frequently affected
with fever  than in  a dry one."  Surely, if Dr. Fordyce's
opinion on this subject were  just, those who thought  differ-
ently from  him might have been made sensible of their error 
127
by less inconvenient and dangerous means than a voyage to,
and residence at, Batavia.  The author then proceeds as fol-
lows :—" Moisture  in the air produces  more  fevers,  the
warmer the atmosphere;  but moisture produces fever in all
temperatures.   The Dutch have  endeavoured  to make  the
country of  Batavia res< m'de Holland in the  immense number
of its canals.  The  consequent moisture of the atmosphere is
very great  in both places ;  but although fevers, therefore, fre-
quently occur  in Holland,  they bear no comparison in num-
ber to those which happen in  Batavia,  where the fatality,
owing  to the  moisture and heat of the climate,  is so great,
that it  is  wonderful  any  person should  even approach that
settlement  but from the  absolute impossibility  of  otherwise
obtaining water or food."   This proof  of  the effects of mois-
ture I cannot but consider as  entirely gratuitous, because, to
use the words of Sir George Staunton,* (whose description
agrees with those given by Captain Cook and other respect-  jfe
able.navigators)  the settlers at Batavia live  " in the midst of
swamps and stagnated pools;  from  whence they  are every
morning saluted with  * a congregation of  foul and pestilential
vapours, whenever the sea breeze sets in  and blows over this
morass;"  and, before  Dr. Fordyce could have been warranted
in ascribing the  violent fevers which are so common in that
settlement  to moisture alone, he ought to have proved,  that in
such  a situation  no other causes existed by which they could
have been produced.!

  * An authentic Account of the Embassy to China.  Vol.i. p. 242.
  f Dr. Horsefield, an American physician,  who now is, or lately was, employed in
travelling over  the Island of Java with the sanction of the government of Batavia, ob-
serves, in an account of his voyage to that island, in the year 1800, (published in Dr.
Cox's Medical Mu#um, vol. i p. 75, &c.) that "it  is impossible for the imagination
to conceive a situation more favourable to the production of marsh miasmata than that
of Batavia. "If," adds he, "human industry and ingenuity should  be exerted  in
planning and constructing an elaboratory  for the  production of pestilential vapours, a
situation exactly resembling that of Batavia and its environs would be the result."
But even here, Dr. Horsefield states the rainy season to be "comparatively healthy,"
to those who have it their power to avoid immediate « exposure to rain;" contrary to 
128
   The author next allows, that "fevers more frequently arise,
 when the moisture  is evaporated from a marshy country, or
 from stagnating water, than when it proceeds from the sea,
 large lakes,  or rivers confined within their banks, and run-
 ning with a rapid stream.  "This," says he, " has given oc-
 casion  to suppose,  that some  other vapours  proceed  from
 marshes  besides water,  and  produce the  disease."   But as
 such a notion must clash with his  own hypothesis concerning
 simple moisture, he brings forward a second proof,  to  show
 that  fevers  have been  produced  by moisture,  when it  has
 arisen from the earth in  a state of purity, that is,  not impreg-
 nated with.any of the matters contained in  the soil which  are
 undergoing the process of decomposition.   " It certainly hap-
 pens often," he says in page  154, "that a considerable degree
 of putrefaction takes place in marshy grounds, and more es-
 pecially  in warm climates; but it is by no means to be con-
 cluded, that moisture in  the atmosphere always produces fever
 in consequence of putrefaction.  Putrefaction  can only take
 place in animal or v egetable  substances.   If water, therefore,
 not impregnated with either, should be in such a situation as
 to produce moisture m  the atmosphere, no putrefaction  can
 take place;  therefore, if fevers ensue, they are certainly in
 consequence of  moisture, not putrefaction.   Many instances
 of this may  be brought, as  in  the war  which took place in
 Flanders, between  1710 and 1711,  an army encamped  upon
 a pure sand,  in which water  was found in digging less than a

that which must have been the case had the doctrine of Dr. Fordyce been  true,—and
Dr. Horsefield assigns as the reason of this greater healthiness during the rains, that
the rivers and canals are then " plentifully supplied with wat<*r, which flows  through
them with considerable rapidity, and  most of the lower marshy situations are entirely
inundated with water." Hut in July, August, and September, thgse waters  become
nearly evaporated; and "the quantities of marsh miasmata now produced,  are not
only inconceivably greater than at other times, but the diseases produced by them are
much more malignant and intractable  in their nature."  And this (which, if Dr.For-
dyce's opinion were just, ought  to  be the season o! health) becomes, to use Dr.
Hoisefield's own words, " the season  of  death and destruction, in which the hospitals
 and church-yards are filled'" 
129
foot deep, and  occasioned a great moisture in the air,  which
produced in a few days numbers of fevers, although the army
was  perfectly healthy before,  and no more fevers were pro-
duced on shifting their ground."
  This last instance, apparently more decisive than the for-
mer,  is, however, of a very  questionable nature  in  several
respects.   It would be injustice towards Dr. Fordyce, to sup-
pose that he could have stated this as a fact, if he had not been
persuaded that  it had really happened, and exactly as he has
related it; but, unfortunately, he neither mentions the spot
where it occurred, nor the author by whom it was related, and
who might have been greatly  misinformed or deceived as to
the circumstances; and every one will agree in this,  that no
fact which is to serve as the foundation of an important doc-
trine, can have  any claim to be received into  a philosophical
discussion, unless it be fully attested.  Now, with regard to
the alleged purity of the sand, on which the camp was pitched,   ^
I may observe, that it is extremely difficult, not to say  impos-
sible, to find any soil that does not contain some portion of ve-
getable and animal matters;  and that, even if  these had not
previously existed in the sand,  they would have  been immedi-
ately supplied by  the army  encamped thereon, and being as-
sisted by the moisture abounding there, would have very soon
afforded vapours, differing greatly from those of pure water.
  But  supposing  the sand  on which this encampment  was
made  to have been perfectly pure, still there  may  have been
marshy ground at a small distance,  whose exhalations might
have caused the .fevers in question ; and it is not assuming too
much  to say, that, in a flat country like Flanders, wherever j
any ground is so low and wet that water is found at less than
a foot beneath the  surface, the surrounding land is likely to be
very  marshy.   Moreover, as the fevers broke out among the
troops only " a few  days" after they had encamped on  the
sand,  there is  more than  a possibility that they were caused,
not by the unhealthiness of  their actual position, but by that
of the station which the army had recently quitted; and one
                            1: 
                              130
  need only read the description which Sir John Pringle lias
  faithfully given in his work  on the Diseases of the Army  of
  that  part  of the Netherlands in  which military operations
  have been mostly carried on in modern times,  in order to be
  convinced,  that  a very  large  portion of the surface  of that
  country consists of marshy ground.
    Such are the objections which occur to this second instance,
  as it stands in the Dissertation on Simple Fever;  and with
  these I should have dismissed the consideration of it, as being
  of too doubtful a nature  to  deserve much notice,  if Dr. For-
  dyce  had not adduced a  similar fact in support of  the same
  doctrine, after a lapse of  eight or  nine years,  which  I  shall
  quote in his own words, from page 63 of his  " Fourth Disser-
  tation on Fever," viz.  " The author has show-n, in a former
  dissei-tation, that moisture, by dissolving in the  air, or  by eva-
  poration, is one powerful cause of fever; that it is often the
  cause of intermittents, as well as of the other diseases which
  have  been above enumerated," (dysentery,  continued or re-
  mitting  fever, and  irregular semitertians, under which  last
 title he  includes the disorder now  known  by the name of the
 Yellow Fever) " without  any putrefaction taking place, is cer-
 tain,  from several instances.   These- diseases have been pro-
 duced in countries where the water was found at only a foot or
 two under the surface of  the earth, whence the moisture has
 arisen and  contaminated  the  air, so as to occasion these dis-
 eases,  while the sail  has been  perfectly dry,*  and there has
 not been the  least appearance of putrefaction, the country be-
 ing clear from woods.   In this case it could be  nothing but
 the 'uoisturef that produced the disease.  One instance of tbis
 occurs in the encampment of the English army in  the  war
 about the year 1745, in a sandy plain in Flanders.  Another

  * Either fix*soil was not perfectly dry, or so much moisture did not rise through it,
as to produce a morbid contamination of the air.
  f T!i s is rathe!' an hast- Rssertion, '•'nice it is obvious, that soils, upon which not a
single tree is growing, mxy nevertheless contain putrefying'animal and  vegetable
substances in considerable quantity. 
in a region of Peru, where water is every where to be found at
about seventeen inches below the surface of the earth, though
the country itself is barren for the want of water, and uninha-
bitable from the number of dysenteries and semitertians which
take place in it."
   The  only difference  between these two encampments  on a
plain of sand,  is that of the dates, concerning which a mis-
take might easily have been made by one who has often stated
facts very loosely;  and  for  this  reason I am inclined to be-
lieve, that Dr. Fordyce alluded to the same fact, wiiile he was
writing each of the passages  I have quoted.   With this idea I
naturally recurred to Sir John Pringle's  excellent Medical
History of the War, between  1742 and 1748, where I expected
to find  the account of this  encampment; but neither in this
work, nor in any other I have met with, relating to the trans-
actions  at this period, have I  been more successful in disco-
vering the object of my inquiry, than I had been before in the
many  searches which I had  made after the instance said to
have happened in the former war.*   There  are, however,
certain passages in Sir John Pringle's hook, which appear in
some measure  to correspond with Dr. Fordyce's statement,
and they are,  perhaps, the instances which the  latter author
had in  his mind on  both occasions.  Sir  John  Pringle, de-
scribing the face of the northern part of Dutch. Brabant,  says,
itf " is nearly as flat  as any ground of the Netherlands, the
only inequalities being some  sand-hills and insensible risings,
which  give the advantage of a few feet  in height to some of

  * Among other endeavours to ascertain the circumstances which Dr. Fordyce ought
to have stated, in regard to his supposed facts, I applied to Dr. Wells, who had editerf
the latter part of his work on Fevers, hoping that, either from the papers of J3r.
Fordyce,  or from their conversations,  Dr. Wells* might be enabled to supply'the'
desired information.  The latter  gentleman,  however, in a letter dated the 30th of
April, 1806, declared himself unable to do this;  politely offering, at the same time,
(o " make inquiry  among others of Dr.  Fordyce's friends, and, should it  be suc-
cessful, to communicate  the result."  No such communication having since been re-
ceived I must necessarilv collude, that the promised inquiry has proved fruitless)
  j- Observations'on the Diseases of \.!ie  Army.  Page 62, 7th Edition. 
132
 the villages.  The soil is a barren sand, and so little water is
 seen, that,  at first sight,  the country might  seem to be dry
 and healthful.  But this appearance is deceitful, for water is
 every where to be found at the depth of two or three feet;
 and in proportion to its distance from the surface, the inhabi-
 tants are free from diseases."   After this the author mentions
 that, during the summer of 1748, the troops which  were can-
 toned in different towns and villages became very sickly, and
 that " the  sickness was much  greater near Breda and Bois-
 le-duc than at Eyndhoven, which lay at a greater distance
from the inundations, and from other marshy  grounds."  The
 following inference comes next, which seems to me to have
 ho necessary connexion with what immediately proceeds, and
 to be not only erroneous, but liable to considerable misinter-
 pretation, viz.  " The moisture, therefore, in most of the can-
 tonments  arose principally  from  the  subterraneous  water
 which exhaled through the sand."  Let us now examine if this
 account can be fairly construed into a proof that pure moisture
 was the cause of this  sickness."*  " On  the 12th of  May,
 1748, the army left Hillenraet, near Roermond, and in a few
 days came to Nistleroy,"  (or Nesterle, which is  situated in
 the centre, as it were, of the North of Brabant)  " where they
 encamped for the last time;" and, " on the ninth of July, the
 camp broke up, and the troops went  into cantonments;"  the
 war being then at an end.  During this intervalf "some sear
 sonable rains, with thunder and lightning,  seemed to prevent
 any sultry heats; the ground besides was dry, and the camp
 airy, so that the sickness was inconsiderable as long as the troops  s
 kept the field."  This  is the only encampment which  I can
 discover to have been  made on  a sandy ground  in the course
 of the war;  but, surely, this cannot he cited as the example in
 which  " numbers  of  fevers  were in  a  few  days produced
 among troops previously healthy,  in consequence of their be-
 ing encamped on a pure sand, where water was found at less
'PagefiO.-                  f Page 01. 
133
than a foot deep."  Nor does the account given by  Sir John
Pringle, of the health of the arm} subsequently to this en-
campment, at all  coincide with Dr. Fordyce's statement, that
" no more fevers were produced on shifting their ground :" on
the contrary, so many fevers broke  out, that* " the troops
had scarce been a month in the cantonments when the returns
of the whole sick were increased by two thousand, and after-
wards  they rose considerably higher."   Besides the army,f
" the peasants were great sufferers," from these epidemic fe-
vers.   " This country," says the author, " had not known so
much distress for a number of years, as two such causes" (of
disease) " had not occurred, I mean the drying up of the inun-
dations,"  which had been made about the fortified towns, since
the commencement of the war, " with  a hot and close summer
and  autumn."   I shall not here inquire what effects  might
have resulted from the operation of these causes, because the
inquiry more properly belongs to another part  of this  wrork,
where it will probably appear, that two such causes as these
were fully capable of producing the  fevers in  question: but
having shown, from the best authority,  that the health of the
army was comparatively  good during the only encampment
which is recorded to have been made in the course of the w ar
between 1742 and 1748, " on a sandy  plain, where water was
found at the  depth  of two or three feet:"  and having also
shown, that the sickness which ensued shortly after the camp
was broken up, among the several divisions of the army, can-
not, with any justice,  be ascribed to the transpiration of sim-
ple moisture  through  a pure sand, since it is even  stated by
Sir John  Pringle himself, who  seems to have been an advo-
cate likewise for  the  noxious properties of moisture, to have
been proportioned  to  the distances of  the  different canton-
ments  "from the inundations and other marshy grounds."
I shall nowT examine  the validity of the third instance, con-
cerning the unhealthiness of " a region  in Peru," which Dr.
* Page 66.                 f Pa5e fi7- 
                           131
 Fordyce  has  annexed to his second  account of the encamp-
 ment on a plain of sand.
   The air of improbability which accompanies his  descrip-
 tion of the region in question, (which certainly ought to have
 been designated by  its proper  name)  will immediately be
 perceived by the reader.  "Water,"  says he,  "is  every
"where to be found at about seventeen inches below the surface
 of the  earth.—The country itself is  barren  for want of wa-
 ter ;" yet so much moisture transpires through the ground, as
 to render the spot "uninhabitable."  Surely, if so much aque-
 ous vapour passed through the earth as to communicate to
 the atmosphere  a morbid excess of humidity,  the soil itself
 could not have been so extremely dry as, from that  very cir-
 cumstance, to be rendered barren; warm dry earth  would,
 undoubtedly, absorb some portion  of  the  aqueous vapour
 in question during its passage; and  we may  safely  infer,
 that,  so long  as the  soil remained dry, the vapour which
 arose from the subterraneous  water must have  been too lit-
 tle for its saturation, and consequently, insufficient to load
 the air with  a noxious degree of moisture.   But neither this
 objection,  nor  such of the objections  advanced against the
 prec-diug  instance, as  are applicable  to the present  case,
 d h rred me from  endeavouring  to  discover if any part of
 Peru  answered the description given by Dr. Fordyce  of this
 particular region :  and since the author, who  never was out
 of Great Britain,  has. on  this  occasion also,  neglected to
 mention  whence  he derived his information, and none of his
 surviving friends are  able (so far as I can learn) to supply
 the omission, I  had recourse  to the best  accounts hitherto
 published  of  that most singular and interesting country,
 (Peru,)  particularly  to thoee  of Don Antonio  Ulloa,  who,
 to the rank of Lieutenant-General  in the Spanish Navy,
 and Naval Commandant in  Peru, added  scientifick attain-
 ments sufficient to  procure his  adoption  into  most of the
 learned  societies in Europe.   This distinguished author has
 given a  narrative of his voyage with Don George  Juan and 
135
 (he  French Academicians,  who were sent by the  Govern-
 ments of Spain and France to South America,  in 1735 ; and
 be afterwards published some observations on Peru and other
 parts  of America, in Spanish, under the title of "Noticias
 Americanas," of which a translation in French, was printed at
 Paris, in 1787, with the title of '• Menioires Philosophiques,
 Historiques, Physiques, concernant L'Amerique, &c."   It is
 more  especially from  the  latter* of these works,  that the
 following  account of  what Dr.  Fordyce  would probably,
 call "the regions"  of Peru,  is  extracted.   The  western
 coast  of Soutli  America, adjoining the  Great Pacific Ocean,
 consists of low land, wiiich forms a kind  of zone along the
 shores of that ocean, varying in breadth from eight  to twen-
 ty leagues, and extending  from 7° or 8° of North Latitude,
 to  27" or 28"  South of the Equator,  the whole of which
 bears  the name of " Valles."  " Au  point ou  finissent  ces
 plats pays commencent les Cordilleres," an immense chain
 of mountains, which runs southward  almost to the Streights
 of  Magellan,  and  occupies at  its base a breadth  of from
 thirty to fifty leagues.   Upon this great mass of mountains
 are  found large habitable  tracts, called Sierras, to distin-
 guish  them from  the low land  on the  coast;  and we  learn
 that these tracts, which Ulloa has named,  " La Partie haute
 Habitee," are at an elevation of 4536 varas, (of Castile, or
 12,451 English feet) " au dessus  des terrains qui avoisinent
 immediatement a la mer."  " On voit par la, que cette partie de
 l'An;erique a  une  bande de terrein sensiblement plus elevee,
 que toutes les autres contrees habitees du globe."  " II y a dans
 la partie haute habitee, des royaumes tres etendus, des pro-
 vinces fort peuplees ; il s'y voit  aussi  de vastes  contrees de-
 sertes."   This high ground, however, serves  but  as a base
for an higher range of mountains:  " les cimes des montagnes
qui s'eJevent sur cette meme plaine elevee,f ont plus de 6,60(1

  * \nd from pages 23.  23, 24 28, 29, 57, 222, 244, of the first volume.
  t The summit of Chimboracon is stated to be 19,595 feet above the ocean. 
                            136
varas de haut (18,117 feet;)  elles surpassent done les autres,
de 2,063 varas (5,664 feet.)"  These surperincumbent moun-
tains, far exceeding all others  on the surface of the globe,
and  eternally covered, with snow,  are, of course, uninhabit-
ed, and therefore  cannot be the objects  of our present consi-
deration : neither is it  the " Partie haute Habitee," the ob-
ject of it, since  according to Ulloa, " on n'y voit ni fievres
intermittentes, ni putrides."  Besides these parts, there are
ravines, extending in different directions through the Sierras,
which he thus describes.  "Dans la partie ele\ee,  la  terre
est entrecoupee de vastes profondeurs, qu'on y appelle Que-
bradas."  " Le fond sert de lit aux eaux qui y coulent, et tien-
nent presque toujours le milieu.  Ces eaux suivent les detours
et les deviations du terrein lateral—& continuent ainsi  leurs
cours dans  ces profondeurs  entre les montagnes,  ^  arrivent
enfin dans la partie basse du terrein, d'ou elles  se rendent a
la mer;  mais la masse  d'eau qu'elles  forment dans cette se-
conde partie a peu de  profondeur, & semble n'ctre  repandue
que sur  la  surface du sol."   These  Quebradas, as  Ulloa be-
lieves,  have been gradually worn by the torrents, which have
descended for a  long  succession  of ages from the  heights;
they vary in their depth  and breadth, the perpendicular  depth
of some  of those chasms being 1,769 varas,  (4,855 feet) or
even more, and their width sometimes exceeding two leagues,
so that " Elles ont assez de surface pour devenir le  local de
nombre d'habitations fort peuplees, qui en  tirent  tous les
produits necessaries a la vie ;" and their  soil  is  moreover
 sufficiently rich and fertile to permit an extensive cultivation
 of the sugar cane.  It is true, that intermittent fevers of a
 dangerous kind are occasionally seen in the Quebradas,  (from
 causes which produce  them in other countries ;) these  spots,
 however, are neither uninhabited  nor barren, but exactly the
 reverse, and, therefore, we  cannot consider them as the un-
 healthy region which  Dr.  Fordyce  meant:  nor  does there
 appear,  from the accounts  I have met with,  to be any otner
 part  of Peru to which  he could  have alluded,  except the 
137
 country lying between  the sea and the foot of the  Cordille-
 ras.   Upon this low  country of the " Yalles" it is  remarka-
 ble that no formal rain ever falls ; but there are wettin -. fogs,
 called  "garuas,"  during what is there named whiter; and as
 " le sable doinine dans les terreins has, raemc a des  distances
 asscz considerables," one is at first led to suppose, that the
 soil must here be barren for want of water; but it  will be
 immediately perceived, that this is far from being  the case.
 During about one half of the year, viz. from July  to Janua-
 ry, which is called  winter in the low lands of Peru, the
 ground receives an ample supply of moisture for all the pur-
 poses of the most luxuriant vegetation,  by a contrivance  of
 nature,  no less  singular than bountiful:  while this  season
 continues, the low country is constantly covered with a thick
 fog, through which the sun is scarcely ever able to penetrate;
 and  this  fog, although not sufficiently  damp to  wet one's
 clothes, yet is moist enough *" pour pen  trer laterre, pour fer-
 tiliser le sol le plus aridc ct le plus sterile de sa superficie, par-
• ceque le soleil ne  petit la dissecher."  During the rest of the
 year, which is the rainy season in the high lands,  and is there
 termed the  winter, the earth is likewise supplied with mois-
 ture, by means of artificial irrigations,  which appear to have
 been in general USe among the  Peruvians, long before the dis-
 covery of America by Columbus.   At  this  time  numerous
 streams are piuring through  the Quebradas into the low
 country,  where many  of them lose  a part  of their  waters
 in irrigating the land.   " Comme on y  a le degre de chaieur
 requis, (says Ulloa) il ne s'agit plus que  d'y faire des petits
 can aux pour conduire l'eau ou il est necessaire ; ainsi de ter-
 reius stmles on en fait des campagnes,  dont la fertilite ne le
 cede pas aux terres les plus grasses."  We must also take no-
 tice that these streams do not all discharge  themselves into
 the sea: some of them which  happen to flow into  situations

   * Voyage Historique de l'Amerique, par Don Geo. Juau & Don Ant de Ulloa;
 Tom. i. p.4.i4.
                             18 
138
 so low,  that " les terreins n'ont pas assez de pente pour leur
 ecoulement," are there arrested in their course ;  and at these
 places the ground becomes swampy ;  it is from this cause that
 " on voit dans les terreins has quelques etendues de terre fan-
 geuse."   After this description of the low country, we cannot,
 certainly, be surprised  at learning,  that intermittent  fevers
 occur  frequently  among its  inhabitants :  we  find, however,
 that even these  fevers  do not correspond with  the  account
 which Dr. Fordyce has given, either of the nature, or  of the
 cause  of them;  for Ulloa says, that " Dans  la partie  basse,
 ces fievres ne sont point dangereuses, quoique longues  et tres
 fatiguantes :"  and it is unnecessary to observe, that fevers of
 this mild nature are not likely to depopulate a district; and,
 in regard to  their cause, it could not be asserted, with truth,
 even if the country had been rendered uninhabitable  by fe-
 vers, that these were produced by pure moisture, since, al-
 though sand may predominate  in  the low lands, as  Ulloa
 states, yet the soil is not exclusively  composed of sand,  and it
 cannot be imagined, that pure aqueous vapour could alone be.
 exhaled  from  a tract  of  country,  of which  a  considerable
 part consists of land which  is not only  cultivated, but ren-
 dered  extremely fertile by copious irrigation; and in  which
 there also appear to he  some extensive patches of marshy
 ground.   Hence we must be convinced,  that Dr. Fordyce
 has been  as  little correct in referring us to Peru, as in send-
 ing us to  Batavia, in  search of the noxious  effects  of sim-
 ple moisture.
   The deference which I conceived to  be due  to  the opinions
 of this  author, especially  when they seemed  to  be corrobo-
 rated, so far as  regards the  tendency of moisture to  produce
 fever,  by those of Sir John Pringle,  and  some other respec-
 table physicians,* and  the importance of the subject  itself,

  * Even Dr. lind, overlooking  many facts of a contrary import, stated by himself,
appears to have adopted an opinion similar to that which I am now controverting.
In his work  on " the Diseases incidental  to Europeans in Hot Climates."—(5th edition)
we find, at  page 9,  this passage, viz. «In my Essay on preserving Seamen I hare 
139
have drawn me into a long examination of the proofs  adduc-
ed by the former writer, in order to point  out their  insuffi-
ciency.  It may,  however, here be mentioned,  that Dr.  For-
dyce, although he entertains no doubt  concerning the  validi-
ty of his proofs, nevertheless finds great difficulty in account-
ing  for the  alledged effects  of moisture; and, towards the
close of his discussion*  of  this subject,  after  repeating  an
observation  already quoted,  viz. that since  water is innocent
when  applied  to  the body in a mass, as during immersion,
but causes fever  when applied in the form of small particles
floating in the air,  " it cannot be the mere application of the
particles of the  water that  produces  the disease;" he says,
" it must,  therefore, be something that they  apply to the body
which occasions it;"—but " what this may be," he confesses,
"is not very  clear."   He  afterwards throws out an  idea,
that, " as the evaporation of water  produces  cold, moisture
may only be a means of suddenly applying cold to the body,"
and that the cold so produced  may be the cause of the fever;
aware, however,  of some objections to this idea, especially,
as  he had previously stated, that heat  rendered the moisture
more noxious as  a cause  of  fever, he concludes with saying,
" but this the  author leaves  to future experiment  and  discus-
sion."   From expressions so full  of  uncertainty, and, I may
say. of contradiction, it  is  evident that he  was by no means
satisfied as to the soundness of his favourite  doctrine; and his
doubts on the subject would  have been still greater, if  he had
recollected  a very interesting fact, related in page 57 of Sir
John Pringle's " Observations on the Diseases of the Army,"
(from which Dr. Fordyce,  as I have already said,  seems to
have intended  to  borrow  his second  instance, relative to the
encampment on a plain of sand) which is so demonstrative of

said, that a malignant fever of the  remitting kind, most frequently a double tertian,
is the genuine produce of heat and faoisture, is the autumnal fever of all hot countries,
and is the epidemic disease  between the tropics : to  which I may add, that it is also the
disease most fatal to Europeans in hot climates."
                *  Dissertation on  Simple Fever. P. 156; 
HO
the opposite effects of pure moisture, contrasted with those of
marsh effluvia,  that no apology can be necessary for introduc-
ing it here.
  According to Sir John's statement, four battalions, of about
seven hundred men each, were stationed in the two islands of
Walcheren and South Beveland,  during the very hot summer
of 1747.  These islands arc from one to two  miles asunder,
and form part of Zealand, which  province (p. 2,) " is not only
low and watery, but surrounded  with the oozy beaches of the
Eastern and Western  Scheld, and the most marshy parts of
the country,"  (the  United  Provinces and  Dutch Brabant
along the Maes) " so that almost every wind, except from the
sea,  adds  to its native  moisture  and unwholesome exhala-
tions."  Under such unfavourable circumstances of situation
and of season, the troops, " both in the field and in quarters,
became so  very sickly, that, at the height of the  epidemic,
some of those corps had but one hundred men fit for duty,
and the Royals in particular, at the end of the campaign, had
but four men who had never sickened.   But  Commodore
MitcheFs  squadron, which lay all this time at anchor in the
channel between South Beveland and the Island of Walche-
ren, in both which places the epidemic prevailed, was neither
afflicted with the fever nor the flux; but amidst all that sick-
ness enjoyed perfect health; a proof," as the author justly
observes, " that the air of the marshes was dissipated, or cor-
rected, before it could reach them."   This account, had it
been known to Dr. Fordyce, or remembered by him, would,
probably,   have weakened his confidence  in  the power  of
moisture to produce fever;  for  he would, I presume,  have
readily acknowledged,  that the  atmosphere could  not  have
been less moist (and he might have found, that it was more
moist) where the squadron lay  at  anchor, surrounded as it
was by water, than in those islands; and, consequently, that,
if simple moisture  had been the real cause of the fevers which
were so prevalent on shore,  the  sailors must have suffered at 
141
least equal sickness with the  soldiers.*  But  his  confidence
therein,  would,  perhaps, have ceased altogether,  if he  had
attended to  the  well-established  fact, of which it cannot be
supposed that this author was ignorant, that the  occurrence
of  marsh fevers may, with  certainty, be prevented, by laying
the marshy grounds  under  water;  an  operation  which  cer-
tainly  would  not diminish the humidity of  the atmosphere.
But  proofs  still more  convincing,  if possible, than  the two
just mentioned,  may be offered in refutation of Dr. Fordyce's
doctrine.  Indeed,  we  know  that the air which passes over,
or  is incumbent  upon marshes,  during  winter, in  this cli-
mate, is generally  harmless  in  regard to the production  of
intermitting or  remitting  fevers,  although  it  is  then  com-
monly more replete with  moisture,  than in summer.   And,
moreover, persons who live on peat-bogs or moors, are, at all
seasons, for reasons to be explained  hereafter,  completely
exempt from  the fevers to which the inhabitants of marshy
grounds are subject; although it  cannot be pretended,  that
less  moisture is evaporated  from the surface  of  the former,
than from that of the latter.   Again, every one can recollect

  *  A similar exemption from  the fevers raging epidemically in the  Islands of Wal-
cheren and South Beveland, occurred in  regard to the people on board of the British
ships belonging to the late expedition  against  Zealand.  This fact, concerning which I
have received numerous coToborating testimonies, from respectable officers employed
on that service, has been officially declared in the report made to the Secretary at War
from Middleburgh, the 10th of October, 1809, by Dr. Blano, Dr. Lempriere,  (physi-
cian to the  Army) and another medical officer,  who were sent by his Majesty's go-
vernment to Walcheren, for the purpose of investigating the nature and causes of  the
malady prevailing among the troops in that island, wherein they state, that they  bad
" ascertained that the crews of the vessels stationed in the very narrow channel, only
a few yards from the land, between Beveland and Walcheren, have continued perfectly
healthy .during the whole campaign;  thus decidedly proving that the  noxious exhala-
tion is nearly confined to its original source."  Sec the " Military Papers relating to
the  Expedition to the Scheldt, presented by his Majesty's command to  both Houses
of Parliament, February, 1810." Marked E< page 110. Certainly the crews of the
ships in question, (between Beveland and Walcheren) who continued in  health, must
have been exposed to at least as much moisture, as the soldiers labouring  under fever
pn shore. 
142
 a multitude of instances in which persons have been  exposed
 for  hours together  in the  heavy mists which are frequent in
 this climate during the winter,  without having been after
 wards attacked by  fever.  But the remarkable healthiness of
 the men employed in the Newfoundland fisheries, where, as it
 is well known, they are generally enveloped in the  dampest
 fogs for several months together,  affords the least ambiguous
 proof,  within my  knowledge,  that the  atmosphere, when
 loaded  with  pure  moisture only,  has  no  greater power of
 causing fever, than it has  when in any usual state of  dryness.
 " It is difficult," says that celebrated astronomer,  Mr. Cas-
 sini, in the account he has given  of his voyage to  Newfound-
 land, " for one who was  never there, to form  an idea of  the
 life the fishermen lead at the Great Bank.   It  must be no less
 powerful a motive than  the thirst after gain,  which  can pre-
 vail upon these poor wretches to  spend six months  between
 the sky and water, in a climate where they are almost always
 excluded from the sight of the sun, and constantly breathing
 so thick a fog, that they can hardly see from one end of  the
 ship to the other."  Page 125.*   In such an atmosphere then,
 if any  where, we might expect to find the effects of  moisture
 on the  human body, manifested  and exemplified in the most
 decisive manner; but fevers,  or other severe disorders, are so
 little to be included among those  effects, that Dr. Lind, after
 mentioning " the surprisingly healthy state of the ship's com-
 panies, who  annually visit the Banks of Newfoundland," adds,
 " it  is a  constant observation, that the men belonging to the

  * The waters which issue from the Gulph of Mexico, forming what is commonly
called the Gulph Stream, flow with considerable rapidity near the Banks of Newfound-
land, bringing with them a temperature of from six to ten or twelve degrees warmer
thanjthat of the super-incumbent atmosphere, and of the sea itself in that part of the
ocean, according to the season of the year.  This superior heat in the Gulph Stream,
aided by its motion, produces a copious evaporation of aqueous particles from the sur-
face, which are immediately condensed by the coldness of the air, so as to produce those
fogs which, during summer, prevail on the Newfoundland station, to a greater excess,
 probably, than in any other part of the globe, unless it be, in the " valles" of Peru. 
MS
Newfoundland fleet,  return every autumn to England with
much more healthy and robust constitutions  than they left it."*
  From the  preceding  remarks I deduce these  conclusions,
viz. that pure  water existing Under any  form  in the atmos-
phere, does not cause fever;  therefore, that marsh exhalations
would be innocent, if they consisted merely of simple mois-
ture ;  and finally,  that, since these exhalations do produce fe-
vers, they  must contain some other matter  than  moisture,
which  imparts  to them  the noxious  qualities they possess.
This leads me to inquire what this matter  may  be.
  The substances which compose the  soil of  marshes differ
little, if at all, from those which are found in other soils, and,
according to the most recent  investigations of chymists,  they
seem to be the  following, viz :  calcareous, siliceous,  and ar-
gillaceous earths; sometimes magnesia,  oxide of iron, and
vegetable and animal matters, in various  proportions, with a
few saline compounds,  (often in quantities so small as not to
be  easily detected) and  water; but they differ as to their rela-
tive  quantities;  the  proportions of  the water  and of the ve-
getable and  animal matters,  compared with  the  other ingre-
dients, being much greater  in  marshy than in dry soils.  If
these various substances be classed according to  their respec-
tive kingdoms,  we shall  readily perceive that none of those
which belong to the  mineral kingdom,  can  constitute the va-
pours which arise  from marshes, because none of them is able

  * See Dr- land's Essay on the Diseases incidental to Europeans in hot climates.
Pages 30, 31-  Since the above  was sent to the press, the author being at Falmouth,
on his way to Jamaica,  went to one of the copper mines at St. Dye, about ten miles
distant, into which he descended with several gentlemen,  his fellow passengers, more
than 120 fathoms, and remained there  three hours, in an atmosphere so overloaded
with moisture that the  clothes, with which they had been  supplied  for the descent at
the mine, were soon made wet,  as was every thing which they had occasion to touch.
But this humid air did not produce the slightest injury to the health of any of them ;
nor could they discover, after having made very particular inquiries, that the workmen
in this and the other mines were more liable to fevers than  persons otherwise employed
above ground; though it  was stated, (hat pulmonary affections were more frequent
among them, probably from causes which do not'relate to this subject. 
144
 to assume an seriform  state,  at least in any temperature to
 which the atmosphere, or the earth are ever naturally heated ;
 and for this reason, as well as for many others, which arc
 sufficiently  obvious, it is plain that the noxious effects of
 marsh exhalations, cannot be  produced by the  mineral sub-
 stances contained in the soil.   With  regard to the other mat-
 ters, I mean those which belong to the animal or the vegeta-
 ble kingdoms, we know that in suitable circumstances of tem-
 perature, air, and moisture, all organized bodies begin to de-
 compose as  soon as the principle of vitality is  destroyed, and
 that, in  the decomposition of them,  a large portion of  tbeir
 constituent parts is converted into ariform fluids of different
 kinds, such  as those which are at present known  by the names
 of nitrogen, hydrogen, carbonic acid, hydro-carbonated, phos-
 phorated, sulphurated, and other gazes.  It is therefore evi-
 dent, that in a marsh, where myriads of plants and animals
 are  constantly  perishing, and  where the presence of water
 causes them afterwards to undergo a  variety of decomposi-
 tions and of new combinations, an abundance of vapours  must
 necessarily  be  disengaged from those  decaying  substances,
 and arise from the surface of the earth, along with the mois-
 ture which is evaporated at the same time.  Hence it appears,
 that the atmosphere of marshes must necessarily contain, be-
 sides common air and moisture, a quantity of vapours extri-
 cated from vegetable and animal matters during their decom-
 position ;  and since the fevers caused by marsh effluvia do not
 proceed from the action either  of pure  atmospheric air, or of
 pure moisture, on the human body, it follows, that they can
 only be produced by that of the vapours last mentioned.  Se-
 veral ingenious persons have endeavoured to analyze the air
 of marshes;  but as their experiments are very imperfect, and
 the results of them, in some respects,  contradictory  to  each
 other, we are  yet without any decisive or satisfactory infor-
 mation on the subject.*   When  science  shall  be more ad-

  » Air collected immediately over, AVd c'.n^-e upon, the surface of marshes, has com-
monly been found to contain hydiogen and carbonic acid gtz in considerable propor3 
145
vanccd,  all the chemical  ingredients of marsh exhalations
may,  perhaps, be  discovered;  but as most, or all,  of the airs
or gazes hitherto known, have  been respired either singly, or
variously combined, by persons who have submitted to the ex-
periments of what  has been called Pneumatic Medicine, or by
others engaged in  chemical pursuits or manufactures, without
any of these  persons having been  attacked by fevers  after-
wards, (although some of those airs have produced  other inju-
rious and even fatal effects ;)  it is very  possible that the pro-
perty  of causing  fever  does not belong to any one of  those
gazes in particular, but  rather to several of them collectively,
or, perhaps to some peculiar miasm  emitted at the same time
with the gazes, which it  may be as impossible to detect by any
tests,  however ingenious,  as it is to  detect the contagions of
the small-pox, measles,  typhus fever, &c. when existing in the
 common air.   We  may never even  discover whether the va-
 pours of marshes derive their  property  of  causing  fever  from

tions, with a great deficiency of oxygen gaz.  That this should be the  case might well
be  expected, considering what the constituent parts of vegetables and of water are, so
far as we have  been able to discover them, and how they must naturally act upon each
other, when undergoing  spontaneous decomposition.  Animals are supposed to consist
 of principles similar to those of vegetables, with the addition of nitrogen, (or azote)
and of sulphur and phosphorus, in different states.  A few, indeed, of  the vegetables
 are composed of nearly the same  matters as animals.  Ammonia, of which nitrogen is
 a constituent part, has been supposed, particularly by Van Mons, to have the property
of correcting or meliorating air, when it abounds with  carbonic acid gaz.  If this sup-
position he well founded, will it enable us to understand why the vapour of animal mat-
 ters only, when they are decomposing or putrefying, does not exL-ite fever in mankind
as that of vegetables appears to do f
   Dr.  William Currie, of  Philadelphia, seems to believe, " that the unwholesoniemss
 of low and moist situations in the summer and autumnal months is not owing to  any
 invisible miasmata,  or  noxious  effluvia,  which issue from the soil, and lurk in the air,
 but to a deficiency of the oxygenous portion of the atmosphere in such situations, in
 consequence of vegetable  and animal putrefaction, in  conjunction with  the exhausting
 and debilitating heat of  the days, and the sedative  power of the cold and damp air of
 the night."  (American Philosophical Transactions, vol. iv. p. 128.)  But if the mere
 abstraction of a part of  the ordinary proportion of oxygen in the atmosphere could oc-
 casion intermittents or remittents, these fevers ought to be produced by every crowded
 assembly, and  in a multitude of  situations, where  no  such effect has been observed o
 suspected'.
                                   19
V* 
146
 vegetable matters alone, or from animal,  or from the mixture
 of both: indeed, the discovery,  could it be made, might prove
 of little utility  towards explaining the effects of marsh exha-
 lations;  but at present  it  seems probable  that  this property
 is  derived  from vegetable  matters exclusively;  because some
 decomposing plants,  particularly hemp and flax, during their
 preparation by  steeping in w ater, and the indigo plant laid in
 heaps (after  the colour  has been extracted) to  form manure,
 have often been accused, and  in several instances  with great
 apparent justice,  of occasioning dangerous fevers among per-
 sons living near  them ;* while, in regard to animal matters,

  * Some difference of opinion has formerly existed among medical writers, concern-
ing the  morbid effects produced by the steeping and partial  decomposition of hemp
and flax to  fit them for  subsequent oprrations.  Lancisi, however, after having consi-
dered  all the  known  facts respecting this question, thinks them easily reconcilable by
admitting that this operation is harmless, if performed in  streams of running water,
(" nihil obesse lini maceratione in aquis fluentibus ;") but noxious in stagnant shallow
■water, and confined situations ;  (" contra vero ejusmodi macerationem  pestilentem esse
constat,  ubi palustres desident  aquse, ventique silent;")  and be gives the history of an
epidemic fever, commonly intermittent  or remittent, and often resembling the terti-
ana lethargica of Torti, which, for several summers, infested and almost depopulat-
ed the ancient town of Urbs Vetus,  in an elevated and salubrious part of Etiuria; and
which was occasioned by ponds or stagnant waters, in the lower part  of the town, in
which hemp and flax were macerated ; (in quibus linum  & cannabis macerabantur")
but tbis being prohibited in 1705, the fevers did not afterwards recur.  See Lancisius
de noxiis paludum effluviis, pages 32, 242, and 254.   1 was also informed at Naples,
that in several places near that city, and particularly in some  beyond the  Grotto of
Posilippo, the  sleeping in houses contiguous  to ditches, in which hemp  or flax were
steeping, had been almost constantly followed by fever.
  Equally injurious effects have been  ascribed to the preparation of indigo, both in the
East and West Indies, by several writers; and, according to the best information,
which I have  obtained on  the subject from  well-informed gentlemen, who had been
 largely concerned in the manufacture of that article,  these are chiefly occasioned by
the exhalations,  arising from vast heaps of  the indigo plant, which  are negligently
formed dfter the colouring principlt has been extracted) near the works and houses
of the labourers, and there left to decompose and become  manure, which is of an ex-
cellent quality after two or  three years.  These heaps, wetted from time to time by
heavv  rains, and afterwards heated by the powerful  rays of a vertical sun, emit, very
copiously, vapors, or miasmata, resembling in their effects those of marshes,  for those
persons whu live near to, and especially on the leeward side of, these fermening ve-
getable masse", a-<.  coiiinn nlv attacked by fevers, chiefly remittents, and similar to
those  which prevail  in swampy situations.  And, according to my information, the 
147
 numerous facts already mentioned, seem to prove that, how-
 ever putrid they may become, their effluvia do not excite fever
 of any kind ;  and, in regard to the mixture of putrefying  ani-
 mal and vegetable matters, we have daily proofs that vapours-
 may  arise  from them,  for example,  from  large  dunghills,
 without sensibly affecting the health of people who live close
 to them,  or who  are enveloped for hours together in their
 fumes, while working upon them.
   As it appears, from these observations, that the noxious inr
 gredients existing in marsh vapours can only be yielded by
 vegetable or  animal*  matters  during their decomposition;
 this conclusion leads us naturally to suppose, that the marshes
 best adapted to emit powerful  miasmata  must be  those  in
 which the  proportion of  vegetable  or animal  substances is
 greatest,  and in which their  decomposition will be the most
 rapid and complete.  The circumstances, therefore, which fa-
 vour  such  decomposition, deserve  particular notice,  as fa-
 vouring the production of miasmata in  an equal degree.
   Animal and vegetable substances require for their sponta-
 neous decomposition, moisture,  the contact of  air,  and  cer-
 tain degrees of warmth.  With  regard to  the  first of these
 agents, (moisture) it is so necessary, that there  is nothing
 more efficacious in preventing such substances from putrefy-
 ing, even for centuries,  than the total  deprivation  of it.   It
 may, therefore, be affirmed,  that  moisture is essential  to

connexion  of these fevers with the heaps of fermenting indigo plants is now so well
understood and believed in that  part of the world,  that the more intelligent indigo-
makers no longer permit such heaps to be formed near their works, or the habitations
of their workmen,  but cause them to be placed at considerable distances,  and to
the leeward thereof,  anththus preserve their labourers in health.
  * In this and  other places I mention animal substances as concurring with the vege-
table in producing marsh miasmata, because there are, probably no grounds whence
these miasmata arise, which do not contain some dead insects and reptiles, with other
animal matters ; and I cannot venture to assert, that these have no share in producing
the morbid exhalations in question ; though, for the lately-given reasons, I am disposed
to believe, that they are wholly formed by the mutual  decompositions of vegetables and
of water; and that  animal matters, when in considerable proportions, may even have
an opposite, or correcting effect- 
148
 putrefaction,  and, consequently,  that no  miasmata can be
 formed, in a soil which is perfectly dry.  Accordingly,  it is
 found  on the west coast of Africa, and in some of the West
 Indian islands, which are liable to long droughts, as Burba-
 does,  and more particularly Antigua,  that marsh fevers occur
 very seldom in those dry seasons; but tliat they become very
 prevalent whenever these droughts are suddenly terminated by
 frequent rains.    But neither will putrefaction take place
 without the presence of air, moisture alone being insufficient
 for that process; thus substances,  whicl.  would have been
 readily decomposed in the open air, have been preserved un-
 corrupted for ages, while immersed in water,  and thereby, in
 a great degree,  secluded from the air; for although it be true
 that air or oxygen exists naturally in water, yet it exists in a
 quantity which is  often too small for any, but  very slow, pu-
 trefaction,  at least in certain substances.
   Examples of this fact are  not, indeed, frequent with ani-
 mals,  probably  because they naturally contain more air, and
 therefore require less for their decomposition than vegetables ;
 but  it is  very  certain,  that many kinds of timber  have re-
 mained under water for a great lapse of time in  a perfectly
 sound  state.  Hence we may perceive, also, that  the forma-
 tion of miasmata, instead of being assisted, will be greatly
 impeded by a superfluity of water,  (dividing and  separating
 the matters to be  decomposed,  and obstructing  the access of
 air to them) and  that it will be  most abundant in that soil
 which  contains no more moisture than is really  necessary for a
 complete  decomposition  of the vegetable and  animal matters
 existing therein*  An  attention to this  important  truth  will
 enable us to understand why. in some  countries,  frequent and
 heavy  rains render marsh fevers prevalent, while in others,
 the deprivation of rain for two  or three  months  produces
 equally morbid effects.   Dr.  Lind was fully convinced  of
these similar results from such seemingly  opposite  causes  in
di:fere;rt countries ; and, at page 43 of his volume on preserv-
 ing the Health of Europeans in Hot  Climates,  (5th edition) he 
119
appears to have thought it difficult to assign satisfactory rea-
sons for them.  What  I  have just mentioned respecting the
Western  Coast of Africa and the Islands of Barbadoes, An-
tigua,  &c. will serve to illustrate and prove the morbid effect
of much rain  in dry  situations; and for instances of equally
morbid consequences in opposite situations, from the want of
rain, we need only refer to  certain countries between the tro-
pics, which being naturally very low, are mostly overflown
during the rainy seasons,  in which their inhabitants are com-
monly healthy; fevers  being rarely  seen among them until
the prevalence of dry weather has so far caused the water to
evaporate from the ground as to leave the  surface uncovered
in many places.  This notoriously happens in the Dutch and
French Colonies on the Coast of Guiana;  I  mean  Surinam,
Berbice, Demerary, and  Essequebo, as  well as at Cayenne,
and the adjoining settlements  on the Continent, where marsh
fevers only prevail in the latter part of the dry seasons.  The
like causes produce or augment the noxious influence of marsh
miasmata at Fort Royal, and its neighbourhood in Martini-
co;  and,  to  use the  words of Dr. Gillespie,  " with greater
effect when the rivers  are low by the  continuance of dry wea-
ther, and when the  tides, which never  rise more  than one
foot, are weak.—This," he adds,  " seems to account for the
generation of remittent and intermittent levers more power-
fully in dry thai  in wet weather, as  is the case here."  Ob-
servations on  Diseases, &c.  on  the  Leeward Island Station,
Kc.  p. 24.   Dr. James  Clarke also, when treating  of the
bilious  remittent fever  in  Dominica, observes,  that " when
there was much rain in the months of May and June, and dry
sultry weather prevailed in the following months of July and
August, this fever raged  much among the troops and stran-
gers."   Treatise on the Yellow Fever, kc.  p.  75.
  This is also the case in a great part of  St. Domingo, as has
been observed  both by French and  Biitish writers.  Among
the former,  M. Gilbert, who was chief physician  (medecinen
chef) to the army scut,  in 1802, under General Le Clerc, to 
                             150
reduce that island, ascribes the aggravated violence and pre-
valence  of the  yellow and other marsh  fevers,  which,  in  a
few months, nearly destroyed that army, to  "les effets d'une
secheresse extraordinaire, et d'une chaleur devorantc."  See
p. 4 of  his " Histoire Medicale  de PArmee Fran§oise a St.
Dominguee."   He afterwards refers, at p. 69,  to the work of
M".  Poupte Desportes,  who  died at  St.  Domingo in  1748,
and who, after having attentively observed the Yellow Fever
in that  island  for fourteen  years, found " qu'elle a ete tou-
jours d'autant plus cruelle, que les annees ont  ete plus seches."
   Baglivi informs us, (Opera Omnia,  p.  157,  158,) that the
marsh fevers,  arising from damp  situations  in  and  about
Rome, were greatly  aggravated by  the like causes;  and he,
therefore, adds "mirum non videatur si consulibus L.  Vale-
rio Potito & M. Manlio, Pestilentia orta sit  in agro Romano,
ob  siccitates  <§* nimios  solis  calores, teste Livio,  Lib. V."
That which Livy here, and in some  other places, has denomi-
nated  Pestilence, was, probably, no other than a violent epi-
demical   marsh fever,  differing, perhaps, a little in  degree
(only) from what is now called Yellow fever.
   These facts  suggest,  and enable  us  to understand, the ex-
pediency of sometimes inundating a marsh, during the heat of
summer, when  its exhalations prove  noxious to  the inhabitants
of a neighbouring town ; it having been always found, that so
long as  marshes are completely overflowed,   the vapours aris-
ing therefrom are innoxious, and that  they only become inju-
rious when so  much  of the water  has been  evaporated  as to
expose the surface of the soil to the  air.*  For these reasons

  • Of this Sir John Pringle gives a decisive proof, at p. 62 of his Observations on the
Biseases of the Army, 7th Edit. viz.  The country round Breda had been inundated at
the commencement of the war, for military purposes; but early in the summer of 1748,
the preliminaries of  peace having been signed, the water was  let off, and the grounds,
which had been covered by it, were, by this operation, made bare and <xposed to the
sun's rays, so that " a dangerous epidemic fever, of the remittent kind," soon " raged
at Rreda and the neighbouring villages.  The St -tes of Holland, b'ing made sensihle ot
thiB, gave orders to let in the water again, and keep it up till  winter."  An expedient
which produced the desired effect, as it has done on other similar occasions. 
151
 it appears very probable that any piece of ground, in  a hot
 climate, which contains a portion of fresh,  or undecomposed,
 vegetable  matters, and which, by being low and flat, with a
 suitable substratum,  or intermixture of clay, is  adapted to
 the retention of moisture, would, if supplied with only a mo-
 derate quantity of water, be soon in fit  condition for emit-
 ting  very concentrated miasmata; and it seems very proba-
 ble, also,  not only that the quantity of water necessary for
 this effect might not  be sufficient to convert the ground  into
 what  is co«nnonly called a marsh, but that it might even be
 so small as to escape  common observation.*
   Here,  however, it is necessary to observe, that,  under
 some  circumstances,  the earth may contain very large quan-
 tities  of  vegetable matters, and an abundance of moisture,
 and jet not be in a state  to give out vapours capable  of caus-
 ing fever, although the temperature should be such as to per-
 mit the formation of them.—This is the case with peat-bogs
 or moors, the inhabitants of which, as I have before remark-
 ed, are exempt from  those intermittent fevers, which are so
 frequent over marshy districts.—These bogs possess,  in a re-
 markable  degree, the power of preserving substances from
 putrefying, it being  well  ascertained, that not only plants
 and trees, but even human bodies with their  clothing, when
 completely immersed in the  peat-soil, will  scarcely undergo
 any change during a long course of years;  and it is proba-
 bly owing to  this peculiar property that they do  not exhale,
 and,   perhaps, do not  generate,  miasmata similar to those
 which  arise from marshes.—For proofs of this exemption of
 the inhabitants of peat-bogs from intermitting fevers,  see Ap-
 pendix, No. 6,

  • Dr.  M'Lean, in his volume on " The Diseases of the Army in St Domingo," at
page 25,  says,  " It must be admitted, that fatal miasmata arise where there are no
very certain appearances of a marshy soil.  The Mole and St. Marks, (St. Domingo)
do not appear  surrounded with marshes, and yet the fever reigns in both these places
with great activity." 
152
  Some chemists, who have made experiments \\itli a view to
discover the nature of peat, are of opinion, that its antisep-
tic powers are derived from that vegetable principle to which
the  name of Tannin has been  recently given.   It appears,
however,  that  a certain proportion of iron is always found in
peat; and as this metal, when either dissolved  or oxydated,
is capable both of preventing putrefaction and of  tanning, or
converting skins into leather,  (a fact not generally known at
present)  there  is room to suspect that chemists may have at-
tributed to that imperfectly-understood principle, tannin, those
properties which,  in reality, belong  to  the oxide  of   iron
alone.*
  Heat is the last of the agents requisite to  the  formation of
miasmata, which we are to notice.  Putrefaction, it is known,
is wholly suspended in a freezing temperature,  and proceeds
very slowly, while the  mercury in Fahrenheit's thermometer
continues below 45°; but, in proportion as the mercury   rises
above this degree, putrefaction takes place more readily, and
proceeds with greater activity, being most rapid and complete
in a temperature of about  100°; every addition of heat,  how-
ever, beyond 100°, seems to check that process.
   Hence we perceive how much more copiously  the miasmata
given out by vegetable and animal substances during their de-
composition must arise from marshy grounds  in hot than in
cool weather ; moreover, a  warm temperature  is suited, in a
remarkable degree, to the growth and multiplication of plants
and animals—and thus it yields a plentiful supply of materials
from which miasmata are formed; it is not surprising, there-
fore, that we should uniformly find the exhalations of marshes
to be most powerful when the seasons are hottest,  or that the

  * I ought here to observe, that the antiseptic power of these bogs, (whatever it may
be) is not sufficient to preserve animal and vegetable matters  from decomposition, in a
very iiigh temperature ; and it is, perhaps, for this reason that peat-bogs, although fre-
quent in countries in which the summer is warm enough for the production of intermit-
tents, are not known to exist between the tropics, unless, perhaps, in the more elevat-
ed parts of Quito and Peru, where the heat is less than in France and Spain.
* 
153
violence of marsh fevers should always correspond with the
heat of the atmosphere at, or some time previous to,  their oc-
currence.   Where  the surface  of the  earth  remains frozen
for a considerable space, as, during the long winters of north-
ern countries, these exhalations have no existence,  and marsh
fevers never occur, unless it be from miasmata, generated and
imbibed  during the preceding  summer and autumn.   They
begin, however, to make their appearance  soon after the re-
turn of spring, but at first only in their mildest and most in-
nocent form;  that  is, as regular intermittents,  generally  of
the tertian type;  and they  preserve this type  while the  tem-
perature continues to  be moderate.   Afterwards,  when the
weather becomes  warmer, these  fevers become  less regular
and more  severe:  and,  in the hottest parts  of the summer  or
autumn, they frequently assume the more aggravated types  of
double tertians, or of remittents.   In this country,  how ever,
where  the summer is but moderately hot, the last-mentioned
types of marsh fever are not usually of a  dangerous charac-
ter ;  but  in Holland, the Netherlands, Germany,  &c. where
the  heats of summer are generally greater than  in this cli-
mate, marsh fevers arc often attended with  considerable mor-
tality,  as  may be  seen in  the  able account  which  Sir  John
Pringle has given of them in his  work on the Diseases of the
Army;  and as was recently experienced in  the  unfortunate
expedition to Zealand.
   In the still  hotter  summers or autumns of Spain, Italy, and
more southern regions, these remittents are  yet more violent,*

  • " Principio sestatis febres, ut plurimum tertians, non malignse, corripiunt:  adaucto
vero sestu, febres continue, atque etiam exitiales urgent; long6 tamen deteriores eva-
surse, et plane pesdlentes cire£ requinoctium antumnale, prajciputi  si  pluvise,  nebulse,
t-ubigines, ventique  austra'les accesscrint.  Tandem circa hyemale solstitium de perni-
cie unique remittunt, etc."  Lancisi de noxiis pallidum emuviis, pag. 42.
  " The epidemic of autumn, and prevailing distemper of this, (Zealand, Brabant  and
Flanders) and other marshy countries, is a fever of an inU-rmitting nature, commonly
of a tertian form, but of a bad kind, which, in the dampest places and worst seasons, ap-
pears as a double tertian, a remitting, or even an ardent fever. But hpwever these
fevers may vary in their appearance, according to the difference of constitutions  and
                              <20 
154
and, as will hereafter be shown, they very frequently appear
in the form which is known at present by the name of yellow
fever, the "most fatal examples of which  may commonly be
found in the hottest parts of the globe, when other circum-
stances are favourable to the  production of marsh miasmata.
Experience, therefore,  w arrants us to conclude,  that  in cool
temperatures, none but the  milder types of these fevers arc
ever produced, and (as will be abundantly proved hereafter,)
that it is only in the hotter,  that they occur in their most ag-
gravated  and  violent forms:  and although  a  considerable
share of their increased severity should, as  I think, be as-
cribed to the direct operation of heat upon the human  body,
a greater ought,  1 presume,  to be  imputed  to  its powerful
chemical agency,  in promoting the formation of  marsh mias-
mata,  more copiously,  and  probably  with greater  morbific
powers.
   I ought here to notice the well-known influence of clay, in
promoting the formation of marsh miasmata, either as a stra-
tum for  the soil,  in which they are formed,  or when mixed
with it in a large proportion.   TJie celebrated Linnseus, who,
in the early part of his life had travelled over nearly the whole
kingdom of Sweden,  found, or thought he had found, that in-
termitting fevers  occurred in  all those places, where the soil
abounded with clay,  and only  in such places.  Strongly im-
pressed with  this fact,  he was led by it to imagine  and be-
lieve, not that clay  contributed to the production of marsh
miasmata, by retaining the water necessary for the decompo-
sition of organized matters, (as is probably the case)  but that
the particles  of clay being dissolved in the water, drank by
the inhabitants of these places, were conveyed into the blood
vessels,  and there occasioned fevers, by creating obstructions;
according to the  Bcerhaavian doctrine, then prevalent.  In

other circumstances, they are all of a similar nature.  For, though in the beginning of
the epidemic, when the heat is greatest, they assume a continued, or a remitting form,
yet, by the end of autumn, they usually terminate in regular intermittents."  Pringle,
Observations on the Diseases of the Army, p. 6.                    -          ^ 
                            155

this belief,  he published his " Hypothesis nova de febrium in-
termittentium causa;"  as an inaugural  dissertation for the
degree of Doctor in Physic, which he took at a later time of
his life than was usual.  In this dissertation he  mentions the
"loca natalia,"  or places in which he had found intermittents
to exist; and the different  degrees of force and frequency in
which they occurred, and also those in which these  fevers
were wholly or  almost unknown.  By this account they ap-
pear to have been prevalent in the Southern and Eastern pro-
vinces of Sweden, but not in the Northern, where, with  a very
few' exceptions, they had  never been seen;  a  circumstance
wiiich might naturally have led him  to take into his conside-
ration the  effects of temperature in contributing to their pro-
duction.  Attending, however,  only to the supposed co-exis-
tence of clayey  soils, and intermittents, (which a  Swedish
clergyman, at Philadelphia,  had represented as being  a fact,
in that part of America also,) Linnaeus  delivered his new hy-
pothesis in these words,  " Nostra  igitur est sententia quod  •
in time  solutse  particular argillacese, qua? lubricse sunt, cum
aqua simul potse et cibo mixtse, sanguinem intrent et tandem
ultimis vasis arteriosis resideant, & morbi symptomata cre-
ent."  In  the truth of this hypothesis he was so confident as
to advance this  assertion,  " Vana tamen est omnis  cura, ni
caveatur simul  a causa data, scilicet aqua argillacea, quod ex-
perientia toties  comprobavit."  Linnsei Amaenitales Academ,
Vol. I.
   Besides  the greater or lesser aptitude of particular soils to
retain the  portions of moisture best  suited to the decomposi-
tion of organized matters, some differences, both in the quan-
tities and qualities of miasmata generated therein,  will pro-
bably result from the particular vegetable and animal sub-
stances dispersed in them,  and from their relative propor-
tions to each other.  Lancisi "De noxiis Palud." &c. p. 44,
supposes the marsh effluvia of particular  places to differ from
each other, as well in their  nature as effects—and Sir John
Pringle asserts, " tha4 the putrefaction  of animal or vegeta- 
                             156
   ble substances, in a dry air, is apt to produce a bad fever of a
   more continued form ;  whereas putrid  effluvia, in a moist at-
   mosphere, have a  greater tendency to bring  on paroxysms
   and remissions."   (Diseases of the Army, p.  324, 7th edit.)
   Probably, however, this distinction, if it has any foundation,
   must principally depend on a greater concentration of the mi-
   asmata extricated in a dry air, than of those which have been
   diluted and diffused by the redundant aqueous particles wiiich
   necessarily accompany great moisture.   Whether this greater
   or lesser concentration constitutes the whole difference  be
   tween the morbid exhalations of particular places and seasons
   is a question which I am afraid to answer, because the known
   facts connected with it are too few  to warrant a decision.   It
   is, indeed, probable,  as will hereafter be mentioned, that the
   miasmata of particular towns, (mostly either sea-ports or ac-
   cessible to shipping) in which the aggravated forms of yellow
   fever have  almost  exclusively prevailed  in the West Indies,
• *  the United States  of America, and the southern parts of  Eu-
   rope, differ from  the common exhalations of  marshes, in
   quality  as  well  as in degrees  of concentration;  but whether
   this difference be occasioned merely by the greater heat which,
   at such times, commonly exists in these towns than in the  sur-
   rounding country,  and which may exalt the powers of such
   miasmata, by perfecting the  decompositions  which produce
   them, or whether  it be partly the result of a difference in the
   organized matters decomposed by that excessive temperature,
   I am unable to determine.
     But,  besides the influence of rain in the formation of mias-
   mata, it seems to assist afterwards in promoting their extrica-
   tion from the soil,  and their diffusion in the atmosphere.   Dr.
   Blane, (p. 261 of his Observations on the Diseases of Seamen,)
   considers moist air as " a vehicle of noxious exhalations, with
   which (says he,) it seems to have a greater chemical  affinity
   than dry air."  This is, at least, true of carbonic acid gaz,
   which is,   doubtless,  one ingredient of these exhalations.
   There are, moreover,  some countries^ in which rains may 
157
promote the extrication of miasmata without any chemical at-
I raction, merely  by loosening and opening  the  surface of the,
earth,  which, particularly on  the  coast  of Africa,  is often
overspread by a hard crust in the dry seasons.  Dr. Lind, in
his work on the Diseases of  Europeans in  Hot  Climates,
states this fact (p. 47,) adding, that, '• by the continuance of
rains tbis crust is softened, and the long pent-up vapours are
set free, which thence become the cause of sickness."
   Dr. Henry Warren, also, seems to have observed the effect
of rain in assisting the extrication of marsh miasmata, but
without suspecting the mode  of its operation,  winch indeed he
was not likely to do, because he believed the yellow7,  or, as
he called it, malignant  fever, of Barbadoes, to arise solely
from contagion.  He states,  however,  at p.  8 of his Treatise,
and,  as he  thinks, " with great certainty, that, at the time
this malignity is actually harboured among us, (i.  e. in Bar-
badoes) a continuation of dry and sultry weather, has been so
far  from giving any aggravation to it, that  it has  rather
seemed to  repress it, and make it lie more lulled and dor-
mant, until the returning rains, and a moist atmosphere, had
set it at liberty to exert  its rage."  It is difficult to  conceive
how rain could  have produced such an effect, if the disease
had been propagated, as Dr.  Warren supposed, by personal
contagion ; and  therefore his statement of a fact, at variance
 with his theory, is the more to  be depended upon, because it
must have clearly manifested itself to his senses; and  it will
serve to confirm what I lately mentioned at p.  198 of the sa-
lubrity of the air at Barbadoes during the continuance of hot
and dry weather.
   It  has been frequently observed by others,  as well as my-
self,  that the prevalence of cold easterly winds, in the spring,
has been soon followed by  that of intermittents in persons
who had been exposed to marsh effluvia.  Dr. Lind,  at p.  16
of his volume on the Diseases of Hot  Climates,  mentions
this to have happened in a very extraordinary  degree, in the
years 1763 and 1766; and he appears to think that an easter- 
                          158
ly wind has some peculiar aptitude for extricating or absorb-
ing marsh  miasmata,  or,  to use his own  words, that  it
" raises a copious  vapour from water mud, and  all marshy,
or damp places."   I  am, however,  disposed  to  believe, un-
reasons to be hereafter mentioned, that,  in this case, the east
winds act merely as an exciting cause upon persons who had
imbibed marsh miasmata during the preceding  summer and
autumn,  and which had remained inactive during the winter.
  From  this general  view  of the sources  of marsh effluvia,
and of the  circumstances which arc requisite  or favourable  to
their production and extrication,  it will be  perceived that the
former depend entirely on the joint influence of  seasons, and
of local circumstances:—The seasons, indeed, vary so much,
as rarely, if ever, to resemble each other exactly in the course
of many years,  and are  sometimes  in one  year  the very re-
verse of what they were the year before at the same  places;
thus of the two  winters  of 1794-5,  and of 1795-6; the for-
mer,  says  Dr. Heberden,  in his paper on  the influence  of
cold upon health, (in the philosophical transactions for 1796)
was " the  coldest,  and the latter the warmest,  of w liicb any
regular  account has  ever been kept in this  country."  We
may conclude, therefore, that considerable variations,  with
regard to the formation of miasmata, must annually occur in
every place; and we ought to find,  not that the health of per-
sons living in or near  a swampy  or low situation is affected
in the same manner every summer or  autumn, but, on the
contrary, that it is very differently affected in different years,
as it is known in reality to be, by all medical practitioners in
marshy  countries.
   Thus it was observed many years ago  by Dr.  Chalmers,
who practised medicine with great reputation for a long time  .
at  Charleston, in South Carolina,  and paid  very  minute at-
tention to the climate, that the yellow or putrid bilious fever
appeared in that city whenever " the weather was very warm 
159
    and wet withal."*  This, he  states to have happened in the
    year 1770,  when " much rain having fallen throughout the
    summer,"  and the weather  becoming  " so warm that the
    mercury often rose to the 96th degree of the thermometer, the
    putrid  bilious  fever appeared in August, and  continued till
    the month  of  October  following."!  The same observation
    has repeatedly been made, before and since his time, concern-
    ing the effects of  a  very hot and  moist season on the health of
    the inhabitants of Charleston,^: and when we recollect that the
    city itself is placed on a low flat point of land,  between two ri-
    vers,  upon  which  great encroachments  have been made by
    wooden wharves, <Scc. and that the  adjoining  country is,  also,
    very low, and in many parts swampy, we shall readily per-
    ceive, that a season  like this must have been extremely favoura-
    ble to the formation of miasmata in that situation.  But a very
    different effect  resulted from the  very  hot  summer of  1752,
    described by the same author,  vol.  1,  p. 22,  and in which
    " the mercury often  rose above the  90th degree throughout
    the months of May, June, July, and August ;  and, for  twen-
    ty successive days,  excepting three in June and  July, the tem-
    perature of the shaded air varied  between  the  90th  and the
    100th  degree ;and sometimes it must have been 30  warmer
    in the open sunshine,  to winch great numbers of people were
    daily exposed for many hours together."—When the mercury
    rose to the 9rth and 98th" in the shade, the atmosphere seemed

     * The ground, upon which the city of Charleston is built, though very low, contains
    a large proportion of sand,  and more frequent falls of rain are, therefore, necessary for
    the production of marsh effluvia therein, than would otherwise conU-ibute to that effect.
      f See his account of the Weather, and Diseases of South Carolina, vol. 1, p. 163.
     i Dr. Moultrit, of Charleston, in South Carolina, in his valuable " Dissertatio inaug-
    urate de febre maligna bilin=a America?," printed  in 1749, mentals it as having been
    there observed,  " Quo culidior est aeli temperies, eo vehementiusfebris maligna bilio-
    sa grassatur"'  And in confirmation of this observation he  adduces the following in-
    stance, viz. "Anno  1748, in eodem loco  (Caroli oppido) febris hsec erupit circa
    medium mensis Augusti, prima cujus septimana nulla ibi unquam calidior erat, ut mer-
£ ^urius in Fahrenhetii thermometro ad 97°, 97 1-2 et 98 in aere umbroso ascenderet, et
    calor hicce cum multis imbribus diu duravit: a- coeli temperie in frigidiorem versd
    nritescit, et inintermittentemfebrimmutabatur." V-.\"x 8. 
                             160
in a glow, as if fires were kindled around us : in breathing, the
air felt as if it had passed through fire ;  nor  were the nights
much  less  sultry  and distressing than the days; refreshing
sleep,  therefore, was a stranger to our  eyes, insomuch that
people were, in a manner, worn down with watching, and the
excessive heat together."   It is not,  I believe,  easy to con-
ceive that any state of the body  could have been more favour-
able to the occurrence  of the yellow  fever than the above;
yet, says  Dr. Chalmers,  " a more healthy season had never
been known than this, so  long as the weather continued stea-
dily warm and fair."  The  cause of this singular healthiness
is,  how ever,  easily  explained:  for  during this  time,  us ap-
pears  from another part  of his work, (i. e. p.  18  and  19)
" a general drought prevailed."  " The earth was so parched
and dry that not the least perspiration appeared on plants,
which shrunk and withered; all  standing waters were dried
up, so that travellers could not find water for themselves or
their beasts for a whole day together:"  " in several  settle-
ments no water  could  be found  by digging ever so deep."
While the earth was so completely exhausted of moisture  it
is obvious that no miasmata would be formed in it.*
   Having offered these examples of the opposite effects,  which
two different seasons have actually produced in the same place
it would be superfluous to enter  upon  a detail  of the  divers
consequences which may result from other varieties of season.
Nor is it necessary  to present a statement of particular facts

 * Dr. John Hunter, in his Observations on the Diseases, &c. of Jamaica,  observes,
at p. 13, that " the heat of tropical climates,  though generally reputed the cause of
their unbealthiness, will not alone pi-oduce fevers, as is strongly exemplified in those
living on board of ship,  who remain free from fevers ; and, also, in the inhabitants of
certain dry iandy ipots, along the coast, in which the heat is uncommonly great, yet
the situations are healthy, as Fort Augusta, Port Royal, and others."
  In Egypt, when the British army, at the siege of Alexandria, in the summer of 1801,
was encamped on dry saild, at a distance from all swamps, with the sea on one side
and the L;ke Maadie on the other, a fever was rarelv, if ever, seen.  I observed a
similar exemption from fever in the  same season at Rosetta, which is at some distance
from any swamp. 
161
to shew that the differences of local circumstances are neither
less  numerous nor less  important, towards the generation of
noxious exhalations than those of season.  It may,  therefore,
be affirmed, that as the inhabitants of any one place cannot be
affected in the same manner in regard to health  every sum-
mer, or every autumn, so likewise they may be very different-
ly affected, in the same season, from the inhabitants of another
place situated within a short distance from themselves.   Thus
it seems perfectly consistent with the laws of nature that the
summer of 1800, which produced the epidemic yellow fever in
Cadiz and Malaga, should not have  been able to produce it at
Gibraltar;  and that the summer of 1804 should have been
such as to occasion the disease in each of these towns.  In an-
other part of this volume  I shall endeavour to shew that the
above  variety in the occurrence of the disorder at those pla-
ces may justly be ascribed to situation ; and will therefore, ab-
stain from any further observations at this time on the influ-
ence, which mere locality possesses Over health, under  differ-
ent circumstances of weather.
  The  distance to  which the exhalations of marshy grounds
may be conveyed from their source,  and retain the power of
causing the  yellow or other marsh fevers, will partly depend
on the force of the wind, and partly on the extent of the sur-
face from which they arise, and on their being more or less
copiously extricated  from that surface.   If the wind be very
moderate, and blow steadily from the same point, and  if  the
miasmata be abundantly emitted from a very great  extent of
surface,  it seems probable that so large  a mass of them as
would thus be formed might be conveyed a quarter, and per-
haps half a mile, before it became so diluted with atmospheric
air,  or so dissipated by the wind, as to lose its morbific power t
and, it is obvious  that such a mass of exhalations,  if it were
wafted into a town, would be able to produce fever  in the ma-
jority of the people inhabiting the quarters which it traversed,
with as much ease as it would produce fever in an  individual
21. 
162
only ;  or, in other words, that it would within a certain ex-
tent, as easily cause an epidemic as a sporadic fever.
  In mentioning " a quarter, and perhaps half of  a mile," as
the greatest distance at which marsh effluvia seem capable of
being conveyed, even under the  most favourable circumstan-
ces, from their source, so as to produce disease.  I  have con-
fined their morbid influence within much narrower limits than
those which are generally described by medical writers ; most
of whom suppose marshes capable of exciting fever at the dis-
tance of several miles.  It is, indeed, to be regretted, that ob-
servations on this subject,  have  not been made, and reported
with greater care and precision.  Sir John  Pringle,  indeed
appears to have thought more justly on this subject,  and  after
describing the epidemic marsh fever which raged in Zealand,
both among the inhabitants and the British troops, in the year
1747, he adds, " But Commodore Mitchell's squadron, which
lay all this  time, at anchor, in the channel  between South
Beveland  and the island of Walcheren, at both which places
the epidemic prevailed,  was neither afflicted  with the fever
nor the flux; but amidst all that sickness  enjoyed perfect
health."  (Diseases of the Army, p. 57.)   This immunity of
the British seamen is,  by the author, justly ascribed to  then'
having been  out of the reach of that which he calls " the moist
and putrid air of the marshes," though the whole width of the
channel is,  I believe, in general, but little more than one mile
and therefore the  squadron could not, even at midway, be pla-
ced at more than half that distance from the grounds whence
noxious miasmata  arose.  Dr. Lind  (on   preserving the
Health of Seamen, p. 69) notices this fact, and makes the fol-
lowing addition to it, viz. " when Commodore Long's  squad-
ron, in the months of July and Augnst, 1744, lay off the mouth
of the Tiber, it was observed that one or two of  the ships,
which lay closest to the shore, began to be affected by the perni-
cious vapour from the land, whilst some others, lying further
out at sea, at but  a very  small distance from  the former, had
not a man sick; at the same time, the Austrian army, under the 
163
command of Prince Lobcowitz,  suffered  so great a sickness,
through the proximity of their situation to  the  marshy coun-
try, that they  w ere obliged to decamp."
  Dr. Blane,  also, observes, that " it is difficult to ascertain
how far the influence of vapours  from wood and  marshes ex-
tends,  but  there is  reason to think that  it is to a very small
distance.  When ships  watered  at Rockfort, (Jamaica)  they
found that if  they anchored close to the  shore,  so as to smell
the land air, the health  of  the men was affected,  but upon re-
moving two cables' length,  no inconvenience was perceived."
(Diseases of   Seamen,  p. 206.)
   But the most decisive evidence on this subject  has been ob-
tained by the  late expedition  to Zealand.   Drs. Blane, Lem-
priere,  &c. in their report to the Secretary at  War, dated
Middleburg,  October 10,   1809, and printed by order of the
House of Commons,  assert their  "having ascertained that
the crews of  the vessels stationed in the very narrow channel
(only a few   yards* from  the   land)  between  Beveland  and
Walcheren, have continued perfectly healthy the whole  cam-
paign ; thus decidedly  proving  that the noxious  exhalation is
nearly  confined  to its  original  source."   Here  it  should be
recollected, that it is stated in  the same  report, that " the
number of sick and convalescents,  in the different hospitals,
amounted to  more than two-thirds of the total  force," at that

  • This expression of " a few yards" is much too indefinite. In conversing  on the
subject afterwards with Dr. Blane, he appeared only to be certain that the vessels in
qaestion, or, at least, many of them,  were staUoned at less than a quarter of a mile
from the shore. According to the best information which I have been able to obtain,
the ships of war at Flushing were anchored genei-ally at about one quarter of a mile
from the shore. Those in the Uoompot channel at about three-fourths of a mile from
land.  It was chiefly in the latter channel, and at about that distance from shore, that
the transports having on board the cavalry, (viz. 2d Dragoon Guards, and 9th and 12th
Light  Dragoons)  were stationed.  These did not land, and, consequently, did  not
partake of the sickness.  Mr.  Webb, Inspector of Hospitals, in  his evidence at the
House of Commons, asserts, that " the men who remained on board the ships were
extremely healthy.'" 
                           164
 time,  "notwithstanding about 1500 sick had  been already
 sent home by different conveyances from Walcheren alone."
   The general prevalence of heaHh on board the ships of war
 and transports  was also confirmed, on my enquiry at the
 Transport  Office,  by Mr.  M'Leay,  Secretary,   and  Mr.
 Houseman, chief clerk of that department.  Dr. Blane,  also,
 had the goodness to communicate to me a letter from Captain
 Hanchett,  who commanded the Raven Sloop of War, during
 the expedition against Zealand,  and being wounded,  had re-
 mained thirteen  nights on shore,  (for the cure of his wounds)
 by which he contracted an obstinate intermittent.   In his let-
 ter, dated Exeter,  April  29th, 1801, Captain Hanchett writes
 as follows :  " the Raven, while I commanded her on the late
 expedition, was more through the narrow channels of Zealand,
 and  more in shore than any other vessel, of any description,
 employed  there; her station being that of the leading ship of
 the squadron in shore withal; and after the action of the 3d
 of August,  I went up the narrow  pass between Schowen and
 Goree,  (within four miles  of Williamstadt) laying not more
 than stpistol shot from that shore, and was the last down upon
 the retreat.   There was,  however, no ague in the ship  but
 mine, which was, no doubt, occasioned by my wound;  and,  I
believe, there were very few in the other vessels of Commodore
 Owen's squadron."  " I had forgotten to  mention that, dur-
ing the time we were refitting at  Ter Veere,  the  men had
leave (to go) on shore, but never staid the whole night;  and,
when laying off Schowen, they went on shore  to bathe and
watch, under the charge of the commissioned  officer of  each
division, e^ery evening at five o'clock; and after bathing they
ran races along the dykes for half an hour, but there  was
never any appearance of ague except in myself."
  The people of  Italy have long had frequent and fatal expe-
rience of the noxious power of miasmata, (by them denomi-
nated Mai'  Aria) with which Rome, in particular,  is greatly
infested during   and  after very hot and dry summers; yet
Dr.  Lind observes, that  the effects of the Seirocco,  or South 
165
  east wind, " which passes over the  adjacent marshes," have
  been experienced to extend only to the parts of the city which
  lay nearest  the  marshes, occasioning  an  epidemic fever in
  these,  while the rest of  the city  was healthy."   See  his  vo-
  lume on Preserving the Health of Seamen, p.  67.
     In like manner Baglivi represents the Mai'Aria of Rome,
  as  acting only in particular spots or parts of the city, and as-
.  serts as matter of wonder, that the healthy are  separated from
  the unhealthy spots, only by very short spaces ;*  the former be-
  ing chiefly on the northern  and eastern quarters  of the city,
  farthest from the river : for the Piazza,  and Porto del Popolo,
  though on the north,  are extremely, unhealthy, by being low
  snd close to the  Tiber.    Indeed,  marsh fevers  at Rome com-
  monly  begin about the Porto del Popolo.


   • Aer ltomanus Squallidus est  &t insalubris, non quidem omnibus in locis, sed iis po-
 tissimum  quse deficientibus aedificiis, pigro atque immoto aere sordescunt; multo ma-
 gis si Tiberi adhserent, vel, convallium instar, montibus obsepiuntur, aut exhalationibus
 subjacent quas veieres parietinoe, cryptse, &  antiquorem xdificiorum  rudera emittunt.
 Ex quo patet regionem Circi Maximi, inter Palatinum atque  Aventinum sitam, om-
 nemque ilium campum qui inter aventinum  ac Tiberim,  portamque  Ostieusem jacet,
 plane noxium esse & damnabilem."  " Qusecunque loca crebris sedificiis ambiuntur,
atque editiora sunt,  in  septentrionem atque orientem  spectant et multem a Tiberi
distant, salubriora : Contra, qua;  sejuncta sunt  & remota a frequentibus tectis, situque
sunt humili, ac  maxime in convallibus, turn  propiora Tiberi,  in meridiem atque
occasura spectantia, minus salubriora judicantur:  Quibus etiam in locis  (~quod sane
mirum) brevissimi intervalli discrimine, hie aliquantum salubris existimatur aer; illic
contra noxius & damnabilis."   Baglivi Opera Omnia, p. 157, 158.
  The reason why particular spots within the walls of liome were destitute, or almost
destitute of houses, seems to be  that their  (notorious) insalubrity had either destroy-
ed or driven away those who  formerly lived thereon, and when the existing houses
were  decayed, bad deterred other persons from  rebuilding in th6se situations: and
therefore,  Baglivi justly mentions  these places  ("deficientibus xdificiis") as being
anion" the most noxious.  It is from a similar motive that the General Committee of
Health, of the City of New York,  in their report on the means of securing the health
of its inhabitants,  (dated  the  20th of January,  1806) after stating that  "various
houses, in  different parts of the city, have, on the recurrence of every  malignant fever,
proved to be the principal seats of  (jisease, and  the graves of their tenants,"  " suggest
the propriety of  prohibiting the  same to be let or occupied as dwelling houses,  that
they may be converted into warehouses, and that any injury sustained by the proprie-
ors  be defrayed by the public."  See p. 95 of  Documents, relating  to the  Board of
Health, printed at Yew York, 1806.
•ft- 
166
   I  was  repeatedly told at  Rome, in the year 1802,  by  per-
sons deserving of confidence, that these fevers sometimes pre-
vailed  among  the  inhabitants on one side of a  particular
street,  whilst those on the opposite side entirely escaped their
attacks;  and this w as said  to have often happened in a cer-
tain portion of the Corso ;  the western side of which  was dis-
tinctly pointed out to me, as being much more unhealthy than
the  other.*  Professor Berthe,  in his work  on  the  fever of
Andalusia, has mentioned  similar facts as occurring in some
of the streets and squares of Cadiz, in the year 1800  ; though
he ascribed it not to the very limited action of marsh effluvia,
but to that of the contagion, by which he supposed the prevail-
ing  fever to have been propagated in that city.   And it seems
highly probable,  that in many cases the miasmata producing
yellow fever  in  sea-port towns of the West Indies, and the
United States of America, arise  from the soil  immediately
around,  and perhaps,  sometimes under  the  very houses,
wharves, &c. where they are imbibed, by the persons in whom
that  fever  afterwards appears.  Accordingly we find that, in
New-York,  Philadelphia, Baltimore,  Norfolk, and  Charles-
ton, this fever always begins, and often continues, exclusively
in the low  streets immediately adjoining to the harbours  and
wharves of these towns, except in the cases of some  individu-
als, who,  after having imbibed the noxious exhalations  of the

  • Similar facts are stated by Lancisi, particularly in the 3d chapter of his second
book, de  Mox. Palud. Effl. in which  are several instances of marsh fevers prevailing
in particular parts of Rome, and its vicinage, whilst other parts closely  adjoining re-
mained healthy.  In one of these he says the salubrious districts might  be separated
from the insalubrious, by a diagonal line drawn, " a postica Pontificii Falatii parte,
quam Belvidere appellant, usque ad emissarium magna; illius cloacae, quae in Tiberira
juxta  Arcis fossam eo loco aperitur," &c. p. 199.  And in the next page he refers to
several  authors who have  attested similar events, particularly Ramazini, De Constit.
anni,  1690,  who describes a tertian  epidemic, which occurred at Modena, in that
year, but was wholly confined  to the low parts, in which there was stagnant water,
and extended no fiy-ther.—" Non ampliora spatia occupasse." The people in other
parts,  (which  he designates)  having never, within  their remembrance, been more
free from fevers.  " "Vunquam alias a febribus magis secures se vixissc meminerint.'
t 
167
 wharves and low streets in question, by residence or employ-
 ment in or near them, happen to fall sick in other situations.*
   After these observations,  respecting the distances to which
 marsh effluvia may be  conveyed horvxmitally, without  losing
 their morbific  power, it may be  proper to  inquire  how far
 they are capable of retaining it, when raised perpendicularly,
 or nearly so, from their source.   Unfortunately, our stock of
 facts relating  this point, is even  more deficient than in re-
 gard to the other; though  it is sufficient to ascertain that their
 power of exciting disease,  is rapidly diminished at very small
 distances  from the earth.
   Dr. Hunter,  in his work  on the  Diseases of the  Army in
 Jamaica, p. 306, says,  " the barracks at Spanish Town, con-
 sist  of two floors, the first  upon the ground, the second on the
 first.  The difference in the health of the men on the two floors
 was  so striking  as to engage the attention of the assembly  of
 the island, (of Jamaica)  and, upon  investigation, it appeared
 that  three  were taken  ill on the ground floor, for one on the

  * Being at the  Horse-Guards on the 10th of November, 1810,1 saw there Captain
 M'Koy, of the 21st regiment of foot, who had then just arrived with dispatches from
 Sicily, and was informed by him  that, in July  and August, 1808, while his own and
 another company were quartered at the post of Venetico, in a barrack of nearly 100
 feet in length, which consisted of one (ground) story, forty men of the latter com-
 pany,  occupying one-half of the barrack, were attacked by a violent mal' aria fever,
 which  proved  fatal to eleven of them, but did not reach a single man of his  own com-
 pany,  occupying  the other half of the barrack, though there was no division be-
tween  the parts or halves occupied  by the two companies, nor any perceptible  dif-
ference in the soil on which the different parts or ends of the barrack stood.  Each
had, indeed,  its own door to pass into and out of the barrack,  but both doors opened
on the same side;—nor was there any difference in the discipline, diet, or  manage-
ment of the men of  the two companies.  Venetico  is situated between  Melazzo,
and Messina,  and is supposed to be more elevated than the Rock of Gibraltar, and, at
least,  1500 feet above the sea.   The barrack stood  at the summit of this mountain,
upon a rock covered by a clayey loam, and the  noxious miasmata were, most proba-
bly, emitted  more copiously from the soi' at or about one end of the barrack, than
that of the other,  though no difference was discoverable therein. Great elevation, in
a warm temperature, is no securitv  against noxious vapours, if the elevated spot be
covered by earth, containing vegetable matters, and in which clay predominates.
Very pernicious marsh fevers notoriously prevail in such situations in the East Indies,
 (where they are called hill fevers) and in other places within the tropics. 
168
other. The ground floor was not, therefore, used as a barrack ^
afterwards.*'  A similar fact occurred at St. Anne's barracks,
in Barbadoes, between  the 27th  July and 20th  of August,
1805, when two hundred and seventy-eight men of the 15th
regiment of foot, then very lately arrived from England, were
attacked by the Yellow Fever, of whom seventy-seven  died.
These men chiefly occupied the barrack which runs towards
the sea,  and  is nearly at right  angles with  the  officers' or
stone barrack, and has " low wet ground on each side."*  In
this barrack the men on the lower floor were " taken ill in the
ratio of three  to one, of those on the upper floor."   This state-
ment I have taken from a report made to Dr. C. Ker, then In-
spector of Hospitals in the West Indies, by Mr. Major Car-
roll, Surgeon  to  the Forces, under  whose  care the sick in
question  were  placed; which report was dated Barbadoes,
10th of September,  1805, and a copy of it put into my hands,
by the writer, in November,  1806.
   Whether similar  differences occur in all climates between
the ground  floor,  and the next above, in regard to the influ-
ence of marsh miasmata, I cannot determine; I believe that
the former are, in this respect, every w here,  much more un-
wholesome than the latter.  Sir John Pringle, after mention-
ing the prevalence  of intermitting  and remitting  fevers at
Ghent, and still more at Bruges, in the  summer and autumn
of 1742,  adds, "it was then observed that such as  lay in the
upper stories,  were much more healthy, than those who were
below in the ground floors, which were all very damp."  (Dis-
eases of  the  Army, p. 13.)   The same  ill  effect  upon the
ground floors  was experienced  during the late  expedition at
Walcheren, and,  therefore, Drs. Blane,  Lempriere,  &c. in
their report to the Secretary at War, lately  mentioned,  say,

  * Dr. Chisholm, alluding to this part of Barbadoes, observes, that, " the eastern
side, where Constitution Hill is situated, and where the  king's-honse, and an exten-
sive barrack stand, is thought to be affected by marshy miasm, from a branch of the
sea, which runs a considerable way into the country."  Essay on Malignant Pestilen-
tial Fever, &c. rol. 2, 160. 
169
" on no account should ground floors be used as sleeping apart-
ments.  The more lofty the buildings the better;  for the te-
nants of the upper stories, not only enjoy the best health, but
when taken ill, have the disease in the mildest form ; an in-
stance of which came under our observation when we visited
Fort Ramakins, and the same is confirmed by the experience
of the natives."   When the small elevation of a single story
(hot  exceeding  twenty feet) from the ground,  is  found  so
greatly to diminish the power of noxious exhalations, it might
be expected that the tops of hills rising  a few hundred feet
above the  level of the sea, or of the surrounding country,
 would always be  found  healthy.  Experience  has,  however,
often proved the contrary,  particularly on  the Morne-fortune
 at  St. Lucie, and on  the Hospital, and  Richmond Hills, at
 Crcnada, where very great mortality has repeatedly occurred
 among British  soldiers.  But in these and similar cases it
 seems probable that the soil, at or near the tops of these hills,
 contained matters suited to the formation of marsh miasmata,
 with sufficient  proportions of ciay to  retain the  necessary
 moisture.   There  can, indeed, be no doubt, that this is  the
 case of the Morne-fortune,  which I observed to be very wet,
 and,  in some degree, swampy.  This  and Richmond  Hill,
 being at  their tops more than seven  hundred feet  above  the
 level of the sea, could not, I am  persuaded, be so greatly af-
 fected merely by exhalations from any low  and damp grounds
 in their neighbourhood.
    After these facts,  relating to the heights and  distances at
 which marsh effluvia  may  be  conveyed from their source, so
 as to produce fever,  it may be proper to notice the greater
 degree of noxious power,  which they are supposed to  exert,
 when applied to  the  body during the night, than when ap-
 plied in  the day.  This  greater noxious power»in the night,
 and especially during sleep,  has been strongly asserted by
 Lancisi, de Noxiis pallidum effluviis,  p. 77, &c.; and he  was
 so perfectly convinced of  the fact that he has devoted a parti-
 cular chapter, (the 21st)  to explain the cause.   "Cur juxta
                              22 
                            170
paludes noctu prasertini indormicntes  magis (piam vigilantes
ladantur?"  And he begins this chapter  by saying, "Nemo
Arbitror de facti vcritate dubitabit qui din mcdica  arte  opc-
ram dederit;"  and then declares. " Nos certe Romana Noso-
comia per  sestatcm, &  autumnun plena videmus miseris agro-
rum colonis; ac per urbem sape dolemus incautos  venatores,
ac peregrinos,  quamquam non longo  tempore  palustria  loca
incoluerint, quia tamen brevem somnum prope lacunas capc-
runt, malignis  febribus afflictari."  These facts he ascribes
partly to an increased  susceptibility of our  bodies,  "qua in
somno ad labcm suscipiendam proniora fiunt,"  and partly to
a difference in  the condition of the effluvia themselves, " qua
per noctem pracipue deteriora evadunt;" and he explains the
cause of this difference in these words,  " Quod vero attinet,
ad effluviorum pravitatem,  certe  eadem post solis occasum
perniciorior est: quidquid  enitn per vim solis attcnuari, dis-
siparique continget,  eo recedente, concretione gravius effici-
tur, terraquc rursus incumbit, et  dormientes infestius adori-
tur,"  &c.  p.  79.   Lancisi refers  to  several authorities and
instances in support of his assertions  and opinions, and con-
cludes by admonishing those who,  in summer,  travel through
the Pontine marshes, between Rome  and Naples,  even with-
out sleeping, not to do  it at night, as  was  too often done, to
avoid  the  greater heat of the day.*    Similar admonitions
are still given  at Rome to all strangers,' and they are founded
on the uniform experience of ages, which has afforded nume-
rous instances  of travellers, who,  in consequence of their pas-
sing these  fens during the night, (thougli the passage requires
but six or  eight hours) have been attacked  with violent and
mortal fevers.   This is confirmed by Baglivi. in the following-
words : " Vetus eniin Latium desertum fere hodie est, & squa-
            •
 * " Neque vero solum dormientibus uoxius est per  noctem palustris aer ; sed etiam
Us qui vigilantes per coenosa loca interfaciunt.  Qua de re monitos vellem quotquot vcl
Neapoli liomam, vel ltoma Neapolim contendunt,  utdiurnos  potiu- sestus subeant,
quam nocturni frigoris voluptate  decepti contemeratam ambientis aeris vim excipiant,"
&c. p. 80. 
171
 lidum ; Austri flatihus immediate obpcitur ;  & variis cjusdem
 in locis, insaluberrimus aer observatur, ut pote circa Ostiam,
 et Portum aestivo prasertim tempore; quo quidem si aliquis in
 prafatis,  aliisque Latii locis pernoctaverit,  & exinde urbem
 revertatur,  corripitur  statim maligna febri,  quam  vulgo ex
 mutatione aeris  dicunt."  Opera Omnia,  p.  158.
   It  will be recollected, that in the instance of the Phenix
 Ship  of War, mentioned  at  p.  96  of this volume, " none of
 those who slept  on shore escaped the sickness, and only three
 of them survived it;"  and that, though nearly all the rest of
 her crew,  consisting of 280 men, went, in parties of twenty
 or thirty, at different times,  on shore in the day, and " ram-
 bled about the island hunting and shooting"—" bartering for
 provisions,  washing linen,"  &c. " not  one of those who re-
 turned to the ship at night was taken ill, or suffered even the
 slightest indisposition."   And  that exactly similar effects oc-
 curred  the  following  year,  with the same ship at the same
 place, where "  she lost eight men out of ten, who had impru-
 dently remained all night on shore ;" whilst  the  rest of the
 ship's company, " who, after spending the greatest part of the
 day on shore, always returned to  their ship before night,"
 " continued  in perfect  health."  In like manner the crew of
the Hound Sloop of War, (then in company with the Phenix,)
by never sleeping on shore, continued in good health.  It may
be recollected also, that in  the cases of  the Ponsborne  and
Nottingham East  Indiamen, (p.  99) those who had slept on
shore were exclusively attacked by the fever; and, in parti-
cular, that  " the carpenter  (of  the Ponsborne) and his crew,
nine in number,  by their all sleeping on  shore, catched the fe-
ver and died, except  one, who  was a negro.  The effects
were  exactly similar in the  cases mentioned by Drs. Clark
and Trotter, (p. 99  and  100)  and  in that of Fontana.   Dr.
 Lind has, moreover, in different places, mentioned other in-
stances of similar morbid effects, resulting from exposure to
marsh effluvia by  night, and the like has  been  done by  Dr.
Blane,  Dr.  John  Hunter. *&c. &c.   We  have,  therefore, 
\~2
reason to believe, not only that the morbid miasmata are con-
densed or precipitated with the falling dews, by the diminish-
ed temperature of the night, and  thus accumidated near the
surface of the  earth, but that the body is rendered more ac-
cessible to their noxious  influence during sleep,  by its greater
relaxation, and by a suspension of those protecting exertions
of the living power,  which accompany our wakeful exercises.
Perhaps something may also be  owing to the fact discovered
by Dr. Ingenhouze,  that vegetables only emit azote or nitro-
gen at night, instead of the oxygenous or vital air, which is
copiously  separated  from  their leaves when exposed to tin-
sun's rays.
  I  ought, were  it possible,  here to  ascertain how,  and
through what channels, the morbid influence of marsh effluvia
is applied to,  and exerted upon,  or within the body, so as  to
become the cause of fever.  But here our knowledge is but
little better  than  complete ignorance.  The  miasmata,  in
question, being absolutely  imperceptible  by any of our senses,
can only be known by the disorders which they excite: these,
however,  are not such as to indicate the manner in which they
were produced,  nor the passages by which the morbific power
has gained admittance.  The throat, trachea,  bronchia,  and
lungs, obviously  present themselves, as the parts  through
which all ariform and respirable substances might be most
readily and naturally introduced within  the system,  but these
parts appear to suffer much less than the stomach, brain, and
nervous  system, from the impressions  of marsh  miasmata;
and as there is much  uncertainty  and difficulty attending
every explanation which has occurred to me on this subject, 1
shall abstain  from proposing any; and proceed to enquire,
how  soon these miasmata, after being sufficiently applied  to
the  body,  commonly produce fever,  and how long they may
remain inactive therein, without manifesting any  change or
effect.
   On this subject Dr. Lind says (p.  182 of his work on the
Diseases of Europeans in  Hot* Climates) that " from com- 
                           173

paring many instances of people who have slept on shore dur-
ing the sickly season, and  in consequence  of it, who alone
have been taken ill out of the whole ship's company, then lying
in  an  open road,  it  appears  that some  are  immediately
seized with sickness or delirium, many are not  seized  with
either, till they have been on board two or three days; several
have been  only  slightly indisposed for  the first five or six
days ; and, in a few, the symptoms of  indisposition have not
appeared before the 10th or 12th day."
  The same author (on Preserving the Health  of Seamen,
p. 78) says, " there are numerous instances of boats' crews
having suffered greatly by sleeping near  the  mangroves,  with
which the sides of rivers are frequently planted in the torrid
zone.  I have known the whole of  a boat's  crew  seized next
morning with bad fevers."  And  at p. 81, he mentions a simi-
lar  fact, communicated  by  the  Surgeon of a  Guinea Ship,
which, going " up one of the rivers for the  sake of  trade,  it
was found very  dangerous  to sleep on shore."—" First the
captain,  then the  mate  and  tw<o or three  seamen were taken
ill,  each of them the morning after  they  had lain on shore."
But such very  sudden  attacks of fever from  marsh effluvia
arc, I believe,  uncommon,  even  in the  hottest  climates or
worst situations.   They, indeed, occur not unfrequently with-
in four or  five days; but are much oftcner delayed  until the
9th, 12th,  and 15th days, after exposure to marsh miasmata,
even at Batavia, Gambia, St. Thomas's, Mohilla,  &c.   Dr.
Jackson, who, like  some others, is disposed to  believe  that
these  attacks  " take place chiefly at   septenary  periods,"
asserts " from  his  own observations  made upon  numerous
bodies of men,"—and upon  healthy soldiers, sent to the  con-
centrated sources of endemic fever," that " among such, fever
scarcely ever appeared before the  seventh day,  commonly not
before the  fourteenth;  and in numerous instances, not till
the expiration of six weeks  or two months, though the cause
of disease, during this time, wras ordinarily in great  activity."
Outline, kc of Fever, p. 24R. 
                            174
                                             •
   Dr. John Hunter observes,  that  " after the human body
 has been exposed to the poison, (of marsh effluvia) sometimes
 a longer, sometimes a shorter period elapses, before a fever is
 produced.   " Men, (he adds)  on  the watering service, are
 not all taken ill at the  same time ;  some fall  sick the first or
 second day, others not till several  days, after they have ceas-
 ed to be exposed to the cause of fever,  by returning  on board
 of ship."—" Some have embarked on board the ship in good
 health, and have been seized after ten or  fourteen days with
 the remittent fever.   Examples in this way have come to my
 knowledge, of  the fever appearing three  weeks after ceasing
 to be exposed to the cause of it."   Observations on the Dis-
 eases of the Army in Jamaica.—He adds, in a note to p. 329,
 that,  " it would be curious and  interesting in the history of
 the remittent fever, to ascertain the interval that may take
 place between  exposure to the cause, and the appearance of
 the disease;" and then mentions the West Suffolk regiment of
 Militia, called,  in 1793, from their own county,  (one of the
 healthiest in England) to  Hilsea barracks,  of  which the
 "low, marshy, and  unhealthy situation, has been  fatally
 known to the  army,  since their first erection."  The men
 were then " all in perfect health ;"—but  " became very sick-
 ly ; and twenty-two died  of  fevers,  before they left the bar-
 racks," about the end of  June following.  In July this regi-
 ment, with eleven other battalions, was encamped  at Water-
 do wn, in the neighbourhood of Tunbridge Wells, and " their
 sick list  soon amounted to 100, out of  500," among which
were  many with fevers, that " had  all the marks of a  bad
remittent;" some of which terminated fatally—and the deaths
in this regiment exceeded the amount of those in all tlie eleven
other battalions together, on the same ground.   But the point
of most importance  is  that some of this  regiment "were
taken ill of the  fever,  in the month of  October, who had never
had it before;"  i. e. nearly four months  after their  removal
from  " the cause of the disease, at Hilsea  barracks." 
175
  In addition to this, he mentions the case of the 18th Regi-
ment of Foot, in 1783 and 1784,  as  stated by  Mr. Venour,
then Surgeon of the regiment,  and now Deputy Inspector of
Hospitals.   By  his statement it appears, that the 18th regi-
ment, after having been stationed at Hilsea barracks, from
the 22d June, 1783, to the 9th October following, was then
embarked for Gibraltar, where, though the regiment consisted
only of 400 men,  the number of agues  was increased, by the
beginning of May, to 280, including women and children,—
of whom a considerable part were then recently  attacked for
the first time; and whilst no  agues existed in any other part of
the garrison.  On these facts, Dr. Hunter remarks,  (p. 334,)
that '• the 18th regiment of Foot, and the West Suffolk regi-
ment of Militia, after leaving Hilsea barracks, were both in
situations where they could not contract fevers,  and the regi-
ments encamped with the latter,  and those in garrison with
the former, had no fevers.  There  cannot, therefore, be  a
doubt that the poison  had remained quiescent in  their bodies
for four, five, and six months."  When thus poisoned, " get-
ting wet in the open air, proved a  strong existing  cause of
fever, as was observed both  in  the  West  Suffolk and 18th
regiments."   He  adds, " ships returning from a warm  cli-
mate, particularly if  they have been in harbour during the
unhealthy  season, have  many of their men  taken ill of the
remittent fever, even two or  three months after being at sea ;
and care  should be taken,  not to confound  this fever with
what is called the Jail, Hospital, or Ship fever."  P. 335.
   Extraordinary  as these facts appeared  to be, when first
made known, the fullest  confirmation of them has been  since
produced by the late expedition to Zealand ;  in which it has
been indisputably ascertained, that considerable numbers, both
 of officers  and soldiers, who were employed on that service, and
 who  escaped the sickness, whilst at Walcheren, and other
 parts of Zealand, were attacked by  intermitting fevers, and
 some of them  as late  as  six, seven,  eight, and even  nine
months, after  being brought  back to  this country; though 
176
 care was taken to  place them generally in situations remote
 from all the known sources of marsh miasmata.   This fact is
 now become notorious; I have seen it verified in the  returns
 of several  regiments, and it has been confirmed to me by a
 great part of the physicians,  and by several of the surgeons,
 both staff and regimental, to whose care the sick of that army
 were committed in this country.
   We may,  therefore, now understand, what had before ap-
 peared to me very difficult to  explain  satisfactorily;  I mean
 the cause of those  intermittents which occur,  more especially
 in fenny countries, at an early part of the spring and summer;
 before the soil or atmosphere  can be supposed to have, at any
 time, in that year,  acquired sufficient warmth, either to form,
 or extricate marsh miasmata, capable of producing fe\ei\
 Consequently vernal intermittents may now be considered as
 resulting from miasmata received  into  the body  during the
 preceding summer or autumn, and (after having remained in a
 quiescent state during winter) rendered active by some excit-
 ing,  or proximate,  cause of  fever  in the spring.  It  may be
 presumed, however,  that in such cases,  the original dose, if I
 may so call it, of marsh miasmata, was  but moderate, be-
 cause its effects would otherwise have been sooner manifested,
 and this will account for the well known mildness of vernal
 intermittents,  and the facility with which they are generally
 cured,*

  » Dr. Jackson, at p. 60 of  his Outline of the History and Cure of Fever, mentions
a detachment who  were  embarked at the Mole, in St. Domingo, for St Marc, and
landed on the 3d of June, among which several were  taken ill of Yellow Fever, du-
ring the passage, and twenty were sent on shore from one ship with that disease, after
her arrival at S t. Marc, of whom eleven  or twelve died, within four days, though they
were all apparently in good health when embarked.  He also mentions, as a circum-
stance which «  appeared inexplicable,"  that at  St. Domingo,  « uncommon sickness
and mortality took place under every transportation of troops, to different posts."
It seems probable, however, that, in all these cases, the troops bad previously imbibed
certain portions  of marsh miasmata, which, though quiescent for some time, ac-
quired a morbid activity by sea sickness, getting wet, or other debilitating causes, du-
ring their transportation from one port to another. It is even probable, that actual
 disease was sometimes produced by such  causes, in persons whose constitutions migb« 
                           177

  From all these facts it may be inferred, that by differences
either in the quantity or quality of the noxious exhalations of
marshes, their operation, as a cause of fever, is liable to great
varieties, in regard to its celerity, or the length of time in
which disease actually  appears; which  is sometimes within
twenty-four hours,  and sometimes not until six, eight, or even
nine months  have  elapsed, and then only when  assisted by
some accidental or  exciting cause.   The longest periods, so far
as I can discover,  have occurred exclusively in cold, or tem-
perate climates  ; the shortest,  only in the hotter; and in ge-
neral there seems to be some foundation for believing, that,
ceteris paribus,  the disease will be most violent in those cases
where it appears soonest after the morbid cause has been ap-
plied to the body; and that the rapidity of its production, will
be in proportion to the quantity and concentration or force of
the noxious miasms ; differing in this respect from the small-
pox, and some  other specific contagions, whose morbid influ-
ence, together with the mildness or severity of the disease re-
sulting from it, seems to depend exclusively upon the state of
the body, in which it is  exerted, and the treatment of the pa-
tient in regard to temperature, diet, &c. &c. and  not upon
either the quantity or quality of the contagion, producing the
disease.  The  state of  the body,  indeed, and other  circum-
stances, have a considerable influence in regard to  the mild-
ness or severity of the fever from marsh effluvia, but not an
exclusive one, as they seem to have in regard to the effects, of
several, at least, of the specific contagions; e.  g.  Dr. John
Hunter  observes,  that if  persons are exposed to the exhala-
tions of marshes,  " when  fatigued by hard labour and long
fasting, the  poison gains  admission more readily  into the
body, and produces immediately the worst kind  of  fever.  It
 is in this  way, (he  adds,) that soldiers suffer so much on ac-
 tual service in  the West Indies : the few cases of fever which

under more favourable circumstances, have withstood,  and finally subdued the poison,
without any attaek of fever. 
178
proved fatal in twenty-four luturs, that occurred to me,  were
all contracted in a similar manner."  (Diseases of the Army
in Jamaica,  &c.)
  There is, however, another condition  of the body, which is
of great importance, in regard to the production of yellow fe-
ver, and which, therefore, requires a particular investigation;
I mean  the cause of that remarkable susceptibility to this dis-
ease, which  is commonly found in persons  who have just ar-
rived at piaces where it occurs, from cold or temperate  cli-
mates ;  and  of the  equally remarkable exemption from it,
which is commonly experienced by the old inhabitants of hot
countries; and which, in the latter, is universally ascribed to
their having become seasoned, as it is  called; but however
familiar this term may be, and of whatever  importance its
proper signification really is, (since it involves the means of
preservation from one of the  most dreadful  maladies which
afflict the human race) it has been long employed either with-
out any precise meaning, or with meanings which are  inad-
missible.  Thus it is often said, that a person is seasoned who
has once had the Yellow Fever; but very improperly, because
the same individual may have the  disorder several times; be-
sides which, many persons become exempt from the fever, and
ought, therefore, to be considered as being truly seasoned,
without having ever suffered an attack of the disease.  It is,
also, frequently believed, that one may become seasoned by re-
siding long in those towns in which the Yellow Fever is apt to
recur;  but the very great numbers of the inhabitants of Phi-
ladelphia, New-York, Malaga, Cadiz, Seville, &c. who have
been swept off by the distemper, within a few years,  are me-
lancholy proofs that an efficacious seasoning is not to be ac-
quired merely by such residence.   Nor can  it be  said, that
those who live near marshes are peculiarly seasoned, because,
in hot countries, numbers of persons, who live  at  a distance
from marshes, are proof against  the Yellow Fever, although
they are sometimes attacked with slight remittents, or inter-
mittents. 
179
  After some reflection on this interesting subject, the various
degrees of susceptibility which are observed in different indi-
viduals,  or in  different places, seem to me capable of expla-
nation on a very simple principle, I mean the effects of tem-
perature on the human frame, which does not appear to have
been sufficiently noticed.
  The body, whilst  in health,  is found always to be, with
very slight variations, at the temperature  of  98 degrees  of
Fahrenheit's  thermometer, and there is good reason to think,
that any considerable  variation  from this point would neces-
sarily produce  morbid  ^fleets.  It seems,  therefore, to  be  of
high importance, that the body should be preserved from such
deviations ;   and the author of nature has, accordingly, pro-
vided efficacious  means for that end :—different opinions are,
indeed, entertained concerning these means;  and  since the
later chemical discoveries have been made,  it has been  gene-
rally believed, that,  in  an atmosphere, the  temperature  of
which is  less than  98 degrees, the heat of the human  body is
maintained at that point,  by a process similar to that  of com-
bustion,  and depending  upon a combination of oxygen gaz
(taken into the lungs by respiration) with carbon and hydro-
gen : and that, in an  atmosphere  heated above 98 degrees,
the temperature of the body is kept down  at that point by the
effect of an evaporation of matters perspired from the skin.
There  are,   however,  insurmountable difficulties opposed  to
this doctrine,  but a full statement  of them would, in  some
degree,  be foreign to  the subject  under our consideration.*

  * In June, 1794,1 controverted this chymical doctrine, regarding the production of
animal heat, at an act, or public exercise, in the University of Cambridge, previous to
the taking of my first degree in physic. Perhaps a summary of some of the facts and
arguments, which render that doctrine inadmissible, may be acceptable here.
  1st. Animal heat is a natural production : and no chemical process like combustion  \
can take place naturally in a healthy animal, because the power of life, while it subsists,
naturally counteracts and suspends all chemical attractions, or affinities  within  the
body ; and even, after death, when this suspension is removed, they spontaneously occa-
sion a (Kffercnt process, that of putrefaction.. 
180
  I will,  therefore, at present, only remark, that it is utterly in-
  credible that these opposite processes should ever be carried  on
  so accurately in reference  to each other, and  be so exactly  ba-
  lanced,  as invariably to keep the body  at the  heat of 98_ de-

    ad.  The attractions or affinities subsisting between oxygen,  hydrogen, and  carbon,
 even if Restrained by the living power, would not,  so far as  our knowledge extends,
 enable them, by combining to form water, and carbonic acid gaz, with a disengagement
 of sensible heat, as, according to this doctrine, they are supposed to do, unless they were
 actually ignited, which they never can be in the lungs or blood-vessels of an animal in
 health.
    3d.  Were it even possible, that the air naturally inspired by the lungs should com-
 bine and  afford  heat in  the manner supposed,  the JUeat, so afforded, being necessarily
 limited and proportioned to  the quantity of  oxygen inspired, would, at all times, be
 greatly insufficient for maintaining the human body at its natural temperature, even in
 the milder parts of Europe ; and, in an atmosphere below the freezing point, it would
 greatly fall short of the quantity of heat commonly abstracted from the body, and  car-
 ried out of the lungs, by the warm moist vapour copiously expired from  them.  So
 that in cold, and even in  moderate weather, one effect of respiration is to cool the
 blood,  according to  the opinion  which, during several ages, prevailed on tbis subject.
 And if the quantity of oxygenous gaz, naturally inspired by  mankind, be  incapable of
 affording heat, sufficient to maintain their natural temperature, the quantity inspired by
 animals of the celaceous order, must be yet more, and much more, insufficient to main-
 tain the heat natural to them, living,  as they commonly  do, from choice, at the edges
 of ice, near the poles, and immersed in a fluid,  (salt water) so well suited  to  abstract,
 and rapidly conduct away their heat, however it be acquired.   The  degrees of animal
 heat naturally belonging to the several genera and species of this order, have not been
 accurately ascertained ;—it  is known, however, to exceed that of  mankind in some,
and probably, does so in all of them.  Some of the species of  whale, particularly the
Balxna mysticetus, (the common or larger whalebone whale)  are of an enormous
 size, and  from 50  to 100 feet in length ; in a few places they are said to have been
found 160 feet long.   And, it is ascertained that,  in  most animals of this  order,  the
passage for air through a part of the trachea, is proportionably " very small  or  con-
tracted ;" and that the pulmonary cells  are smaller than in quadrupeds, which,  says
 Mr. John Hunter,  " may make  less air necessary." (See his Observations on the Struc-
ture and Economy of Whales,  in the Phil.  Trans, vol. 77,  p. 418, 419)  And as
these animals, in  addition to the smaller quantity of air taken in their lungs at  each in-
 spiration, do not  commonly breathe  oftener than  once  in about fifteen minutes, and
 when frightened, only once in about haif anhour, (See Phil. Trans.  No. 387, p. 256.)
it must be  absolutely impossible  that oxygen, so sparingly received into their lungs,
should,  upon any  principles   yet  known,  afford  supplies of   heat  sufficient to
maintain the high natural temperature of these animals,  (whose osconomy nearly resem-
bles that of men and quadrupeds) in the cold water, by which they are surrounded.
   Finally, to avoid  unnecessary proofs, and demonstrate beyond the  chance  of  con-
tradiction, that animal heat is not produced by respiration, we need only recollect, 
181
 grees, in all the diversities of temperature that occur in dif-
 ferent climates and situations,  and, therefore,  that this im-
 portant  conservatory function must depend  on a power more
 exalted in its nature, and more certain in its  operations;  w hich
 can be no other than  the power of life,—a power which,  in
 proportion as it is more vigorous  in robust individuals at the
 prime of life,  notoriously  enables them to resist  the opposite
 extremes of  heat  and cold,  and  preserve their bodies  at the
 proper standard, more perfectly,  and for  a greater  length of
 time,  than at a more advanced age.  I will not venture to as-
 sert that no  addition to  the heat  of the body can be  made,
 either directly  or indirectly,  by the  combination of oxygen
 with  the blood,  and I readily admit, that its temperature may
 be diminished by a copious  evaporation  from  the  surface;—
 but, if either of these causes should co-operate with the living
 power to a small extent,  the one  in raising,  and  the other in
 lowering, what  is called animal  heat,  it  must  always be  in
 complete subordination to the higher principle of which  I have
 been speaking, and to which nature has committed the impor-

(what is well known)  that it continues to be produced for some time  after respiration
has entirely ceased, more especially in  persons  who die by apoplexy,  or by suffocation,
from funfes of burning charcoal, &c. who are  frequently observed to  retain  their for-
mer temperature undiminished for several hours after all breathing has stopped ;  and
in some cases, it has even been raised above the  standard of health ; e. g. Dr. Clarke,
 (on Diseases, &c- in Long Voyages, vol. 1, p. 4-i,) says of a seaman, who  died by  apo-
plexy, from a " coup de soleil" that, after all the external signs of life bad  disappeared,
when " no motion was to be felt in the  thorax, nor any pulsation in the  arteries ;"
 when his jaws were locked, his eyes dead, and storing, " the heat of his body was much
above the standard of health, and communicated a burning pungency to the  touch  ; be
was bled largely from the arm and jugular ; the blood was very hot,  and it  was  with
difficulty stopped."  Indeed, heat continues to be more  or less generated in all persons
after what is called death, so long as they retain any portion of excitability or living
power.   Were it not for this they would be reduced to  the temperature of the  sur-
rounding atmosphere,  as speedily as  another body of the same  species  and  size,
which, after being absolutely dead and cold, had been artificially heated to the same
degree.
   The natural beat of vegetables seems to  be analogous to that of animals, and
equally  the product of a living  power, independently of any process resembling
 i-.orabustion. 
IH2
 taut charge of preserving the temperature of the body at the
 standard of health, amidst all the varieties of climate,  and  of
 external  circumstances.   This  is  a charge which cannot be
 fulfilled in an atmosphere like that of England, the mean tem-
 perature of  which may be estimated at  50°, without  a consi-
 derable expenditure of the living power, in order to  generate
 constantly,  at the mean  rate of 48° of animal heat:  and after
 the body has been, for a length of time, accustomed  to make
 this exertion, it is easy to perceive that, upon removing into a
 warm  climate, such as that of the West Indies,  the  general
 mean temperature of which may be taken at 79" or 80%  very
 material changes in the functions of the system become abso-
 lutely  necessary  for  the preservation  of health.   But these
 changes are not to be suddenly effected;  and,  until  the body
 becomes perfectly accommodated to the heat of this  new cli-
 mate,  the whole  animal ceconomy  must be  considered  as al-
 most in a state of morbid  excitement.*  It  is not this state,

  * There  is a great analogy between animals and vegetables in regard  to their pre-
disposition, from habit,  to generate certain portions of heat; and in their susceptibi-
lities from the same cause, of being inordinately excited by a removal to climates or
situations, warmer than those to which they have been accustomed, Mr. T. A. Knight,
in  bis " Observations on the Method of Producing New and Early Fruit," (in the
 Trans, of the Horticultural Society, part 1, p. 30) mentions the following facts:
"If two plants of the vine, or  other tree of similar habits,  or even if obtained from
cuttings of the same tree, were placed  to vegetate during several successive seasons in
very different clJtnates ; if the one were planted on  the banks of the Rhine, and the
other on those of the Nile, each would  adapt its habits to the climate in which it was
placed ; and, if both were, subsequently, brought in early spring into a  climate simi-
lar to that of Italy, the plant, which "had adapted its habits to a cold climate, would
instantly vegetate, whilst the other would remain perfectly torpid. Precisely the same
thing occurs in the hothouses of this country, where a plant, accustomed to  the
temperature of the open air, will vegetate strongly in December, whilst another plant,
of the same species, and sprung from a cutting of the same original  stock, but habi-
tuated to the temperature of a stove, remains apparently lifeless.  It appears, there-
fore, that the powers of vegetable life in plants, habituated to cold climates, are more
 easily brought into action than in those of hot climates;  or, in other  words, that the
plants of cold climates are most excitable."  P. 191-  " But, the influence of climate
on the heat  of plants,  will depend less on the aggregate quantity of heat in each
climate, than on the distribution of it in  the different seasons of the year  The
aggregate temperature of England, and of those parts of the Russian empire, that 
183
^of excitement) however, which alone is productive of fever;
since we  know  that innumerable  persons  have gone  from
Europe to the hottest regions of the globe, and have continued
there for years, without being attacked  by fever, when other
causes  did not assist in  producing that disease.  The inhabi-
tants of South Carolina, as I lately mentioned, were exposed
to this kind of excitement, in an  extreme  degree, during  a
great part  of  the summer of  1752, and  yet  had never been
more healthy ; and other instances of the same import, might,
if necessary, be adduced.   But, although the simple operation
of the warmth of hot climates upon the human body be not the
cause of this disease, yet it is  chiefly, if not entirely, to  the
various degrees of that derangement which it occasions in per-
sons not  accustomed  to warm climates, that  I attribute all
those varieties of liability to the  epidemic   Yellow Fever,
which  are  observable  in different individuals, from the  ex-
treme susceptibility  of northern strangers to  the almost com-
plete immunity of Creoles, and more especially of African ne-
groes.  It may be very difficult  to point out the  particular
means by which heat  occasions  this  extreme susceptibility;
and yet it is .not difficult to understand, that  a morbid cause
may be able to produce a much more violent disease, when it

are under the same parallels of latitude,  probably does not differ very considerably;
but, in the latter, the summers are extremely hot,  and the winters intensely cold ;
and the changes of temperature between the different seasons are sudden and violent
In the spring, great degrees of heat suddenly operate on plants  which have been long
exposed to intense cold, and in which excitability has accumulated during a long period
of almost total inaction; and the progress of  vegetation is, in consequence, extremely
rapid.  In the climate  of England, the  spring, on the contrary, advances with slow
and irregular steps, and only very  moderate and slowly-increasing  degrees of heat
act on plants in which the powers of life has scarcely,  in any period of  the preced-
ing winter,  been totally inactive. The  crab is a native of  both countries, and has
adapted alike its habits to  both ; the  Siberian variety, introduced into the climate
of England,  retains its habits, expands its leaves, and blossoms on the first approach
of spring, and vegetates strongly in the same temperature, in  which the native crab
scarcely shows  signs of life ; and its fruit acquires a degree of maturity, even in the
early part of an unfavourable season, which  our native crab is rarely or never seen
to attain." 
181
is assisted by the co-operation  of so powerful  an agent  as
heat, than it could produce when acting by its own single in-
fluence ;  and it  is upon this principle that I shall endeavour
to explain the general law, by which the susceptibility to the
Yellow Fever is, csetcris paribus, regulated.   To accomplish
this object, it will be necessary to take  a  concise view of the
climates, in which the Yellow Fever has principally raged,
and  to  apply the principle  just mentioned to the  results,
which the experience of several years,  in each  of them,  has
afforded.
  The variation of temperature,  to  which the climate of  the
West Indies  is subject in the course of  the year, is comprised
within a few  degrees ; for the mercury in the thermometer sel-
dom descends below 70c during  the winter months,  even in
the coolest part of the mornings, and I have rarely found it
(in the smaller or  windward islands) to rise above 88° in the
shade on the  warmest days of the summer ; though the heat is
said  to be sometimes a little greater  in  St. Domingo, and the
other large islands.   The excitement  in  the system, which
ensues immediately upon  a person's coming into  so warm a
climate  from a temperate region, renders him,  as I have  al-
ready said, eminently liable to the Yellow Fever, when expo-
sed to the influence  of marsh effluvia :  by degrees, however,
the excitability producing this commotion  abates, and, at the
end,  sometimes of twelve months, but oftener of a year and
half, or two  years, he acquires the power of supporting this
high temperature, and then becomes almost as insusceptible of
the disease, as the natives or old inhabitants ;  and  afterwards
retains this happy immunity, so long as he continues in that
climate, the great uniformity of  which does  not, indeed,  af-
ford  him any means  of losing it.   He may, likewise, go from
the West Indies to those parts of North America, or of Spain,
where the  Yellow Fever is raging with the utmost fury,  with
almost a certainty of escaping  the  disease;  and even if he
should not  preserve his health perfectly in such situations,  he
will, at the worst, be only seized with a mild remittent or  in- 
185
  termittent fever, though living in the midst of those who are
  dying with the yellowr fever in its aggravated forms.
    The horrid massacres and pillage of the white proprietors
  in the French West Indian Islands, by their negro slaves, (in
  consequence of the principles instilled by the French revolu-
  tion) had so alarmed the wretched  survivors, that great num-
  bers of them fled  for safety to different parts #of the United
  States.  We were  about  three  thousand  French, says Dr.
  Valentin,  (the author of a late Treatise on the Yellow Fever,
  who was,  himself, one of  that number,)  when we landed at
  Norfolk and Rortsmouth, in the Bay of Chesapeake, in July,
  1793, after the  dreadful catastrophe at the Cape:  some of
  those who remained in these towns were seized with a remit-
  tent, but not one with the yellow fever, although our sudden
  transition from affluence to absolute want, might have been
  fully capable of predisposing us to  this malady, which a stag-
  nant and  heated  atmosphere,  and a  low  swampy situation,
  seemed, of necessity to produce, in  the, country in which we
  arrived.   (Page 68.)
    Many of these refugees were also living at Philadelphia in
  the same summer of 1793, during  which  above 4000 of the
  inhabitants died of  the distemper;  but (as we are distinctly
  told by Dr. Rush,) they universally escaped it.  In this place,
  however,  it will be proper to  remark,  that the immunity
.  which Creoles possess, relates chiefly to that variety of yel-
  low fever which is epidemic.   I have already mentioned that
  a fever, attended with all the  symptoms which are  held cha-
  racteristic of  the  yellow fever,  may, in hot  climates,  be
  brought on by  intemperance, great fatigue after being over-
  heated by the sun's rays, sudden diminution of  temperature,
  violent agitations of mind, and other causes, which are known
  to be capable of exciting fever in all  countries: to this spora-
  dic fever Creoles are subject, though in less violent degrees
  than Europeans; for no  length of residence  in any climate
24 
186
  can  be  supposed to  exempt one  from the operation of such
  causes.*
    The climate of the United States of America is very unlike
  that  which prevails between the tropics;  for the variation of
  temperature,  within  the year,  is not in the former  limited to
  18 or  20  degrees,  as  in the latter, but extends from 60 to
  80 degrees; the heat in summer being often  greater than in
  the West Indies,  and the cold  in winter being in many parts,
  much below the freezing point.  Nor does the  same climate
 prevail over all the states;  for although, during the warmest
 part of the year, the heat being nearly  as great at Philadel-
 phia, New-York,  and other towns in the latitude of 40 or 41
 degrees north, as at  Charleston, in South Carolina, which is
 seven or eight degrees  nearer to the  equator, yet the annual
 mean temperature of the more northern states, is considerably

   * Dr. Lempriere does not seem to believe that these causes alone will produce the
 fever in question. He says, (Diseases of the Army in Jamaica, vol- ii p. 112) "that
 how much soever persons are  exposed to the sun where marsh miasma does not pre-
 vail, the attack of fever does not ensue; and that, whenever there has been an in-
 stance  of Idiopathic fever, in situations that are deemed healthy, it  will  be found,
 upon careful inquiry, that the patient had been exposed to marsh miasma, in an occa-
 sional visit to some place where it exists."  That this may often be true I believe, but
 not that it is always so;  for, though mere exposure to  the sun, without a sudden
 cooling of  the body, or the co-operation of some of the other causes just mentioned,
 mayr not be sufficient to produce fever, yet I am fully convinced of its having done so,
 not unfrequently with such co-operation.   But, whether the fever so produced, will
 be, in all other respects, exactly similar to an Idiopathic fever produced in the way
 which  Dr.  Lempriere supposes, and especially, whether it will  have an equal tenden-
 cy  to remit, is more than I am willing as yet to decide.
  Though  Dr. Hillary  practiced, with the highest reputation, in Barbadoes,  for a
 considerable number of years, there is good reason to  believe that all the cases of
 yellow  fever which fell within his observation, were merely sporadic, and most of
 them produced by some  of  the causes which I have  mentioned, as sufficient for that
 purpose;  and it must be principally to such cases that Dr.  Lind alludes, at p. 120 of
 his volume on Preserving Health at Hot Climates, when he says,  " I am very  sensi-
 ble  that one or two persons  may sometimes  be seized with the yellow fever, when
 no  other person in the  neighbourhood labours under it;  and  even  that, at such  a
 time, its most mortal symptom, the black vomit, may attack a  person newly arrived,
 without any previous complaint "  He afterwards observes, at p  178, that  " drunk-
 enness, or any  debauch, will often give a fever, which in less than forty eight hour?
terminates in the death of the patient." 
187
less than that of the southern, because, on the one hand,  the
season of heat is of shorter duration, and, on the other,  the
winter is much  more severe  in the former than in the latter.
The cold at Philadelphia, for instance, is so great, that  the
Delaware " river is frozen  from three to nine weeks  almost
every winter,'"'* and is yet more intense  at  New-York, and
in most of the  towns of New  England: but at Charleston, as
we are informed, by Dr. Chalmers, " it seldom freezes more
than four or five times in that season;  and then a thaw  so
soon succeeds, that in the space  of ten years the ice may not
be strong enough to bear a man."  (See an Account of  the
Weather and  Diseases of South Carolina, by  Lionel  Chal-
mers,  M. D. vol. i. p. 23.)
   It is owing to these differences between the  same seasons
that, while  the annual mean temperature of Charleston is es-
timated at 66  degrees,  (according to a Register kept by Dr.
Chalmers, for ten years,)  that of Philadelphia is reckoned at
only 52" 5, and that of Newr England at from 50 to 48 de*-
grees;  and from these  differences  there will also result cer-
tain physical effects in the inhabitants, which claim a particu-
lar attention.   In the southern states, where the summer be-
gins earlier, and the autumn lasts longer, than in the higher
latitudes^ the inhabitants  have to endure a long continuation
of hot weather; and in doing this, they at length acquire, in
a considerable degree, the power of supporting heat; of which
power they lose but a small portion during the winter, because
the frosts  being there  neither frequent nor  of  long continu-
ance, their bodies  accommodate themselves with ease to the
mild temperature of that  season, and there are  few occasions
in the course  of it, when those greater efforts are required
which the body is obliged to  make  whenever it has to resist a
severe degree of cold, and, by the frequent making of which,
it seems to be always rendered less able afterwards to sustain
heat.  Hence  it results,  that the southern  inhabitants  can

  * Geography of the ¥nited States of America, by Jed. Morse, A. M. 4to. p. 426. 
188
 scarcely be affected by the moderate  warmth of the ensuing
 spring,  or the gradual increase of temperature, during that
 season;  and that  they will be able to  support the subsequent
 heats  of the  summer, with little or  no morbid excitement.
 But, in  the northern  states, the comparatively  short term of
 the hot season does not there permit the inhabitants to acquire
 an equal share of the power of supporting heat with their fel-
 low citizens in the south :  and that share of it which they do
 acquire,  is much diminished afterwards, or, perhaps, wholly
 lost, during the long and  rigorous winter of those latitudes,
 when great and continued  exertions of the animal powers be-
 come necessary that they may be  enabled to  sustain so cold a
 temperature.  It is, therefore,  obvious,  that on the return of
 the summer, the transition which the inhabitants of the north-
 ern states will then have made, from  extreme cold to exces-
 sive heat, must be the means of causing a much higher degree
 of excitement in them than will ever be produced in those of
 the southern states, for the reasons before given, and, on re-
 curring  to facts, it appears from them  that when the yellow
 fever has raged over  this part of the world, (which seems
 never to  have happened except  when summers have been ex-
 ceedingly hot) the degrees in which the citizens of the diffe-
 rent towns of America were liable to the disorder, correspond
 exactly with the power of supporting  heat conferred on them
 habitually  by their respective  climates.  Accordingly,  the
 citizens of Savannah  and  Charleston  are almost equally ex-
 empt from the yellow fever with Creoles, as  I had the oppor-
 tunity  of witnessing in both places in the year 1797.  But,
 that this  may not seem a mere assertion  of mine, I shall beg
 permission to quote the testimony of Dr. Ramsay, of Charles-
 ton.   This very respectable physician, after mentioning that
 the yellow fever had  occurred there in  seven out of nine of
 the last years, of the last  century, and  had continued in all
those years from the month of July to  the following Novem-
ber,  distinctly says, that,  " with very  few exceptions (chiefly 
                               189

 children,) it exclusively fell on strangers to the air of Charles-
 ton."*
   The  situation of Norfolk, in Virginia, is nearly  midway
 between Charleston and Philadelphia, and its climate corres-
 ponds with its situation, being colder than that of the former
 city, but  warmer than that  of  the latter.  The yellow fever
 has  frequently appeared there; and, according to the testi-
 mony of  Drs. Taylor  and Hansford, (residents in that town)
 it has, at least,  " in its malignant form, always originated on
 the (banks of the) river, or on low, new-made grounds, and in
 houses built on the  docks.  In all cases, it begins with stran-
 gers and  new settlers,  affecting every one in proportion to his
 time of residence, and  leaving the old inhabitants not wholly
 exempt, yet proof  against  its destroying power."   "Persons
 from higher latitudes  often  fall victims,  but with  European
 strangers, the  fever was generally  uncontrollable."  (New-
 York Medical Repository, vol. iv. p. 205, 6.)  This account
 is strongly confirmed  by Doctors Seldon and Whitehead, of
 the same  place,  in  a well-written statement, which will be in-
 troduced hereafter.
   With regard  to the towns of the more  northern states, as
 Baltimore, Wilmington, Philadelphia, New-York, New-Lon-
 don, Boston, &c. there is ample proof that the inhabitants of
 each of them become more subject to the disease, as their situ-
 ation approaches to the north: for, it is but too evident, from

  * See Dr. Ramsay's Review of the Improvements, &c, in Medicine, in the eighteenth
century, read on the first day of the nineteenth century, before the Medical Society
of South Carolina, p. 39.  If this testimony, delivered before so many  persons ac-
quainted with  its truth or falsehood, and never, as I  believe, controverted  by  any
one, could need confirmation, I might adduce that of the late governor of that State
(Mr. Drayton) who, in his Review of South Carolina,  printed at. Charleston, in 1802,
has made the following statement, at pages 9,7 and 28. " The Typhus icteroides or
putrid bilious, or Yellow Fever,  is, however, particularly local to Charleston; and is
not known  to have originated in  the country.  To the  natives, and long inhabitants of
this city it has not yet been injurious.  But those who come from the country, during
the autumnal  seison, or who have not been accustomed to spend the fail months in
Charleston, or to foreigners at their first arrival, it is particularly dreadful, and many
are those who fall victims to its fatal influence."                             fc 
190
the registers of the  deaths, reports of the Boards of Health,
and other authentic  documents, which have been made public,
that whenever the epidemic has broken  out in those places,.
the mortality has not been  there almost wholly confined to
strangers,  as in the  southern towns; but,  on the  contrary,
that a very large majority of those  who  had the  fever  and
died, consisted oi fixed residents.  This has been especially the
case in the four last  mentioned towns, the citizens of  which
seem to have been almost as readily attacked and carried off
by the disorder,  as foreigners even from the north of Europe,
though persons lately arrived from hotter  climates generally
escaped it.   In like manner, the official account of the yellow
fever at  Cadiz,  in  1800, asserts, that,  "persons  lately ar-
rived in  that city from the  West  Indies, did not suffer  an at-
tack of the  epidemic,"  while those  persons who  had come
" from Canada,  and other northern countries," were very lia-
ble  to the  disease.
   Thus, by  attending to the usual  and necessary effects of
heat on  the  human  frame,  under different circumstances of
climate,  it will be perceived, that we obtain a simple explana-
tion of some of  the most important  general facts with which
the occurrence of the Yellow Fever is connected.  An addi-
tional proof, that the security from that disease is principally
derived from the ability  to endure  great  heat,*  without  its

  * The natural ability to endure great heat varies not only among different races ot
men, but also  among individuals of the same race, though living constantly in the
same situations, e. g. light and red-haired  people with very white skins,  universally
bear cold better, and are more incommoded by heat,  than the black-haired with dark
skins.  But, besides these  constitutional differences., there  is another, which depends
more immediately upon the establislied habit of generating certain degrees or portions
of animal heat, for the purpose of keeping the temperature of the body at the health-
ful standard; and it is this difference extending generally to all sorts of persons, that
is now more immediately in my contemplation; though its effects  are liable to be
augmented or  diminished  by the constitutional peculiarities of individuals, and of the
several races among mankind.  Probably the power of habit may also, as Lancisi, and
others, have believed, extend so far as to diminish the morbid influence of marsh
miasmata upon persons who, from their birth, or, for a considerable number of years,
have been more or less exposed to their impressions, at least there are facts,  or sup- 
191
 causing  any considerable derangement in the animal econo-
 my, is,  that this security continues only so long as this abi-
 lity continues: for, if the inhabitants of warm climates re-
 move, for a fewr years,  into  cold countries, and afterwards
 return, they  are then found to be  liable  to the  fever.   So,
 likew ise, the refugees  from  the French West-Indian  islands,
 in America, who, as was before observed, at first universally
 escaped  the disorder, were frequently attacked by it after they
 had passed three or four  winters in  that country.   Another
 important proof of the same nature,  is the  more frequent ap-
 pearance, and  the greater severity  of the Yellow Fever, in
 populous cities,  than in the  country :  circumstances which it is
 natural  that we should expect,  when we recollect the various
 causes which  contribute to  warm the atmosphere in towns,
 and which do  not exist  out  of them ; such, for example, as
 the absorption  of  solar heat by, and the reflection of  it from
 the walls of houses,  and the pavements of streets, the assem-
 blage of a number of  living  bodies;  the many fires kept up
 for domestic purposes, and the obstruction to the circulation
 of the air, occasioned by large  collections of houses.  By a
 combination of these causes,  the temperature  of the atmos-
 phere, in  a large town, may  be raised to a degree  sufficient
 to produce the Yellow Fever within it, while that of the neigh-
 bouring  country  may not  be high enough for its rural exist-
 ence.!   There is an interesting fact connected with this last,

posed facts,  which support this belief.  In regard to individuals, who, by long residence
in cold climates, have become habituated to the generation of large portions of animal
heat, it must be remembered, that the  cold, which forces this habit upon them, will
naturally produce in them a considerable rigidity and strength of fibres, with an inflam-
matory diathesis, and that, when they remove directly to an intertropical situation,
they will commonly carry with them a great accumulation of excitability, which, co-
operating with the  established  habit of generating much animal heat there, may
readily produce in them a most aggravated and violent form of fever, from a cause or
causes which, in the relaxed systems, and with the diminished excitability of persons
who have resided many years in hot climates, would only produce  an intermittent or
remittent.
  f Dr. Caldwell, in his Medical and  Physical Memoirs, says, " Philadelphia, like
every other large and populous city, possesses a factitious climate of its own, different 
192
which ought not to be omitted.  Dr.  Ramsay,  whom I  have
before  quoted,  after  mentioning,  that  persons  coming  to
Charleston  from the higher northern  latitudes of Europe and
America, had been most subject to this disease, and had most
rarely survived it,  states, that " the  inhabitants of the coun-
try parts of South Carolina had little better chance of escap-
ing it altogether,  if they came into the city, or of  recovering,
when  attacked ;"* but,  considering that,  according to Dr.
Chalmers,  the atmosphere is  always from TO1 to 15  hotter in
Charleston than in the country, where it frequently  freezes
pretty hard, whilst, at the same time, nfc signs of ice appear
in  town, we shall instantly perceive  that the people from the
country are  susceptible to the fever in the same degree, when
compared with those  of the  town,  as  persons coming from
towns considerably to the north of Charleston ;  and it is also
plain, that the  same  reasoning is applicable  to the  country
people residing near most other large towns.f

from the climate of the surrounding country."  " The summer climate of Philadel-
phia, and of other'large cities, similarly situated, is an artificial torrid zone, in which
the thermometer rises from four to six degrees higher than it does at the distance of a
few  miles in the country."
  By a very accurate account of the state and variations of two Register thermometers
kept, one in London, and the other at Newick Park, in Sussex, in the winter of 1806-7,
it appears, that, though the latter place  is thirty-five geographical miles south of the
former, yet the weather was commonly between  four and five degrees colder at
Newick Park than it was at the same hours and days in London. This account was given
to me by the late Mr. Tiberius Cavallo, whose care  and love of truth are well known.
  *  We are informed by  Spanish and other writers, particularly Humboldt, that this
also happens at  Lavera Cruz, where the Yellow Fever exclusively  attacks strangers
from more temperate northern climates, or persons coming to town, from higher and
cooler situations  in the country; and this is also the case in Jamaica, &c.  See Dr.
Dancer's Medical Assistant; or, Jamaica Practice of Physic, p. 84.
  f The younger Michaux, who, under the auspices of the French government, made
a second voyage to the United States of America  in 1801, tells us that he landed at
Charleston, in South Carolina,  on the 9th of October in that year, contrary to the ad-
vice which was given him, and which was followed by the other passengers, of retiring
to Sullivan's Island until the appearance of frost;  that he was soon after attacked  by
the  Yellow Fever, which, in that very  year, proved fatal to  eight-tenths of all the
strangers in that city, and which had nearly cost him his life.  He observes, that  this
disease varies in the degrees of its intensity every year, and that the inhabitante ol 
193
   If after all these facts, which are not  less  in conformity
with the simplest  laws  of nature, than in harmony with each
other, and which  appear to me to form a chain of convincing
and even decisive evidence, any further proof could be desired,
concerning the uniform correspondence of the exemption from
the Yellow  Fever, with the power of supporting heat, it is
afforded by the knowledge of the various degrees in which ne-
groes  are susceptible  to the disease under  different circum-
stances.
   The annual  mean temperature  of those  parts of Africa,
which  are peopled by  the various  tribes of negroes, is, per-
haps,  no where less than 84° upon the coast, and it is, proba-
bly, several  degrees higher in the interior.   This, however,
is only to be understood of the temperature in the shade, or in
the coolest  places, and  does not  indicate the greatest heat
which  the  natives  of  Africa  can sustain,   nor even that
which  they may  be said to  bear  habitually:  for it will be
recollected,  that they pass  a great part of the day  in  the
open  air,  and  as  their bodies are generally  naked,   ex-
cept about  the  middle, they  are  fully exposed to  the  ac-
tion of the sun's rays,  the direct heat of which has been esti-
mated, and, I believe,  without  exaggeration, to  vary  from
120° to 160%  while the thermometer in the shade marks  from
85" to  110°.  But the bodies of blacks, and especially  their
colour,* are so admirably adapted for supporting, or rather for
Charleston are but little affected by it.  But, that those who live in the higher parts of
that state, at the distance of two or three hundred miles, and  who came to Charleston
during the four months, in which the Yellow Fever commonly prevails, are as liable to
be attacked by it as strangers ;  and, therefore, (he adds) all intercourse between the
country and city is suspended for one-third of the year, excepting that of a few white
persons who, from necessity,  go to the latter, always taking care, however, not  to
sleep there ; and that of negroes bringing provisions, who are but little subject to the
disease.  See Voyage a L'Ouest des Monts Alleghanys, &c. par  F. A. Michaux,
M. D. &c. A Paris, 1804. p. 2, 3, 4, and 5. This  account accords with the information
which I have received from medical and other gentlemen of unquestionable veracity,
and well acquainted with Charleston.
  * See in the Philosophical Transactions of the Royal Society, for 1804, " An Enquiry
Concerning the Nature of Heat," &c. in which the effect of a black skin, or of a  black
external surface, in promoting the cooling of bodies,  is proved by experiment  See
also Mr. John Leslie's " Experimental Inquiry into the  Nature and PropagaUon of
Heat.
                            „ OK 
194
  resisting, the intense heat in which they arc naturally destin-
  ed to live, that,  at all times, their skins feel cool to the touch
  of an European.   Endowed with these physical peculiarities,
  they are there so little subject to fevers, that the  disease does
  not appear to have a distinct and peculiar name in any of their
  languages.   Sometimes,  indeed, they  are  affected  by  slight
  febrile indispositions;  but   these as Dr.  Winterbottom ob-
  serves,   in  his  Account  of the Native Africans  of  Sierra
  Leone, (vol. II.  p.  13,)  are seldom of longer duration  than
 twenty-four hours,  and  they  are usually the  sequel of  some
 debauch,  and especially  of that excessive intemperance, in
 which they indulge at the funerals of their friends.*
    In the West-Indian Colonies,,  blacks  are still so far exempt
 from febrile disorders, that even intermittents, the mildest of
 fevers, seldom occur among those negroes who are employed to
 labour in the fields, and they  do not often even  among those
 who have diminished their power of enduring heat by wearing
 clothes,  and by living with peculiar indulgence in the cooler
 dwellings, provided for  the  comfort of Europeans-!  Nearly
                                                     *
  * Vitruvius seems to have been the first who noticed a difference in regard to the
predisposition to fevers,  and the po^er of supporting them with fortitude, between the
inhabitants of cold and those of hot climates.  He says, Lib. vi. cap  1. " Sub Septen-
trionibus nutrfuntur gentes immanibus corporibus, candidis coloribus,  directo capillo &
rufo, oculis caesiis, sanguine multo, quoniam ab humoris plenitate ccelique refrigerationi-
bus sunt confirmati. Qufautem sunt proximi ad axem meridianum subjectique solis
cursui, brevioribus corporibus, colore fusco, crispo capillo, oculis nigris, cruribus in-
validis, sanguine exigus,  solis impetu perficiuntur; itaque etiam  propter sanguinis
exiguitatem timidio es sunt ferro resistere, sed ardores ac febres sufferunt sine timore,
quod nutrita sunt eorum  membra cum fervore ; itaque  corpora quse nascuntur sub
septentrione a febri sunt timdiora & imbecilla, sanguinis autem abundantia ferro re-
sistant sine timore."
  | Dr. Mosely, in his Treatise on Tropical Diseases, (3d edit. J p. 146, asserts, that
none of the Europeans sent in 1780 on the expedition against St. Juan, " retained their    f
health above sixteen days,  and not more than three hundred ever returned; and those
chiefly in a miserable condition.  It was otherwise with the negroes who were em-
ployed on this occasion; a very few of them were ill, and the remainder of them
returned to Jamaica in as  good health as they went from it."  He adds, it was the
same at the taking of Fort Omoa from the Spaniards.  " On that expedition half the
Europeans who landed died  in six weeks.  But  very  few  negroes; and not one of
two hundred that were African born.  The Creole negroes did not bear hardships so 
                               195

 the salne may be said of the negroes belonging to plantations
 of rice, in the Floridas, and the State of Georgia, which, it is
 well  known,  are almost always made on swampy grounds,
 because they require to be overflowed at certain times : on the
 rice plantations,  in the  Carolinas,  however, blacks some-
 times have  intermittent and  remittent fevers,  though  neither
 so frequently, nor so  severely,  as  the whites, who reside on
 the same spots;  but they seldom or  never have the epidemic
 Yellow Fever, as Drs. Moultrie,  Lining, and Chalmers, of
 Charleston, have formerly attested; and, as subsequent expe-
 rience has sufficiently proved.   In Virginia, however,  and in
 Maryland,  negroes  have occasionally been  attacked  by the
 latter disorder,  and they are found to be still more subject to
 it  in the states which are to  the north of these, as  Delaware,
 Pennsylvania,  New-York,  and New  England.    Dr. Rush
 says, that he w^as led to believe, from various publications on
 the Yellow  Fever, that the blacks would escape  it, while it
 was epidemic at Philadelphia,  in 1793 : but,  as  he candidly
 confesses, it  was  not long before he was convinced of  his er-
 ror, for it  seems that, although the disease  was  commonly
 lighter in them than in white people, ** yet many of them died
 with it,"  at that unfortunate period, and many more of them
 have also died of it, in that city, during the epidemics of the

 well." This accords with Dr. Dancer's account of that expedition ; but he adds, that
 though the Mosquito Indians, who were sent upon it, suffered from fevers, and still
 more from fluxes,  the Indians of Cape Gracios a Dios, who have an admixture of ne-
gro blood, suffered less than any other Indians.  The great and almost peculiar exemp-
tion from fevers, enjoyed by the black natives of Africa, is  also asserted by M. Bour-
geois, in his Dissertation "  Sur les Maladies de St. Domingue," printed in a volume,
entitled " Voyages Interessans  Dans DifFerentes Colonies. " p. 417,  where he says,
"Les Negres de la Cote," (d'Afrique) " et les Negres Creoles font presque en ce
genre deux especes diffirentes ; car ceuxci, quoique d'une complexion forte et vigo-
reuse dont n'approchent point nos Creoles Wanes, ont pourtant plus frequement que
les autres la fievre et les diverses sortes de maladies auxquelles les blancs pai-aissent
spdcialement affectes.  Les negres nouveaux, qu'on  nous mene d'Afrique, sont d'un
temperament plusdur;" "Jamais les negres nweaux ne paient, en amvant dans la
colonie, ce qu'on y appelle le tribut." 
                                196
  following years.*  Thus we find  that negroes, by  long resi-
  dence in  cool or temperate  situations, become susceptible to
  the Yellow Fever,  from the same physical causes as whites ;
  though always in an inferior degree to the latter,  under simi-
  lar circumstances:  and, to  complete the  analogy,  they are,
  like whites, very liable to it, when, after having passed sonic
  years in cold  countries, they are carried back to hot climates.
  This  has  been sufficiently proved  by  the results of the three
  great importations  of blacks into Sierra  Leone, which have
  been made within a few years ;  the first from this country, in
  1787, and the others from   Halifax, (Nova  Scotia) in 1792,
  and in 1800.   Upon each of these occasions,  a  considerable
  number of the blacks were  seized with fevers, and many of
  them died; but the proportion both of sickness and of mortality,
  was much smaller in them than in  the whites,  who  were sent
  out  at the same  time to superintend or  assist the  new  set-
  tlers.f
    In the preceding  enquiries,  I have attempted  to  ascertain
  and describe the uniform course of nature in regard to the
 formation  and operation of  miasmata, and in  regard to the
 effects of heat  on the human  body ; and, if the principles, to
 which I have been led, be not erroneous,  it will,  I think, be
 admitted, that the joint  influence of marsh miasmata, and of
 an atmosphere unusually and sufficiently heated upon persons
 habituated  to a cold or  temperate climate, is,  of itself, fully
 capable of causing an epidemic Yellow Fever, exactly resem-

  •  These negroes had many of them been born in Pennsylvania, and the others must
 have lived in that part of America, long  enough to lose a great part of their constitu-
tional peculiarities ;  for  no unportation  of negroes had been permitted by the laws of
that state during the preceding ten years.
  t I have now before me a statement  of the progress, extent, and decline of the
sickness and mortality which attended each of these importations of negroes, compared
with what befel the whites at Sierra Leone, in these respects, made from official docu-
ments, reports, and correspondence which I was permitted to inspect.  The results ac-
cord with, and fully confirm, the principles and conclusions here  advanced : but I ab-
stain from printing this  statement, as I had  intended, because it may not be thought
Sufficiently interesting for the space it would occupy. 
197
bling that which has committed such ravages in the West In-
dies, the United States of America, and the  South of Europe;
1 mean a disorder which does not recur but  after very irregu-
lar intervals, and with degrees of severity, varying  at each
recurrence, and which uniformly  attacks with violence per-
sons of a certain physical constitution, while it allows other
persons to escape with a mild,  and often without any disease.
It will, moreover, be perceived from the same principles, that
the  influence of these  causes, when  it  is sufficiently  powerful
to produce an epidemic  Yellow Fever, can only produce one
of the above description.   With the assistance of those  princi-
ples, it will be easy to understand by  what simple means the
 atmosphere of a town, in  certain climates,  may become,  and
 must occasionally become, so vitiated, at least in some parts,
 and so productive of dangerous fevers, as justly to claim the
 appellation of an epidemic constitution,  and this, without re-
 quiring the smallest aid from contagion,  or from those occult
 causes and supernatural  agencies, to which writers  have had
 recourse, when they undertook to explain the  meaning of that
term;  without admitting, in short,  the  operation  of a single
 agent, of whose actual existence there is not  as complete evi-
dence as we can possibly have of the existence of  any agents
in physical cases.*  And, however few the causes may  appear

  *  Sydenham appears not to have known, or even suspected, the influence of marsh
effluvia as the cause of intermitting or remitting fevers, though Hippocrates, Galen, Var-
ro, Columella, Palladius, \ irtruvius, Diodorus Siculus, Lionysius Halicarnassensis, Strabo,*
and others, had observed, and very distinctly mentioned, the insalubrity of stagnant wa«
ters,  swamps, &c. without, indeed, properly understanding the ways or means by which
their morbid effects were produced.  Sydenham, after telling us  that  he had, in vain,
laboured to discover why seasons, apparently similar to each other, were  accompanied
or followed by very dissimilar effects, in regard to health and diseases, adds,  " Ita enim
se res habet; Varite sunt nempe annorum constitutiones, qua? neque calori, neque fri-
gori,  non sicco humidova ortumsuum debent, sed ab ocultd potius etinexplicabili qua-
dam alteratione inipsis terra visceribus pendent, unde aer ejus modi effluviis contami-
natur, quae humana corpora  huic aut illi morbo addicunt determinantque."  (De
Morb. Epid. c. ii. p. 41.)  Thus he manifestly overlooked the materials, the situations,
and the conditions of the atmosphere (in regard to heat and moisture) whieh contribute
to the production of marsh miasma, and sought  for occult and inexplicable changes in
the very boivels of the earth, whence he supposed effluvia to issue, contaminating the 
198
  to be,  by which I have endeavoured  to shew, that the various
  gradations of severity,  observed in  fevers,  which  originate
  from miasmata, are produced, let  it only be recollected  that
  (as every new discovery demonstrates,) nature  accomplishes
  all her wonders,  not by employing a multitude  of agents, but
  by merely varying the combinations  of a few simple means.
     That fevers,  occasioned  by  marsh  effluvia,   often  prevail
  epidemically, is a fact which has been  so frequently  observed
  and attested, that any proof of it would be  superfluous.*  It
  ought, however,  to  be  remarked,  that  the epidemical  pro-
  gress of these fevers often  very much resembles that of a dis-

 atmosphere, and  subjecting the  body to various diseases.  These notions he repeats
 in other places : and,  when he attempts to assign a reason for the prevalence of inter-
 mittents epidemically in autumn, he seems to think, that so far as they resulted from a
 change of air, such change was accidental.
     *  " Intermittentes febres scepius  epidemics grassantur  quam  alii  morbi. Van
 Swieten, Tom. ii. p.  264 sect 659.
     "Certa Romanorum observatione constat, postingentes Tvberis ' inundationes oriri
 febres epidemicas in urbe valde graves ac perniciosas."  Baglivi Opera Omnia, p. 51,
     Sir John Pringle (Diseases  of the Army,  p. 192) has justly supposed the fifteen
 plagues, mentioned by Livy, as having occurred at Rome before the year, (Urb. Cond.J
 59  to have been so many destructive  epidemics  produced by exhalations from  the ad-
 joining marshes ; and I may add from the low grounds, at the bottom of its hills, espe-
  cially those along the Tiber, where marsh fevers appear to have greatly prevailed, from
 the  earliest periods of its  history.  These seem to have been most commonly of the
  semitertian form ;  as Galen (de Temperam. lib, ii.) represents the Hemitritx as being
  the common epidemic of Rome.
     " Les maladies epidemiques ou populaires sont la source, presqu' exclusive, des mor-
» talites." " Le rapprochement des observations sur les maladies populaires demontre
 •leur parfaite identite.  En effect, ces maladies sont les memes dans tous les pays, tous
 les climats, &c. elles sont dans l'abord,<fefa  classe  des fievres remittentes & intermit-
  tentes ; elles  eprouvent seulment quelques varietes qui ne sont pas plus considerables
  d'un  pays a un autre, que d'un individu a Pautre dans le meme pays." Precis sur les
  maladies epidemiques qui sont les sources de la  mortalite  parmi les gens de guerre,
  les gens de Mer, &c. (a Paris, 1787) Par M. Retz,  Medecin ordinaire du  Roi, ci-de-
  vant medecin ordinaire des Hopitaux de la Marine, a Rochefort.  Not to extend these
  references unnecessarily, I  will only add, that Lancisi, in his second book De Nox. Pa-
  lud. Effluv. has given distinct histories of five epidemics, from marsh miasmata, whichj
  in  his time, had greatly infested the Roman  or ecclesiastical territory.  He writes
  "Daturusautemhocsecundolibro, quinque historias insignium epidemiarum, qu» prse
  aliis  nostra setate propter palustres aquas,  varia Ecclesiastic* ditionis loca parvagate
  sunt," See. p, 188, &cc. 
199
 < ase propagated  from person to person  by contagion, with
 only this exception, that it is frequently more rapid ; a cir-
 cumstance  which has,  however, been  commonly overlooked
 by indiscriminating observers.   Upon such occasions, those
 persons in each  family who happen to  be most exposed  to
 marsh miasmata, and most susceptible  of their effects, will
 be first attacked; those who are exposed and susceptible,  in
 ihe next degree,  will be the next attacked, and so  on in suc-
 cession.
   This, which is the natural course of a disorder arising from
 that cause, has very commonly induced a belief, especially in
 times* of general  alarm, that those  who first  sickened, had
 communicated the fever to the next,  and these  to others suc-
 cessively :  and,  consequently, that the fever was contagious.
  Vnd, in this way, even Stahl, with all his good sense, and dis-
 cernment was so  far misled, that, though justly  convinced that
 regular sporadic intermittents w ere destitute of any contagious
 property, he strangely believed  them to  change their nature,
 and  acquire that property merely by attacking great numbers
 of persons, in the same season and neighbourhood.*
   It is not  my intention here to notice  all the supposed varie-
 ties of marsh  fever, which  have been  minutely described  by
 Torti and  others,  with little or no practical advantage.  It
 will  be  sufficient for my purpose  to observe,  that  the forms
 most prevalent  in  hot climates seem to  be derived from the
 tertian,  variously complicated, or compounded;  and that of
 these, the form which was called Hemitritseus, or  semitertian,
 by  Celsus, (the  Hemitriteon of the Greeks) and  to which
 Lind, Sauvage,  and  many other  modern writers, have ap-
 plied the name of Tertiana Duplex, or double tertian, is ge-
 nerally the most malignant and destructive of all  the marsh
 fevers in hot climates and seasons; and more especially when,

   * " Quid notius quam febris tertiana ? quid certius quam quod ilia legitima, longe
.absit a contagiosa communicatione ? quid vero  familiariiis quam ut etiam epidemici,
imo contagiosi grassari observetur I" Stahlius de Febribus, a Goez. p. 29. 
200
by  great  excitement*  from  the  causes  already  mentioned,
the paroxysms are  so much. prolonged  and  crowded upon
each  other,  as to appear like a continual fever, or, at least,
to leave  no sensible  remission  during  the first  thirty-six,
forty-eight,  sixty, or seventy-two hours; as commonly hap-
pens  in what is called  yellow fever.]    This  seems  to be
the "irregular semitertian"  of  Dr.  Fordyce, in which, ac-
cording to  his  Statement, (4th  Dissert,  p.  61,  &c.) "the
hot fit is  frequently prolonged,  so  as  to  leave  no other
mark of an intermittent to distinguish it from a continued fe-
ver, excepting the exacerbations not taking effect in the even-
ing.'^   He concludes, however, that  it is not a continued fe-
ver, from " an agreement of all  those who have had, or have
seen, or have treated the disease,  in the following observa-
tion."  " It happens often, that a patient apparently becomes
greatly relieved, and appears in a state as if he were recover-
ing, when,  all at once,  a fresh  attack  takes place, and car-
ries him off."  This, he adds, " is  the  most formidable dis-
ease  incident to mankind.   It has frequently been called the
plague."
   Alexander  seems,  as  Dr.  Fordyce has observed,  to have
died  of an irregular  semitertian,  caught by  surveying the
marshes   adjoining  the  river  Euphrates,  to  ascertain the
means by which they  might be most advantageously  drained.
 The daily reports or  bulletins, respecting the progress of his
 disorder,  have  been  preserved and  transmitted to us by
 Ariian.

   * Dr. Fordyce, at p. 46 of his fourth Dissertation, mentions as a mischievous effect
of strong arterial action, or general inflammation in intermittingfevers, its prolonging the
hot fit. so as to render the intermissions imperfect,  and converting an  intermittent into
 a continual fever.
   The late  Captain  Bernard Romans, who was a man of observation, as well as ve-
 racity, says, in his Natural History of East and West Florida, (p. 238)  that the inter-
mittent fever, in that part of America, " attacks people in the same form as the con-
 tinued fever; the first fit frequently lasting three days, without intermission."
   f Dr. Gillespie says of the Yellow Fever among the West India Leward islands, in
 1794, 5, and 6, that it might " be called a remittent fever, or tertiana continua, as
there were always remi-sionsin casesterminating well,"—and, " as the epidemic insen-
 sibly changed into the form of a tertian fever." 
201
   In  thus connecting what is called yellow fever with inter-
mittents and remittents,  as being only an aggravation of the
latter, and, consequently, as being devoid of contagion,  I
feel myself supported, by great authorities, and by facts,  as
decisive as they are indisputable.   There are, however, per-
sons of considerable eminence as medical men, who strongly
contest the derivation of  yellow fever from marsh miasmata,
asserting that it has no relation to marsh fevers, but is exclu-
sively produced and propagated by a, peculiar contagion.  This
opinion seems to have been very extensively and inconside-
rately adopted, especially in  Europe; and as a demonstra-
tion of its fallacy,  if it be, as I think, fallacious, must con-
duce  to the best interests of mankind,  I propose, in the next
or fourth part of this Essay, to exhibit a summary statement
of the principal facts regarding the history of yellow  fever,
in different parts of Europe and America,  and regarding its
manifest connexion with  fevers notoriously originating from
marsh effluvia; confidently believing that this statement, (sup-
ported by ample proofs,) with the conclusions fairly deducible
from  it, will completely remove all uncertainty or doubt from
the mind of every  impartial and judicious  reader, who shall
bestow proper consideration on the subject.
  All this, however, will not accomplish my undertaking, be-
cause there are persons,  particularly Dr. Chisholm, who ad-
mit that yellow fever, as  it existed in the West Indies,  previ-
ously to the year  1793,  was derived from  marsh miasmata,
and destitute of contagion, but assert,  that  a " nova pestis, a
peculiar, original, foreign pestilence,  recently generated,  and
utterly unknown before,  endued with a new and distinct cha-
racter, possessing new  powers of devastation,  and capable of
propagating itself throughout  the world," was introduced by
the ship Hankey,  into  Grenada, on  the 19th of February,
1793.  See Dr. Chisholm's Letter to  Dr. Haygarth, p. 217,
and 218.
   From Grenada,  Dr. Chisholm states this new pestilence to
have  been propagated over not only a great part of the West
                            26 
202
Indies and North America, but also to Ireland,  Cadiz, Ma-
laga, Carthagena, and  other  places in  Spain,  and  also to
Gibraltar, and in some of these places,  to  have supplanted
the yellow fever, properly so  called.   However strange and
chimerical this recent generation of a new7 plague may appear,
now that miracles are believed to have ceased, it has been, in
some degree,  admitted and believed by a considerable num-
ber of persons, among whom are several for  whose judgment,
in other respects, I feel great deference, and, as the purpose
of this Essay w ill not be fully attained, unless it can be made
evident that there is no reasonable foundation  for believing
that the supposed nova pestis was essentially or specifically
different from the common yellow fever, of the West Indies, I
shall undertake to perform this service, also, to  what I think
the cause of truth, in a separate Appendix, No. 7.
   In addition to  all  this, I  must observe, that some physi-
cians,  of great respectability, appear  to have believed, that
the yellow fever  is either commonly or occasionally a sort of
hybrid or  mongrel  disease,  resulting from an application of
the contagion  of typhus fever,  to persons who have been pre-
viously exposed to the impressions of marsh effluvia,  or from
the action of  the  latter, upon  persons who have  before im-
bibed the  former.   As either of these causes is undoubtedly
capable of producing fever  alone, in suitable circumstances,
we may reasonably suppose, that an  effect equally  morbid
would result from their joint operation, unless there be some-
thing in their natures, which disposes them rather  to counter-
act than assist each  other.  But of  this I believe  nothing is
know n; and, therefore, I see no decisive objection  to the pro-
duction or existence of a fever, from the united action of con-
tagion and of miasmata;  though  there  is  not,  within my
knowledge, any fact which either proves or renders it very
probable, that any such  hybrid production  ever  has taken
place; and, in general,  it is not philosophical,  or proper, to
assign two causes for an effect which may be produced by one.
If, however, a mixed disease were producible by  these causes, 
203
 I should expect to find it at, or in the neighbourhood of Ports-
 mouth, rather than  in  the West Indies ;  because, at the for-
 mer, persons are often  exposed simultaneously to the action
 of both of these causes, which can rarely if ever happen in the
 West Indies,  where the heat soon  extinguishes the contagion
 of typhus fever,  and would,  probably, hinder the propagation
 of any hybrid disease, like that under consideration, if it could
 be either produced in, or conveyed to,  that part of America:
 whereas,  such a disease,  occurring  at Portsmouth, in  any
 season when the temperature is moderate, might,  from  its
 affinity with typhus, reproduce itself in persons who had been
 exposed  to  the  exhalations of marshes, or in  the absence of
 such persons, it might occasion a pure typhus fever onfy.
,   Sir John  Pringle has supposed,  (Diseases of the Army,  p.
 188,) that  the  Hungarian fever,   described  by  Sennertus,*
 without his having any personal knowledge of it, and w^hich
 is said to have  spread  widely in the year 1566,  (as was  be-
 lieved by contagion)  must have been " a compound of our au-
 tumnal and hospital fever," or the hybrid disease  in question:
 and Dr. Lempriere,  though he  represents typhus fever as a
 rare disease in the West Indies, (see vol. 2d of Diseases of the
 Army in Jamaica, p. 25, 32, 33, &c.) yet at page 38 and  39,
 of the same volume,  he  treats of a fever at Jamaica, which he
 supposes to have been a typhus  combined with yellow fever,
 or  modified by  the  causes producing yellow  fever: and,  at
 page 81, he mentions a "variety of yellow fever," attacking
 sailors and  soldiers almost exclusively, and with  great  mor-

  *  Medical writers have often described fevers as being contagious with so little con-
sideration or foundation, that we may reasonably suspect the spreading of this fever, to
have  been merely an effect  of marsh miasmata, imbibed  by the imperial troops in the
marshes of Hungary, and producing  their morbid effects, some mont/is after, when the
army had separated and removed into othei situations, as happened with the British
troops who were lately at Waicheren.  If this were the cuse  instead of the  mixed
disease supposed by Sir John Pringle, the fever in question could not have specifically
differed from the marsh fevers which so frequently prevail in Hungary, viz, the  Mor-
bus llungaricus Lang. Lemb. 1 1. cp. 4, the febris Hungaricaseu castrensis of Junck-
er, the amphimerina Hungarica of Sauvage, &c. 
204
 tality, which he supposes to have been a combination of the
 tropical endemic and of typhus fever.
   Dr. Chisholm, also, in  some parts of his  account of the
 supposed New Pestilence at Grenada, appears (as far as I am
 capable of discovering his meaning)  to imagine that it was
 generated by a sort of conjunction of contagion, with marsh
 miasmata, as I shall have occasion to notice in my Appendix,
 No. 7.  And, finally,  Dr.  Blane also appears to connect yel-
 low fever with the  contagion of typhus, at least when it pre-
 vails extensively.  He says, (p.  609  of his Observations  on
 the Diseases of  Seamen.)  " After laying  together, and con-
 sidering fully all the facts  relating to this  subject,  it appears
 to me that the yellow fever cannot be produced, but in a sea-
 son or climate, in which the  heat of the atmosphere is pretty
 uniformly, for a length of time,  above the  80th degree of
 Fahrenheit's thermometer; that,  under the influence of this
 heat, Europeans newly arrived, and more especially in cir-
 cumstances of intemperance, or fatigue in the sun, may be
 subject to it in many instances;  but that it has usually become
general only  by the previous influence of that infection which
produces the jail, hospital, or ship fever,  or from the influence
 of putrid exhalations;  and that, when  so produced, it con-
 tinues itself by infection.   It would be too tedious to enume-
 rate the 'multiplied proofs of this,  which have occurred to me
 in my connexion with the public service."  But, though Dr.
 Blane did not think it expedient,  on  this occasion, to favour
 his readers with a statement of the " multiplied proofs" in
 support of his opinion, which had occurred to himself, and
 which, by that circumstance, would have been highly impor-
 tant, he  seems  to have afterwards intended to make a full
 compensation for this  omission, in his  letter to  Rufus King,
 Esq. (late minister plenipotentiary from the United States of
 America,) in which, to justify his belief of the contagious na-
 ture of the yellow fever, he refers to,  and strongly relies upon,
 the events which followed the capture " of two French armed
 ships from Gaudaloupe," by the Thetis and Hussar frigates, 
205
in May, 1795, on the coast of  America.  This transaction,
though  unfortunately, he had no personal knowledge of it,
Dr. Blane, selects and holds up to Mr. King,  and the public,
as affording " a conviction of the reality of infection as irre-
sistible,  as volumes of argument:" and he afterwards refers
to it,  in his letter to Baron Jacobi, the Prussian minister, as
affording decisive evidence  on the subject.  I was, therefore,
induced by my particular regard for the writer of that letter,
and by  the great estimation in which his judgment and expe-
rience are deservedly held,  to enter upon a minute investiga-
tion of  this transaction, w hich  I should not have done had it
been brought forward on less respectable authority.   The re-
sults of that investigation will be found in my eighth  and last
appendix,  and they  will, I am  persuaded,  sufficiently prove
that yellow fever was not the disease supposed to have mani-
fested contagious properties on  that occasion.  Having thus,
as I hope,  encountered and removed all the difficulties which
were opposed to the  adoption of my  own conclusions on this
subject, I shall proceed to the last part of this Essay.
KXD OF PART THIRB- 
PART  FOURTH.
As one  important purpose to be attained by the view which I
am about to take of the  history of Yellow Fever, is that of
establishing its  identity,  or near affinity  and connexion,  with
the fevers which are indisputably  and notoriously produced
by marsh miasmata;—it seems expedient, first to ascertain
the characteristic peculiarities of the latter, as they have  been
generally manifested in the temperate climates of Europe, in
order that, being ascertained,  they may  afterwards  serve as
points or features of comparison and  recognition, in regard to
those which distinguish the Yellow  Fever.
  These characteristic  peculiarities  of marsh fevers appear to
be, 1st, that of occurring in their simple and mild  form of
intermittents during the  spring; 2d,  that of being exasperat-
ed, and converted to remittent, and,  apparently,  to continued
fevers,  by excessive summer heat, and this generally with a
great increase  of  malignity,  (especially in  low and moist
situations) when this excessive heat is long continued and ac-
companied with a, total  or very unusual deprivation of rain;
3d, that of being reconverted and brought back to their mild
intermitting form,  at  the approach or commencement of win-
ter,  and afterwards extinguished or  suspended by a continued
frost: 4th, that of most frequently  and violently attacking
strangers from colder climates, and more salubrious situa-
tions ;—and 5th, that of never being communicated from per-
son  to  person by a contagious property.   Several facts and
authorities, tending to prove  these  peculiarities of the fevers
in question, have been incidentally  mentioned in the  preced- 
201
ing parts of this  Essay.   A multitude of others might be
added, but the following will suffice.
  Dr.  Lind, in  his Essay on the Diseases of Europeans in
Hot Climates, after mentioning, that " in particular spots of
the low  damp island  of Portsea, agues frequently prevail,
and  sometimes the flux, during the autumnal season," adds
" in some years they  are much more  frequent and violent
than in others."   It is observable,  that their attack proves
al ways most severe to  strangers, or those who have formerly
lived on a drier soil,  and on a " more elevated  situation."
He next mentions,  the regular tertians with perfect intermis-
sions,  which prevailed  at Portsmouth  in  May,  June,  and
July,  1765,  and  then  proceeds  in  these  words,  "In the
month of August, the quicksilver,  in Fahrenheit's thermome-
ter,  rose to  82' in the middle of the day.  This heat,  toge-
ther with the want of refreshing rains,  spread the  fever, in-
creased its  violence, and,  in many  places,  changed its form.
At Portsmouth,  and throughout almost  the whole island of
Portsea, an alarming continual, or remittingfever raged, which
extended itself as far as Chichester.  At the  same time the
town of Gosport, and the opposite side of the harbour, though
distant only one mile from Portsmouth, enjoyed an almost total
exemption from sickness of every kind; and in the neighbour-
ing villages and farm houses on that side, only a mild regular
tertian ague prevailed, which  however distressed whole fami-
lies.  The  violence of the  fever,  with its appearance in  a
continued remitting or intermitting form,  marked, in  some
measure, the nature of  the soil.   In Portsmouth, its symptoms
were bad,  worse at Kingston, and still  more dangerous and
violent at a  place called half-way  houses,  half a  mile from
Portsmouth,  where scarcely  one in a family escaped this
fever,  which there generally made its first attack with a deli-
rium.  In the large suburb of Portsmonth, called the com-
mon,  it seemed to rage with more violence than in the town,
some few parts excepted: but even whole streets of this suburb. 
208
 together with the houses in the dock-yard, escaped it.   P. 18,
 19,  20.
   This exemption  of particular streets, ecc. from the disease,
 is an important fact which often occurs  in regard to marsh
 fevers,  and will be easily understood from what has been men-
 tioned between pages 224 and 229 ; and it well deserves to be
 remembered,  not  only  as  a distinguishing  mark of these
 fevers,  (produced  by a  cause arising immediately  from  the
 soil) but also as an incontrovertible evidence of their total want
 of any  contagious property ; for contagious fevers are not thus
 narrowly confined and limited in their progress.
  To this  testimony of Dr. Lind, I will join that of the late
 Dr.  Robert  Hamilton,  who practised as a  physician, with
 great reputation, for more than forty years, at Lynn, in Nor-
 folk ; and published " Observations on the Marsh Remittent
 Fever," which prevailed,  with unusual violence and  malig-
 nity,  in that part of England, during several uncommonly hot
 summers, which followed a great inundation from the  sea in
 1779, so as very  nearly to resemble " its appearance in many
places between the  tropics."  Of this fever, he says generally,
 " If a very wet winter and spring are succeeded by a very hot
 and dry summer,  in which the ditches  and marshes are nearly
 dried up,  it is very generally  epidemical,  and spreads  widely
 around  us.   It most commonly appears  about the  middle of
 August,  and lasts till the ditches are filled  with water, and
the marshes somewhat  covered; which, with a frost,  usually
puts a period to its raging in that form,  for that season; for
it now generally changes  to the  type  of  a genuine intermit-
tent."   He deemed this fever, as it prevailed after the inun-
 dation,  in 1779, "to be the same distemper  with the  bilious
remitting fever of the  Netherlands,  the  tertiana  duplex of
 Minorca, the remitting fever of Bengal,  the  yellow fever of
 the West Indies, and the bilious remittent of  Senegal."  Sup-
 posing it to " differ only in malignity and fatality from those
 of hot  countries, in proportion to the  difference  of climate."
 See pages 27, 28,  32. 
209
   If we  proceed to  the continent  of Europe, we shall find,
that even in the northern, but low  and  damp  island,  upon
which  Copenhagen is situated, an  excessively  hot and dry
summer, in 1652, was able to  produce a violent  epidemic ter-
tian, of  which Thomas Bartholine,  (who was attacked, with
all his  family,  by it) has given an account;* and which fever
was the more  remarkable, because, upon  dissecting  the bo-
dies of those who died of it, he found the stomach and  duode-
num always mortified, or, at least,  inflamed,  as is almost in-
variably the case,  in those who die of Fellow Fever.
   Passing over what Forestus and  others have related of the
violent marsh  fevers, (once  called  the plague,)  which fre-
quently infested the city of Delft, (almost surrounded by stag-
nant waters, and placed on low moist ground) we learn from
Silvius de le Boe, that a very  malignant remitting, and inter-
mitting fever raged within his own  obsei~vation,  at Leyden, in
1669,  in consequence of a very hot summer and  autumn,  with
little or no rain,  and an unusual stagnation of the air;  by
which the water of the  canals  and ditches became greatly  di-
minished, and highly corrupted.  He  mentions  two-thirds of
the  principal inhabitants  of that city as having died of this
epidemic.  See Prax. Med. tract. X.
   Sir   John Pringle, treating of the  autumnal  fevers of the
British army in Flanders, says, "this remitting fever attend-
ed every campaign,  and was most frequent and fatal after the

  * Thom# Bartholini Historiarum anatomicarum rariorum Cent.  I & II. Historia
LVI. Febris tertiana Epidemia.
  " ^Estate 1652 prater morum & coeli nostri consuetudinem calidissima & siccissima.
Hafnice  & vicinis locis grassabatur febris tertiana intermittents epidemia, quse multas
families velut conspiratione quadam invasit, prostravitque.  Varium  in hac observavi-
mus typum ; modo  enim singulis recurrebat dicbus, modd alternis, modo vaga, ssspis-
sime  post «a*?«SR«» redibat. Symptomata varia  comitabantur, ingens capitis dolor,
imprimis colli sen musculorum occipitis, lumborum & dorsi, calor urens, vomitus bilio-
sus, sitis, inquietudines, nonnunquam deliria, & petechia? remissionis tempore evanes-
centes, & cum paroxysmo revertentes," Sjc.  "Multis in hac urbe diuturnu • vomi-
itus post febrem istam remansit, ut ventriculum in febre hac imprimis affectum, sicut
in malignis solet non dubitarim," &c
                            27 
210
 hot summers of the years 1743 and 1747;* but, in  the  cam-
 paigns of 1744 and 1745, the  seasons being temperate, fewer
 were seized,  and the cases were milder."  See  Observations
 on Diseases of the Army, p.  172.  The same respectable au-
 thor, treating, at p.  180,  of the fevers among the troops sta-
 tioned near the  inundations, in  Dutch Brabant, in 1748,  ob-
 serves that, " in the greatest heat of the weather, and rage of
 the distemper most of these fevers answered the description of
 the **V«s,  or ardent fever of the ancients, which Hippocra-
 tes does not rank with the inflammatory diseases of the winter
 and spring, but  with the epidemics of summer and autumn.
 (Aphor. lib.  iii. Aphor. xxi.)  Sir. J. Pringle  adds,  " but
 it was observable, that even in the worst parts of the country,
 as soon as the weather cooled, in the decline of autumn, the fe-
 vers began to assume a milder form; and,  in the  end of the
 season,  differed little from the common intermittents of other
 places."   In the next page, he makes the following observa-
 tion :  "At the height of the  epidemic, it appeared that both
 intermittents  and remittents, by  extending  or doubling their
 paroxysms, frequently changed into a  continued and dangerous
form,  and that most of those whom we lost died in this way."
   Dr.  Francis  Home,  who  also  served  at the  same  time,
 with the British army in Flanders and Holland, gives a simi-
 lar account of these fevers.  "  The change of weather,  (says
 he) from heat to cold, made  always  a sensible alteration in
 the symptoms.  In Jwt weather they were more severe, and the
 disease inclined more to the continued fever."  Medical  Facts
 and Experiments, p. 46.f

  * Werlhof de febribus, p. 3, mentions the excessive  number of fevers of various,
 types, which infested almost all Europe, and especially marshy places, from the enor-
 mous heat of two summers; "ab enormiilb colore oestivo annorum 1726 & 1727."
 Van Swieten also makes a similar observation : " Sic observatur post fervidtssimas
 ffistates prsegressas autumnum hsemitrsearum febrim fera cissimum esse," torn,  ii-
 p. 455, and another,  (torn. iii. p*, 06) viz.: " Ubi  post fervidissimas & siccissimas
 testates autumnali tempore grassantur epidemicse febres continua?, remittentes, &c.
   t All the epidemic marsh fevers described by Lancisi, appear to have begun about
 the summer solstice, and to have increased and become more exasperated  by great 
211
   The  latter of these authors treating,  at p.  18, of the
 •' Epidemic Remittent  Fever" of the Camp at  Worms, in
 1743, says, ** there is  another symptom which attended this
 fever, and that is a jaundiced colour in their eyes  and skin,,
 and very often a complete jaundice."  Sir John Pringle also
" describing  (at  p. 72.) the marsh  fevers of Flanders, says,
 " some grow yellow as in the jaundice: this colour was ob-
 served to be more frequent in the first  campaign than after-
 wards :   it was an  unfavourable,  but not a  mortal sign."
 Afterw ards Dr. Brocklesby mentioned, (at p. 269 of his Ob-
 servations) as occurring in the autumnal fever of 1758, among
 the soldiers, on the Isle  of Wight,  a  " suffusion of bile,
 which  had often tinged  the skin of the  deepest tjellow,  and
 sometimes blackish colour."  We see, therefore, that even  in
 temperate European  climates, fevers from marsh miasmata
 sometimes  have this symptom, in common with the bilious
  remittent,  and Yellow Fevers between the tropics.
     These testimonies, concerning the intermittents of Europe,
  and the changes of which they are susceptible, might,  proba-
  bly,  be thought sufficient for the purpose  intended to be an-
  swered by them;  I cannot,  however, omit to notice their ap-
  pearance and effects, as they have occurred in Zealand, par-
  ticularly during the late expedition to that province.
     Dr.   Wind,  who translated into Dutch,  Dr. Lind's Essay
  on Preserving the  Health of Seamen,  and who, with  his  fa-
  ther, had practised  physic twenty-eight  years in Walcheren,
  has  added to  that translation,  as we are informed by Dr.
  Lind,  the following account of  these fevers, viz:  " at Mid-
  dleburgh a sickness generally reigns towards the latter end of
* August, or the beginning of September,  which is always most
  violent after Jwt summers.   Its makes its appearance after the
  rains  which  generally fall in  the latter end of July:  the

  heat and dry weather until the autumnal equinox ; after which they were found  to de-
  cline : and, finally, cease upon the accession of cold winds and rains at the beginning
  of winter; and wherever fevers observe this course, they may safely be considered
  as resulting from marsh miasmata. 
212
 sooner it begins the longer it continues, being checked only b v
 the coldness of the weather."
   " Towards the  end of August,  and the  beginning of Sep-
 tember,  it is a continual burning fever, attended with a vomit-
 ing of bile, which is called the gall sickness."   He afterwards
 mentions that  " strangers, who have  been  accustomed to
 breathe  a dry pure air do not recover so quickly" as the na-
 tives; adding that this fever is "the same with  the  double
 tertian fevers between the tropics," that it is, " not infectious,"
 and seldom proves "mortal to the natives."—But that " the
 Scotch regiment, in the Dutch service  has,  at Slays,  been
 known to  bury their whole number in three years."   See
 Lind, oil the diseases of Europeans in Hot Climates, p. 23,
 &c.   This account of the morbid influence of marsh effluvia in
 Zealand, was but too well confirmed by the  extensive  sick-
 ness which so lately, and in a few weeks, disabled the British
 army there, at a time when no extraordinary heat or drought
 had occurred to aggravate the symptoms.  In  Dr. Blane's
 Letter to the Physician-General,  dated  Middleburgh,  Octo-
 ber 3d,  1809,  and printed, with other official  documents,
 presented to both Houses of Parliament, in February,  1810,
 marked E. p. 103, is the following passage, viz :
  " It appears,  from the last general weekly return,  that near
 two-thirds of the whole numeral strength of the army is inca-
pable  of duty.  The  mortality, during the last four weeks,
 has been  about one thousand.   All the regiments are affected in
 nearly an equal degree;  and it does not appear that their ill-
 ness is connected with the nature of their duty, nor  that it is
owing to privation or  neglect  of any kind;  for those are  ^
equally sickly who have enjoyed the utmost ease  and comfort
in cantonments, as those who have been  engaged in the siege
of Flushing."  '«Nor has  it been owing to any thing  unfa-
vourable  in this year, in comparison of former ones; on the
contrary, the native inhabitants affirm that they are now less
sickly than usual at the same season; and they account for it
from the unusual quantity of rain that lias fallen the last two 
213
or three months;  and they consider il as fully established by
observation, that the  most sickly seasons  are those  in which
there are great drought and  heat in the latter end of summer,
and the  early parts of autumn, owing, probably, to the in-
creased putrefaction and exhalation produced by these causes.
I find, upon inquiry, that a  like degree of sickness  prevailed
among the French troops, who occupied Flushing during the
last seven years ;  and that, in former times, the Dutch troops
from the Northern States of  the United  Provinces suffered
equally.  Other  proofs, if necessary, could  be  adduced, to
evince that the present unfortunate state of the army here, is
solely imputable to the  contamination of the air, from a soil
the most productive of deleterious  exhalations of  any perhaps
in Europe, producing an endemic fever, which  has, at  all times,
been particularly severe upon strangers in the autumnal months.
I find also,  upon inquiry, that though this is by far the  most
sickly season, the residents of this,  and the  neighbouring
islands,  are far from  enjoying at any season, the  same de-
gree of health  as in the more salubrious parts of Europe;"
and, in an unpublished letter on this subject from Dr. Blane
to the Surgeon General,  dated at Middleburgh, October the
4th, 1809, I find the following observation:  " it is  fortunate
that the administration of medicine is simplified by the uni-
formity of the cases, which almost all  consist of the  endemical
intermitting and remitting fever."
  •This deplorable calamity has, however, enabled us to make
some very useful additions to our stock of knowledge, respect-
ing marsh fevers ;  and one of  these is a full and indisputable
confirmation of the fact, which  the most judicious and best in-
formed physicians already believed, that these fevers do not
possess any contagious power or quality whatever: of this I  have
numerous and decisive proofs now lying before me:  a part of
them will, however, be sufficient.
  But I ought  previously  to observe,  that, as all the troops
landed in Zealand were more or less exposed to the influence
of marsh effluvia, it must have been difficult, if not impossible, 
                          211
to distinguish the effects of contagion, had it  existed among
them, from those of miasmata; and,  therefore,  I shall draw
no conclusion on this subject from any thing which occurred
to the twenty-six thousand eight hundred  and forty-six pa-
tients,  including relapses, who were admitted into the gene-
ral  and regimental hospitals of the British army  there,  pre-
vious to the 18th of November,  1809, or to those afterwards
added to this number, before the final evacuation ; but I shall
confine my inferences solely to what followed the return of se-
veral regiments or battalions not  required for the occupation
of Walcheren,  and the removal of twelve thousand eight hun-
dred and  sixty-three  sick,  (including  a  small  number  of
wounded) from that island, and  from  South Beveland, be-
tween the 21st of August and 16th December,  1809, who were
all  landed, and placed in dry, wholesome  situations, within
the Kentish and Eastern districts, under the general superin-
tendence of Mr. Keate, the Surgeon General.  That gentle-
man, at different times, visited, and minutely inspected, the
several  hospitals in these districts;  and,  upon his return to
London, on the 5th of October,  1809,  immediately after he
had performed  this duty  throughout the Eastern district, he
obligingly put into my hands  a statement of the results of his
observations respecting the prevalent disease, from which I
was permitted to make the following extract,  viz.
   " It is certain, that  more or less of the poison which created
 this sickness, has been imbibed by  all the troops previously
 to  their leaving Walcheren,  and that,  in many instances,  it
 has not produced its noxious effects until the men have reached
 this country, and have even marched to their respective quar-
 ters.  This is  obvious at Colchester,  Weeley,  and Wood-
 bridge, where many have fallen  down with this disorder, af-
 the slight fatigue of a short march."
    " It does not appear that this disease is of a  contagious na-
 ture,  not one of the attendants, whether nurses, orderlies, or
 medical officers, having  contracted  it, as I am informed."
  Mr. Keate told me,  relative to this point, that he had made 
215
very minute inquiries on the subject, of every medical officer
with whom he had an opportunity of conversing,  and particu-
larly of Drs. Fellowes, Roberts,  Wardell,  and Tice,  and of
staff-surgeons, Ross and Emery, and that they were all unani-
mous in stating that no instance had fallen under their know-
ledge of the disorder having been communicated to any per-
son about the sick.
  Nor did subsequent information or observation  alter the
Surgeon General's opinion on this subject, as is  fully proved
by the following  extract from  his letter to Francis Moore,
Esq. Deputy Secretary at War, dated 14th December, 1809.
  " I must also remark, after much inquiry from the most re-
spectable medical officers into the subject, that neither in th»
Kent nor in the Eastern district, had any instance of conta-
gion been known to have occurred in the General Hospital;"
(i.  e. those appropriated for  the Walcheren sick) "a  fact
which sufficiently demonstrates the fallacy of the assertion ad-
vanced  against these establishments,  and so readily credited
by many persons, viz. that they are the chief cause and source
of contagion in armies."
  The observations made by the Physician-General, when he
visited the sick,  returned from Walcheren,  at Harwich,  Col-
chester,  and  Ipswich, in September,  1809, were  similar to
those of the Surgeon-General, in regard to the total absence
of contagion,  as appears by his  three official letters to the
Deputy Secretary at War, of the 11th,  13th, and 15th of  that
month,  printed in the Minutes of Evidence  on that subject,
by order of the House of Commons ; and that his subsequent
information,  from the army physicians, and other medical
officers,  was of the same import, may be inferred from his
printed testimony to the House  of Commons,  on the 8th of
March, 1810, when, being asked this question, "might not a
fever, of a more fatal kind  than that which subsisted among
the troops at Walcheren, be generated on  board the trans-
ports in which they came from  that country, so that no infe-
rence is to be drawn as to  the state of the sick, at the time 
                            216
they  were put on  board ?"  he answered, " if that had beeu
the case, there would have been contagion in the different hos-
pitals I saw at Harwich,  Colchester, and Ipswich^and there
was no contagion—nor has there been any contagion."
  To these testimonies I may doubtless  be permitted  to add
the results of my own very  minute and extensive inquiries on
this, to me interesting subject, which have, without exception,
most  unequivocally manifested the total absence of contagion
in or  by any of the sick from Zealand.   Such was the infor-
mation given to me by Mr. Warren, Deputy Inspector of Hos-
pitals, who, under the  Surgeon General, had the  superinten-
dance of the sick  from Zealand, in the  Kentish district,  as
well  as of Dr. Neale,  then principal  Medical  Officer of the
General Military  Hospital,  at Deal, and  also  of Doctors
Faulkner, Faber,  Tamer,  and Morgan, all Fellows of the
College of  Physicians,  and physicians  to the  army,  or em-
ployed as such temporarily,  with the sick  from Zealand,  in
that  district;  such also was my information from sir James
Fellows and  Dr.  Roberts,  army  physicians,  and from Drs.
Harvey and Laffan, who were then employed as  such in the
Eastern district.  These gentlemen,  as well as those in the
Kentish district, uniformly assured me,  that no patient, hav-
ing the Walcheren or  Zealand fever,  had,  as  they believed,
given that disease  to any other; and that, according to their
knowledge and information, none of the attendants,  or others
employed in the several hospitals,  and who had not been ex-
posed to marsh miasmata in Zealand,  were attacked with the
fever in question.*

  • Mr. Nixon,  Surgeon to the first regiment of Foot Guards, favoured me  with
some valuable information respecting the extent and  effects of the Zealand fever, upon
the 3d battalion of that regiment, w hich, to the number of 872, landed at South Beve-
land, the 2d of August; of these 359 were attacked with  this fever, between the
19th of that month and the 14th of September,  (sixteen days :) and though, on the
last of  these days, they  embarked on board the Leyden, to return  to this country,
and actually re-occupied the barracks at Chatham, on the 16th of Seiitember, only
117 of  the battalion had ultimately escaped the fever, on the 8th of March  following;
and  some of the 117, who had so escaped, were, for the first time, attacked by it, 
217
   In addition to those inquiries I made others, respecting the
 hospital ships and transports  employed hi removing the sick
 from Zealand to Harwich, Deal, and other ports in this king-
 dom,  in order  to  ascertain whether any  of their respective
 crews had been infected by this service; but I did not hear of
 a single instance in  which this was even  suspected to have      ■«
 happened.  Deputy Inspector Warren, in a letter to me, da-
 ted the 9th of October, 1810, wrote as follows: " In reply to
 your question,  relative to the state of health of the crews  of
 the transports that were employed in conveying the sick from
 Walcheren to this country ?  I have every reason to believe they
 remained free from the disease, with which the troops were
 affected ; as I do not find that more than two or three applica-
 tions were made for admitting  sick seamen into the Hospital
 at Deal, and such applications would have been  made  to a
 considerable extent, if they had at all partaken of the disease."
   At my request,  Dr.  Faber made a similar  application  to
 Staff Surgeon Lidderdale,  who had been  employed at Flush-
 ing,  in superintending the embarkation of the sick, removed
 thence to  England;  and,  in consequence thereof, Mr. Lid-
 derdale wrote to Dr. Faber, on the 22d of October, 1810, a
 letter,  of which the following is an extract, viz. " The same
 transports  were not always, but frequently, employed in re-
 moving the sick from Walcheren to this  country; and I did
 not observe that their crew s laboured under the same  disease
 as the sick; and, from conversations with the navy, I learn-
 ed, that only those men who were  on shore, and exposed to
 the same causes as the troops,  laboured under the Walcheren
 fever."  He afterwards mentions his having had opportunities
 of observing the Asia, (a large Hospital ship, carrying about

as long  afterwards as the middle of June, 1810,  Mr.  Nixon, however, assured me,
that neither in the Hospital at Chatham, nor in that of Westminster, to which this
battalian was  afterwards removed, had there been any appearance of contagion.
None of the Hospi;al servants who were not in Zealand having taken the fever, nor
any of the soldiers' wives, or connexions.
                             28 
218
 sixty patients in cradles) and declares, that he " saw nothing
 like infection extended to the crews of that ship."
   My inquiries were afterwards extended, in order to disco-
 ver whether any effect, indicating the existence of contagion,
 had been produced by  the  bedding and  clothes  used  by the
 sick at Walcheren, and removed to this country mostly with-
 out being washed,  and in a very filthy condition, as I was in-
 formed by Mr. Moss, Purveyor of Hospitals  there, and by
 his Deputy,  Mr. Boning, verbally.  To the former of these
 gentlemen I addressed certain written questions, in the month
 of August, 1810; but he, being then  on the eve of  his depar-
 ture for Sicily, could not, as he  stated in his letter to me of
 the 13th of  that month, " answer them  otherwise than in a
 general way," viz. " several thousand articles  of wet and
 dirty bedding, cloathing, &c.  were  received from the regi-
 mental hospitals throughout the island,  of which time did not
 permit either the drying or washing:  I found it,  therefore,
 necessary to require  a board of survey,  in  order to  decide
 upon the propriety of  shipping them  in their  actual state;
 the board having decided that,  in so  short a voyage, no dan-
 ger or  damage could be expected,—the whole of the  articles
 in question were shipped by the Asia, Ceres, and  Eleanor."
 He adds—
   " I have not heard that the least sickness whatever prevail-
 ed among the cre.ws of either of the above ships;  and when
 it is  considered that the stores were not landed for several
 weeks beyond the calculation of the board "of survey, it seems
 clear that the members were fully justified in their opinion."
   The bedding and clothing in question  having been landed,
 after considerable delay, was transferred to  the store-keeper
 general, whose deputy,  Mr. Barker, in answer to a note from
 the Surgeon-General, on this subject, wrote,  (on the 25th of
 September,  1810)  "that the dresses* and bedding, received
  * These dresses were all  of flannel, and mostly worn by  the sick next to their
skins; they were, therefore, well suited to retain, as well as imbibe, contagion, if any
had existed. And even if none had existed, it ought, according to the general opinion 
219
from the several transports returned from Walcheren, were,
in general,  in a veinf foul state, and were immediately sent to
the mills to be cleansed, but he did  not hear of any infection
having arisen from them to any of the parties through whose
hands they  passed.
   Considering these facts as more than sufficient to prove that
the marsh fever of Zealand does not possess  any contagious
quality,  I shall now proceed to a rapid view  of the History of
Fellow Fever in America and Spain.
   It has been asserted and believed, that the Yellow Fever, at
least  in its  most violent form,  did not attack the first settlers
in America.   Of the truth of this assertion it is now difficult
to decide, because no one of the earlier historians has left us
any account of their diseases sufficiently minute and discrimi-
nating.   It is, however,  manifest from various facts related
on good  authority,  and  several passages in  the writings, of
Peter Martyr,  that  the earlier Spanish  adventurers to the
West Indies suffered greatly by marsh miasmata, particularly
those who  first attempted  to establish themselves in  Darien
about the year  1512,  at a place which  the  Spaniards called
Sancta Maria Antiqua, where  many of  them died.  Of this
place Peter Martyr  writes,  in the  6th chapter of his  third
Decade,  "that the air  is  more pestilential  than  in Sardus
(Sardinia).    The Spanish inhabitants are all pale and yellow,
like unto them  which have the yellow jaundice."   And this
be ascribes not  to the latitude but to the local circumstances
of the place,  situated "on the banks of the river of Dariena,
in a deep valley, and environed on every side with high  hills;
by reason  whereof  it  receiveth  the sun-beams at  noon-tide,

on this subject,  to have been generated^ these dresses, and by the  bedding of the
sick, (which, as I was informed by Mr. Moss, amounted to more than 10,000  separate
articles) considering the foul condition in which they were brought and kept together
for I believe, six or eight weeks; and, as no such effect happened,  we may here
find another proof that contagion, properly so calU?d, is not generated by accumula-
tions of mere animal filth, even when derived from living human bodies, under disease,
and especially that of marsh fevers. 
220
directly perpendicular over their heads ; and they are, there-
fore, sore vexed  by the reflection of the beams,"  kc.  " The
place is also outrageous by the nature of the soil,  by reason it
is compassed  about  with muddy and stinking marshes, the
infection whereof is  not  a little increased  by the heat,"  &c.
He adds, " now, therefore,  they consult  of removing their
habitations: necessity caused them  first to fasten their foot
here,  because they,  which first arrived in those  lands, were
oppressed with such urgent hunger,  that  they had no respect
to change the  place,  although  they  were  thus vexed by the
contagion of the soil, and heat of the sun ; beside the corrupt
water and infectious air,   by  reason of venomous  vapours and
exhalations  arising  from  the  same."   See Robert  Eden's
Translation, in black letter, which I have here used,  (but with
modern spelling)  not having the  Latin original  at hand.
This  extract will sufficiently prove what,  indeed, could not
reasonably be  doubted, that marsh effluvia have,  at all times,
destroyed human life in America, as well as in other parts of
the world:  and if they did not produce an epidemic yellow
fever, in the highest  degree, among the first European adven-
turers thither, the reason, probably, was, that before consider-
able towns were built, the solar heat would not have arisen so
high, as it now does in the cities where that disease has most
often  prevailed,  nor would the soil,  whilst nearly covered by
trees, be accessible to the sun's  rays,  or capable of producing
miasmata so highly concocted, (if I may use that expression)
and virulent, as when deprived  of its natural verdure and pro-
tecting shade, nor would they so readily find the  means of in-
temperance and debauchery which large cities afford.
   The earliest marsh, and probably Fellow Fever, of which
we have any distinct account, as prevailing epidemically, and
w ith great mortality, in the West Indies,  was, I  believe, that
which occurred at Barbadoes,  in the year 1647.  From two
letters,  written  by Mr.  Richard Vines,  then a  planter and
practitioner of physic in that island, (which were  published
hy the late Governor Hutchinson, in his collection of  Massa-
                   r 
?2i
chusett's Papers) and  from Mr. Ligon's  History of Barba-
does,  it appears, that this fever began in  or about the month
of August, after a severe drought of six months continuance,*
attended with  very tiot  weather,  and followed  by  a great
scarcity  of food.   Mr. Vines'  letters were addressed to Go-
vernor Winthorp,  in  New England,  whence he had  lately
arrived; a circumstance which will account for his sentiments
and language on this subject.   He appears to have considered
the  fever as  a punishment for the  sins of the  people  of the
island, proceeding from  " the Lord's heavy hand in wrath;"
and, being satisfied with this cause, he does not seem to have
inquired for, or thought of any other, but says,  in his second
letter, dated April 29th,  1648, that,  " the sickness was an ab-
solute plague, very infectiousf and  destroying,  insomuch  that
in our parish, there were buried twenty in a week, and many
weeks together fifteen or sixteen.   It first seized on the ablest
men  both for  account and ability of body.   Many  who  had
begun and  almost finished great sugar works,  who dandled
themselves in their  hopes,  were suddenly laid in the dust,  and
their "estates  left unto  strangers.   Our New England  men
here had their share, and so had all nations, especially Dutch-

   * But little more than twenty years had then  elapsed since the first settlement
was made in that island ;  and so little of it was at that time cleared and cultivated,
that dry weather, assisted by great heat, was best suited to the production of noxious
miasmata; contrary to what has been the case at Barbadoes, since it attained its high-
est state of cultivation many years ago.  About the time when this fever prevailed,
there had been a great and sudden influx of inhabitants from England, in consequence
of the civil commotions at home, and of other causes.  Indeed, there never has been
an extensively epidemic Yellow Fever known in the West Indies without the previous
arrival of considerable numbers of persons from  more temperate climates.  Hence
times of sickness have there commonly been times of war.  During peace, a few pas-
sengers, arriving in single  ships, and dispersing themselves in the cooler, and more
wholesome parts of the country, are mostly enabled to escape the Yellow Fever; and
the seasoned inhabitants are rarely susceptible of it.
   f Believing the  disease to be "an absolute plague," Mr. Vines, must naturally
conclude that it was  « very infectious," especially  as many persons were attacked by
it nearlv at the same time ; a circumstance which, in that age, was thought sufficient
evidence of the contagious nature of a disease. 
222
 men, of whom died a  great  company, even the wisest  of
 them."
   Mr. Richard Ligon, whose History of Barbadoes was pub-
 lished in 1657, tells us that he arrived there early in Septem-
 ber, 1647, when "the inhabitants of the islands, and shipping
 too, were so grievously visited with the plague, (or as killing
 a disease) that  before a month was expired after our arrival,
 the living were hardly able to bury the dead."   Though not
 a medical man like Mr. Vines, he appears to  have bestowed
 some thought on the physical causes of this disease, and upon
 the question, " whether it were brought thither in shipping:"
 or occasioned  " by the distempers  (irregularities) of the peo-
 ple of the island, who, by the ill diet they keep, and drinking
 strong waters, bring diseases upon themselves."   And though
 he observes that the truth on this subject  " was not certainly
 known," he  adds, that  he has " reason to believe the latter;
 because, for one w^oman that died  there were ten men; and
 the men were the greater deboystes"  (i. e. most debauched).
 " In this sad time (says he) we  arrived in this island; and it
 was a doubt whether this disease or famine threatened  most,
 there being a general  scarcity of victuals  throughout the
 whole island."  P. 21.
  The reason  which  induced Mr. Ligon  to  think that the
disease had  not been imported, is  certainly deserving of at-
tention :  for to have been imported it  must have  been conta-
gious, and a contagious disease would  not have spared the
women in a manner so extraordinary, merely because  they
 lived more temperately.   There  were,  however,  much better
 reasons for  not considering it as an imported disease, which
 Ligon mentions at p. 25, without being sufficiently sensible of
their operation.at that time;  I mean  those arising from the
situation and local circumstances of Bridgetown  and its har-
bour, where the  disease  seems to have  mostly prevailed.
" Upon the most inward part of the Bay (says Ligon) stands
the town, which is about the bigness  of Hounslow, and  is
called the Bridge, for that a long bridge was made at  first 
223
over a little nook of the  sea, which was rather a Jog than a
sea.  A town ill situate;  for, if they had considered health as
they did  conveniency.  they never  would have set it there,"
kc. &c.   " But (adds he) the main oversight  was  to  build
their town  upon so unwholesome  a place.   For the ground
being somewhat lower than the sea banks are, the spring tides
flow over, and there remain ; making a great part of that flat,
a kind of bog or morass, which vents out so loathsome  a sa-
vour, as cannot but breed ill blood,  and is, no doubt,  the
occasion of much sickness, to those that live  there."   And
when it is recollected that this morass  was at the  east side of
the town,  and  that the trade wind  blowing  over the morass
upon the  town,  would  directly convey its exhalations  to the
inhabitants, and that the long-continued  hot and dry weather
would necessarily render  these exhalations uncommonly noxi-
ous, w-e surely  need not look for any  other morbific agent or
influence.
   A similar fever, and doubtless  from similar causes, pre-
vailed about the same time at St. Christophers, Guadalupe,
cVc.  Mr. Webster has lately published the following extract
respecting  it,  from a  MS.  of the New  England Historian,
Mr. Hubbard, viz.: " It  extended through the plantations in
America,* and in the West Indies.   There died at Barbadoes
and St. Kitts  five  or six thousand each; whether  it  was a
plague, or  pestilential  fever, it prevailed  in the islands,  ac-
companied with great drought, which  cut  short potatoes,
(doubtless  the  sweet  potatoe, or  convolvulus  battatas)  and
fruit."  See New -York Medical Repository, vol. vii.  p. 322.
   P. Du  Tcrtre also  mentions this disease,  and calls  it  the

  ♦ Governor Winthrop, in a letter to Mr. Vines, dated at Boston, 24th August, 1647,
had mentioned an epidemic sickness which then  lately overran that part of  \merica,
and which appears to have been an influenza, and not a marsh, or Yellow Fever.  Air
Vines, after acknowledging the receipt of this letter, writes, (with  sentiments like
those he had entertained of the epidemic at Barbadoes) " I perceive by your  letter,
that the Lord did shake his rod over New England: it was his great mercy, only to
put you in remembrance."  By these expressions we may conclude, that the  disease of
New England was attended with little or no mortality. 
22b
plague,  (la peste, jusqu' alors  inconnue dans les isles, kc.)
He says it began at St. Christopher,  and in eighteen months
carried off one-third of the inhabitants.   That it was accom-
panied with a violent pain of the head, great debility of the
limbs, and  a constant vomiting;  and that  in  three days  it
sent the patient to his grave.   Perhaps this is nearly as good
a description of the Yellow  Fever as  one,  who was not a
medical man, might then be expected to give of it.  He adds,
that this disease was brought to Guadalupe by a ship called
" Le Boeuf," from La Rochelle, in France. He had previously
stated that it was imported by some ships ("' quelques navires")
into the  French islands, (St. Christopher's  being then half
French) without any mention  of  their names or the places     ^
whence  they came, and, probably, he had  no better reason
for this loose statement that a belief that the plague, till then,
as he says, unknown in that part of the world, must have been
imported, and,  of course, imported by ships, when the places
to which it  was supposed to have been introduced were islands.
He did not know that the plague (even if it had  then been at
La Rochelle) could not  exist,  much  less spread epidemically,
within the  tropics;  I need not observe that  this is also true
of typhus fever;  because the latter has not the  smallest re-
semblance  to a disease, attended with constant vomiting, and
which generally proved fatal in three days.  Therefore,  Du
Terre's supposition, that the disease was imported and con-
tagious, deserves  no attention,
   Fortunately, those peculiarities of season, and  of local cir-
cumstances, which are necessary to render marsh fevers both
epidemical  and  violent,  do not commonly recur but at con-
siderable intervals :  and I do  not find that the Yellow Fever
again became prevalent in the West Indies until about  the
year 1686, when it appeared at Martinico, and subsisted for
several  years.  And, as a French ship of war, the Oriflamme,     j
arrived about the same  time at that island, with a number of
French people, who had, some time before, settled themselves
at Merguy and Bancok,  in  Siam,  (whence they  had been 
225
     driven, when the French  intrigues at that court were frus-
     trated)  the  disease,- as usual,  was supposed to  have been  im-
     ported by that ship, and, therefore, was called Mai de  Siam.
     There is  not, however, so far as I can discover,  any account
     of the supposed introduction of this disease by the 0*rillamme,
     except that  which is given  by Father  Labat, a Dominican or
     Jacobin Friar,  who arrived at  Martinico the 29th January,
     1694, seven or  eight  years  after  the  event in question;  and
     his account (which  must  have  depended  on  hearsay)  is ex-
     tremely loose and defective.*   He tells us that the Oriflamme

      * Father Labat, after mentioning that one of his order, le Pere Loyer,  had been
     Tately attacked with  a disease of which, in the course of it, he was supposed to be dead
     five or  six times,  but which without proving mortal, lasted thirty-two  days, adds,
     "On appelloit cette maladie le Mai de Siam, parcequ'il avoit ete apporte a la Martin-
     ique par le Vaisseau du Roi, V Oriflamme, qui, revenant de Siam, avec les debris  des
     Elablissemens qu'on  avoit fait a Merguy & a Bancok,  avoit  touche au Bresil,  ou
     il  avoit  gagne cette maladie, qui y faisoit de  grands ravages depuis Sept  ou huit ans.
     Ce vaisseau perit en  retournant en France.  Les Symptomes de cette maladie etoient
     autant differens, que  I'eto'ient les temperamens de  ceux qui en etoient attaquez,  ou
     les causes qui la  pouyoient produire.  Ordinairement elle commengoit par un grand
     mal de  teste & de reins, qui etoit suivie tantot  d'une grosse fievre, et  tantot d'une
     fievre interne, qui ne se manifestoit point au dehors."
       " Souvent  il survenoit  un debordement de Sang, par tous  les conduits du  corps,
     memepar les pores,- quelques fois on rendoit des paquets de vers de differentes grandeurs
     & couleurs, par haut & par bas. II paroissoit k quelques uns des bubons sous les aislelles
     & aux aisnes, les uns pleins de Sang caille  noir & puant, & les autres pleins de vers.
     Ce que cette maladie avoit de commode,  c'est qu' elle emportoit les gens  en fort
     peu de  temps; six ou sept jours tout au plus terminoient 1' affaire."  He  adds, that
     he  had  known but  two  persons who died of the disease, after it had  continued
     more than fifteen days; that some persons,  who felt nothing more than a little head-
     ache, fell down dead in the street,  while walking for the air;  and that in most of
     them, the flesh became  as  black  and putrid in a quarter of an hour  after death,
     as if they  had been dead four or five days :—That the English, who were frequently
     made prisoners, carried the disease to their islands; and that it was communicated
     by the same  means  to the Spaniards and  Dutch, and made great ravages when he
     left  the islands, in 1705.   He concludes by saying, that he was attacked twice with
     this disease;  that he escaped the first time, after four days of fever, and vomiting of
     blood; (" apres quatre jours de fievre & de vomissement de sang") but, that the se-
'■*    cond ti i e be was in danger six o.- seven days.  Such is his account, faithfully and ful-
     ly extracted, from pages  72,  73, and 74,  of the 1st vol. of  the original  Paris  edi-
     tion of his " Xouveau Voyage Aux Isles de 1' Vmeriques," in 6  vols. 12mo.  printed in
     1722.  Dr. Chrisholm, at p. 105 and 106, of the 2d vol.  of his essay, has given 
226
 touched at Brasil, and caught the disease, which he represents
 as  having  been  prevalent there  for  seven  or  eight years.
 There is, however, no reason, that I  can discover, to  believe
 that any contagious fever has, at any time, subsisted in  Brasil,
 though that country is not exempt from violent marsh  fevers;
 nor is it probable, considering the known jealousy of the Por-
 tuguese government, in regard to  the admission of strangers
 at Brasil, that any would  have been  permitted  to land from
 the Oriflamme,  and communicate with the  inhabitants, so  as
 to become infected  by a fever of that sort, if it had  existed
 there.   We are not even told which of the harbours  in that
 extensive country  the  Oriflamme entered; she might have
 anchored in one which was surrounded with  marshes, and I
 should conclude this to have been  the case, if it were ascer-

an extract on this subject, taken avowedly from the Histoire Generate«Des Voyages,
which extract is very incorrect and defective, though he asserts that his readers
will  find it " is literally taken from t/ie original."  An assertion which ought not to
have been made, because it is not true, and because he manifestly had had no op-
portunity of  comparing this extract with the original of Pere Labat.  Unfortunately,
there are but too  many  other instances of his  want of caution in making assertions,
even the most positive,- though I  am willing to believe, that an intention to mislead
has not been  among his  motives.  Such also is the account of a disease which, accord-
ing to Dr  Chisholm,  " differs materially from the endemic yellow remittent, and
bears a  striking affinity to the true plague,  as  well as to the malignant  pestilential
Fever of 1793;"  and we, therefore, need not wonder that this gentleman, who is
anxious  to assimilate Yellow Fever with plague, should state this account to have
been given by La Fabat,  with his accustomed accuracy and minuteness,''* though I
believe few other persons  will be satisfied with it in these respects.  To say nothing
of its important omissions, who will believe  the occurrence of buboes, sometimes
fitted with stinking,  black,  coagulated  blood, and  at other times with worms ?
or that there was any foundation for what he  says  of packets or bundles of worms,
of different  sizes  and colours, discharged upwards and  downwards ? excepting this,
that  persons troubled with worms, often discharge them  in  consequence of fever,
and  some other diseases ;  though their doing so is not a symptom peculiar to any dis-
ease, and much less  to the Mai de Siam*  Hut in truth,  Pere Labat does not seem
to have intended fully  to describe the symptoms of that disease, which  he says
were as different as  the temperaments of the individuals attacked by it, and as the
causes by  which  it was produced; si plain indication that he considered thejlisease
as arising  from  different causes, and, consequently,  not always from contagion.
This part, however, of Labat's account, is one of those which are omitted in Dr
Chisholm's extract. 
221
 tained, that a fever was prevalent among her passengers  and
 crew  before  they reached  Martinico,  and  not  until their
 arrival in  Brasil; but  if, as seems not improbable, this only
 happened upon  their arrival  at  Martinico, we  can  have no
 difficulty in finding abundant, and  much more  likely causes
 for  the  disease  in  the  carenage  of that island, which even
 Dr. Chisholm  declares to  be " the most  sickly  hole in the
 West Indies;" (vol. 2. p. 84.) or, indeed, at St. Pierre, the only
 other harbour of that island in which a ship of  war, circum-
 stanced as the Oriflamme wras,  can  be supposed to  have re-
 mained.*  And, indeed, ttye greater part of Martinico, is so
 abundant in  every thing favourable  to-the  production  of the
 most deleterious miasmata, that there is no island in the West
 Indies  of the same size in which all the varieties of marsh
 fevers  prevail oftener,  or with  greater mortality;  nor  can
 any thing be more chimerical  or unreasonable than the having
 recourse either to  Brasil or  Siam,] for contagion, as the cause
 of any fever which  ever  was prevalent in the  West  Indies.
 Of this a multitude of  proofs  might  be given, if  the notoriety
 of the facts did not render them completely unnecessary.
  * Dr. Chisholm, having mentioned that " the prevalence of the yellow remiUent fe-
ver, at a. certain period of the year, at  Fort Royal, (Martinico) should not  excite
surprise,  the cause being so abundant in its neighbourhood," adds, " that part of the
city of St. Pierre, called the mouillage, being very low and moist, although not marshy,
is also subject to tbf> destructive fever during the same period, the  hotter months"
  f Ksempfer, who touched at Siam, in his way to Japan, gives the following account
of the river Merman, the part most connected with the subject of marsh fever. " It
overflows its branches like the Nile in Egypt, though, at contrary times, and by setting
the country under water,' renders it fruitful.  This overflowing begins with the month
of September."  " In  December, the waters begin to fall by degrees."  "When the
■waters fall, and return to their former channel, (the river) they (the  inhabitants) are
apprehensive that a great mortality will ensue, among men and cattle; to avert which
calamity, a solemn festival is kept throughout the whole country, in order to appease
the destroying spirits,  (miasmata) which remain after the  water is run  off."  "The
banks of this river are low, and, for the greater part, marshy, yet"—"'they are  pretty
well inhabited : along  them appear  many villages,  the houses of which are raised on
piles." " From Rankok to the harbour, there is nothing but forests, deserts, and moras-
ses."  Ksempfer's History of Japan, vol. 1. p. 44.  In such a country and climate,
marsh fevers may well be supposed to prevail, whenever  the surface of the inun-
dated ground is left bars^  and exposed to the sun's rays. 
228
   Soon  after this  epidemic prevalence of  Yellow Fever  at
Martinico, it seems to  have  occasioned  great  mortality  at
JVms, (i. e. in 1689,; but  no  description  of it,  worthy of
notice, has been preserved.
   The same fever appeared  again  as an  epidemic at Barba-
does,  in  1695, and continued for  several years after.   Mr.
Hughes mentions this on the authority of  Dr. Gamble, who is
stated by him to remember that this fever " was very fatal" in
that year; and, as all who had  any accurate knowledge of it
in 1647, were probably dead or removed, " it was then called
the new distemper," and  afterwards " KendaVs fever;" also
"  the  pestilential fever, and  bilious fever."   It is said to have
been frequent and  fatal  in May,* June, July, and  August,
and then  mostly " among strangers ;" " though  a  great many
of the inhabitants, in the year  1696, died of it;  and a great
many at  different periods since."   " The same symptoms did
not  always appear in  all patients; nor alike in every year."
See Natural History of Barbadoes, p. 37.
   This  statement is  amply  confirmed by  Captain  Thomas
Phillips, in the account of his Voyage to Africa and Barba-
does,  published in the 6th volume of Churchill's  Collection.
He was at Barbadoes  with  a large ship in 1694,  and says, it
was the fate of that island to be then  " violently infected with
  * Barbadoes  was then so generally and highly cultivated, and the soil so much
more apt to become deficient, rather than redundant  in moisture, that the rains,
which commonly begin there in the  month of  May, were then, as at present, bet-
ter suited to the production of Miasmata, than the very dry weather which produ-
ced them in 1647.  Some other West Indian islands have undergone a similar change,
particularly Antigua. Dr. Ctiisholm states, that when the French, under Mons.
D'Enambuc, were driven from St. Christophers by  the Spaniards, in 1629, anil
"sought an  asylum in Antigua, they found it so unhealthy, so marshy, and so  inca-
pable of cultivation, that  they,  with one accord, intreated their leader to conduct
them toMontserrat," them " inhabited by the Caraibes." Since that time, however,
both the soil and atmosphere have frequently  become so dry as to produce effects
highly detrimental to the inhabitants and their cattle, &c.  Some of these Dr-
Chisholm mentions as having occurred in 1779, adding,  " when these destructive dr
tracts of weather are suddenly succeeded by a profusion  of rain,  which generally
happens once in three or five years, a very fatal epidemic  remittent is the  conse- f
quence."  See his Essay, &c. vol. 2d, p. 276 and 279- 
229
the plague, so that, in the late war, it proved a perfect grave
to moil that came there, all new comers being generally seized
with pestilence; of which very few recovered.   Captain Tho-
mas  Sherman, of his Majesty's  ship  Tiger,  in  two years
that he lay there,  buried out of her, 600 men, as he told me,
though his compliment was but 200; but still pressing new
out of the merchant ships that came in to  recruit his number
in the room of those that died daily."  " I lost (adds Captain
Phillips)  about eighteen of my men by it, and, in, truth, I did
not expect to escape myself, and was, therefore, so indiffe-
rent that there  was not a friend, or acquaintance of mine,
seized  with the distemper, but I freely and frequently went to
visit him, which possibly was  the reason that I escaped, by
having accustomed  myself to the town, and most infectious air
from the beginning,  which I  did  by the advice of the ever-
honoured and worthy Colonel Kendal, &c."  "while those
that kept in the country,  in better air for fear of it, were
commonly infected when they came on any  business to town.
Here died about twenty masters of ships during' my stay here,
of which number  were Captains  Gurncy  and  Bowles,  who
commanded  his Majesty's ships, Bristol  and  Play-Pri%e."
P. 253.
   It appears from this account that the disease prevailed chief-
ly in Bridgetown,  and that persons coming to it from healthier
parts of  the country, and imbibing miasmata, produced by the
local circumstances  which Ligon had long before described,
were attacked by  the fever, as constantly  happens on similar
occasions, at Charleston, Philadelphia, &c.
   Here  it may be observed that,  in every instance,  wherein
the causes of marsh fever have  been so powerful as to produce
a violent epidemic in the West  Indies, and with that exaspera-
tion of symptoms  which seems  more incidental  and natural to
this  kind of fever,  than to any other disease,  persons have
been disposed to consider it as the plague, or  a new distem-
per.   Dr. Henry  Warren fell into  the same  mistake after-
wards, (as Dr.  Chisholm appears to have done, more recent- 
230
 ly, at Grenada,) when the Yellow Fever again became preva-
 lent  at Barbadoes, between  the year 1732  and  1738.  The
 true plague, indeed, had not appeared in any part of Europe
 holding a communication with the West Indies,  subsequently
 to the years 1720 and 1721, when it proved most fatal at Mar-
 seilles and in some other  parts of Prove nee; and,  therefore,
 Dr. Warren concluded, that the Yellow Fever,  which he saw
 at Barbadoes, in 1732, and the following years, and which he
 denominated a " malignant fever," was a continuation of  the
plague,  which  he imagined to have been brought from  Mar-
 seilles to Martinico, and thence to Barbadoes, in 1721, by the
 Lynn ship of  war;  although  Dr. Towne,  who  lived and
 practised  as a physician at Barbadoes,  about that time, and,
 in 1724, wrote upon the Yellow Fever there, under the deno-
 mination of " Febris  ardens biliosa," appears to have had no
 knowledge or suspicion of any such importation, or of any dif-
 ference between the Yellow Fever  of his time, and that which
 had previously occurred ; nor of its being any other than an
 indigenous production of that  island  ;*  yet Dr.  Warren
 charges Towne with  having confounded " two most different
 maladies," viz.  " the malignant and the  ardent fever of Barba-
 does ;"  and he  represents the  former as being a fever " truly
 of the pestilential kind," upon grounds and reasons which Dr.
 Hillary,  and others,  afterwards contested  as being chimeri-

  * Towne describes his ardent bilious fever as commonly terminating " in a favoura-
ble crisis, or the death of the patient, about the fourth day after the attack."  (Trea-
tise on the Diseases of the West Indies, &c. p. 20.)   lie supposes this  fever to pro-
ceed from  a redundance of bile, and that the yellow suffusion was produced by the
efforts of nature,  to  depurate the blood, by throwing this redundant bile upon the
surface.  " The regular crisis,  therefore, of this fever, (says he) generally disco-
vers itself by a suffusion of the bile all over the surface of the body aboiu the third
day."  He adds, that an appearance of it may often be discovered  "in twelve hours
after the  attack, if you carefully inspect the coats of the eyes, and the sooner it ap-
pears the more encouraging is the prognostic," he.
  I have mentioned,  at p. 34, my belief, that the yellowness might, with attenlion,
be, in many instances, " first discovered on the eyes " Probably tbis would always
be the case, if their predominating redress, in the early part of this fever, did not
render the yellow tinge, in a great  degree, imperceptible. 
231
cal or fallacious.  But, independently of ttyeir facts and argu-
ments on  this  subject,  what I have mentioned, at p. 222,
224,  of the acknowledged and absolute impossibility of pro-
pagating the plague within the tropics, will sufficiently  refute
Dr. Warren's opinions and allegations.
   Dr. Hillary  was a well-educated physician, and practised,
with unequalled credit, for many years, in Barbadoes ; and,
as the Yellow Fever does not appear to have  prevailed there
epidemically, during his time, he must have had the best op-
portunities  for  ascertaining whether it possessed any conta-
gious property  or not; especially  as.he, undoubtedly, saw
cases of it, arising from all the several causes which have been
already mentioned as capable of producing idiopathic Yellow
Fever;  some of wiiich might be supposed, more likely than
marsh miasmata, to occasion fever with a contagious quality.
And he has delivered the result of all his observations in the
following passage, viz.:
   " I never could observe any one instance, where I could say,
that one person was infected  by, or received this fever from,
another person who had it; neither have I ever seen two people
sick in  this  fever in the same house, at,  or near,  the same
time,  unless they were brought into the same house when they
had the fever upon them, before they came in.  From whence
(adds he)  we may conclude,  that it  has  nothing of a conta-
gious or pestilential nature in it, and that it is a different fever
in all respects,  as  it will more fully appear hereafter."  See
bis volume on  air, and  Epidemical Diseases,  in Barbadoes,
2d edit. p. 145, 6.
   In confirmation  of Dr. Hillary's testimony,  I  shall adduce
that of Dr. James  Clark, now, or late, of Dominica, deliver-
ed in  his Treatise on the Yellow Fever, &c. after twenty-five
years constant and extensive practice in the West Indies.  At
p. 22, he states facts respecting the appearance of this fever
in Dominica, during the years 1793,  4, 5, and  6,  in which
years Dr. Chisholm asserts the fever at that  island to have
been, what he calls, the malignant pestilential  fever, brought 
232
to Grenada by the Hankey,  in  1793,  and thence propagated
to the other  islands : these facts decidedly prove  that this
supposed malignant fever manifested no contagious quality in
Dominica; but I shall reserve  them  to be employed in my
appendix, No. 7, on that subject.  The following paragraph,
taken from p.  52, 3, of Dr.  Clark's Treatise, appears to re-
late more immediately to the Yellow Fever, as it  commonly
occurred before the year 1793.
  This fever has not prevailed much in these Windward Ca-
ribbee islands for many years past.  At Fort Royal, in Mar-
tinique, where there is a great prevalence of mephitic efflu-
via,  arising from the marshy ground at the back of the town,
it generally broke out in the summer or autumnal season,  on
the ariival of troops from France,  or of a number of seamen
who  had never been in the  West Indies before:  and the  same
thing happened at Point a Petre, in Grand Terre, Ghiadaloupe,
almost annually, and from the same cause ; but it was  never
looked upon as an  infectious  disease, nor  did it ever spread
among the natives of the towns,  or among those  who  were
seasoned to the climates; nor was it ever carried from thence to
the other islands.  In this island but few cases  have occurred
for these last twenty years, and these have chiefly been at
Prince Rupert's Head, where from the stagnated water in a
large morass near the town and fort, the marsh miasmata pre-
vails in  a higher  degree.  Since the swampy  places, which
were in  the  town of Roseau, have been filled  up,  this  fever
has  been seldom observed;  but, previous to the year 1792,
we had generally violent thunder storms, heavy rains,  or  se-
vere gales of windr  during the autumnal season:"  and  these
Dr.   Clark  considers  as obviating  the  prevalence of this
fever.
   I have the more readily availed myself of Dr. Clark's tes-
timony,  concerning  the Yellow Fever at Martinico and Gua-
daloupe, because, for more  than twenty years, he  resided in
an island between and very near to both, and because I believe 
233
that no French physician, practising in either of those islands,
has written any thing on the subject worthy of notice.
  In  regard to  Grenada, I have  Dr. Chisholm's  authority
for  asserting, that, from the  year 1763,  when  that  island
"was ceded to Great Britain, and till the year 1793, (thirty
years J no contagious fever, and  no epidemic, of the charac-
ter  of the malignant pestilential  fever, appeared" there.  See
Essay, kc.  vol. 1, p.  295.  Whether the fever of 1793 was
such as Dr.  Chisholm has described it, will, I hope, be fully
ascertained in my seventh appendix.
  And here I shall close my  view of this subject,  so far as
relates to the Windward Caribbee islands, with an addition
of only one  document, declaratory of the opinions and expe-
rience, in those  islands,  and on this  question,  of the officers
of the hospital-staff, in  the army, commanded by Sir Ralph
Abercrombie, during the year 1796, and a great part of 1797,
when, unfortunately, they had but too many opportunities  of
seeing and treating the Yellow Fever.  That my readers may
be informed of the origin of this document, I must observe*
that, in  November,  1796,  the medical staff-officers at Marti-
nico, were assembled at  the General  Hospital of ha Charitet
when an  order from the army medical board was read to them,
requiring their  opinions, concerning the disorders  most pre-
valent in that army :  and it being proposed that a committee
should be appointed, to prepare  a statement of our opinions,  I
suggested that  a  single general statement  would,  as  I con-
ceived, but  imperfectly answer the purpose, and that it might
be better that each individual  should separately state his own
opinions ; and this suggestion  being adopted, Mr. Young,
Inspector-General of the Hospitals to that army, after  some
delay, was  furnished  with  our  separate opinions,  and with
those of the Hospital-staff officers  in the other islands; and,
in  consequence thereof, he wrote  a  letter to  the  army me-
dical board, dated St. Pierre,  23d July,  1797,  of which the
following is an extract, viz.  :
   By his Majesty's ship,  Arethusa,  I send, agreeable to my
 letter of the 25th ult.  un4er  cover to the Secretary to the
                             30 
2U
board, the opinions of the medical officers  of this staff, on the
prevailing diseases among the troops  in this country*  by
which  the board will perceive that contagion, or infection
has had little or no share in the mortality ; and  I must beg
leave to add, that it has never occurred in a single instance, to
my observation."  My own individual opinion was in exact
conformity with that  which Mr.  Young has here expressed.
I had  never  discovered any appearance of contagion  at  St.
Lucia, nor when placed at the head of the hospital depart-
ment,  at  Barbadoes,  in  the  summer of  1796,—nor  after-
wards, when officiating as physician to the forces at Martini-
co ; nor again when placed at the head of  the medical staff in
Grenada,  during a great  part of 1797,  and until my return
to England.
   St. Domingo next  presents itself to our observation,  in re-
gard to the history of Yellow Fever: of its aptitude in  many
parts,  to  produce  highly  noxious miasmata,  and the fevers
resulting  therefrom,  in all their various forms, there has
been but too  much evidence even  within a few years.  Wit-
ness the  many thousands of British soldiers, who perished
there by these fevers, between the years 1793 and 1799, and
the numerous French  army, sent thither in 1802, under Ge-
neral Leclerc,  and which in a diort space was nearly annihi-
lated by the same  fevers;  of which a very sufficient  account
has  been given  in  the Medical History (Histoire MediCale)
of that army by its chief physician,  M.  Gilbert.
   The earliest  mention which I recollect of the prevalence of
Yellow Fever in St.  Domingo, is contained in certain manu-
scripts, of M. Bourgeois,  formerly Secretary to the Chambre
of Agriculture, at Cape Francais, published, after his  death,
by his nephew, in 2  vols. 8vo. under the title of " Voyages
Interessans  Dans Differentes  Colonies;" from these  it ap-
years, (p. 202) that,  in the year 1731, a Spanish squadron
arrived at Cape Francais, commanded by Don Manuel  Lopez
Pintado, in the St. Louis, of eighty guns, who, besides several
ether  ships  of war,  had, under his convoy, some very rieli 
                           235

galleons.   They were returning to Spain from  Porto Bello,
and, having suffered greatly by a storm, had put into the Cape
to refit, where  they remained five months, surrounded by
sources of marsh miasmata; and having already,  as  we are
informed by Don Antonio Ulloa, (in the  5th chapter of the
first book of his Voyage to South America) been grievously
attacked by the  Yellow Fever, " vomito prieto," before they
left Carthagena, we need not wonder that, in this last situa-
tion,  they continued to be afflicted by the same disease,  and
of a form  probably more violent than'bad been  previously
noticed at the Cape:  especially in regard  to  Petechise  and
Hemorrhages, from different parts of the body, proceeding,
as I conclude, from a scorbutic disposition to which sailors, at
that time, were almost  invariably subject, especially after
long voyages.  Here they  expended great  sums  of  money,
and thereby enriched many  of the  inhabitants, but,  like the
Oriflamme, at Martinico, they were accused of introducing,
at Cape Francais, a new pestilential fever: "  On pretend,"
says the author of the manuscript in question, (p. 205) " qu'elle
occasionna l'esptce de  mat pestilentiel  qui a long terns regne
dans le Cap, k que l'on traitait faussement du nom  de Maladie
de Siam," kc.  At p. 432,  M. Bourgeois, in a  " Memoire,"
written by himself,  "sur les  maladies les plus communes a
St. Domingue," reverting to  this event, observes, that " Le
nom de Maladie de Siam vint  a 1'esprit de quelqu'un,  a cause
d'une espece de  resemblance dans la malignite ;  aussitot  cela
se repandit, & cette  denomination impropre, est demeuree  aux
fievres malignes, tres communes dans ce pays-ci.  Les plus
mat fesantes,  s'attachent principalement  aux nouveaux  ar-
rives," kc.  He then proceeds to mention the most remark-
able symptoms of these fevers, especially the violence  of their
first attack,,with a strong determination to the head, inflamed
appearance of the face, yellowness of the skin, and  profuse
hemorrhages from various parts of the body, and  sometimes
even through the pores of the skin.  He adds, p. 434, that all
the fevers of St. Domingo are of the same kind, and  nearly 
                          236
related  to  the intermittents,  double  tertians, and continued
fevers, with or without exacerbations, (" avec redoubkmens,
ou sans redoublemens") in Europe.
  The name of Maladie de Siam having been thus applied to
the most violent form of marsh fever in St. Domingo, it was
adopted by M. Poupee-Desportes, a physician  of great merit,
who arrived  there  in the following year, and, during the
fourteen succeeding years, kept an account (founded on accu-
rate observations) of the  weather and diseases,  as they oc-
curred first at the Cape, and afterwards at Fort Dauphin, by
which it was acertained,  that the prevalence or absence of
Yellow Fever, at those places, invariably  depended upon the
changes  of season or constitution,  in regard  to  heat and
moisture, especially during the summer  and autumn.   Thus
at the Cape, in 1733 and 1734, after very copious rains, ex-
tremely hot and dry weather commenced,  and  lasted during
the summer and  autumn, inducing a violent Yellow Fever,
(" Mai  de Siam"  which reigned exclusively for the space of
four months, and carried off more than half of the new comers
and sailors; while there was very little sickness in the more
elevated country situations.  Again in 1739, 1740, 1741, and
1743, after extremely hot and dry weather for a considerable
time, the Yellow Fever again became prevalent, and fatal to
a great  part of those who wrere attacked by it, and who, as
usual, were-chiefly strangers.   On the other hand, the tem-
perature in 1735, 1736, 1737, 1738, and 1742,  was mild, or,
at least, moderate; and, in those years, this fever only oc-
curred sporadically,  and with diminished violence,  so that
most of the new comers, who were attacked by it, recovered.
Mr. Poupee-Desportes also  observed, that when this fever
prevailed as an epidemic  among  strangers, and  in its more
violent forms, at the Cape, and  at Fort Dauphifl, it affected
the seasoned inhabitants only  as a mild bilious remittent, or,
as he called it, a lymphatic  fever.  From this constant de-
pendance of Yellow Fever upon the state of  weath er, this
author infers that it ought to be regarded " comme-iiue de ces 
237
maladies dont il faut chercher la cause dans la constitution de
l'air;" and, consequently, not as produced by contagion.  See
Histoire  des Maladies de St. Domingue, torn. 1. p. 191.
  I ought here to mention, according to the information given
by M. Valentin, formerly " Premier medicin des Armees de
St. Domingue, kc. at p. 58 and  59 of his Traite de la fievre
jaune d'Amerique, that, in the French West Indian colonies,
and especially since  the time of  Poupee-Desportes,  a distinc-
tion has  been made  between " la maladie de Siam, and la
fievre jaune," which last was known under the  denomination
of  " fievre ardente maligne,  ou fievre bilieuse  maligne ;*'
and sometimes under that of " la Matelotte."   That these
diseases  were " identiques," or, at most,  only presented a
variety in their effects.  That the  name Mai de  Siam  was
given when the signs of dissolution of the blood  were present
in the highest degree, (" au Comble") when, besides a jaun-
dice, the blood became extravasated under  the skin, making
its  way  through different  natural  outlets  or passages,  and
transuding by the pores at some points of the cuticular  sur-
face, (par  les pores de quelques points de la surface cuticu-
laire.")  It seems probable,  therefore,  that this  distinction^
and this  application  of the name Mai de Siam, were derived
from an  unusual prevalence  of  Hemorrhages and Petechise,
observed in the crews of the  Oriflamme, at Martinico, and of
the Spanish squadron, at St. Domingo, when labouring under
the Yellow Fever; and that, in both cases, there  was, as
might well be expected in such long voyages,  and  at those
times, a great predisposition to scurvy, or to a dissolved state
of the blood, in the persons so affected; though Hemorrhages,
&c; have occurred not unfrequently  in other situations to per-
sons under Yellow Fever, and sometimes when  there was no
appearance of a scorbutic disposition.
  Unfortunately, this account of the wTeather and diseases at
St. Domingo was not continued by any other physician after
the death of  M. Poupee-Desportes  : though it appears from
M. Valentin's Treatise, that the French  physicians at St.
j
i 
233
  Domingo had generally thought the Yellow Fever to be not
  contagious, and that this was also his own opinion.
     Of the Yellowy and other marsh fevers,  as they affected the
  Biitish  army  at St.  Domingo, during the  late war, a very
  good account has been given by Dr. Hector M'Lcan, to which
  I must refer those of my readers'who wish for more ample in-
  formation on this  subject; only observing that, he also deb%
  vers  it as his decided opinion, that " what has been called
  Yellowr Fever there, is not an infectious disease; that it is the
  common remittent endemic of that  country,  applied to the
  English or European constitution."   This  opinion is repeat-
  ed almost in  the same words,  at p.  71,  and again at p. 78,
  where he says, " there is no point on which I am  more de-
s  cided than the  absence of contagion  in the remittent of St.
  Domingo;"  and this he declares to have been the opinion of
  Dr.  Scott,  Dr. Wright,  and Dr. Gordon,  (all physicians on
  the St. Domingo Staff,) and of every medical man w ith whom
  he conversed  at that island.*
    In regard  to the fever which  destroyed the army under
  General Leclerc, at St.  Domingo, in 1802  and 1803, I must
  refer my readers to M. Gilbert's Histoire Medicale,  only ob-
  serving that  he also declares it not to have  been an imported
  disease,  but to have  originated in an atmosphere extremely
  heated,  and  filled With  marsh effluvia (" elle a son  origine
  dans un air  tres-chaud, sature d'emanations marecageuses")


    * Dr. Jackson, who was also on the Hospital-staff at St.  Domingo,  has delivered
 similar opinions in his Outline of the History and Cure of Fever, &c.; in which he
 states the endemic fevers of the West Indies to be produced  by exhalations from the
 surface of the earth, and that, « though they often destroy life, they beget no power
 of propagation in the patient,"—" that they may become epidemic,  but not conta-
 gious."  Of their varieties, he says, " the disease, in the more violent forms, is, or ap-
 pears to be, continued, in some situations ;  in others it is remitting,  and of regular
 type.  In wet weather, and on swampy grounds, the endemic of the country (St. Do-
 mingo] is usually remitting in form; and, under this form, exhibits appearances of
 jaundiced yellowness, of black vomiting, purgings of black matter, haemorrhage from
 different parts of the body, petechia?, lividn.ess," &c. 
239
 p. 93.  He adds,  in the next page, that it is not contagious ;*
 and that this is the opinion of the generality of Practitioners.
 —But, that it is epidemic for almost all new  comers;  and a
 tribute which must commonly be paid by them  within the first
 year after landing.  And having asked, at p. 77, whether the
 Fellow Fever be a disease, from the bilious (or marsh) fevers,
 he answers, "il y a tout lieu de croire  qu'elle n'est  autre
 chose que le maximum  des fievres remittentes bilieuses," i. e.
. there is every reason to believe that it is  only the highest or
 most violent form, of bilious remitting fevers.    At p. 80, M.
 Gilbert advises those  who are under the necessity of living in
 the city of Cape Francois,  to remove  from the shores of the
 sea,  and especially from the environs " de L'embouchure de
 la riviere du haut  du Cap;  lieux  ou la brise  de terre porte
 chaque jour les Emanations  marecageuses de cette surface im-
 iliense de  lagons, qui s'etendent de  L'embarcadere de la  Petite
 anse, au  bourg du haut du Cap."
    The first epidemic fever, in Jamaica, of which I have found
 any account,  is that  mentioned by  Dr. Trapham,  in a little
 volume,  entitled,  " State of Health of Jamaica,"  printed in
 1679, about twenty-four  years  after the capture of the  island
 by Cromwell's  forces.  In  this volume the author, after re-
 presenting Jamaica as not  liable to any  pestilential or  epi-
 demical disease,  adds, p. 81,—" I  know it hath  been  com-
 monly received,  that, about eight years since,  when the vic-

   * It must be observed, that M. Gilbert delivers this opinion that the Yellow Fever
is  not contagious with a sort of qualification ; because he  supposes that, when great
numbers of patients, under this putrid gangrenous disease, as he  calls it, are collected
together, the emanations from their bodies may excite fever in persons who are con-
stantly exposed to them, and also exposed to the causes which originally produced the
fever,-" ("a faction des causes qui  la font naitre") but these causes (miasmata) must
be sufficient alone, and the emanations from the sick must, therefore, be superfluous.
He had observed that the attendants on the sick in hospitals at the Cape, were fre-
quently attacked with the fever; but, as this was the case of almost every one out of
the hospitals also, and, as the hospitals were, according to his own statement, placed in
the most unwholesome part of the  town, (whence he says they ought tobu removed)
it  would have been extraordinary indeed, if persons, by remaining in  them, had
escaped the disease. 
240
 torious fleet returned from the signal Panama expedition, that
 then they brought with them an high, if not pestilential fever,
 of which many died throughout the country.  But, this being
 a foreign distemper, brought from abroad, the causes of which
 I could not so well judge of, I  am not as yet forced from my
 opinion thereby, but conclude Jamaica more happy than to be
 annoyed therewith, directly and cyriginally."
   Dr. Trapham here alludes to the famous expedition  under
 Henry Morgan, who,  at the head of about 1200 Bucaneers,.
 took Panama, in 1670, and returned to Jamaica with so much
 plunder  that  his  own share'amounted  to 400,000  dollars.
 With this he became a planter, was made Lieutenant-Govern-
 or of the island, and knighted.  Of the fever, with which
 these men were affected,  at and after their return,  I can find
 no distinct account; but, as in  their march across that  part
 of the continent,  they must have  been almost continually ex-
 posed to marsh effluvia, and,  after their return,  with so much
 wealth, would naturally have run into debauchery and intem-
 perance of all sorts, there can be no difficulty in finding suffi-
 cient causes  to produce among them  even the most violent
 fevers in that climate.   That marsh fevers have subsequently
 prevailed at  Jamaica,  to great and fatal extent  is but too cer-
 tain ; though  distinct and   accurate  accounts  of them  are
 wanting; at least, I have found none anterior  to the  Essay
 on Yellow Fever, by Dr. John Hume, who, for many years,
 had the direction pf the Royal Marine Hospital, at Jamaica,
 and was  afterwards commissioner for the sick and hurt of the
 Royal  Navy.  This gentleman computes that in 1741 and
 1742, after the return of Admiral Vernon's fleet, from the un-
 successful attempt upon  Carthagena, 11,800 sick were sent
to the Royal Hospitals of Jamaica, and that, of this number,
not  less than  7000 were  attacked with the Fellow or bilious
Fever.  " Of these (says he) I used to compute that 1500
died, that is something less than one in four;  but,  in this, I
 pretend not to be  exact."   See Dr,  Hume's  Essay,  in  the 
241
volume  on West  India Diseases, published by Dr. Donald
Munro.
  Dr. Williams,  in his Essay on the Bilious Fellow Fever of
Jamaica, (which Essay occasioned a duel between the author
and  Dr. Bennet, and the deaths of both) says, this disease,
at the time of the expedition to Carthagena, was "so gene-
ral  and fatal, that people  looked upon it  as  a plague,  and
shunned the  sick as they would contagion."   It does not ap-
pear, however, that he, or any well-informed medical man at
Jamaica, then believed it to be contagious.   On the contrary,
Dr. Hume  says, (p.  238)  " we have undoubted proofs that the
disorder is neither a plague nor contagious, as Dr. Warren has
alleged."   He observes, that it commonly made  " its attack
after hard drinking,  violent exercise, dancing, and sleeping
in the open air ;  that " strong muscular men  are most liable
to it, and suffer most;" that " Creole white men are rarely
seized  with it;" that he " never knew any Creole  white wo-
men ill of it;"  but has known it prove  fatal to  European
white women, though  " they  are not so liable to  it as the
other sex."  He adds, " I have never seen any negro, male or
female, native or foreigner, attacked with  the bilious fevei,"
p. 237 and 238.  In all these particulars the fever  at Jamai-
ca appears to have agreed  with  what has generally been ob-
served of yellowr  and  othei' marsh fevers.  It appears  also,
that many  of the cases which fell under the care of Dr. Hume,
were extremely exasperated, and  attended with  vomitings
" of a  coffee colour," as well as " black," and with a mortifi-
cation of the stomach,  which, he says, was always found after
death,  " in all such subjects as I  have either  opened myself,
or seen opened by others,  after having had black vomiting."
See p.  217.
  Dr.  Lind,  in  his work  on Preserving the  Health of Sea-
men, says, that the Lords  of trade and plantations wishing to
ascertain, for a particular purpose, whether the Yellow Fever
of Jamaica was contagious or not, " a physician was consult-
ed, who had long practised in that island, who gave it as his
                            ol 
242
 opinion, that from  the Fellow Fever of that island  there was
 no infection."   This (he adds) was not only the opinion of
 that gentleman in  the court, but is  the belief, as  I am in-
 formed,  of the  best practitioners  in that island, and also of
 Dr. John Eliot," (since Sir John,) " a skilful physician in
 London, of Mr. Nasmyth," (Surgeon to Admiral Holmes,
 of Jamaica) " and  many others,  who have had  opportunities
 of being well acquainted with the diseases of Jamaica."   See
 p. 292, 3d edit.
   Of. similar import is the testimony of  the late Dr. John
 Hunter,  as delivered in his excellent work on the Diseases of
 the Army in  Jamaica, in which,  at p.  83, he declares him-
 self " able to say with certainty,  that it, (the Yellow Fever,)
 is not infectious."  He adds, " in the Military Hospitals, the
 sick,  admitted  with fevers, were above  three quarters of the
 whole; and they were often much crowded together,  yet there
 was no reason  to believe that a  man, with  any other com-
 plaint, ever caught a fever in the Hospital."  This testimony
 has, indeed,  been repeatedly  given, though  not in  the same
 words, by Dr.  Hunter, in different parts of his work.
  ^hese facts and  opinions might  probably be  thought suffi-
 cient in regard to  the Yellow Fever at  Jamaica,  had it  not
 been supposed by some  persons that a malignant pestilential
 fever was introduced at that island,  from Grenada, in 1793,
 and there mistaken for Yellow Fever: to ascertain the fallacy
 of this supposition, it may not be  improper to adduce the  tes-
 timony of  Dr.  Lempriere, now physician to his Majesty's
 forces, who was  then employed in that island.  This gentle-
 man,  at p. 22 and 23 of the 2d vol. of his Practical Observa-
 tions on  the  Diseases of the Army  in Jamaica, says of the
 Yellow Fever,  that it became so prevalent, and proved so
 fatal in Jamaica,  during the years 1793, 1794, and 1795, as
to give rise to a very general opinion, that it was highly infec-
tious,  and that  it had been imported  from the  windward
islands by contagion."—" But, to  those who understand the
influence of contagion, it will appear, that  this disease  did 
243
 not prevail as if it were of such kind ; for it chiefly affected
 the newly-arrived European,  as yet unnerved by the climate,
 whose high health alone rendered him subject to its ravages ;
 while the delicate and weak persons, particularly liable to the
 influence of contagious diseases, were altogether exonerated
 from this fever."  The same  author, at p. 29 and 30, posi-
 tively denies the existence of  any contagious property in this
 fever; adding, p.  31, that it  did not spread generally over the
 island  as a contagious disease would have done,  in the then
 existing circumstances ; but " was confined to those situations
 only where remittent fevers are most prevalent and fatal, and
 to those subjects who had  lately arrived from Europe with ro-
 bust and plethoric constitutions."  At p. 47,  Dr.  Lempriere,
 to account for the occurrence of this fever,  with uncommon
 violence in 1793, mentions that the rains usual in the month
 of May were then excessive,  and that they were followed by
 very  extraordinary heat in June, July,  and August; which
 naturally occasioned a  more copious and  more concentrated
 exhalation of miasmata, than in former years;  and as a much
 greater number of persons arrived about that  time from Eu-
 rope, in  consequence of the war, the violence of the fever, and
the numbers attacked by  it,  were very much increased, as
 might well have been expected; though it  attacked none who
had long resided at Jamaica, and  entirely ceased, as usual,
 about the month of January; until re-produced  by similar
 causes, in the following summer and autumn.
   In a paper concerning the Yellow Fever,  which prevailed
 at Jamaica  in 1793,  1794, and 1795, read by the  late Dr.
 James Walker,  to a medical  society, which had been formed
 at Port  Royal  to  investigate the  nature  of this fever, the
 author describes it as  attended  with a constant  propensity
to vomit, by which mucus and bile were first thrown up ; and
 afterwards,  generally about the third day, a  matter resemb-
ling coffee grounds, and sometimes of the colour, consistence,
and tenacity  of  tar.  Hemorrhages  were frequent, from the
mouth, nose,  and, sometimes,  from the axilla, anus, and va.- 
244
g'ina.  Near  the  close of the disease, in those cases which
terminated fatally, a yellowness  appeared, first in the eyes,
and  on the neck,  gradually extending over the whole body,
and acquiring a  darker hue; very few had  petechial erup-
tions.  In  1793 and  1794, the fever  did not intermit, and
often terminated fatally in two  or three days.  In 1795, it
became somewhat milder,  and more protracted.  It was near-
ly confined to newly arrived Europeans, though some old re-
sidents in the interior  (and probably high and cool) parts of
the island, were  reported to have  been affected by it.  The
author believed the disease not communicable from one per-
son  to another;  observing,  that " in the  public Hospital,
where many people were necessarily in the same wards, with
numbers  in this fever, neither any of them, nor of the atten-
dants upon them, were infected."  See New  York Medical
Repository, vol.  1, p. 486, 7.
   I shall dismiss  this  subject, so  far as regards Jamaica,  by
referring my readers to a small,  but vfcry valuable, Treatise
on the Yellow Fever of that island, by Dr. Grant, a physi-
cian (as  I am informed) of the greatest eminence, and most
extensive practice there.   He considers this fever decidedly as
not being contagious ;  and as being only an aggravated form
of the remittent of hot climates,  exclusively attacking those
who have lately arrived from colder countries,  and who bring
with them an inflammatory diathesis.  He observes, however,
p. 27,  that " in its mildest state, under its clear remitting
form, it attacks both the long resident  and native ;" and that,
" for several years past,"  (i. e. previous to 1801) " the native
and  European, of long residence, have experienced it,  under
a greater  degree of aggravation of  symptoms," than for-
merly.
   Were I to extend this  view to  other West-Indian islands,
and  to the Spanish settlements on the continent  of America,
particularly at Carracca, La Guayra, Venezuela, Carthage-
na,  Porto-bello,  and  Lavera-crux, it would present a repeti-
tion of nearly similar facts.   Believing, however, that a state- 
245
 ment of them  would be thought superfluous, and even tire-
 some, I beg leave to direct the attention of my leaders to the
, United States  of America, where the  occurrence of frost in
 winter presents the disease in different  circumstances,  and
 where  the  facts, regarding  its origin, nature,  and supposed
 contagious property, have been, within  a few  years,  atten-
 tively observed, and also discussed with great ability, as well
 as nice discrimination.
   Proceeding,   then, from Jamaica northward,  Charleston,
 in South Carolina,  first offers itself to our observation.   And
 here  I  gladly  avail myself of  a statement  on  this  subject,
 made by  Dr. David Ramsay, of that city,  in  his  " Review
 of the  Improvements,  Progress, and  State  of Medicine, in1
 the  18th  century, already cited at p. 188.   The  statement
 in question is at p.  39,  and in the following words:
   " In the year 1699, a disease prevailed in Charleston, which
 swept off a great part of the  inhabitants, and some whole fa-
 milies.  This was then called the  plague, though afterwards
 supposed to have been the  Yellow Fever." *
   In the year 1732, the Yellow Fever began to  rage in May,
 and continued till September or October.   In the height of the
 disorder, there were from  eight to twelve whites  buried in a
 day, besides people  of colour.  The ringing  of bells was for-
 bidden, and little or no business was done. | In the year 1739,

   • This  disease is mentioned at p. 142, of the first vol. of the History of South
Carolina, (London, 1779)  as having « carried off an  incredible number of people;"
among whom were  the chief justice, the episcopal clergyman,  the receiver-gene-
ral, the  provost marshal,  "and almost half the members of the  assembly." In-
deed,  the situation of Charleston, however  convenient for trade  and navigation, ap-
pears to  have  been, from  the  beginning, eminently productive of marsh fevers in
summer and autumn. Governor Drayton, in his View of South Carolina,  (p. 24)
says, " at its first settlement, Charleston was said  to be so unhealthy, in the au-
tumnal months, that, from June to October, the public offices  were shut up, and
people retired to the country."
   | Dr. John  Moultrie, whose  father was,  during forty years, at  the head of his
profession in Charleston, and who,  in 1749, published,  at Edinburgh, an excellent
inaugural  Dissertation  " de febre maligna biliosa America, 4to. after  mentioning
therein, that this disease prevails most violently in proportion as the beat of die atr 
246
die  Yellow Fever  raged nearly as violently  as in  the year
1732 ;  and it was observed  to fall  most severely on Europeans,
In 1745 and 1749,  (rather 1748) it returned, but with less vio-
lence;  however, many young people, mostly Europeans, died of
it.   It appeared again in a few cases, in 1753 and 1755, but did
•ot  spread.   In all  these  visitations,  it was  generally  sup-
posed that the Yellow  Fever was  imported;  and it was re-
marked that it never spread in  the  country,  though often carried
there by infected persons, who  died out  of Charleston, after
having caught the disease in it."
   " For forty-two  years after 1749, there was no epidemic at-
tack of this disease,  though there were occasionally, in differ-
ent  summers, a few  sporadic cases of it.    In the year 1792, a
new era of the Fellow Fever commenced.    It raged in this city
in that year, and also in 1794,  1795,  1796,* 1797,  1799, and
1800.   In these last seven visitations of  this disease, it ex-
tended from  July  to November, but was most rife in August
and September; with a very few  exceptions (chiefly children)
it exclusively fell on strangers to the air of Charleston, and was,
in no instance, contagious."

mosphere is greatest, adds, " in Caroli-op\ndo exeunte mense Junio, anno,  1732, cum
nulla aura per aliquot hebdomadas cestum torrentem refrigerasset, adeo sceviebat ha;c
febris, et tarn acuta et lethalis erat, ut multis post diem 2m. vel 3m. mortifera essct"
" Anno 1748, in eodem loco febris hsec iterum. erupit, circa medium  mensis Augusti,
prima cujus septimana nulla ibi unquam  ealidoir  erat, ut Mercurius in Fahrenhetii
thermometro ad 97", 97 l-2», et 98°, in acre umbroso ascenderet, et calor hicce
cum  multis imbribus diu duravit," p. 8.  He adds, at  the top of the next page,
that  the  atmosphere, sometime after, became cool, and the epidemic, from a Yel-
low Fever, changed to an intermittent  " a coeli temperie  in frigidiorem versa, mites-
cit et in  intermittentem  febrim  mutabalur."   He observes, in the same page, that
though most people  thought the  fever contagious, he  had  seen many  persons
who  maintained a close and daily intercourse  with the sick, and did not get the dis-
ease, if  they avoided violent exercise, and exposure to external injuries.  Hesajs, p.
6, that the North Americans pretend  they derive the disease from the West Indies,
but that the West Indians say it  is not indigenous there. He thinks, however, that
sufficient causes exist among both; with and among these causes he includes " ingens
dstus aeris," marsh effluvia, violent  exercise, drinking to excess of ardent spirits,
&c.  He says, the epidemic of 1745  manifestly began from the latter cause, in a sailor,
and not from any imported contagion. 
241
  This uncontradicted statement, publicly made by an eminent
and respectable physician, in the hearing of hundreds, who, if
it had been erroneous, and  particularly if the  Yellow Fever
had manifested any contagious quality in South Carolina, must
have been able, and disposed, to assert the truth, may well be
considered as decisive evidence on the subject; especially as it
w as printed at the request of the Medical Society of that state.
Dr. Ramsay had, indeed, previously stated this fact more cir-
cumstantially in his address to  the same Society, on the 24th
of December,  1799, when, speaking of the disease in question,
as it had appeared there during the preceding summer and au-
tumn, he  says, " We have  no reason to believe that the Yel-
Jow Fever was either imported among us, or communicated by
contagion.  It raged  most  in the north end  of King  Street,
where the greatest number of persons from the country resided,
and in those streets where sea-faring persons usually fixed
themselves.  No physician, or nurse, took the disease.  Stran-
gers, who left the city, and afterwards sickened  and died in the
country, were not the occasion  of death, or even of disease, to
those who attended them in their last illness."  See New York
Medical Repository, Vol. 4, p.  100.
  Again, in the Charleston Medical Register,  for  1802, Dr.
Ramsay, alluding to the Yellow Fever, which had then recently
terminated, declares that " no  instance can be recollected in
which there was any ground to suppose that the Yellow Fever
w as either imported, or had been  contagious.  No physician,
nurse, or other person," having " intercourse with persons la-
bouring under Yellow Fever, caught the disease.  It was ex
clusively confined to strangers, and among them there was  no
evidence of its being communicated from one to another."
   The like absence of a contagious quality continued to  be
manifested by this disease in succeeding years.   Dr. Ramsay,
in giving an account of the Yellow Fever, as it had appeared
at Charleston in the summer and  autumn of  1804, (in a letter
addressed to  Dr. Mitchell,  and dated the 14th of December,
 1804), writes as follows:—" A few cases of Yellow Fever oc- 
248
curred prior to the 10th of July; but, from that day till about
the 20th of September, it might be said to be epidemic.  From
and after that time  it gradually declined, and finally disap-
peared about the 1st of November."  " The weather was un-
commonly warm, while the epidemic raged, and the number
and mortality of its  subjects increased with the increase of
heat. The disease was marked with the  ordinary symptoms
which have been so often described, and are  so well known as
to make a new statement unnecessary; but, in tbe following
particulars, an unusual proportion of patients deviated from
what had been tbe more common form of the disease in pre-
ceding years.  Neglected intermittents frequently terminated in
Fellow Fever.  The  black vomit was neither violent nor con-
stant, even in fatal cases, where the depleting system was car-
ried to a proper  extent."  " As usual, the disease  was con-
fined to persons who were strangers to the air of Charleston;
but  it attacked some who had resided among us one or two
years, and, in a few  cases, more."   But in  these there " has
generally been a great proportion  of exciting causes, such as
intemperance, long exposure to the damps  of  night,  or the
scorching rays of the sun."   This disease, in no instance proved
contagious."  See New York Medical Repository, vol. 8, p. 365.
  I shall conclude these statements, in regard to Charleston,
by  the following extract from Dr. Ramsay's Letter to Dr.
Miller, dated the 18th of November, 1800, viz. "The disputes
about the origin of the Yellow Fever, which have agitated the
Northern  States, have  never existed in Charleston.   There is
but one opinion among the physicans and inhabitants, and that
is, that the disease wras neither imported nor  contagious.  This
was the unanimous sentiment of the  Medical Society, who, in
pursuance of it, gave their opinion to the government last sum-
mer, that the rigid enforcement of the quarantine laws was by
no means  necessary, on account of the Yellow Fever."  " My
private opinion is, that the Yellow Fever is a local disease, ori-
ginating in the air of Charleston."   See New York Medical
Repository, vol. 4, p. 218 and 219. 
249
  North Carolina having no large city, has been  less fre-
quently infested with the violent forms of marsh fever.   But
Dr. De Rosset, of Wilmington, in that  state, has described,
what he calls a pestilential fever, which prevailed there in the
autumn of 1796, accompanied with yellowness of the eyes and
skin; and " ultimately the true black vomit, a,^  described by
writers on the  Fellow Fever."   He describes Wilmington, as
being much exposed to marsh effluvia, and the weather of that
summer as having been unusually hot and dry subsequently to
a very wet spring:  Of this fever, he says, " I have no doubt,
in my own mind, of its having originated  among us, nay more,
of its differing from our common bilious remittent but in  de-
gree ; of its originating from the same causes, and being aggra-
vated by the circumstances of the season." " I did not observe
one instance of its being communicated by contagion; nor do I
believe  it  was so."   " A few cases every year, of our common
fall fever, take on all the symptoms of a violent Yellow Fever."
See New York Medical Repository, vol. 2, p. 143, 4.
   In proceeding northward,  our next object will be Norfolk,
in Virginia, which, being a considerable port, and abounding
in the sources of marsh  miasmata, has,  on several occasions,
been severely attacked with Yellow Fever, as I  have already
noticed, at p. 191.  Several of these attacks fell under the
observation of M. Valentin, who landed in Virginia, with
many other fugitives, from St. Domingo, in the summer of
1793, as is mentioned at p. 185; and this gentleman, after
noticing the various attempts made at Philadelphia,  to prove
that the disease in question had been produced by importation,
says, at p. 84. of his Treatise, " Nous  avons vu la Maladie
eommencer a  Norfolk, sans qu'on ait pu en accuser aucun na-
vire recemment arrive :  les Medecins de ce lieu n'ont memt
jamais eu cette opinion."   In the next and following  pages lie
observes,  that  the Yellow Fever  never  appears there but in
those months  when  the air is extremely hot  and sultry, with
but little motion.  That, in  1796, the summer was very wet,
and  the  Yellow Fever  only appeared  sporadically; being 
250
 little more than the common bilious remittent.  But, in 1797,
 the drought was extreme at Norfolk, (and, consequently, the
 heat) during  the  whole  of July,  August,  September, and
 October;  and that the Yellow Fever then raged furiously as
 an epidemic,  and with symptoms  of unusual malignity, be-
 ginning about the end of August,  and continuing until about
 the middle of November, when the weather, becoming cold
 for two  or three days, the fever entirely disappeared, as it
 has invariably done in every part  of the United  States, soon
 after the occurrence of frost.   Between pages 92 and 102,'
 M. Valentin  states a number of facts and reasons, proving
 the local origin of the disease at Norfolk, &c. and its having
 manifested no contagious property in  circumstances  where
 such property, had it existed, ought to have become evident.
 He describes the situation of Water Street,  at Norfolk, and
 the  composition of the new-made  ground,  as it is  called,
 which serves  as a foundation to  the houses of that  street,
 adding, that it is in that part of the  town that he has  con-
 stantly  seen  the greatest number of  Yellow Fever patients,
 labouring  under  the  disease in its worst forms, with he-
 morrhages, &c.  See  p. 101.
   At p. 191 of this volume, I have  inserted an extract from
 an account, given by Doctors Taylor and Hansford,  of the
 Yellow Fever, as it prevailed at Norfolk, in the summer and
 autumn of  the year 1800; and I will  here subjoin extracts of
 another account, given of this disease at the same time and
 place, by Doctors Selden and Whitehead, two other  physi-
 cians of Norfolk, viz. " Europeans  and natives of the North-
 ern States, who had not been accustomed to warm climates,
 were most exposed to  the attack of  the disease in its severest
forms; those,  from the same countries, who had resided here
for some time, and strangers from this and the neighbouring
states, were not exempt, but the disease  (in them) put on a
milder form ; while  those who aaere born in Norfolk,  and
were old residents  of the place, never enjoyed a greater portion
of health, in any former season, none  of them died, or were 
251
even affected with the prevailing  epidemic.  This  entire ex-
emption of the permanent inhabitants of Norfolk, different from
what was experienced in more northern parts of America, as
Philadelphia,  New-York,  and Baltimore, may probably be
accounted for, on the supposition  that our situation  and cli-
mate here, approach nearer to the circumstances of the West
India islands,  w here strangers in general are the only persons
attacked with  Yellow Fever."
  These gentlemen  further  observe, that, " for more  than
two months, subsequent to the 25th of June," (of that summer)
" the inhabitants of Norfolk lived in an atmosphere constantly
heated above the 85 th degree of Fahrenheit's scale, and some-
times to the 94th and 95th degree, but very frequently above
the 90th."   That,  " on the 5th of October, a deluge of rain
fell,  accompanied with  a  powerful sweeping wind from the
North-East; the weather became suddenly  very cool; the
mercury fell to 48° on the morning of the 6th, and, on the 7th,
it was as low as 42° of  Fahrenheit.  In si few days after this,
not a vestige  of Yellow Fever was to be seen  in Norfolk."
The  same gentlemen add,  " that part of the town, where the
malignant  fever chiefly prevailed,  stands entirely on  made
land, reclaimed from the river by sinking pens of large  logs,
and filling them up chiefly with green  pine saplins, which are
slightly covered over with earth,  or  gravel.  In some places
large openings are left for the formation of docks ; in others,
wharves are formed next the channel  of the river, while the
interior parts  are  still covered with  water, and, in  many
others, the lots remain  in their original state."   They also
mention other  sources of marsh effluvia, which acted upon, as
they observe," by the powerful rays of an almost vertical sun,"
must have been very sufficient to produce this disease, which,
as they state,  " for several weeks, after its  commencement,
was  quite local."  See New-York Medical Repository, vol. 4.
p.  129 and seq.
  The same disease prevailed again at Norfolk  in 1801, when
the four physicians, before-mentioned, subscribed  a  declara- 
252
 tion, dated the 12th of October, 1801, in these words, vise.
 " we do certify that the malignant Yellow Fever, which pre-
 vailed  with violence  for  some  time past,  has now nearly
 ceased, and that the health of the town appears to be improv-
 ing daily.   We know of no instance in which the disease has
 been communicated by contagion."  Medical Repository, vol. 5,
 p. 225.
   Baltimore, in Maryland, falls next under  our observation.
 In this city, especially at  FeWs Point,  or  East Baltimore,
 (which is greatly infested by marsh effluvia,) the Yellow Fever
 has several times  prevailed, and with great  mortality,  since
 the year 1793.  In a Treatise on this Disease, published  in
 1798, by Dr. Davidge, a physician of eminence in Baltimore, he
 states, that in the preceding year, 1797, " the bilious or re-
 mitting fever, in its ordinary form, prevailed in that town,
 and particularly at the Point;"  and that this  continued " un-
 til it was gradually lost, in the severer degree of Fellow Fever,
 as the season advanced in the month of August:" that, " from
 this time, until early in November,  when  it became  entirely
 extinct, the Yellow Fever alone was observed; and it  was
 obviously more severe, more early in its occurrence, and more
 general in its prevalence, in the direction of the winds which
 blew over certain  marshes,  stagnant waters,  and depositions
 of filth."  He, therefore,  considers  " intermittents, remit-
 tents, and Yellow  Fever, as merely varieties  of one disease,"
 —asserting " that the Yellow Fever cannot be propagated
 by contagion, out of the sphere wherein it originated."  See
 New-York Medical Repository, vol. 2. p.  83, 84.
  Of the epidemic Yellow Fever which occurred at Baltimore,
 in the  year 1800, the faculty of medicine of that  city, in a
report to  the mayor,  say,  "  after the most  scrutinizing in-
vestigation, the faculty have found no proof, or even cause of
suspicion, that the fever which  lately so  unhappily afflicted
our city, was derived from foreign  causes;"  and, in  support
of this declaration, they give  a particular account of thirteen
 cases, in which the disease first appeared, all of whom were in 
253
 persons who had been exposed to marsh miasmata, but had
 not communicated with any vessel, " engaged in foreign com-
 merce ;" and  " were attacked at such  distances from each
 other as to preclude the probability of any one of them having
 derived it  from the  other."   They  proceed,—" the  gradual
 manner in  which this disease  becomes epidemic, is an addi-
 tional  proof that it is not derived from foreign sources;" and
 after describing the milder cases which occur at the beginning,
 before the causes acquire full force, they add, " if this disease
 were imported, the prominent features would develope them-
 selves at first, and these precursors, and  more mild grades of
 the disease, could not affect thousands on shore, who never
 had any communication w7ith vessels from the West Indies,  or
 any diseased body."   " The faculty believe the following  to
 have been the principal sources of this late malignant fever,"
 —First, "  the cove which extends from the mouth of  Jones's
 Falls to the interior of Fell's. Point, the bottom of which was
 left bare, by the recess of the  tide, for some weeks, immedi-
 ately preceding the epidemic appearance  of the fever.  This
 was occasioned by the prevalence  of north and east winds,
 which continued a great part of the summer."   " Such is the
 situation of this pestilential cove,  that  all the filth conveyed
 into it by the west, north-west, and south winds, must remain
 to stagnate  and putrefy under a summer's sun."  " From the
 united testimony of the physicians at Fell's Point, the  disease
began on the borders of this cove; and its progress could  be
traced through  the streets, in  whatever,  direction the winds
wafted its poisonous effluvia.   Such was  the pestilential con-
dition of this sink of putrefaction, that the  labourers, employed
in filling up its northern shore, were compelled to relinquish
their undertaking early in the summer."
   " Second.—The docks, in general, but more especially the
interstices between the wharves, where the water stagnated,
and afforded a proper matrix for the generation of pestilential
effluvia."
  They  afterwards mention several  other causes,  of more 
254
limited operation, such " as stagnant water retained in cel-
lars," " ponds, and low grounds in the city, and its vicinity;"
—and, finally, " the  made grounds, of which  the wharves,
and the lower parts of some of the streets, are  formed," and
then conclude,—" from these sources we derive  the first cases
of the late fever, and, from these, fomented by the summer's
sun, we believe it to have become afterwards epidemic.  We
are more strongly impelled to ascribe our late malignant fever
to these causes, from having ascertained that it did not exist in
the higher parts of the city, remote from exhalation, unless it
had been carried there from the Point, or from the lower parts
of the city."
  The course I have taken leads us next to Wilmington,  on
the river of Delaware, situated on  a spot which gradually
rises to the height of 109 feet,  as it recedes from the river of
Delaware,  between which, and the  town, is  an extensive
marshy low flat, more than a mile wide.  On two other sides,
it is bounded by two large streams of water, called Christiana,
and  Brandy-wine  creeks;  and by the side of  the first is an
extensive marsh, which, in the spring of the year 1798, was
drained for the first time,  so that  a  surface of 100 acres of
mud were in the following summer, exposed to the sun, which
produced very offensive exhalations; and,  in consequence of
these, the Yellow Fever, with its most violent  symptoms, be-
came generally prevalent  in September of that year, in  the
lower parts of the town, and  occasioned the deaths of above
200 persons in that quarter; whilst  the more  elevated parts
were almost  wholly  exempt  from the disease.  Dr.  John
Vaughan, who has given a minute account of this fever, in
the  3d volume of the New-York  Medical Repository,  at p.
368 and seq. and who had previously* believed the Yellow
Fever to be a foreign and a contagious disease, was  induced,
by the facts which then fell under his observation,  to adopt
the  contrary opinion.  Here was abundant evidence  to prove
that the disease had arisen solely from the noxious exhalations
to which the lower part of the  town was particularly exposed: 
255
 and he could not discover a single instance in which the fever
 had been communicated to any person who had not been with-
 in the reach of these exhalations.
   This fever again recurred at Wilmington,  in  September,
 1802, subsequently to an interval of very hot weather,  which
 began about the middle of August, and in which the tempera-
 ture varied from 80° to 96" of Fahrenheit's  thermometer, as
 is stated by  Dr.  Vaughan,  in his "Concise History" of
 this fever, printed  at Wilmington,  in 1803 : according to his
 statement, "the sources  of noxious  effluvia in the southern
 and fiat part of the town were much increased by a regulation,
 but partially executed, for bringing the  streets to an uniform
 descent  from the  summit of the hill.  A number of cellars
 were filled with water; a  new dock formed, and  the gutters
 lowered  in some places, and raised in others,  forming  nume-
 rous depositories of filth."   " The fogs (says he) collected in
 the evenings,  were suspended on the flats during the nights."
 "This semi circuit of the fogs, from Market Street  southward
 and eastward, was the seat of concentrated disease."—" The
 poisonous matter exciting disease, was evidently a constituent
 part of the fogs.   Many persons visited the infected district,
 in clear  weather, and in the day-time, without injury;  and
 several of the same persons contracted disease by a single ex-
 posure in the night time,  after the fog had collected."  " The
 non-contagious nature of the disease was repeatedly attested,
 by persons sickening  after  removal, from the lower to the
 higher parts of  the town,  and being nursed with every  atten-
 tion, and dying without communicating the  malady to their
 attendants."  He adds, " the indigenous nature of the disease
 was evidently characterised, by the ultimate sameness of eve-
ry form and grade of fever.  After the middle  of  September,
the subordinate forms and grades of fever, not arrested within
48 or 72 hours, invariably passed on to the malignant grade of
the disease."  There was  a final termination of its progress
" by a single frost." 
256
  Philadelphia falls next under  our observation.  This city
was originally intended to occupy the flat space of ground be-
tween the Delaware and Schuylkill Rivers, a few miles above
their junction; it has,  however, been found more convenient
to extend it to a greater distance along the west bank of the
Delaware, under  which bank, upon a low space of ground,
originally  intended as a cartway  to the wooden  wharves
which abut and encroach upon the bed of the river,  an exten-
sive street, called Water-Street, has been formed, extending
from the northern line  of the city, southward to  the sw ampy
ground given by the founder, William Penn, to be formed into
a dock, which, not being done,  and the exhalations from this
swamp proving noxious to the inhabitants, it has  been arched
over, and covered with earth, so  as  to become the foundation
of a street, called Dock Street, near  which an offensive  sewer
empties itself into the Delaware.
  The ground between the  southern  extremity of the city, or
rather of the suburb,  called  South wark,  and the junction of
the Delaware and Schuylkill, is generally  very low,  rich,
and damp, I might say swampy in many places ; and,  appa-
rently, is as well suited to  produce marsh miasmata as any
part of Zealand,  and  with  greater morbific powers, because
the summers at Philadelphia are much hotter.  On the north-
ern extremity also, in and about the suberb called Kensington,
are low swampy grounds, of considerable extent; and a great
part of the city itself stands upon a loamy, or brick  earth,
which is very impenetrable to water.  Thus situated, it can
hardly be necessary to  observe,  that Philadelphia has been
frequently infested by marsh fevers, though it  is not known
that, previous to the year 1793, they assumed epidemically the
violent form of Yellow Fever, except in the years 1699,  1741,
 1747, and 1762.*  The great  mortality  which the Yellow

  *  Dr. Rush, in tbe 4th vol. of his Medical Inquiries, &c. p. 69, refers to a cli-
 nical lecture, delivered December 3d,  1766, at the Pennsylvania Hospital,  by the
 late Dr. Thomas Bond, and preserved by order of the managers, in the 3d  vol. of
 their Minutes, in which he declares,  " that he had seen the Yellow Fever five times 
257
 Fever produced in  1793 at  Philadelphia,  is  well  known.
 From the great numbers attacked by it,  at that  time,  and
 the influence of pre-existent opinions  on the subject of conta-
 gion, the physicians, as well as the inhabitants, seem to have
 immediately, without enquiry  or consideration,  concluded
 that it must be  a contagious disease,  and. most of them in-
 ferred, as a  natural  consequence, that it had been imported
 from some part of the West Indies; though  there was much
 disagreement in  regard to the  particular vessels, chargeable
 with this importation, as well as in regard to the places whence
 it had been  brought;—some deriving the evil from Grenada,
 others from different ports of St. Domingo, &c.   On that oc-
 casion Dr. Rush, dissatisfied with the contradictory evidence
 about the importation of the  disease, though he admitted it to
 be  contagious,  and,  consequently, capable  of importation,
 thought he had discovered a more probable cause for its pro-
 duction in a  cargo  of damaged or putrefying coffee.   Thus
 overlooking the influence of  marsh miasmata, which ought, at
 least, to have been strongly suspected, considering that  the
 fever began  in   Water Street, and afterwards  appeared  in
 houses adjoining other swampy grounds  near Dock Street,
 Kensington,  and Southwark;  and  considering, also,  that it
 resembled a  marsh  fever in almost every circumstance,  es-
 pecially in the  season  at which it appeared ; in the evident
 remissions with  which it was  attended ; in the circumstance
 of its leaving unhurt  all the  French fugitives  from the  West
 Indies, and others who had long resided in hot climates ; and,
 in its cessation immediately  after frost.
  At the commencement of this disease, M. Devese, late Sur-
geon-General of the  troops, in the northern  division  of  St.
 Domingo, who had long practised at Cape Francais, having
escaped from the ruins of that city, reached Philadelphia, and
though the Physicians there had generally declared the fever

 in Philadelphia.  The second time it was indigenous, from evident causes, and  wa«
 confined to one square of the city." Upon this Dr. Rush remark?, that "the loca-
 lity of this fever designates its putrid origin," i. e. from marsh effluvia.
                            33 
258
to be a  contagious  disease,  he honestly  and courageously
maintained the contrary, and ascribed it, exclusively, to local
causes, probably without making any converts to his opinion
at that time; but the committee of  superintendance,  and the
physicians, willingly availed themselves of his experience in
the treatment of the disease, so far  as to intrust him  with the
direction of the spacious Hospital at Bush Hill, which had
been just established for patients  under the Yellow Fever;
and in which  his  practice was attended with  great success,
perhaps, in some  degree, from its salubrious  situation.  In
the following year, M.  Devese published,  at Philadelphia, a
Dissertation on the Yellow  Fever  of the preceding year, (in
that city) stating his reasons for believing the disease to have
been neither imported nor contagious  ; which, though not so
conclusive  as we  can now give, probably helped to induce
some, at least, of the physicians there to inquire and think,
with  greater  freedom, on  the subject.   For  in 1796,  Dr.
Rush, when giving an account of this fever,  as it occurred in
1794, (though much less extensively than in 1793) would not
admit contagion to be one of its characteristic marks ;  deeming
this quality to be rather accidental, and to depend on circum-
stances of season, country. &c. ; and, on this occasion, he ap-
parently, for the first time, ascribed  the  fever to exhalations
from gutters, and stagnant ponds of water, in the neighbour-
hood of the city ;  having observed, that " where there  was
most  exhalation,  there  were most  persons  affected by the fe-
ver."  See his Medical Inquiries  and Observations, vol. 4.
p. 63.
   In the month of November, 1797, Dr. Rush, Dr. Caldwell,
and eleven other physicians, of  Philadelphia, whose opinions,
respecting the Yellow Fever, were now at variance with those
of a majority of the College  of Physicians there, being  called
upon  by  the governor of Pennsylvania to state, for the infor-
mation  of its  legislature, the results of their researches and
experience, respecting the  " origin,  progress,  and  nature,"
of the epidemic Yellow Fever, which had then just terminated, 
259
 (on the occurrence of frost,) these gentlemen, in their answer,
 say, "  we conceive  the fever,  which has lately prevailed in
 our city,  commonly called the Yellow Fever, to be the bilious
 remitting fever of warm climates,  excited to a higher degree
 of malignity by circumstances to be mentioned hereafter ;"
 and they  allege the following, among other reasons,  for this
 belief, viz :
    1st. That both fevers have a similar origin.
   2d.   That  the  Yellow  Fever  occurs  in " those months
 chiefly in which the bilious fever  usually prevails,  and is uni-
 formly  checked and destroyed by the same causes,  viz.  heavy
 rains and frosts."
    3d.   That " the  symptoms of the  bilious and Yellow Fe-
 vers are the same  in their nature, and  differ only in degree."
   4.  That  the common bilious and  Yellow Fevers often run
 into each  other,  &c.
    5.  But  after having made these  approaches to the truth,
 they state,  as another reason, that  " the common  bilious and
 Yellow7 Fevers are alike contagious, under certain circumstances
 of the weather,  and of predisposition in  the  body :"*   Not
 suspecting it to be impossible that contagion  should ever  be
 either acquired or lost by the presence or absence of such cir-
 cumstances.   In the following year, the same physicians and
 others, being  then incorporated  as " the Academy of  Medi-

  * It deserves hereto  be remarked,  that while Dr  Rush and his associates thus
erroneously represented the common bilious, as well as  the Yellow Fever, to be some-
times contagious, the College of Physicians, in their answer to the governor of Penn-
sylvania, dated  December  5,  1797, state, as their principal reason for believing
the two diseases to be essentially different, " that a malignant remittent fever has
never  been, to  our knowledge, contagious in this climate."  They had, immedi-
ately before, admitted the  occasional existence of "solitary cases of malignant re-
mittent fevers, the symptoms of which resemble so much the disease in question, (Yel-
low Fever) that they are very often  supposed to be the same."   Hence we  see,
that to  raise  up a baseless distinction between these fevers, the College,  after ad-
mitting one to be  void  of contagion, assume the other to possess  that property,
though without proof, and  at a time when, except among the physicians in Philadel-
phia, there was  not one in twenty of those  who had seen  the disease in other
parts of the  United States,  that believed what  was thus assumed. 
260
cine of Philadelphia," were  again called upon by the gover-
nor, in regard 'to the Yellow Fever of the preceding summer
and autumn, (of which 3648  persons were computed to  have
died at Philadelphia, exclusive of many who fled and died in
the country,) and they declared, in their  letter, dated De-
cember 3d,  1798,  "that the disease is not contagious in the
West Indies, and rarely, if ever,  so in  the United States, in
hot weather, at which time only it makes its first appearance in
our country.  So general (they add) is this opinion, that some
physicians have unfortunately refused to admit the  existence
of the fever  in its commencement in our city,  only because it
was not contagious."  Here was a farther  approximation to
truth, made by these gentlemen ; and it  is probable that they
would have  then completely renounced all belief of the suppos-
ed contagion of Yellow Fever, had not their doing so been op-
posed by Dr.  Rush, whose mind had been so strongly biassed
in favor of that belief, that he  could not relinquish the notion
of an occasional or accidental occurrence  of that quality until
very many proofs, in opposition  to it, and  those of the  most
decisive nature,  had been presented to his consideration.  At
length, however,  he obtained  the fullest conviction on the
subject, and announced it by a long statement of "  facts, in-
tended to prove  the Yellow Fever not to be  contagious," &c.
" In a letter to  Dr. Edward Miller," published in the New
York Medical Repository, vol.  6, p.  135 to  150.   Towards
the conclusion of this statement are the following  passages,
viz :
  " You will perceive, from the facts and reasonings contain-
ed in this letter, that I have relinquished the opinion  published
in my account of the Yellow Yever, in the years 1793, 1794,
and 1797, respecting its contagious nature.  I was  misled by
Dr. Lining, and several West India writers," &c.----"  I am
aware of the influence which such changes in medical opinions,
as I have acknowledged, have, upon a physician's  reputation;
but small, indeed, should I consider the total sacrifice of mine,
could it avert the evils which are connected with a  belief in 
261
the importation  of pestilential diseases,"  kc.  Not content
with having done this,  Dr. Rush, in the preface  to a subse-
quent  edition of his Medical Inquiries and  Observations,
made the following  declaration, and caused it, moreover, to
be inserted in the Medical and Physical Journal, No. 85, and
in other periodical works, viz.
   " In the 4th volume the reader will find a retraction of the
author's former  opinion of the Yellow Fever  spreading by
contagion.   He begs forgiveness of the friends of science and
humanity, if the  publication  of that opinion has had any in-
fluence in increasing the misery and mortality attendant upon
that disease.  Indeed, such is the pain he feels, in recollecting
that he ever  entertained or  propagated it, that it will long, and,
perhaps, always deprive him of the pleasure he might other-
wise have derived, from a review of his  attempts to fulfil the
public duties of his situation."
   And here I must observe, that  if the conviction  of any one
man can reasonably influence the opinions  of others, on this
subject, the  preceding declaration, by Dr. Rush, ought to pro-
duce that effect; made  as it was,  not precipitateiy or capri-
ciously, but with  slowr  and cautious deliberations ; not from
the impulse  of former prejudice, but in direct opposition to it;
not from a vain desire of  appearing to be infallible, by vindi-
cating opinions inconsiderately promulgated, but with a con-
scientious and humble, (I had almost said humiliating) purpose
of condemning and renouncing such opinions, and  of atoning
for them, if  necessary,  even by the sacrifice of his reputation,
at the shrine of truth.   I  flatter myself, however, that no loss
of reputation  has been incurred by  this  proceeding.  To me
Dr. Rush appears  as being more  estimable  after this  honest
avowal of an  error, than  he would have been,  had  he  never
fallen into it: and I earnestly hope, that in similar circum-
stances, I should,  most  willingly, follow his example.
   When Dr. Rush thus denied the supposed contagion of Yel-
low .Fever, he had  probably seen more  of that disease than
any other physician in  any country; and  if the many thou- 
262
 sands of cases of it, which fetl under his immediate observa-
 tion, and the still greater number of which he was doubtless
 informed, not only did not afford any such evidence of con-
 tagion, as, with the aid of his prepossessions,  could maintain
 him in his former belief on that subject, but, on the contrary,
 manifested so unequivocally a total absence of any  contagious
 quality,  as,  in spite of these  prepossessions to impel him to
 make the declaration before-mentioned, who that supposes Dr.
 Rush to have possessed  common intellect and discernment,
 will believe  the Yellow  Fever to be contagious; unless he
 knows it to be so by unquestionable facts within his own ob-
 servation, and of the  most decisive import.   Facts,  such as I
 believe to have never existed, in regard to this disease.
   Numerous statements, concerning the origin, progress, and
 nature of the Yellow Fever, at Philadelphia, in different years,
 are now before me ;  all agreeing in the most important points
 with those which I have  recently introduced,  concerning its
 appearance at Charleston, Norfolk, Baltimore, &c.  and, there-
 fore, lest I should exhaust the patience of my readers,  I will
 only select a  few passages, from a lecture, introductory to a
 course of clinical lectures, delivered at the Infirmary of the
 Public Alms  House,  in  Philadelphia, by Charles Caldwell,
 M. D. respecting  the Yellow Fever, as it  occurred  there,
 in 1803.
   After various preliminary observations, together with an
 account of the very sultry, humid atmosphere, which prevail-
 ed  at Philadelphia during the  month of July,  and excited
 many distressing apprehensions, (the thermometer  commonly
 indicating a  temperature between 80' and 90") Dr. Caldwell
 mentions two cases of disease, which appeared on the 19th of
that month, " in adjoining houses at the corner of Chesnut
 and Water Streets; and were but too well calculated to realize
 and  confirm  these melancholy anticipations."  These  cases
were those of two " females, under the age of sixteen years;
one of whom  died on the 5th day  of her illness, and the other
recovered -, but they both  exhibited unequivocal symptoms of 
263
malignant fever.*  It is worthy of remark, that, adjoining to
the houses where these persons resided, were a yard and pri-
vate alley,  containing stagnant water and putrid substances, *
which, for a week or ten days previously, had emitted a smell
highly offensive to the neighbourhood.  The families where
the sickness occurred, did not hesitate to attribute their mis-
fortune to this insufferable stench."  " From the 28th of July,
till the 5th or 6th of August, four other cases of malignant
fever appeared  in  the same  neighbourhood, three of which
terminated fatally."   These  persons had not " the slightest
intercourse with each other, nor with  any common source, ex-
cept the atmosphere of the place where they resided.  A know-
ledge of  this induced most of our citizens to consider  this
disease  as nothing else than a high grade of autumnal fever,
or, what was  afterwards very emphatically denominated  the
Water Street fever."   Another " very decided case (of malig-
nant fever)  made its appearance in the  person  of Mrs. Cole,
on  the  23d, and terminated, in death, on the 27th of July."
She " resided  in  Water,  near South  Street, upwards of a
quarter of a mile  from  the  former situation,  and had  not
been  out  of her own neighbourhood for several weeks pre-
viously  to her illness."
  " There existed another point where malignant fever threat-
ened at the same time to attack us.  This was in Water, near
Race  Street, about  a quarter of a mile in an opposite direc-
tion from  Chesnut Street."  " Mr. Jolly,  of that neighbour-
hood, sickened  on the 28th,  and  died on  the  31st of July,
with symptoms of high malignity.  Between the 1st and 10th
of August, six  other persons,  in the  same neighbourhood,
but who had no intercourse with each other, were  attacked
by the disease, one of whom  died on  the 4th  day of his  ill-
ness : the others all recovered."   In none of these cases was
the fever communicated to any other person.

  * It will, doubtless, have been already observed, the terms Yellow Fever, and
Malignant Fever, are used by the physicians of the United States as synonymous. 
264
   " As yet all parts of Philadelphia, except  Water  Street,
which must be regarded as the low ground of the river Dela-
ware, enjoyed an unusual exemption from disease."*   " On
the 12th of Angust we had  a heavy fall of rain, which was
succeeded by a remarkable change in the temperature of the
atmosphere, the mercury sinking ten degrees," by  a  preva-
lence of northerly  winds  for ten  days,  during which " the
city remained free from any further cases  of malignant dis-
ease."
   " On the 23d of  August the wind shifted to the southward,
and the  atmosphere  became humid, warm,  and oppressive.
This change was view ed by many as  a precursor of further
sickness."   " On the morning of the  25th, a dreadful  fire
broke out  in Water, near Market, Street," and "  drew to-
gether a vast concourse of people.  Of these some  were en-
gaged in violent exercise, while others were standing idle in
the streets, on the  tops of houses, or at windows,  many of
them only  partially dressed."  This occurrence "was  well
calculated to act as the exciting cause of disease; accordingly,
in the course of two  or three succeeding days, eight or  nine
persons, immediately adjacent to where the fire had  raged,
were attacked  by malignant fever."   They had  all  "been
more or less exposed at the fire," without having " previous-
ly  had any  mutual intercourse."   " The disease   appeared
suddenly, and  nearly at once; in five or six families, the in-
dividuals of which had never exchanged a visit,  or even a
word, either business  or ceremony.   From this  time,  the
number of  sick continued daily to increase."   " But this was
not all.   During the first week of September, the disease re-
newed its  attack, in  all  those neighbourhoods where  it had
made its appearance in preceding parts  of the season.   In-

  * Here Dr. Caldwell remarks,  that, in tbe autumn of the summer in question,
" the low grounds of most large rivers in the United States, were subject to malig-
nant fever. Along the banks of the  Susquehannah, the ravages of this disease
were melancholy and unprecedented.  In some instances it hurried whole families
to the grave." 
                           265

deed,  there were now scattering cases of it in most parts of
Water Street, between  Race and Alinod Streets;  a distance
of somewhat more than a mile.   But the  district, extending •
from  Market to Walnut  Street, and from  the east side of
Front Street to the river Delaware, constituted the principal
theatre of its ravages.   With such violence did it rage within
these  limits, that, on the 12th of the  month, the Board of
Health thought it right to advise the inhabitants to remove,
and to interdict all  unnecessary intercourse with  the  sickly
neighbourhood."
  " Throughout  the remainder  of the month  of September
and till near the close of the first week in October, the dis-
ease continued,  by feeble efforts, to advance slowly from the
low ground  of the river, towards the more  elevated parts  of
the city.   Except, however, in alleys, and other filthy places,
inhabited by the poor, it  did not make  its way across  Second
Street,  nor did it, save in a few places, advance even so far.
It may be confidently asserted,  that that portion of Philadel-
phia,  which  lies to  the westward  of  Second Street,  never
enjoyed a higher exemption from disease,  than during the late
season.   As the fever receded from the low ground, and ma-
lignant atmosphere  of  Water  Street,  it became  more and
more  mild,  and  manageable,  till  its  evanescent  shades  in
Second Street were, in  many instances, much lighter than the
common remittent of the country."
   " After the 10th  of October, the disease  was  no  longer
spoken of as a thing dangerous or alarming;  and,  before the
20th,  there  was scarcely a case of it existing in the city."
   " As it has never been alleged by any one,  that  the malig-
nant  fever  of last season was introduced  into Philadelphia
from  the WTest Indies,  through the channels  of commerce,"
&c. those who considered it as an evil necessarily of extra-
neous birth,  looked  to New York  alone,  as  the   immediate
source of our misfortune."
   " Though facts were daily occurring to convince them, that
the disease  could not, by any mode  of communication, be
                          34 
2tib
 transplanted from Water Street even to Third Street," (i. e.
 across two parallel streets  only) " they still contended, that
• it had been conveyed from New York to this place,  either b>
 land,  by  water, or  perhaps  on the  wings  of the easterly
 wind."   To shew the absurdity of this Dr. Caldwell observes,
 that this fever first " appeared in New York on the  17th, and
 in Philadelphia on 19th of July;" and that " contagion could
 not  possibly be  conveyed thence to Philadelphia,  and there
 communicated so as to produce its effects, in the short space of
 two days;"  and, moreover, that " it has been clearly proved,
 as far  as a negative  proposition is capable of proof, that the
 late fever of New York could not  be propagated even in
 Newark, Brunswick, Amboy, nor  any  of the  neighbouring
 towns  or villages,  though thousands of the citizens removed
 thither, many of them actually  labouring  under  the  disease.
 How then," says he, " could it be  conveyed ten times the dis-
 tance by one person in health."   Other cogent reasons are join-
 ed to these,  which I omit as being superfluous.   I  have been
 inducecj to prefer this account of the  Yellow7  Fever of 1803,
 in Philadelphia, (extracted  from the New York  Medical  Re-
 pository, vol.  1,  second Hexade, p. 143 and seq.) principally
 because the early interruption, which it received by a dimi-
 nution of the temperature of the atmosphere, rendered its pro-
 gress slower, and its  extension more limited, than usual, and
 thereby afforded opportunities of distinctly  observing, and
 circumstantially  describing,  the facts, regarding  its com-
mencement and propagation,  which is often impossible, in
 more rapid,  violent,  and extensive epidemics.
  Next after Philadelphia,  the  city of NewT York claims  our
 attention.*  Many sources of marsh miasmata appear  to

  * An accurate description of the local circumstances of this city is perfixed to Dr
Miller's report to the  governor of the state, " on the malignant  disease which pre-
vailed in the city of New York in the autumn of 1805."  It is in these words,—
  " The city of New York lies in lat.  40p 42. 8.  N. and long. 74p 9. 45. W.; at the
confluence  of the River Hudson, and of Long-Island Sound, or the East Kiver;
aed, on the southern and narrow  extremity of  Mahattan Island,  which is  about fif- 
267
have been created  and annexed to this city, subsequently to
the peace and independence of the United States, in 1783.  It
was, however, long since, and, probably, from its beginning,
very frequently  troubled with  intermittent, and  what  were
called  bilious remittent fevers ; probably  sometimes  aggra-
vated,  by great summer heat, into the violence and mortality
of Yellow  Fever:  though,  by  the  want,  or negligence of
medical writers, we have no accurate account  of them.  It
may,  I think, be presumed, that  an epidemic of this kind oc-
curred at New York, in the  months of August and September,
1702;   mention  being made of one which in those months
(when no other fever is likely to have  prevailed epidemically)
killed about seventy persons w eekly, by George Keith,  in the
account of his travels from  New  Hampshire  to Curituck:
(printed in London, 1706.)   He had then  become a clergy-
man of the Church  of England, after having been a Quaker;
and appears to have preached on the 30th of September, at a
fast  appointed by  the  governor,  on  account  of  the recent
great mortality which then  amounted  to 500 persons,  a very

teen  miles in length,  and  from one to two in breadth.  The site of the city, as it
originally  stood, was very  irregular,  being broken into hills and declivities, and in-
dented with small rivulets or creeks, skirted  with marsh.  Many of the hills are level-
led ;  but the marshy grounds, though covered with houses and pav&ment, are still
low and moist.  The  city is about twenty-seven  miles  from the ocean,  and  is
washed  on both sides with  water of great  depth, whose current is very rapid,
whose tide ebbs and flows about six feet, and which is nearly as salt as that of the
neighbouring sea. On  both sides of tbe city  considerable encroachments have been
made on  the water, by artificial ground, the  whole extent of which   may be
computed at not less than 132 acres.  Of this, ninety acres lie along the East River,
and forty-two along the  Hudson.  The portion of it on the East River forms that
part  of the city where malignant fevers  have always first become epidemic, and
chiefly prevailed*  The wharves and docks are constructed of logs and loose stones.  -
All the fresh water, used by the inhabitants, is procured from wells within  the city,
and is now become extremely impure.   The  population of New Yerk may be
estimated  at about  76,000.
  * Dr. Miller explains this in another place, by observing, that the " made ground
on the North, or Hudson's River, is much less extensive,  and the materials com-
posing it much less foul  and corrupt, than that on the East River;" and that " the
miasmata  come to maturity on the one side, two or three weeks sooner  than on
the other." 
268
considerable proportion of the inhabitants at that period!  O ver~
looking  the intermediate space  of time  until 1791, we  find,
that a considerable number of cases of Yellow Fever occurred
in the autumn of that year, in  a part of Water  Street,  near
Peek Slip, then noted for the filthy state  of the neighbouring
docks.   Others occurred to a  greater  extent in  1794; but
were confined to persons who either lived,  or were commonly
employed near the slips, wharves,  and other obvious sources
of marsh miasmata;  and this was the case in the three follow-
ing years.   In 1798, the disease prevailed more violently and
extensively  as an  epidemic, and wras computed by Mr.  Har-
die, in  his plain and circumstantial account of it, (printed in
8vo.  at New York, 1799,) to have occasioned the deaths of
2086 persons in that city.  The committee, appointed by the
Medical Society  of the  State of New  York, to inquire into
the  symptoms, origin,  &c. of this  disease, appear, by  their
printed report, to have been convinced of its domestic origin,
from local  causes: and they declare, as  the result of  their
experience,  that  " it is not a contagious or catching disease,"
in the popular and common acceptation of the phrase; that it
is not communicable from person to  person,"  kc.  See New
York Medical Repository, vol. 3,  p.  293.
   During'the summer and autumn of 1800, in the neighbour-
hood of Water  Street,  and of the different  slips, and  other
acknowledged sources of miasmata, one hundred or more  cases
of Fellow  Fever occurred simultaneously  and intermixed, in
the  same situations, with  intermitting  and bilious remitting
fevers :  of the former, more than fifty terminated  fatally, in
 a few  days; many  of them  " exhibiting the  symptoms of
yellow skin, black vomiting, and stools,  Hemorrhages,  &c."
 On  this occasion it was not pretended that any importation
 of the disease had been made, nor that it had been propagated
• by contagion, "  beyond the limits  of that portion of the at-
 mosphere  of the town,  allowed by every body to have  been
 contaminated by the exhalations of putrefaction; and within
 such limits it is well known that  an adequate cause is  con- 
269
 stantly  in  operation,  independently  of  contagion."   See
 New-York Medical Repository, vol. 4, p. 207-8.  About twice
 as many cases of Yellow Fever occurred in the following year
 at New-York in the same months,  and in nearly the same
^situations, with similar results.
   In the summer and autumn of 1803, this disease recurred
 more extensively, and with greater violence, in  consequence
 of the excessive hot weather which began early in July, and,
 excepting five or six days in that month, (say Doctors Mitchell
 and Miller,) was more intensely  and  uniformly hot, than we
 ever remember before to have experienced in this climate, for the
 space of some time."  "  The first public  alarm took place
 from some deaths  about the  Coffee-House  slip,  and in  that
 neighbourhood, where, from the number and malignity of the
 cases, the atmosphere must have been charged with miasmata
 of great  virulence."  " The streets lying near the margins of
 the two rivers, and those inhabited by the poor," &c.  " suf-
 fered the principal ravages of the disease."   A large portion
 of the sick " consisted  of instances  in  which one  individual
 only was attacked in the midst of a family, the members of
 which assiduously  attended the  patient, without contracting
 the disease.   Many aged, and very young persons, whose con-
 dition imposed confinement in their houses, without the occur-
 rence of any  preceding case in their families, were attacked
 with the disease in its most virulent form.  Multitudes,  also,
 took the disease, who had  not previously approached any  sick
 person,  any suspected vessel, or any families alleged to be
 imbued  with  contagion.   One  person  was attacked in the
 Debtor's Prison, who, for  three months before, had not  been
 beyond its walls, and no other person in the prison was pre-
 viously,  or subsequently, affected with the disease; many who
 fled from the  city, were  attacked with the disease  and died,
 not only in  all the surrounding  country,  but  at  Newark,
 Elizabeth town, Brunswick, kc. without communicating in-
 fection,  in  a single  instance, to physicians, nurses, or  any
 other attendants.  But, they add, one of the most decisive 
210
proofs of the non-contagiousness of ATellow Fever, is derived
from the absence of all contagious influence from  our  Yellow-
Fever Hospitals."  " These  asylums are  generally  erected
within two or three miles  of the cities to which they  belong,
but entirely beyond the reach of an atmosphere contaminated,
by the local miasmata of the city.  Neither in  New-York
nor in Philadelphia, is there a single example of a person em-
ployed in these Yellow Fever Hospitals, being attacked by
that disease, unless he had previously passed sometime within
the limits  of the sickly city."   See New -York Medical Re-
pository, vol. 7, p. 183-4.
  In a letter from Dr. Miller,  the resident physician for the
city of New-York, to his excellency Governor Clinton, dated
January 6, 1804, the preceding facts are more minutely stated,
with the others, proving, as far as the subject was susceptible
of negative proof, that the fever in question did not arise from
any foreign or imported contagion. Of the mortality produced
by this fever, from its commencement, about the 20th  of July,
till its cessation, at the end of October, Dr. Miller says, " the
number of deaths in this city amounted to  503 ; those at the
Hospital at Bellevue, to 103,  and those at the Marine Hos-
pital,  in Staten island, to 68; making  a total  of  674 : to
which should be added  an indefinite  number, who fled  from
the city, and died of this  disease in the neighbouring  country
and villages."   See  printed  " documents,  relating  to the
Board of Health."   (New-York, 1806, 8vo.)  p. 35.
   The summer  of 1804 was but very moderately warm  along
the coast of America, northward of Carolina, and, as  might
be expected, the Yellow Fever  did not recur at New-York,
&c. in that year.  But the summer of 1805 was, according to
Dr. Miller's official statement,* " remarkable for the duration,
as well as the intensity, of heat, along the whole  of our coast
(United States); and the consequence  was,  not only that
  * In his masterly report, made as resident-physician for the city of New-York, to
the governor of the state, dated January 12, 1806, and printed with  " documents re-
lating to the Board of Health," 8vo. 
271
 nearly all the Atlantic cities were visited with pestilence, but
 that, in several of them, it made its appearance in forty-eight
 hours, or nearly of the same time, an occurrence which cannot
 be explained on the  contingency  of contagion."  As usual,
 sporadic cases of the disease first occurred :  but, at the begin-
 ning of September, these,  according to  Dr. Miller's official
 report, "  had become so numerous as to  ascertain the exist-
 ence of the  epidemic ;"  which, throughout  September and
 October,  continued to prevail with more or less severity,  ac-
 cording to the fluctuating states of the weather; but, towards
 the close  of the latter month, the coldness of the season had
 evidently checked  its progress, and, at the beginning of No-
 vember, the city was  nearly restored to its usual health.
   From returns,  authenticated  by  the  city  inspector, (Mr.
 Pintard)  it  appears  that  the  number of inhabitants then
 amounted to 75,770, and that of these 26,996 retired from the
 city :  and, as may be presumed, from  the  most unwJwlesome
 parts of it;  by which the number of persons attacked by the
 disease was doubtless much diminished  :  as it only amounted
 to 645, and  that of the  deaths to 302 :  Of these twenty-eight
 were in the Marine Hospital, and fifty-two in that of Bellevue:
 and abbut forty others  are supposed to have sickened and
 died in the country, after their flight.
   Dr.  Miller,  in  his  report to the Governor, states that,
 " during the early period of the epidemic, nearly all the cases
 took place" (as formerly) " on the eastern side of the city, in
 Front, Water, and Pearl Streets, and principally below Bur-
 ling Slip :"   But  " afterwards became more diffused :" and,
 •'• about the 20th of September, began to prevail near the north
 river :"*  Where, from circumstances already mentioned,  he

  *• Party zeal and prejudice often render men incapable of deriving any evidence or
information from facts, but such as suit their own views and purposes.  Dr. Chisholm,
at page 205 of his letter to Dr Haygarth,  introduces one to himself, from Dr. Hosack,
dated New-York, July 9th, 1808, in which there is an abundant display of zeal,  I do
not say for maintaining: tbe cause of truth, but for asserting tjie supposed contagion and
importation of Yellow Fever: He also communicates his intention to write and print 
212
 supposes that " the  miasmata come to maturity"  later thai}
 on the  east side.   He adds,  " on the whole, the low  grounds,
 on the margins of the  two rivers,  certainly produced  a chief
 part of the cases."   P. 46.

 a letter, charging Dr. Miller with  " want of candour," in his official report to the go-
 vernor; which charge he founds upon the following statement, viz.
  "As a member of the Board of Health, he (Dr. Miller) must have known that the
 disease was confined for many weeks to a small portion of the eastern side of the city,
 and that, not a case occurred in any other part of the town, that was not referable to
 that,  as its source.  Such was the  statement of the Board of Health, to our citizens,
 and, in consequence of which, they forbade intercourse with the infected portion of our
 city, and ordered an abandonment of that part of tbe town,  &c"
  He adds, " a few weeks after, the infection extended a few streets further.  The
 Board of Health accurately denned its  limits, and again declared, that still not a case
 occurred but could be traced to this spot of the city,  as  its source.  Dr. Miller care-
 fully enumerates the cases occurring, and the numerous parts of the city in which the
 sick reside, but as carefully suppresses the observation of the Board, of which, too, he
 was a member, and must have known, that tbe persons so taken sick, had, prior to
 their attack,  been exposed to  the infection by frequenting the infected spot"  How
"strangely Dr. Hosack here mistakes tbe obvious  import  or evidence of an important
 fact ? One of the strongest proofs of the  local origin of Yellow Fever, results from the
 circumstance of its beginning,  and remaining, almost exclusively, in particular spots
 or situations.  Of this, Dr. Miller was very sensible; and, if he omitted to state " the
 observation of the Board,"  respecting it,  he could only have done so because it appear-
 ed superfiuous, after he had so  distinctly mentioned the facts to which it related.   And
 is it, then, possible, that  Drs. Hosack and Chisholm can have been so inept as to believe
 that these facts could operate in supporting their opinion of the importation and conta-
 gious nature of this disease ? Do they conceive, that if it were contagious, it would have
 been  so many weeks  confined to  one spot, and that, when it afterwards " extended a
 few streets further," those  only would have been attacked by it, who had visited that
 identical  spot ? This is exactly what would happen in regard to a disease not contagious,
 but arising from miasmata;  because, the soil in which they are produced being immova-
 ble, and  its exhalations incapable of causing disease,  at any considerable distanee from
 their source, persons to be acted upon by them must necessarily  approach that source.
 But contagion having no such immoveable origin will  not be thus confined ; persons in-
 fected by it, and sickening  in different  places, naturally infect others,  who soon sp ead
 the disease widely,  so that the spot where it first appeared often becomes less dange-
 rous than most others, and its  atmosphere does not continue to produce disease, when
 the sick have been removed, and the houses shut up, as happens in cases of yellow fe-
 ver.   With  the same fatuity,  Dr. Chisholm, in his letter to Dr. Haygarth, has pub-
 lished one from Dr. A.  Fothergill, late of Bath, who, writing to the American consul,
 at  Bristol, of the Yellow Fever at Philadelphia, in 1805,  and mentioning that it had, in
 November, received a check, apparently from the cooler season setting in ;"  adds, " It
 remained for  some weeks a local disease in the southern suburbs,"  (adjacent to the 
273
   Dr. Miller adds, at p.  53, " It appears,  from the  records
 of this epidemic, that there were  thirty-one streets of the city,
 most of which continued  to  be crowded with  inhabitants,  in
 which only a single case  occurred in each;  and, in the mass of
 six  hundred cases,  reported to the Board  of Health, there
 were only  thirty-five houses in which more than a single case
 was found."   " The great mass of persons attacked with the
 disease,  consisted of such as never had approached the sick,
 or any other assignable  source of contagion ; and, on the con-
 trary, as will  presently appear, great numbers were exposed
 to close intercourse with the sick,  without injury."
   Further,  in regard to this epidemic, the health officer,  Dr.
 Rodgers, made a  long,-minute,  and satisfactory report to the
 Board of Health,  (dated December 19th, 1805) of every  ves-
 sel, and of every  circumstance, connected with the possibility
 of an importation  of the  disease, which is concluded in these
 words.   " I have now clearly shewn, as far as negative proof
 can go, that whatever  might have been the cause of the late
 epidemic, it did not arise from any neglect of duty at the qua-
 rantine ground, nor did it come  through that channel."*  Pre-

marshy low grounds, at the confluence of the Delaware and Schuylkill) "but, at length
was communicated to several of the principal streets in the city, as far as Eighth street,
westward," (persons who had been exposed to miasmata in other places, happening to
fall sick in these) " but it chiefly infested Water street, Front street," (running paral-
lel with, and next to Water street) "and the margin of the Delaware."  He adds,
" many of the professors and medical practitioners here, deny that the disease is conta-
gious, and in this notion the body of merchants bear them out."  Dr. Fotbergill, how-
ever,  adheres to the old  notion of contagion and importation, and no wonder  that it
should have adherents, in men who fancy they can see evidence of a contagious quality,
in facts which decidedly prove the contrary, to all who are able to reason with impar-
tiality.
  In the letter first mentioned, Dr. Hosack invited Dr. Chisholm to "visit the United
States," adding, "you would find materials for giving a final blow to your enemies;
three or four months residence liere would be sufficient."  Was this a sincere effusion
of intolerant zeal, or did Dr. Hosack intend that his invitation should reach Dr. Chis-
holm on the first of April ?
  * One motive for this report appears to have been, that " attempts had, as is stated
by Dr. Rodgers, (p. 19)  been made by some, to prejudice the public mind against him,
because he," (who had had the best opportunities of observing and judging of the facts)
                                35 
214
viousto this conclusion,  the health officer  had given  an ac
count, in detail, of all the early cases of Yellow Fever, which
came under his notice, in order that the  board   might judge
whether the disease went from the  quarantine ground  to  New
York, or came from the city,"  to  the Marine Hospital.   Of
these cases  a  great  proportion occurred in  "a  particular
neighbourhood in  Water Street; which neighbourhood did not
exceed two  hundred yards from one extremity to the other."
" The circumstance (says be)  of so  many sickening  in one
house, and within so narrow a  compass, in Water Street,  and
the disease having appeared  in a former year first in that very
neighbourhood, and in  every year  of  pestilence,  always first
shewing itself in  situations precisely  similar, establish the po-
sition of a domestic origin.   Nor can it be pretended, (he  adds)

" believed in other causes of di.sease than importation." These " attempts" seem to
have been connected with a newspaper attack,  (which I have not seen) made by Dr.
Hosack, of New-York, on Dr.  Rodgers, in tbe preceding month, when the latter had
shown some unwillingness to allow the former, accompanied by two other persons, to
inspect the Marine Hospital, without some pledge on their parts,  to secure himself
against a repetition of the ill-treatment or  misrepresentation  which he complained of
having lately suffered. Dr. Chisholm, in his letter to Dr. Haygarth, (pages 72 and 73)
avails himself of this transaction to charge Dr. Rodgers with having  " made a most sin-
gular and unexpected attempt to exact from those gentlemen a preliminary stipulation
of concealment ,•" and appears  to attribute  it to guilty apprehensions in Dr. Rodgers;
asking, "why have recourse to arts so unbecoming; were there not sinister objects to
be  obtained ?"  Knowing nothing of this  transaction but the little which Dr.Chis-
holm has stated, I am but ill qualified to answer  his question.  I can, however, easily
conceive, that, as  Dr. Hosack  had  been long known to be a very zealous advocate for
the supposed contagion and importation of yellow fever, Dr. Rodgers might well sus-
pect, what seems to be true, that the former had come to inspect the Marine Hospital,
and quarantine ground,  in the hope of discovering something to enable the believers in
importation to obviate the triumph of their opponents, or, at least, make it a matter of
doubt, whether the disease of that season had not arisen from imported contagion;  and,
as this would, of necessity, imply negligence on the part of Dr. Rodgers, and as he
could  not well expect candour and fairness from one so much prejudiced, and a«ting
from  the motives  just mentioned, it seems to me that Dr. Rodgers might, very  ho-
nestly, have wished to secure himself from  misrepresentation, and that it would have
better become Dr. Chisholm had  lie been less eager in attributing bad motives to Dr.
Roilgers, especially as it  appears, that after Dr. Hosack and his friends had seen all they
wished to see, they could find no subject of complaint, except Dr. Rodgers's backward-
ness in gratifying their curiosity. 
275
that the communication between quarantine ground could pro-
duce it Jicre, because this wras  exactly the place where, of all
others, the communication  was least:  nay, there could be
none  at all, for there were no stores,"  &c. " nor had any of
these thirty-five patients been at the quarantines,  at any time
of the summer previous  to their admission, nor  had any of
them any  connexion with  infected ships or  diseased  per-
sons."
  In order to  bring this view to a conclusion,  I have only to
notice, in  a few words, the occurrence of Yellow Fever at
JVew London, in  Connecticut.   At Providence, in  Rhode
Island, and at Boston, in Massachusett's  Bay.   At the for-
mer of these  towns, this  disease appeared as an  epidemic  I
believe for the first, and  only time, in the months  of  August,
September, and  October,  1798,  in which the summer was in-
tensely hot and dry,  beyond  all example ; the thermometer
having been,  for several days, in succession,  at  from 95° to
97°.  The disease  first appeared  about the  26th of August,
and terminated in October.   " The whole  number of persons,
whose complaints clearly indicated the pestilence,  or,  as it is
called, the Yellow  Fever, did not exceed 246 ;" and, " of the
above number, 231 cases were clearly traced to the spot where
the  sickness  commenced; that  is, the  patients were conver-
sant, or had been  in that part of the city,  a few  days, before
they were seized.  The part in which the septic gas appears
to  have  been so  highly concentrated, extended sixty  rods
north and south," (along the harbour) " and about twenty
rods west, being bounded  easterly on the harbour."  This  cir-
 cumstance clearly  manifests the connexion of the disease with
 miasmata, proceeding from the grounds, wharves, &c. imme-
 diately adjoining  the  water; though the respectable  clergy-
 man, by  whom  (with  the approbation of several other gentle-
 men members of the committee of health, &c.)  the account on
 which I principally rely, was drawn up,  appears to ascribe
 the disease chiefly to exhalations  from a quantity of salted
 fish then beginning to putrefy, within the  space where the 
                           276
disease began.  He adds, " we have not even a shadow of
ground to suppose the disorder was not of domestic origin.''
Dr. Coit, a physician of New London, in a letter  to  Dr.
Mitchell, states, that the persons first attacked, (and to whom
he  was  called)  were an  innkeeper, with his wife, son,  and
daughter, living  in  a street  next and  close to the  Water,
(Bank Street) and that within a very few days he  was called
to  eleven other  patients  in the same  street, and  all within
eight rods of the innkeeper's House. Eighty-one persons died
in all.  There was  no appearance or suspicion of contagion
from the sick.  See New York Medical Repository, vol. 2. p.
304-5, and 372 to 378  ; also vol. 3, p. 229.
  At Providence, the Yellow Fever became prevalent in 1797;
also in 1800, and again in 1805.   "It has uniformly made its
appearance, and committed its principal ravages, in the south
part of Water Street, or the lanes and alleys immediately ad-
jacent; and those solitary cases,  which  have occurred else-
where, could, with very few exceptions,  be traced to this de-
voted spot."  " The portion  of Water Street which has been
thus repeatedly the seat of Fellow Fever,  is less than a hundred
rods in  length.  It has, in this place, a south-east direction.
The houses on the water side  are  built,  as  near  as possible,
to the natural bank of the river.  The  wharves,  of course,
which are extended in rear of them, westward to the channel,
are artificially raised,  partly filled with earth, and partly con-
structed with  logs, covered  with  oyster-shells  and  earth,
leaving  vacuities  beneath, &c."    " The  south-end of the
street is bounded by  a small cove, or  inlet from the river,
which receives, through a swale, or ravine, (before  noticed)
the wash  of an extensive range of meadows;"  which, fer-
menting in  hot  weather,  afford  unwholesome  exhalations.
To these and other  local circumstances,  described  by Dr.
 Wheaton, (in his " Brief Account of the Yellow Fever, which
has appeared,  at  different times,  in Providence,") he  adds,
that the spot just mentioned is  "  confined by hills eastward
 and westward;"  and that, by  " presenting  a south-western 
211
slope to the water, it gives to the mid-day, and afternoon sun,
an almost vertical power."
  Dr.  Wheaton  informs  us, that the summer of  1797 had
been remarkable for a long continued drought;  but, about the
1st of August, there ensued  " abundant rains," which "were
succeeded by an intensely Iwt sun; the thermometer, in an airy
situation ranging from 86u to 91°." " The Yellow Fever made
its first  decided  appearance on  the 13th  of August," and
" continued to  rage to the 30th of September,  in which time
it attacked 102 persons, of whom forty-five died.  Its  early
disappearance was  ascribed to the almost universal desertion
of that  part  of the town, and to a "very heavy  rain and
tornado," which occurred on the 8th of October.
  " In  1800, the first case of  Yellow Fever occurred  on
the 15th of August, and the disease continued to prevail until
the 5th of October."   " There were, this  year, eighty-three
reported cases of Yellow Fever, of which fifty proved fatal."
The  sickly district was more " universally deserted than in
the preceding year;  a circumstance which may account for
its early disappearance, as the other  parts  of the towns were
uncommonly healthy."
  " In  1805, the disease made its appearance as early as the
25th of July, after  a very unusual  duration of hot and dry
weather.  As the town council  directed  an  immediate and
complete evacuation of this part of the town, it soon subsided,
and, on the  10th of August, had disappeared.  The people,
however, being impatient to return  to their habitations, se-
veral new cases  occurred in September."   " Here, as else-
where,"  (adds Dr. Wheaton) the Yellow  Fever " has not
been propagated  by the sick in  situations otherwise healthy;
or, in other w ords, has not been found contagious.  Of a  great
number removed  to the Hospital, in  an airy situation, south-
west of the  town, there has been no instance of the disease
being taken by the  attendant physicians or  nurses.  See New-
York Medical Repository, "vol. 10, p. 329  to 337.
   At Boston, during the prevalence of very warm weather, in 
278
the month of August, 1796,  and " at the south-east  part  of
the town, near  a considerable  extent  of  flats, which were
daily exposed, for some hours, to the action of the sun, a fever
began, and spread thence to the neighbourhood of some of the
docks, proving  fatal to about thirty persons.  Dr.  Warren,
an eminent physician there, in a  Letter to  the  American
Academy of Arts  and Sciences,  then  declared that  he  had,
almost every autumn, seen  at Boston a considerable number
of similar cases, " not excepting the black vomit, nor  the yel-
low  skin;" and that it w as, " what  is properly  termed, a
bilious remittent fever."
   "  In the year 1798 this fever recurred in a very aggravated
form, during the prevalence of  extremely  hot weather, when
the thermometer was often  above 90",  and sometimes at 96%
of Fahrenheit's scale.  It  attacked only those who  lived, or
passed sometime in the vicinity of a mill-pond, drained of its
water, so as to leave the mud, and other impurities, exposed
to the sun's rays; and in the vicinity of several large docks,
into which large quantities  of refused vegetable and animal
matters were conveyed from the market.
   According to Dr. Brown, " not one of twenty, and upwards,
 who first took the disease, recovered'"  and, in  all, about three
 hundred died of it.  " The fever prevailed with much malig-
 nity, till about the middle of October, when it was  completely
 checked by an inundating storm, from the  north-east, of three
 days' continuance:" He adds, from the latter part of July,
 to the middle  of September, " the  weather  was, perhaps,
 never known so uniformly and excessively hot and debilitating."
 It is asserted also,  " that the fever did not seem to be con-
 tagious :" that there was " no instance of its being commu-
 nicated to the nurses or attendants  of the  sick, in places where
 the disease  was  not originally  contracted."   See  New-York
 Medical Repository, vol. 2, p. 360  to 363.
   This fever appeared again at Boston, in August,  1802, and
 prevailed until the  month of October, (in the same parts of the
 town as before,) " and with greater malignity than in  any 
279
former year, equalling the worst species of genuine plague ;
yet tbe range of the  disease was quite limited."  " It com-
menced in debility, which increased with the progress of the
disease, till it terminated in death,  more commonly on the
third day, seldom so late as  the  fifth: indeed, the patient
might be said to be dying from the  moment of  seizure.  The
venous  congestion was  very  apparent  from  the  bloody
suffusion of  the eye ;  from the cadaverous  appearance of
the  countenance, and  from  the livid  tinge  of  the whole
surface of the body  and limbs ;  the cuticular  vessels,  and
those of the  adipose  membrane* being loaded  with putrid
blood."  The disease was " wholly confined to houses promis-
cuously situated at the  heads of wharfs, in the s&uth part of
the town; and it was remarkable, that if a patient, under the
disease, was carried  out  of the range  of  the  morbid atmos-
phere, into a healthy  part of the town,  and attended by per-
sons there resident, the disease was  not communicated in a
single instance :  but not so if he remained on  the spot where
he took the disease."   New-York Medical Repository, vol.
vi. pages 338 and 9.
   I  do not find that the disease was even suspected to have
arisen from any importation of contagion.
   Those of my  readers  who, by a love of truth, may have
been induced to follow  me attentively,  in  the  view  which I
have now taken  of the  Yellow Fever,  in different  parts  of
America, and whose  minds  are unbiassed, will, I am confi-
dent, clearly recognize in that disease all the peculiar features,
and characteristic marks by which marsh fevers  are distin-
guished  in all  parts  of  the world.  And  they will naturally
conclude that, though it  be  the most aggravated and violent
of the fevers  arising from  miasmata, this  aggravation and
violence are produced only by a greater concentration or viru-
lence in the latter, joined to a greater intensity of atmosphe-
rical heat, acting on  persons, but little accustomed to bear it,
whilst they retained the excitability of cold or  temperate cli-
mates, together with an habitual disposition to generate that 
280
 portion of animal heat which  such climates require.  They
 will  have seen  that  the yellow,  like other marsh fevers,  is
 alw ays exasperated by great heat, and extinguished or great-
 ly mitigated  by cold;  that, between  the tropics, it prevails
 simultaneously with the milder forms of marsh fevers, violently
 attacking strangers from cold climates, whilst the  natives or
 long residents are at  most only subject to  intermittents or
 mild remittents: they will have  ajso  seen,  that  in  temperate
 situations, this disease  in the early  part of the summer, be-
 fore the atmosphere has become intensely  hot,  is  commonly
 preceded by,  or  rather shews itself in, the forms  of intermit-
 ting or remitting fever; and that w hen being exasperated by
 excess of Wat, it has  assumed,  and for  some time prevailed
 under,  the appearance of an  epidemic Yellow Fever, the ac-
 cession of cool weather speedily reduces it again to its milder
 forms; and that a freezing temperature soon puts  an end  to
 its appearance, even  in those  forms,  as it  commonly does  to
 other fevers occasioned by exhalations from  marshes, and to
 no others: And  they will also  have  seen,  that the  common
 bilious  remittent, of hot  climates, which is universally ad-
 mitted to be the effect  of miasmata,  differs from the Yellow
 Fever,  only  by being a  little  less violent :  that, at the
 utmost, their symptoms vary  only  in  degree;  and  that, in /
 truth,  even  this  difference is  often so  imperceptible,  that
 the  College  of  Physicians of  Philadelphia, when  anxious
 to assign  a  distinction between  the yellow,  and  the bilious
 remittent fevers, thought it necessary to  allege  one Vhich
 is not  only invisible, but without existence (i. e. contagion.*)

  * It has commonly happened in places liable to yellow fever, when the cause of that
disease (miasmata) exists, without being sufficiently powerful  and abundant to create an
epidemic, that a few cases of yellow fever occur, intermixed with what are called bilious
remittents and intermittents,  all from the same cause, and sometimes even in the same
families.  In other seasons, when the miasmata are sufficiently abundant and powerful
to produce an epidemic yellow fever, tbe first cases of it are often accompanied by, and
scattered among, remittents and intermittents ; and if, as happened at  New York, in
1805,  some of the  physicians should believe that yellow fever can only be produced by
an imported contagion, and no vessel should have arrived from the West Indies, so as 
281
 In fact,  there is  no difference between these  fevers, except-
 ing the  greater violence, and consequently greater  danger*
 attending the former, than the latter; for the Yellow colour
 appears  in  both,  and, supposing  the  fatal  black  vomit, with
 profuse hemorrhages and petechia, to occur only in what is
 called  Fellow Fever, (though they are  sometimes seen in fevers
 known and admitted to arise solely from marsh effluvia) they
 cannot  be  included  among its  essential  or  distinguishing
 symptoms, unless death be also considered as  essential  to the
 disease.*  Nor can  any  exasperation of  symptoms,  which
 has been preceded by a great increase of heat, give any rea-
 son to  suspect that a fever, whose symptoms are thus exas-
 perated,  did not originate from miasmata; because such an
 eaxsperation  is invariably produced by that cause, in marsh
 fevers ;  and by it they are susceptible of the most dangerous
 and malignant appearances.   Of  this  Sir John Pringle  was
 fully convinced, when,  at p. 324,  of his work on the Diseases
 of the Army, he made this observation, viz.
   " I shall observe,  upon  the whole, that  the autumnal  re-
 mitting  and intermitting  fevers,  of low  and  wet  countries,
 when at  the worst, may be  considered as  another  species of
pestilence, since they have been seen with all the virulent symp-
 toms peculiar to that class of diseases."
   As a  farther proof of the  identity  of  Yellow  and marsh
 fevers, I shall remark that, besides their simultaneous concur-
to be chargeable with such importation, these physicians have commonly thought it pro-
per to declare, that these cases were not the yellow, but the common indigenous, bilious
fever; and thus they have, as is asserted, sometimes hindered the inhabitants from leav-
ing a noxious situation until it was too late.
  • Dr. Lind, at p. 118, of his Essay on the Diseases of Hot Climates, (5th edit.) treat-
ing of the yellow fever, says, " having considered this disease with attention, I am now
of opinion, that the remarkable dissolution of the blood, the violent hemorrhages, the
black vomit, and the other symptoms which characterize the yellow fever,  are only
accidental appearances, in the common fever of the West Indies. They are to be es-
teemed merely as adventitious in the same manner as purple spots, and bloody urine,
are in the small-pox, or as an hiccup in the dysentery ; like these  they only appear
when the disease is accompanied with an high degree of malignity, and, therefore, al-
ways indicate great danger."
                               36 
282
rence, and mutual interchanges,  as before-mentioned,  they are
not unfrequently converted one into the other,  in the very same
individual.   Of this  there are  many  instances  and proofs,
some of  which  having been  already noticed, I need  only ad-
duce the following extract, from  Dr.  Rush's  Letter to Dr.
Miller, dated  October  8th,  1802,   concerning  the Yellow
Fever which then prevailed  at  Philadelphia,  and  with  more
than common mortality, at least, in proportion to the  numbers
of sick.  " Never (says  Dr.  Rush) has the unity of our au-
tumnal fever been more clearly  demonstrated, than in  our
present epidemic.   Its four principal grades, viz. the inter-
mittent, the  mild remittent, the  inflammatory bilious fever,
and the malignant Yellow Fever,  have all run into each other in
many instances.  A tertian has ended in death, with a  black
vomiting;  and a  fever, with  the face and   eyes suffused  with
blood, has  ended  in a quotidian,  which has yielded  to a  few
doses of bark.   The Fever, in Baltimore, I  have  been  in-
formed,  has put  on  the  same multiform appearances  and
changes."   See New  York Medical Repository,  vol. vi.  p.
249.  Greater proofs of near affinity than these can  hardly be
desired.*

  * The convertibility of yellow and marsh fevers into each other, was attested, almost
half a century since, by the late Dr.  Huck Saunders, who had become well acquainted
with them, as an army physician in the West Indies and North America. " It some-
times (says he) depends upon the manner  in which a patient is treated in the begin-
ning, whether he shall have a yellow, or only a remitting or intermitting fever."  See
Pringle's Diseases of the Army, p. 108.
  Dr. Bush, and bis associates, who were incorporated as the Academy of Medicine, of
Philadelphia, in their letter to the Governor, December 1st, 1797, say, " by depleting
remedies, the most malignant yellow fever may be changed into a common bilious fe-
ver ; and, by tonic remedies, improperly applied, the common bilious may be made to
assume the symptoms of the most malignant yellow fever."  Dr. Drysdale, writing of
the yellow fever at Baltimore, in 1794, observes, that this fever, in its favourable issue,
would sometimes terminate in a tedious quotidian, or tertian ague."  See Cox's Medi-
cal Museum, vol. i. p, 41.
  Dr Gillespie, also, in his "Observations,  kc." already quoted, after mentioning the
epidemic fever, which had proved fatal to at least one half of the crews of the Spanish
squadron, captured by Admiral Harvey, at Trinidada, in February, 1797, adds, that
from " Uie accounts which our medical gentlemen collected at Trinidada,"  this epi- 
29$
   Finally, the Yellow and marsh Fever's resemble each other
 by attacking  the same organs or parts of the body, especially
 the stomach  and smaller  intestines, which were found to be
 inflamed in  remittent fever, even at  Copenhagen: and  they
 also lay the foundations of similar chronical affections.
   With so  many proofs of identity in their cause, and of the
 nearest affinity in  their  symptoms, and reciprocal conver-
 sions into each other, as  well as in their effects on the human
 body, and  their changes  by heat and cold,  &c. it  would be
 highly unreasonable not to consider them as being only varie-
 ties  of one disease.   And  I think  with  Dr.  Rush, that we
 might  as well "distinguish the  rain which falls  in gentle
 showers, in Great Britain, from that which is poured in  torrents
from  the clouds in the  West Indies, by different names  and
 qualities, as  impose  specific names and  characters  upon the
 different states of bilious (or marsh)  fever."   See Medical
 Inquiries, &c. vol. 4, p. 45.
   Among  the  points in which the yellow,  resembles other
 marsh fevers,  (and  which,  therefore,  co-operate in proving
 their identity) I might have included that of its possessing no
 contagions  property : for certainly this fact has been attested
 and demonstrated in so many places, and by so many unques-
 tionable authorities,  that  no unprejudiced reader, who shall
 have  bestowed proper  attention upon  the  proofs and  occur-
 rences which  have been stated in the preceding pages, can en-
 tertain the  smallest  doubt respecting it.  Wishing, however,
 not merely to convince the unprejudiced, but to reclaim  and
 undeceive those of an opposite description, so as to obviate all
 future disagreement on this important question, I shall here
 introduce a few additional facts, testimonies, and arguments,
 respecting it.

demic appears to have been  " an ardent Yellow Fever, terminating in remittent and
intermittent fevers, in a manner similar to what happened here, (i. e at Martinico) in
1796," as mentioned by him, at pages 130,1, and 2; and also at page 164, 5. I could
easily fill many pages with similar facts and authorities, 
2U
   One fact, which decidedly proves the Yellow Fever  to be
 destitute of any contagious power, is that of its never having
 been communicated to others by any  one of the  many  thou-
 sands who, in the West Indies,  as  well as  at  Charleston,
 Norfolk, Baltimore,  Philadelphia, New York, kc.  were re-
 moved beyond the reach of marsh miasmata, whilst labouring
 under the disease, or after having imbibed its poison ; though,
 in many of these, the disease appeared in its worst forms, and
 proved mortal.   That this  has been  the case in all  these
 places, will have been seen in the view which  was lately
 taken of this subject.   Of the importance, as  well as of the
 certainty of this  fact, the late Dr. John  Hunter was justly
 convinced.   " What may  be considered (says  he) as  an  expe-
 rimentum crucis,  to prove the non-existence of contagion is,
 when the sick leave their usual residence,  and go  to  other
 places which  are  healthy,  without spreading  the  disease.
 This (he adds) constantly happens in the remittent fevers of the
 Wast Indies,"  (among which  he includes  the  Yellow Fever.)
 See Diseases of the Army  in Jamaica, p. 322.
  Dr. Miller, in his report to the governor of New York, has
 made a similar statement, in these  words : " Many who had
 contracted the disease in  New York, died of it  at  Boston,
 Albany, and other cities at a distance; many, likewise, at
 Greenwich,  Brooklyn,  and other villages, in  the  neighbour-
 hood.  In no instance did these victims of the  epidemic com-
 municate contagion."
  To invalidate this statement, Dr. Chisholm,  at p.  177 and
 178, of his Letter to Dr. Hay garth, refers to another^ said to
 have been made by Dr. Wistar, respecting a case of Yellow
 Fever, at Germantown, in the year 1798, when "  one person,
 who had been  in Philadelphia" four days, and in a sickly
neighbourhood, returned home, on the 7th of August,  and, on
the 9th, was attacked  with Yellow  Fever, which  terminated
fatally in four days."  " Ten cases,"  says Dr.  Chisholm,
" are specified of  the disease excited by  contagion emanating
from the body of this  person."   To specify such cases is not 
285
difficult for one who  acts under the influence  of party zeal;
but this is not proving their existence.  We are told, indeed,
that in most of the  cases the disease appeared to have been
contracted at the house of a Mrs. Johnson; that " one per-
son received  the  infection from  sorting the  clothes  of her
deceased daughter,  and another from the bed  on which his
mistress died," and these pretended circumstances, the only ones
of which any mention  is made,  are to serve as proofs, suffi-
cient to  overturn  the evidence of, probably,  fifty thousand
cases, in which this disease has manifested that it possessed no
contagious quality.   Persons who believed that nothing could
produce the Yellow  Fever except  contagion, might  conclude
that it had been produced  in ten persons, from  one  who had
been at Philadelphia;  for they would naturally neglect to in-
quire whether these persons had  not also been there, or to
some other source of marsh miasmata, which is a million of
times more probable than  that nature should depart from her
constant uniformity, and render the same disease contagious
in one instance, and not contagious in  50,000 others.   Rely-
ing on this undeniable and fundamental truth, I should think
it a waste of my own,  and  of my readers' time,  were I to em-
ploy it in a further investigation of the cases in  question,
given,  as they are, without any  proof, or even any circum-
stance, but those just  mentioned, and which are suited only to
vulgar apprehensions.  If such cases had really occurred, and
with such evidence as to render them  credible, Dr. Rush, who
must have heard of them, and who, at that time, believed that
the disease might sometimes be contagious, would, probably,
have been so far confirmed in that belief, as to have abstained
from the public  retraction, which he  afterwards made of it;
and he certainly would not, in the very letter containing that
retraction, have declared,  as he did, that the Yellow Fever
" has uniformly perished in the high and healthy  village of
Germantown,  when  carHed from  Philadelphia."  See Medi-
cal Repository, vol.  6, p.  165. 
296
   The impossibility of spreading the disease in situations re-
 mote from marsh miasmata has been attested, not  merely by
 persons who believed it not to be contagious,  but by one of
 the  strongest assertors of the contrary opinion, by the very
 person who appears to have first misled Dr. Rush, and others
 on this subject,  (I mean  Dr. Lining, of Charleston) more
 than half a century ago.   His  words are these, " although
 the infection was spread with celerity through the town, yet,
 if any from the country received  it in town,  and sickened on
 their return  home, thg infection spread no farther, not even  so
 much as to one in the same house."   See Dr. Lining's Letter
 in the  Edinburgh Physical Essays,  vol. 2, p. 373.   This ad-
 mission, of a truth, of the most decisive  import,  from Dr.
 Lining, ought to have opened the eyes of Dr. Haygarth,  or,
 at least, to have moderated that overbearing confidence which
 he has repeatedly manifested in his  belief of the contagious
 nature  of the Yellow  Fever.   That he was sensible of the
 weight of this admission, and  of the evidence afforded by it,
 I am forced to conclude, from  the circumstance of his having
 very unfairly excluded,  and, to  the utmost of his power, sup-
pressed it, when he thought proper to fill the two first pages
 of the appendix to his Letter to Dr. Percival, with other
 parts of the same Letter, (from Dr. Lining) in  order to per-
 suade his readers that Yellow Fever was contagious.
  What Dr. Lining thus admitted,  and Dr. Haygarth sup-
pressed, was found true even in regard to the  fever which
Dr. Chisholm supposes to have been imported to Grenada, by
the Hankey.  For persons who  took that disease from the
atmosphere at St. George's, and sickened in the country, did
not, as I am well informed, communicate the disease to  any
person there, and of this Dr. Chisholm cannot, I think, have
been ignorant.  This  was  also the  fact at Dominica, where,
according to Dr. Chisholm, this  malignant pestilential fever
was transplanted, and prevailed in 1793, 4, and 5. Dr. James
Clark, (a writer of unquestionable veracity) states, at p. 64, of
his Treatise, that—"when patients, labouring under this fever, 
297
 were removed to high situations, for the sake of breathing a
 cooler and purer air, and who, notwithstanding, fell victims to
 it, the people about them were never infected, nor did the disease
 ever prevail afterwards in such places."—But I will  not abuse
 the patience of  my readers  by adducing further evidence  on
 this point.
   Another, and, if possible, a stronger proof, of the non-ex-
 istence  of contagion  in  Yellow Fever,  is  derived from the
 Hospitals.  If a disease be supposed to possess any  contagious
 power,  however small, there is no  way in which that power
 can be so readily concentrated,  and rendered manifest, as by
 collecting great numbers of persons, ill of that disease, within
 the  wards of an Hospital.   And it is in those which have
 been exclusively appropriated for cases of Yellow  Fever, at
 New-York, Philadelphia, &c. that we ought to find the most
 striking and irresistible  evidence of its  contagious  quality,
 if it does really possess  any.   But  the evidence which  they
 have afforded is of a very different import. And here I will re-
 cur to Dr. Miller's (before-mentioned) report to the governor
 of New-York, against which Dr. Hosack, with all his eager-
 ness to object,  could find no objection but the omission of one
 unimportant observation, favourable to  Dr. Miller,  and un-
 favourable to his opponents.  Dr. Miller's words are,—" no^
 communication  of the  disease  was  ever observed  in Yellow
 Fever Hospitals, situated at a  small distance from the cities
 to which they belong.  No  exception to this  has ever occurred
 in any of the numerous seasons of this  pestilence at our Hospital
 at Bellevue, the Marine Hospital at Staten Island, that of Phila-
 delphia, or any other in the  United States ;  provided the  ma-
 lignant air of the city had been avoided.*   The  force of this
  * Dr. Chisholm attempts, at page 174 of his letter to Dr. Haygarth, to pervert the
plain meaning of Dr. Miller's proviso,  that  " the  malignant air of the city had been
avoided."  "Then (says Dr. Chisholm) this malignant air could be diffused to distant
and scattered points, and yet could not extend itself to Hospitals  at a small distance
from its origin." But the Hospitals were not at a small distance from its origin, nor
had Dr. Miller said or admitted that this malignant air could diffuse itself to distant
and scattered points;—for, though persons  occasionally sickened at such points, the 
288
fact seems never to have been duly considered or  appreciated.
The numerous retinue of medical attendants, nurses, washer-
women, servants, &c. which belong to  an Hospital,  must  be
known  to every  body.    How  greatly  they  are  all  exposed
to contagion,  if it  could  be supposed to exist in this case,
is equally known.   The most malignant degrees  of the dis-
ease  are  constantly  found in these institutions.   The  expo-
sure of the physicians,  and their  attendants,  is  well under-
stood.   The  duty  of the  nurses  leads to  an  incessant, and
unreserved,  intercourse with the sick," &c. &c. yet, not only
all these have invariably escaped the disease,  but  likewise  all
the persons occupied in  the removal of the sick, from the city
to the Hospital, who, in this service,  went,  without reserve,
into the most pestilential quarters of the town, entered the
most filthy apartments, &c."*
   The facts, here  stated by Dr. Miller, are of such notoriety
that no farther proof of them can be necessary ; especially as
my readers  will have seen the like testimony given  by others
in the view lately taken of this disease; I find, indeed, that in
taking it I overlooked a Letter from Dr. Ramsay,  published
in  the  Medical Repository, vol.  4,  at p.  220, and  dated

miasmata might have been exhaled from particular unwholesome spots, very near to
them,  and when this was not the case, the persons in question, without waiting for the
miasmata to reach them; might have gone to the places where they were produced,
as was undoubtedly the fact. Dr. Chisholm tells us, that he has inquired, at p. 274 and
288, of vol. i, of his Essay, "bow far the influence of marsh miasms extend," and this,
by reference to the pages in question, appears in his opinion to be two miles; and he
thence concludes, that if these miasms existed in Philadelphia or New-York, thej
"would certainly affect the adjoining Hospitals."  How little he knew, and how much
he was mistaken, on this subjeet, must have been manifested by the facts already stated,
at p. 162, 3, and at p. 164, 5, and 6, of this volume.
  * Dr. Miller, in a note, explains the escape of these persons, by stating, " that they
all resided, during the season, at the alms-house, in an elevated and healthy part of the
city ; and, consequently, were only, for a short period, at any one time, immersed in
the noxious atmosphere."  But  their communication with the sick lasted for a loDger
time, and was such as must have propagated the disease, had it  been contagious. Dr.
Miller adds, in another note, that several persons died of the yellow fever in the alms-
home, in 1798, and that, " although the house then contained about eight hundred per-
sons, no communication of contagion took place." 
             if               289

 Charleston, November,  18,  1800, in which he writes, u that
 of forty-one cases of Yellow Fever, which" (in the preceding
 months)  " took  place in  the Marine Hospital, forty were
 brought there from  the shipping in the harbour, with  the  dis-
 order on them, and, in many cases, far advanced.   Only one
 case originated in the Hospital,  and that was of an old intem-
 perate man.  While so many patients were dying of the Yel-
 low Fever in the Hospital, there was  always  a considerable
 number of  other patients under the same roof, who  all, with
 this  one exception," (originating  probably in drunkenness)
 " escaped it.   This is the more  remarkable, as the  greatest
 uumber of them, as well as several of the nurses, were stran-
 gers, and affords additional  evidence, that the disease was not
 contagious."   He mentions, that the  Hospital is half a mile
 out  of Charleston.*
   Of the non-existence of  contagion  in Yellow Fever,  Dr.
 George Fordyce seems to  have been convinced, near the close
 of his life, though in opposition to all that he  had formerly
 believed and taught on the subject; for, in  his fourth Disser-
 tation on Fever, the last which  was published previous to his
 death, he states, as  the result of  all his  inquiries, and of the
 best information which he  had been able to obtain by convers-
 ing  with, and cross-examining, individuals,  who  had  had  op-
 portunities of observing the  semitertian fever of  hot climates,
 (for, so he called the Yellow Fever) in those towns  where it

  * My readers scarcely need be reminded of tbe facts which I have mentioned at
p. 182—3, on the authority of Dr. John rfume, Dr. John Hunter, Dr. Walker, &c. of
the absence of contagion in the different hospitals at Jamaica, notwithstanding the
many thousands of patients with yellow fever, admitted into them at different times.
Nor of the opinions of the medical officers of the army under sir Ralph Abercrombie,
on this subject.  I can safely aver,  that  several thousand cases of tbis disease fell under
my own observation in the  West Indies, and that I did not find the least appearance of
 a contagious quality in any of  them.  The  fevers of the East Indies, though so ex-
 tremely violent as sometimes to produce death in a few hours, are equally destitute of
contagion. Dr. Wade, on the diseases of seamen and soldiers in Bengal, asserts, at
p. 3,  that, during the course of a long  and assiduous practice there, he " had not ob-
served, to the perfect conviction of his own judgment, either in or out of  the hospitals,
a.single instance of contagion"  among  fevers.
                            37 
290
prevailed, " that in Hospitals where patients  were received
ill of that fever, the physicians, surgeons, and  other attend-
ants, were not oftener seized with  it,  than the other inhabi-
tants of those towns."
  The advocates for contagion in America, (who,  though,
pertinacious,  are  now  very few  in  number,)  when embar-
rassed by the well-known and admitted fact of the disease's
never spreading in the country,  pretend that the  air is there
too pure; which is doubtless, true, if by purity they mean that
it is not sufficiently charged with marsh miasmata to produce
fever; and this is also  true in those  hospitals, in which the
disease cannot be propagated.   And if this be their meaning,
it only amounts to this, that  their supposed contagion does
not act, unless there be also present another very sufficient,
and in fact, the only cause of  the yellow fever.  J3ut, if they
mean any thing else, or mean what is commonly supposed to
constitute atmospherical purity, this  certainly does not exist
in crowded hospitals; and their explanation is a mere subtcr-  .
fuge,  to which persons  will often have  recourse,  rather than
candidly retract an erroneous  opinion.
  Besides the universal exemption of the physicians at New-
York, from yellow fever, during the epidemic of 1805, (in con-
sequence of their having  then  learned, in great degree, to
avoid the spots infested  by marsh miasmata) Dr. Miller, in his
report, mentions the dissection of persons who had died of yel-
low fever, which, if the  disease had been contagious, must
have  proved  a source of danger.  " Many of  the physicians
of this city," says he, " were frequently engaged in this mode
of investigating the disease, and minutely examined bodies in
a very advanced state of putridity; and yet they all continued
in perfect health."  But,  besides the  dissections here men-
tioned by Dr. Miller,  it appears that a great number have
been made without harm in other places, and  particularly at
Philadelphia: together  with many experiments upon the black
matter vomited in the last stage of yellow fever, calculated to
ascertain whether  it  possessed  any  contagious  property. 
           §              291

 Vmong  these  may  be noticed some very  remarkable ones,
lately exhibited by Dr. Ffirth, at Philadelphia, in the presence
of several medical gentlemen of good characters.  After some
experiments of less importance, he inoculated himself in the
left fore-arm with the black matter which had been just before
vomited by a moribund Yellow Fever patient; a slight inflam-
mation ensued, which subsided in three days, and the wound
readily healed; he then confined, by  a  black sticking plaster,
some of the same matter, immediately  after its ejection, over
a cut in his right  arm, for two days,  and then found that  it
had occasioned  no inflammation, the wound readily healing,
without any formation of pus.
  These experiments he repeated above twTenty times, in vari-
ous parts of his body, with  similar black matters ejected by
Yellow Fever patients, in Philadelphia, during the  epidemics
of 1802 and 1803.   He also put  it into his eye, without ex-
periencing any more inconvenience than coldtwater  produces;
he also inoculated himself with the saliva and serum of patients
 under Yellow Fever,  and  with as little effect.   He exposed
 himself to the exhalations  of the same black matters, (which
 had been recently  vomited) heated in an iron vessel, and ex-
 perienced no unpleasant consequence, or sensation.  He swral-
 lowred  the  inspissated  matter,  which  remained  after  this
 evaporation, made into  pills, without  finding his stomach in-
 commoded thereby;  and he, finally, drank  two ounces of the
 recently-vomited black matter undiluted, and found it harm-
 less,  after having  previously taken without any bad effect,
 considerable quantities of similar matter, diluted with water.
 These nauseous draughts,  and hazardous  inoculations, will,
 doubtless, be thought sufficient to prove, that neither the blood
 nor the saliva of patients, under Yellow Fever, nor yet the
 black matter, the  vomiting of  which is  justly deemed the
 most fatal  symptom of the disease, possess any  contagious
 property.   (See   Dr. Ffirth's  Dissertation on  Malignant
 Fever;  Also New-Fork Medical  Repository,  2d Hexade,
 vol. 2. p. 70.) 
                            292              ♦
   I have  already noticed the constant extinction of Yellow
 Fever by frost, as one of those points in which it exactly re-
 sembles the marsh, and only the marsh, fevers.  This instruc-
 tive and highly important fact is, however,  capable of a more
 extensive application, for it not only proves the origin and
 nature  of  all these  fevers, but  it also proves  decidedly that
 the Yellow Fever has no power of propagating itself by con*
 tagion ; and, consequently, that it never proceeds from it.  In
 considering  this fever  as produced  by marsh  miasmata, we
 readily understand  why (like other marsh fevers)  it should
 cease when the atmosphere no longer retains sufficient heat for
 their generation and exhalation; but this diminution of tem-
 perature could not extinguish a fever subsisting by contagion.
 Frost has  no access to the apartments, and still  less to the
 bodies, of persons under Yellow Fever.  Upon  its occurrence,
 fires, with additional bed clothes, secure  them from its ap-
 proach, and fron» even the smallest interruption to those mor-
 bid secretions, or actions, by which contagion is supposed to
 be generated : and,  therefore, if contagion were the cause of
 Yellow Fever, new cases of it ought to occur,  during winter,
 especially as we are  not acquainted with any febrile contagion,
 which  is  liable to be rendered inactive, merely by such a
 diminution of temperature as is sufficient to stop„the progress
 of Yellow  Fevvr.   It certainly  would have  no such  effect
 upon typhus fever, small pox, measles,  or,  indeed, any con-
 tagious disease, within my recollection.  Dr. Chisholm, how-
 ever, from the resolution which he seems to have made of  re-
 sisting  or evading the evidence of all facts  repugnant  to his
 promulgated  opinions,  endeavours to account for this extinc-
 tion  of  Yellow Fever,  (at p.  177) by pretending that " it is
 admitted that Yellow Fever is the product of infection, in
 combination with a high temperature"—adding, " If it is so,
 and of this there can be no reasonable  doubt,  cold  weather
must have  extinguished  it."  By infection, I  presume  Dr.
 Chisholm  means contagion,  and  if so,  I must deny the ex-
 istence of any such admission as he pretends, except by  him- 
293
 self, and those who have adopted his peculiar opinions, in re-
 gard to the fever alleged by him to have been derived from the
 Hankey ; for he has repeatedly and strongly denied the ex-
 istence of contagion in the Yellow Fever which prevailed in
 the West Indies  before the  year  1793.  But  perhaps Dr.
 Chisholm, as  the inventor of that fever,  or,  at least,  of its
 supposed origin and contagious power,  may think  himself
 intitled to endow it w ith any qualities  which may suit his own
 purpose,  and, consequently, intitled to combine  febrile conta-
 gion,  even with  that  high temperature  which has  always
 proved destructive  of it;  but, even  with this  incongruity,
 which  I  am not disposod to adopt, we may reasonably expect
 a little uniformity and consistency in his  account of the pro-
 perties and effects of this  extraordinary combination;  and
 require that he should not represent it  as  necessarily extin-
 guished by cold weather in North America after having assert-
 ed,  as will hereafter be seen, that it prevailed extensively
 among the British troops in Ireland, in the winter of 1795, 6.
   As the more violent forms of yellow or marsh fever have
 chiefly occurred in the sea-port towns of North  America, as
 wrell as of the West Indies, and from the same causes,  those
 persons who,  in regard to the former, have chosen to repre-
 sent the Yellow Fever as the product of an imported conta-
 gion,  have in  several, though  not in all cases,  been able to
 discover some vessel, recently arrived from the West Indies,
 about the  time when the local causes  of Yellow Fever,  from
 excessive  heat, &c. wrere become powerful at Philadelphia or
 New-York, and this  vessel being placed in immediate contact
 with these causes, and some of  her crew being, consequently,
 soon attacked with fever, the sufferers, or the innocent  ves-
 sel, to which they  belonged, have been charged with the guilt
 of importing  a contagious disease,  and  this under  circum-
stances where  it has sometimes been difficult to  demonstrate
the  truth, in opposition to confident statements,  which, in
such cases,  are commonly made, and  which, with a  few of
 those omissions or  misrepresentations, naturally resulting from 
£94
party  zeal, often give an appearance of probability to the
charge.  Indeed, statements of this nature have been adopted
and published by the College Physicians,  at Philadelphia; the
only corporation, I believe, of any kind  in the United States,
which  entertains similar opinions of this  subject.
  But, as  the existence of a contagious  quality  in the
Yellow Fever has not only never  been proved or made pro-
bable,  either in the West Indies or  North America, but on
the  contrary,  this  disease  has,   in   many  thousands  of
instances,  manifested,  in the  clearest  and  most  decided
manner,  that it  possessed no  such  quality ;  and, as  with-
out it,  no importation of the disease, from the West Indies,
is  possible,  and  propagation  of it in the  United  States,
such statements can have had no foundation in truth,  nor the
smallest  claim to serious notice.  If the disease were conta-
gious,  the  fact  must  have  been  indisputably demonstrated
more than ten thousand times, considering the multitudes who
have been victims to  it, and there  would long since have been
no more doubt on the subject, than there now is of the conta-
gious nature of small  pox and measles.  The  uniformity  of
nature, and the necessary connexion  between cause and effect,
will not  allow ns to believe in the fortuitous  occurrence of a
few  rare instances of contagion from Yellow Fever,  in oppo-
sition to the immense mass of facts by which  that disease has
been proved destitute  of any such quality,  and the probabili-
ties will always he a million of times greater that these sup-
posed rare instances,  have originated in ignorance, error, pre-
judice, or falsehood, than that effects so monstrous should ever
have really occurred.*   With this conviction,  I cannot resolve
to misemploy  my time by undertaking a particular examina-
tion of the  instances in  which the Philadelphia College sup-
pose the Yellow Fever to have been imported, especially as
Dr. Caldwell seems to have sufficiently noticed and  refuted
them all,  in his  several publications ; and particularly in his

   * While it is notorious that tbe yellow fever cannot be propagated a single mile
 from Philadelphia or New-York, it is completely absurd to suppose, that it can have
 been transported by a contagious qnality one or two thousand miles across the ocean-. 
                           205

Essay on the pestilential or Yellow Fever, as it prevailed in
Philadelphia in  the year 1805, subjoined to his translation of
Alibert's Treatise on Malignant intermittents.
  Believing that I have done enough,  and more than enough,
to prove that the Yellow Fever has no contagious power, and
that it arises exclusively from local causes, such as have been
described, I shall conclude my Essay in regard to the United
States of America, by adducing  the hitherto uncontradicted
testimony of Mr. Jefferson (their late president) delivered by
an official message to  both houses of congress; which affords
a complete  general confirmation, by the most unobjectiona-
ble,  as well  as  highest, authority of  the facts stated in the
preceding  pages.  The message  was  communicated on  the
third of December,  1805, and the part, to which I refer, was
in the following  words, viz :
  " In taking a view  of the state of our country,  we in the
first place, notice the late affliction of two of our cities under
the fatal fever, which in latter times has occasionally visited
our shores.   Providence, in his goodness, gave it an early ter-
mination on this occasion, and lessened the number of victims
which have usually fallen before it.  In the course of the seve-
ral visitations by this disease, it has appeared that it is strict-
ly local, incident to cities, and on the tide waters only,  in-
communicable in the  country, either  by  persons under the
disease,  or by  goods  carried from diseased  places;  that its
access is with the  autumn,  and it disappears with the early
frosts.  These restrictions, within narrow limits of time and
space, give security even to our maritime cities, during three-
fourths of the year,  and in the country always."
  Having thus established the origin and non-contagious na-
ture of the Yellow Fever, I might here finish this inquiry did
it not seem expedient,  for many reasons, to extend it to the
violent and very destructive fevers which, within a few years,
have prevailed epidemically in the south of Europe, and  more
especially in Spain, and at Gibraltar,  in  order, by compar-
ing them with the  Yellow Fever, to ascertain their identity, • 
                            296     ^
  which,  however manifest to my conceptions, has been denied
  by many, and even by some who have had  opportunities  of
  becoming acquainted with the Jbrmer, at least.
    And here I regret extremely, that,  having determined  to
  confine  this publication to a single volume,  I am  under the
  necessity of laying aside a  great mass  of facts,  which 1 had
  collected, with no inconsiderable trouble, respecting the pre-
  valence and different  forms or gradations  of marsh fevers,
  not only in Africa, and the East Indies, but in various parts
  of France, Italy, Sardinia, Sicily, Malta,  Greece,  &c. and
  which,  had I room, would greatly  illustrate the subject, and
  confirm what I  have already written,  as well as what I am
  about to write of the  Yellow Fever at Cadiz, Gibraltar, &c.
  I must, however, introduce what I have to  say in regard to
  the latter, with a few observations respecting Rochefort, Bour-
  deaux,  and Lisbon.
    The former of these cities is nearly surrounded either  by
  salt, or fresh-water marshes,  so  that, in  summer  and au-
  tumn, strangers can seldom reside there a fortnight,  without
  an attack of marsh fever.   On  the South-east side,  in  parti-
  cular,  are extensive fresh-water marshes,  which, when  the
  wind blows over them upon the city, in very hot dry weather,
  produce violent and dangerous fevers, and render them epide-
  mical at Rochefort.   This was  the case to  a remarkable de-
  gree in  1694,  when, according  to  Sir John Pringle, (Dis-
  eases of the army, p.  32S)  " a fever broke  out in Rochefort,
  in France, which, on account of the uncommon symptoms and
  great nwrtality,  was at first believed to be  the plague.  But
  M. Chirac, who was sent by  the  Court to inquire into  its
  nature,  found the cause to arise from some marshes that had
  been made by an inundation of the sea:  and observed, that
  the corrupted streams, which  smelled like  gunpowder, were
  carried to the town by the wind that had long blown from that
  quarter.   About two-thirds  of those who  were taken ill died.
  This fever raged in June,  July, and August, and  then  ended
.  upon a great fall of rain, which purified the air, and refresh- 
297
ed the stagnating water."  Sir John Pringle  refers to Les
CEuvres Posthumes de M. Chirac, for  an account of this fe-
ver.   In the Eloge of M.  de  Chirac, printed in the Hist. &
Mem. de L'Acad. R. des  Sciences," for the year  1732,  at
p. 121, this  fever was designated  as  a " Maladie Epide-
mique,  qu'on  appelle de Siam," (an Epidemic called  Siam
fever) doubtless from its resemblance of the Yellow Fever, to
which that name had then been given at  Martinico.  Mr. Chi-
rac is stated to have dissected  the bodies of nearly 500 persons
who died of it, and he mentions his having generally  found
the stomach greatly inflamed, and,  in some parts, mortified.
   Violent  fevers, which were considered as pestilential, for-
merly prevailed very often in the  summer  and autumn, at
Bordeaux,  and  frequently compelled the  parliament to re-
move to other  places.   The  Cardinal de  Sourdis, having
formed  a just  opinion of the cause of these fevers, under-
took to drain  a very offensive marsh, which then existed on
the  west side  of the  city.—Accordingly, two great canals
were dug by his orders, and  at his expence,  to convey  the
stagnant water into the  river, and a fine causeway  being
erected over  the infecting spot, and planted  with rows  of
elm  trees,  the plague, so  called,  ceased to appear.  " L'on
eleva dans  le lieu ou etoit un Cloaque infect, une belle Chaus-
see,  que l'on borda d'Ormeaux.  La Peste n'a  point reparue
depuis cette epoque."  See Memoires de la Societe Royale de
Medecine,  torn. viii. p.  272  and  seq. where, also, a very
interesting report to the Society will  be found, of the dif-
ferent parts of  France in which marshes  abound, and of the
fevers,  intermitting,  remitting,  and sometimes apparently
continued,  which prevail in their neighbourhood, with greater
or less malignity during  summer  and autumn.  It seems,
however, that though Bordeaux has been, in a considerable
degree, relieved from these fevers, since the work,  executed
at the expence of Cardinal Sourdis, yet the very hot, as well
as dry,  summer and autumn of 1804, (which occasioned the
Yellow Fever in many parts of Spain, Gibraltar,  &c.) assist"
                           38 
298
 ed by some new attempts at draining, begun at an improper
 season at Bordeaux, produced in this city a malignant  epi-
 demic  fever,  which Dr.  Galway, a physician of eminence
 there,  states to have had  very short remissions, and to have
 often terminated fatally,  before the fourth  paroxysm.   The
 daily mortality  from  it is said to have exceeded  fifty for
 some time.  It  prevailed chiefly in  the  quarter  called the
 " Departemcnt," where the ground  is lowest, and the streets
 narrow :  and  this quarter  was  deserted by  all persons in
 easy circumstances.   See  New-York  Medical Repository,
 vol.  4, of 2d Hexade,  p.  263, 4.
  Lisbon, since the earthquake, in 1755, has been, in a great
 degree, exempted from  marsh fevers; which, however,  was
 not previously the case, especially in the lower part of the
 town between  the  bottoms of the  hills  and the  river; a  spot
 where the streets were narrow, dirty, and, as I believe, un-
paved.   In the eloge of Mr. Sanchez, formerly first physician
to the Empress of Russia, (Anne Ivanowna,) inserted in the
4th volume of  the  " Hist. De la Societe Roy. de Medecine de
 Paris, it  is stated, (in a note, at p.  215) that he had witness-
 ed the ravages made at Lisbon  in  1723, by a very mortal
 epidemic; and that Dr. Bertrand, a physician, who had  dis-
 tinguished  himself during the plague at Marseilles, in 1720,
 being consulted by the King of Portugal, declared the latter
 to have been a different disease fnom the epidemic, at Lisbon,
 in which black vomitings were the most alarming  symptom :
 (" des vomissemens noirs etoient le  Symptome le plus effray-
 ant.")  Mr. Sanchez  is also  stated to have  observed,  that
 this epidemic rarely attacked women, and that the  negroes of
 both sexes  completely escaped it.   These facts were obvious
 indications of  the Yellow Fever;  but I found others more de-
 cisive,  In the library of the British  Museum, M. S. 4376.
 Plut. II. J. is a letter,  dated Lisbon, October 30th, 1723,
 signed William Cayley, (apparently the British Consul there)
 and  addressed " to Dr. Kennedy,  Physician  to the British
 Factory  at Lisbon," in which, after mentioning " the sick- 
299
■**ess," which had prevailed for some time, without any abate-
 ment ; " still continuing to take off numbers of its inhabitants,
 some of whom die suddenly, and in such a manner as has given
 cause to suspect the disease to be attended with pestilential
 symptoms," he calls on Dr. Kennedy for his "  opinion" re-
 specting it,  " and the observations he had been able to make
 in the course of his practice;" to the end that he, Mr. Cayley,
 might,  according to  his  " duty, transmit the same to his
 Majesty's Principal  Secretary  of State,  in order  that,  if
 deemed contagious, due precautions may be taken to prevent
 the  same from  being introduced into his Majesty's Domi-
 nions," &c.
   To the preceding letter  is subjoined an answer,  signed
 Gilbert Kennedy, and dated, the 31st of  the  same month, of
 which the following is an extract, viz.:
   " The tveat last  summer began  late, but continued very
 violent,  and  much longer than usual, so that the grapes, which
 were more plentiful this year than many years past, were
 burnt up, when pretty ripe.  All the summer was sickly, but,
 about the middle of  August, there appeared  the  fever which
 now reigns,  accompanied with a pain of the head and loins,  a
 great sickness at  the heart and stomach,  with reachings to
 vomit, very contagious in the lower parts of the city, going
 generally through a family, and very fewr families escaping it,
 especially in the close, narrow streets.   The  high parts  are
 much freer than the low parts,  and the villages  and country
 houses about  town are entirely free from this distemper, notwith-
 standing the great communication.  The recovery  is generally
 accompanied with  the yellow  jaundice.  The only mortal
 symptom in this  epidemic is the vomiting black choler, but this
 symptom is so rare, that I have met with it but twice in above
 a  hundred I have seen with this distemper."*

   * It seems probable, from several circumstances, that the worst cases of this dis-
 ease occurred among the poorer inhabitants of Lisbon, and that Dr Kennedy's prac-
 tice being nearly confined to the British Factory, who were in better circumstances,
 he saw fewer cases of black vomitings than the Portuguese physicians.  I ought 
300
   " By his Portuguese Majesty's order, there have been three
 bodies of persons dead of this  distemper opened in the public
 Hospital, in all which the blood appeared dissolved  like the
 thin lees of wine;  and in one of them, who had the  black
 vomit, there  appeared, besides, black  spots  upon  the skin,
 which were only superficial; the gall bladder and intestines,
 with a small quantity of black gall  in them, and the stomach,
 with a large quantity of the same."
   " The reasons why great numbers have died of this distem-
 per  are; firstly, the many poor who live here most miserably;
 and before they can procure any assistance, are carried off by
 the force of the disease, which is extremely violent for the two
 or three first days, having rarely any crisis that is usual in
 other fevers;—Secondly, the Portuguese  method of treating
 all fevers by bleeding, morning  and evening,  while they last;
 which has generally been pernicious in this epidemic.  From
 all its appearances, hitherto, it seems very clear, that it is
 contagious only among those  wliose bodies  are predisposed  by
 living in  a close, noisome air, and abound with bile, or labour
 under some error in the non-naturals.  Strangers, who drink
 wine,  (i. e. are intemperate) are more  universally attacked
 with it than the Portuguese:  among the  latter  no   man  of
fashion has had it, nor has it yet entered any  convent, except
the Irish, although they all  assist the sick."
  With so many facts, decisively proving that the disease was
not communicated by the sick to the well, and that it only at-
tacked persons who had been exposed to the influence of marsh
effluvia, we might well wonder that Dr. Kennedy had not dis-
covered  the truth,  did we not  recollect the  general dispo-

 further to observe,  that Dr. Kennedy mentions,  in his letter, that the weather had
 « changed several times to rain and cold," without any abatement in the distemper.
 It may, however, be presumed, that these changes were not very considerable, and
 they obviously were not lasting; and, therefore,  not likely to produce any sensible
 benefit.  Moderai e showers of rain,  occurring with some intervals, have been found,
 in America, rather to promote than diminish the progress of yellow fever; probably,
 by favouring the extrication of miasmata; and at Lisbon, in the month of October,
 no great diminution of temperature is likely to have been thus produced. 
301
sition which then prevailed to believe in the supposed contagion
of fevers,  without discrimination or consideration.   To those
who have formed correct ideas  on this subject,  it must now
appear absurd, to represent a fever as being " very  contagious
in the lower parts  of the city," very little so in the " high:"
and  as  having no existence in  " the  villages  and country
houses about the town,  notwithstanding their great commu-
nication."
   I will now proceed to Cadiz.  This eminent maritime  city
has frequently been afflicted by violent and destructive  epi-
demics.
   Dr. Felix Pascalis, who lately travelled over a great part
of Spain  to  procure  information, and ascertain facts, on this
subject, mentions on  the  authority of Dr.  M. Gonzales,  (au-
thor of a " Dissertation Medica sobre la Calentura maligna
contagiosa," or Yellow Fever, which prevailed at Cadiz, in
the year 1800,) that, " during the seventeenth century,"  this
city " had been four times visited  by horrid  pestilences, of
which there are monumental indications, and  religious festi-
vals,  instituted to commemorate their duration,  cessation, &c.
There are, however,  no  such discriminating accounts of these
epidemics, as  will enable us to decide,  whether they arose
from marsh miasmata, like those of the last and present  cen-
turies at the same  place, or whether they were the plague,
properly  so  called ;  but, considering how frequently  and
loosely the latter appellation was given to very  different  dis-
eases, when attended  with great mortality, the form is highly
probable.   Dr. Pascalis, however, asserts, that the Fellow
Fever prevailed at Cadiz in 1730, and that the physicians  sent
from  Seville, and who critically examined  the disease, " did
not omit to notice the (yellow)  colour of the patients, and the .
vomito prieto:" and for evidence of this he refers to  " Cadiz
Illus trada, lib. 6."   He asserts, also, tljat this disease pre-
vailed there at other times in the last century, particularly in
"  1736, 1744, 1746, and 1764."  As  authorities for the three
first of these epidemics, he refers to  the  writings  of Dr. N. 
302
 Rexano, Dr. Gregorio Condemina, and El Vicario Ecclesias-
 tico de la Isla de Leon."
   Of the epidemic, in 1764, an account has been written, in
 Latin,  by Dr. Salvarez, (or Salvareza) then a principal phy-
 sician at Cadiz,  by which  it appears to have exactly resem-
 bled  the  Yellow Fever  of America.  He, indeed,  calls it
 Vomito Prieto, because black vomitings, as w ell as yellowness
 of the  skin, frequently occurred.   Dr.  Lind,  also, in his
 Essay on the Diseases of Hot Climates, at p. 122, after men-
 tioning, that Fevers,  similar to Yellow Fever, have appeared
 " in some of the southern parts of Europe, during a season
 when  the  air was  intensively hot and  unwholesome,"  adds,
 " this happened at Cadiz, in Spain, in the months of  Septem-
 ber and October, 1764, when excessive heat and want of rain
 for some months, gave rise  to violent epidemic, bilious  disor-
 ders, resembling those of  the  West Indies,  of which  an hun-
 dred  persons  often died in a day."   He afterwards gives a
 particular  account of the  symptoms, and  then  informs us,
 that " the dead bodies having been examined by  order of the
 court of Madrid, the stomach,  mesentery,  and  intestines,
 were found  covered with gangrenous spots,  the orifice of the
 stomach appeared  to have  been greatly affected, the spots
 upon it being ulcerated."   He also informs  us, that the dread
 of this disorder forced many people of fashion to  retire into
 the country, where they remained in perfect safety from it."
 Reverting, again to this epidemic, at p. 161, he says  " it did
 not extend  its influence to any ship which lay at a distance
 from the city;  as I am informed by Dr. Maguire,  an  eminent
 physician of that place.   His Majesty's ship, the Tweed, was
 then at anchor in Cadiz bay ; an officer, and several of her men,
 who had been onshore, were seized  with this fever; but all
 those  who  were sent on  board the  ship recovered,  no bad
 symptom  appearing; in their fever, whilst  a disease, similar
 to black vomit, and the Yellow  Fever, and equally mortal,
 depopulated that large city."  From these  accounts, it ap-
pears that the disease was not propagated in the country, and 
303
that  seamen, who had  imbibed miasmata on shore, and be-
came sick, did not infect  others when sent on ship board:
and, consequently, that the disease was not contagious.—Nor
does  it appear that any suspicion then existed  of  its having
been imported from any other place.
   In  the summer of  1800, this  fever  again appeared as a
most  formidable  epidemic,  not only at Cadiz,  but in almost
all the sea port towns of Andalusia,  particularly Seville,  St.
Lugar, or Lucar, Puerto-Santa  Maria,  Puerto-Real, Rota,
and L'lsla;  occasioning the deaths,  as is computed, of nearly
eighty thousand persons.  It also prevailed, at the same time,
on the coast of Barbary, particularly  at Tangiers and  Te-
tuan.  On this melancholy occasion, the government of Spain
(which, some years before had dictated certain  prescriptions,
written by the king's physician, Dr. Masdevall, to be exclu-
sively employed by the Spanish  physicians  in  fevers similar
to the present, and certain  opinions  to  be also  subscribed by
them  on the  subject,)  thought proper to order a long and cir-
cumstatial publication to be  made as a supplement to the
Madrid  Gazette  of the 28th  of October, 1800,  under the
title of a  " Description of the  Epidemic Disease which began
at  Cadiz,—its origin  and propagation—the different symp-
toms  and effects of it,  and the method of cure,  &c.   Publish-
ed by order of government,  for the  instruction  of the public,
and particularly  for  the notice  and regulation  of the prac-
titioners  of physic, kc."   (See Medical  Repository, vol.  5,
p. 103, kc.)
   In this publication it is stated,  that the preceding winter
had been long and wet, the rainy season having  been pro-
longed  till the month  of May; after which the summer be-
came intensely hot, and the  thermometer, from  the middle of
July, rose to  85° of Fahrenheit's scale;* that an  easterly

   * Soon after the epidemic in question had ceased, a pamphlet, written by Don
 Rodriquez Armesto, an officer of the Spanish navy, and entitled "Reflections on the
 Epidemic which prevailed in Cadiz, and the neighbouring towns, in the autumn of
 1800,"  (" Reflexiones sobre la Epidemics padecida en Cadiz," &c.) was published. 
301
wind  succeeding,  lasted forty  days, and  being (as is usual
there)  very  hot,  subjected  the  inhabitants  to  extreme  heat,
with sweatings so profuse that  they could obtain no relief but
by  bathing.   That, about  f?--  8th  of August, bilious fevers
began to appear; and, from the 10th to the 15th of that month,
many people in the  quarter of Santa  Maria  were attacked
with what proved  to be the epidemic in question.
   Among the  more general  symptoms of the  disease,  those
are mentioned which occur in other  marsh  fevers—Those of
the more violent cases are stated to have been  Subsultus ten-
dinum,  Delirium  or  alienation of mind, Hiccough,   convul-
sions, hemorrhage  at the nose,  bloody  vomitings, bloody  and
black  stools,  yellowness  of  skin, petechia, and,  finally,  black
vomitings, similar to those  which, at  certain  seasons of the
year, are endemic  at  Vera  Cruz,  Honduras, kc.   (" La he-
morrhagia de  narices, la vomicion sanguinolenta  por la boca,
la melena, deyecciones de Sangre, la ictericia, las petechias,
y ultimamente el vomito atrabiliario,  a que han querido Ilamar
vomito prieto,  semejante al que  es endemico en ciertas est aciones
del  ano, en  Vera  Cruz,  Honduras,  kc.)  These symptoms,

 after having been licensed in the usual manner. The author was, however, soon ar-
 rested on a charge of having diffused false, dangerous, and seditious opinions, and
 compelled to subscribe a formal retraction of them,  so Car as they were at variance
 with the creed which the court thought proper to adopt respecting the supposed im-
 portation and contagious nature of the fever in question.  More than fifteen hun-
 dred copies of this pamphlet were publickly burnt; a few, however, escaped de-
 struction, and Dr. Pascalis, going afterwards to Spain, found means to procure two of
 them, and has given an abstract of their contents  in the New-York Medical Reposi-
 tory, vol. v. Hexade 2d,  p.  131, &c.  By this abstract, it appears that the author
 endeavoured to prove that the epidemic had been produced by  atmospherical and
 local causes; and that for this purpose he adduced accurate meteorological observa-
 tions, demonstrating, among other things, the extreme heat which had then pre-
 vailed."  " These," says Dr. Pascalis, " were official, as he was, by royal authority,
 keeper of the royal observatory of the Isle of Leon :" and by these it appears, " that
 the thermometer marked 95 degrees," (instead of 85") a degree of heat "equal to
 that of Senegal."  1 presume, however, that we are not  to consider 95 degrees as
 the constant temperature of that season, but only as that which it sometimes attained
 in the shade, for in the sun  he states it to have often been at 112 degrees, even in
 very damp places. 
305
 and especially those  qf which the original description is re-
 peated in Spanish,  can leave no room to doubt concerning the
 nature of the disease.
   It is added that the most  fatal symptoms were coldness of
 the extremities,  feebleness of the eyelids,  vomiting of matter
 like  coffee-grounds, hiccough,  convulsions, and coma.   The
 account  of the methods  of  treating the disease,  and of the
 reasonings of the  Spanish  physicians,  respecting its causes,
 are not sufficiently  interesting for the space which they would
 occupy,  were I  t6 give even an  abstract  of them.  It is
 stated, however, as a fact,  that  persons, who had lately ar-
 rived from  the  West Indies, owing to their being accustomed
 to the  like seasons, did not suffer an attack  of this epidemic,
 and that  even those who had been long resident in that part of
 Spain, were, in a  great degree,  exempted from it;  and, on
 the other hand,  that persons from Canada, and other (north-
 ern)  countries, were extremely  liable to it, which are  circum-
 stances clearly manifesting its resemblance to Yellow Fever,
 and its want of contagion.   The  physicians  are also stated,
 not to have  observed pestilential  buboes,  carbuncles, or  an-
 thraces,  in  any  of their patients:  and,  we  are told  that,
though several were afflicted with phlegmonous tumours, end-
 ing in gangrene, others with erysipelatous vesications of like
tendency, and some with parotids,* yet they were not of that
kind  which appertains to  the true  plague, and which had been
described by Chicoineau,  at  Marseilles,  and  Samoilowitz, at
Moscow.
  In  looking for adequate causes  of  this epidemic, we  shall
readily find  them in the  situations,  and local circumstances
of Cadiz,f and the other towns  of  Andalusia,  in which it

   * Parotids have been repeatedly mentioned  by Lancisi, and others, as occurring in
 tbe marsh fevers of Italy, and they are sometimes observed in the yellow fever of the
 West Indies  and North America.
  f The town of Cadiz is upon a point of land,  which, by advancing into the sea,
 forms within itself a spr>cious harbour. The external part of the city, or that which is
 nearest the ocean, is chiefly built on a rock, and is a little elevated.  But the part
                             39 
30b'
prevailed.   About  the  end  of  July,  the epidemic  made  its
first  appearance  in'the  Barrio  of  Santa  Maria,  inhabited
chiefly by New  Castilians, who  were generally poor and  la-
borious,   and  it  soon  extended  itself to the  low  and damp

 which is eastward, and adjacent to the harbour, is placed on very low, damp ground,
contiguous to marshes.  Indeed, almost tbe whole country round the Bay is flat, low,
and swampy, and the sides of tbe harbour are, moreover, covered by salt pans.   An
intensely hot easterly wind blew constantly  in 1800, for six weeks, over the har*
hour,  and over tbe other sources of miasmata just mentioned, conveying the latter
directly upon the adjoining quarter of Santa  Maria, at the south-eastern side of  the
town, where the streets are narrow and filthy,  and where the epidemic appeared
first,  and continued longest.  Thence it extended itself westward, exactly in the di-
rection of the wind.
   Puerta Real, Puerta Santa Maria,  Rota, and the town of Isla,  (which last is sur-
rounded by  salt pans) adjoin either the  harbour or the bay of Cadiz,  and they all
partook of the epidemic,  as might be expected,  from their low situations, and other
circumstances.
   Not far from  Rota is the river Guadalquiver, on whose left or northern bank is
 placed the city of Seville, round which  the country, to a considerable distance, is so
 low, that, as Mr. Townsend has observed, (Travels through Spain, vol. 2, p. 353)
 " it is frequently overflowed, and, upon some occasions, the water has been eight feet
 high, even  in their habitations.   He  adds, p. 356, that  " the soil is rich, and being,
 at the same time  very deep,  its fertility is exhaustible," p. 357.  That, " in conse-
 quence of vapours and miasmata,  occasioned by  stagnant water,  and by frequent
 floods,  the inhabitants of Seville  are subject to tertians, and putrid fevers," (mean-
 ing tbe more violent marsh fevers.)  What  Mr. Townsend has  mentioned of  tbe
 soil  round  Seville  is true,  also of tbe  whole country along tbe Guadalquiver, be-
 tween that city and S. Lucar,  a space of twenty leagues; and, therefore, we need
 not wonder  that the towns and villages contiguous to this river should,  in all ages,
 have been noted for  tbe prevalence of  autumnal marsh fevers, called  by the Span-
 iards, Tavardillos, or Tabardillos, and resembling what, in  the West Indies, are
 commonly  named bilious  remittents.  These  Tabardillos,  indeed, were, in some
 extraordinary seasons, so  much aggravated in tbis part of Spain as to be deemed
 the  plague.  (See  Ray's Travels, p- 41G.)  Don Rodr. Armesto  informs  us, " that
 Seville is proverbially offered as an instance of annual  (autumnal) plagues,  where
 it never was thought necessary to establish rules of quarantine on  any description
  of vessels."  (Medical  Repository,  2d Hexade,  vol.  5, p. 131,  and seq.)  In an
 ancient work, by Doctor Juan Ximenes Savariego, printed at Anteguera, in 1602,
 and  entitled Tratado de Peste,  1  find tbe  authour mentioning,  at p. xvii. as the
 cause of the fever which he calls Tavardillo, pools of stagnant and corrupted water,
 like that of  lagoons  and inundations of rivers, such as those of the Guadalquiver,
 at Seville, these late years.  (" Estangues de Aqua estanqua, y corrompida, como
  de lagunas, y inundaciones de  Rios, como las a  avido  de Guadalquibir en  Sevilla es-
  tosanos passados.")   He adds,  that persons ill of this fever do not generally  give 
307
streets of  Sopranis  and  Boqueta,  (near the  sea gate) and
thence to the quarters of Ave  Maria, and St. Antonia; and
having,  by this  time,  attracted  the notice  of government, a
meeting of physicians was convened,  who, after consulta-
tion,  unanimously agreed in reporting the disease to be a
simple  synochal fever, and not contagious.   Indeed, the epi-
demic was so mild (as often happens  at  the early appearance
of marsh  fevers witliout the  tropics) that even  at  a  third
meeting of  the physicians, several of them  declared they had
not lost  a  single patient by the reigning disease, and many
asserted, that of two or three  hundred cases, not more than
one or two  had terminated  unfavourable.  At this  meeting,
however, a student  of the  College of Medicine, at  Cadiz,
Friar Juan  de Acosta, belonging to the Convent of St. Juan
de Dios, who  had  seen most of tlte  sick brought into  the
Hospital of  this convent,  (adjoining  the  Barrio of  Santa
Maria,)  declared the  fever to  be very  acute, and of a very
bad sort, but concurred  with  the otliers in  thinking it  not
contagious.*
   Some days after  this, says Dr. Arejula, " we, physicians
in Cadiz,  began to  observe these fevers more seriously and
attentively.   It was natural that, having called them gastrico
bilious fev ers, void of  contagion,  we  should  also  believe  the
cause of them to be general, existing in the town; we recol-
lected, according to  the text of the great Hippocrates, and  the
observations of succeeding physicians, that much rain in win-
ter and spring, followed  by great heat  in summer,  like that
which had been experienced at Cadiz, was the cause of fevers,

it to  their attendants.  When we consider how unusually the rains  were  pro-
longed throughout  this part of Spain, in the spring of 1800, and tbe inundations
which  must have been thereby produced, together with the intensely hot and dry
weather, which succeeded  and lasted for a long time, we certainly need not be at
any loss respecting  the cause of this epidemic.
   * See " Breve Descripcion de la Fiebre Amarilla padecida en las Andalusias,"
&c. or a Brief Description of tbe Yellow Fever which prevailed in the Andalusias,
fxc. from  1800 to 1804inclusive, by Don Juan Manuel de Arejula, printed in 1806,
 at the Royal Press in Madrid, 8vo. pages lo4. 156. 318. 
308
 epidemics, and  the plague.  We thought, moreover, that we
 had found another powerful cause in the kennels (Cancrias)
 occupying the  middle of our streets,  and receiving all  the
 foul water, and excrementitious matters, which we considered
 as sources of carbonic, hydrogenous, ammoniacal, sulphuret-
 ted-hydrogenous, and other unwholesome gazes."  It seems,
 however, that, notwithstanding these opinions, tbe physicians
 of Cadiz, (as those of  other places have often done)  soon lost
 sight of the effects of miasmata, or rather ascribed these effects
 to a supposed contagion, extending from the bodies of the sick
 to the well.  They observed, says Arejula, " that the person
 nearest tbe sick was commonly the first attacked with the dis-
 order, and that, if it got into a house, all had  it in a few days;
 that it proceeded from one to the next house,  and thus extend-
 ed the length of a  street;" and this course, which, however,
 was neither constant nor uniform, they considered as  a deci-
 sive proof of contagion ; though, supposing what  must have
 been  true, that  where the disease  made this  progress,  the
 houses and persons were within  the reach of miasmata, the
 facts in question might be as well explained without, as by the
 operation of a contagious influence.
  At  p.  248, Arejula  endeavours farther to account for the
 spreading of the disease, by stating that the New Castillians,
 among whom the fever began, and who, being greatly attached
 to the second person of the trinity, and members of  a frater-
 nity, bearing his name, and  believing that  their devout  and
fervent supplications to him,  would stop the  epidemic, deter-
mined upon making a solemn procession,  with his image, and
 obtained permission for that  purpose,  from  the magistrates,
though not until they had had recourse to menaces, which in-
timidated the government.  The procession accordingly took
place,  about  the 5th  of  August,  an immense  concourse  of
the people joining therein, and it lasted seven hours;  during
which time, these unfortunate people were exposed to the rays
of a burning sun, and, under great fatigue, to all the mental
agitations which religion or fear  could produce;  and  this 
309
chiefly in those parts of the town  where the marsh miasmata
were most powerful. That a procession, in such circumstances,
should produce a great extension of the disease can hardly be
doubted; though  not in the way which Arejula, and others,
have supposed ; for,  as the well, and not the  sick, joined in the
procession, personal contagion was not likely to be  present
and active among them.  Similar processions were continued
almost daily, and, undoubtedly, with very mischievous effects,
until Don Tomas de Morla, as Captain General of Andalusia,
assumed the government, and put an entire  stop to them; but
the disease had then nearly reached its full extent.*
   At Seville the fever first appeared in the low, unwholesome
suburb of Triana, consisting chiefly of narrow unpaved streets,
adjoining the Guadalquiver, but on the side  opposite to the
city.   It next appeared in another unwholesome suburb ; that
of Los Humeros, also adjoining the river, and  only separated
by it from Triana;  and thence by  the middle of September,
it had extended nearly over the whole city, occasioning, be-
fore it terminated, the  deaths of fourteen thousand,  six hun-
dred,  and eighty-five persons therein.
   When the physicians at Cadiz had  mistaken the effects of
miasmata for those of personal  contagion,  (a mistake which,
in that crowded city, and with its numerous processions,  &c.
it might  have been difficult to avoid) the next step was to
ascertain its origin.  I  do not find that, on any former appear-
ance of  Yellow Fever,  in that city, its introduction, from any
part of America,  had ever been suspected, or that any precau-
tion had  ever been employed for its exclusion : though, if it
had been a contagious disease, such precautions  would  have
   * Don R.  Armesto  says the evil was augmented by making public fires in the
 Streets of Cadiz to purify the air, and thus producing an artificial heat,  which pre-
 cluded  the salutary effect  that might have sometimes resulted from a slight refresh-
 ing breeze : that it was augmented also by the dread and  panic of reported conta-
 gion, and by numerous acts of religion, e. g. by tbe funeral processions  which suc-
 ceeded every death ; by the " holy images, relics,  and sacramental objects which
 were incessantly offered to the eyes of a dejected  people," and by  " thundering.
 preachers solemnly warning every one of his approaching dissolution." 
310
 been  highly expedient,  considering how often the galleons,
 and other ships from Porto Bello, Havanna, and  other  parts
 of the AVest Indies, had been attacked by the disease, in  re-
 turning thence to Cadiz; as happened to  the  squadron, &c.
 under Don Lopez Pintado,  mentioned at p. 337.
   But in the summer of 1800,  the government,  as well as the
 inhabitants, of Cadiz, appear to have adopted the belief of an
 importation of the supposed contagion from America, and a
 ship,  called the Dolphin, belonging to Baltimore,  was gene-
 rally and decidedly selected and accused as having been the ve-
 hicle of  this mischief: and reports were fabricated, by which
 three persons were stated to have died of Yellow Fever on board
 the Dolphin, during her passage, and what had been supposed
 to be the first cases  of the fever at Cadiz, were declared to have
 occurred in different individuals, who had all directly communi-
 cated with the Dolphin,  or some of her crew;  and other sai-
 lors belonging to the same ship were said to  have found their
 way  up  the Guadalquiver, through  St.  Lugar, (in  which
 town however, the  disease did not appear  until the middle of
 September) and, by  lodging  in the suburb  of  Triana, at
 Seville,  to have produced the Yellow Fever there, some days
 before its appearance at Cadiz.  These stories, in point of  de-
tail and seeming accuracy,  were such  as Dr. Haygarth, by
his letter of the 23d of May, 1799,  solicited Professor Water-
house to procure for him respecting the importation of Yellow
Fever  into Philadelphia,  &c. and they were circulated gene-
rally,  and with great confidence,* so that Don Pablio Vali-
ente, Intendant of  Cuba, who had chartered the Dolphin, to
bring himself and his family to Spain,  was, notwithstanding

  * These stones were adopted, and most of them published, in substance, by Pro-
 fessor J. N. Berthe, of Montpellier, who was sent by the French government,
 with two other physicians  (M. M. Pierre Lafabric, and Victor Broussonet,) into
 Spain, to ascertain facts and collect information,  respecting the epidemic of Anda-
 lusia, in 180O, of which he has given a Precis Historique, in a large volume, Svo.
 printed at Paris, in 1802.  Some account of the stories, relating to the ship Dol-
 phin, may be found at and between p. 52 and 59.
i 
311
his rank  and connexions,  arrested upon a criminal charge,
tried before the Royal Audienza, at Seville,  and,  after a full
investigation,  and eleven  months  imprisonment,  fully  and
honourably acquitted of having introduced the Yellow Fever
at Cadiz ;  and he was,  probably,  as  a compensation for the
injustice he had suffered, afterwards promoted by the govern-
ment.   In  the course of this prosecution, it was juridically
proved, that the Yellow Fever had not appeared at the Hava-
na, whence the  Dolphin sailed in May, 1800, until some time
after her departure; and though she touched at Charleston on
the 2d of June, and sailed thence on the 10th of that month, it
was, (in consequence of an application from the Spanish govern-
ment,) certified unanimously, at an extraordinary meeting of
of the Medical  Society  of South  Carolina,  on the  5th  of
April, 1801, (twenty-two respectable physicians being present)
that " to the best of their knowledge, no Yellow Fever had
existed in that town, or in the Port of Charleston, prior to
the 20th of June, in the year  1800."   They also declared, on
the ground of specified facts,  their conviction that the disease
in question had  never been propagated by contagion.   It was
also proved,  and particularly by the testimony  of Don Jose
Caro, a Spanish physician, who had returned as a passenger
on board the  Dolphin, and was  examined,  on  oath,  by the
judges at Seville, that the diseases,  of which the  three sai-
lors* had died on board of that ship, were not of  the nature of
Fellow Fever,]  but  different  diseases, of which an account
was given.   It was,  moreover  proved, that no  symptoms of
the Yellow Fever had appeared in any person on board the
Dolphin, and, consequently,  that the  disease could not have
been introduced by  that  ship.  Dr.  Arejula has,  therefore,
deemed it proper to reject the stories concerning the Dolphin,
and to confess that it was impossible  to ascertain whence the

   • Professor Berthe, at p.  340 of his volume, has multiplied these deaths to three
 times three, or nine.
   f See Dr. Pascalis's Account of this Prosecution, &c. in the New York Medi
 cal Repository, vol. 9 p. 386, 7, and 8. 
312
 epidemic was derived.   He, however,  represents it as having
 been spread by contagion from  Cadiz, to the other  places
 where it prevailed, and,  as having been exactly similar to the
 Yellow  Fever of America, (seep. 153) in which bis opinion
 agrees with that  of Professor  Berthe,  Dr.  Gonzales, and
 Other Spanish physicians, by  most of  whom it  is now called,
 " la Fiebre Amarilla,"  or the  Yellow Fever.
   After the treatment which Don R. Armesto and his publica-
 tion underwent,  it can hardly be expected that any Spanish
 author would openly profess to disbelieve the contagious na-
 ture  of this epidemic, or  that  I  should  be able  to adduce
 Spanish authorities to support my owrn  opinion on that point,*
 and  I shall, doubtless be  thought to  have done  enough, if,
 availing  myself of the facts  asserted or admitted (for other
 purposes)  by those who  represent the disease  as being  con-
 tagious, I demonstrate the  contrary from these very facts.
   Among the facts in question, one which has  been much in-
 sisted upon by the contagionists, and particularly by Professor
 Berthe, is what may be  called  the Geographical Progress of
 the disease, which, though  readily explained, by supposing it
 to proceed from miasmata generated  in particular  situations,
 and wafted in one direction  by a long-prevailing wind,  is
utterly inexplicable upon the supposition of its resulting  from
personal contagion, because, in great  cities, men do not  al-
 ways communicate,  in  the slightest degree, with their next
 neighbours, and they  never  communicate exclusively  with
these, but very often  with persons  at considerable  distances,

  * Don Armesto is not the only person who has been  punished in Spain for ex-
 pressing his sentiments on the subject of Yellow Fever.  Doctor, now  Sir .lames
 Fellows, who went from Gibraltar  to Malaga and  Cardiz, in order to procure in-
 formation on this subject, after mentioning, in a letter to me,  (dated Algesiras
 Bay, February 27, 1806) the obstacles which he had encountered, says, the great-
 est " was the mystery and secrecy with which all the information I obtained was
 enveloped."—I found the Spanish physicians very willing to afford me information,
 but I could not get them to tell me all they knew; for, in tlds country, Doc-
 tors,  who give their opinion  too freely, about the nature of a disease, are banished,
 as was the case of one at Malaga, and another at Carthagena."

                      % 
313
 and  in  various  directions, by whom the effects of personal
 contagion would soon  be felt, and spread on all sides.  " It
 was distinctly observed, says Professor Berthe, at p. 74, that
 the malady affected to seize, with  scarcely any  interruption,
 all the houses which were situated on the same side of a street,
 and that  it rarely passed  over  to the other side, where the
 streets were wide, and well aired.  In some parts of the town,
 (he adds) the distemper has been seen to stop, as  it  were, for
 a time, as soon as it had reached to houses standing in a pub-
 lic square, and even to retrograde, with respect to the direction
 in  which it had previously advanced, by appearing in the ad-
joining houses, rather than in those which were separated by
 the breadth of the square."   These Mr. Berthe has strangely
 conceived to  be clear indications of the contagious nature of    M
 the disease;—as if the next neighbours, on the same side of a
 street or  square, had been the  only persons in all Cadiz  who
 visited, or approached, each other.   And here I must remark,
 that,  though the *professor represents his supposed contagion,
 as so feeble and inert that it could not make its way from one
 side of a street or square to the other, he has most inconsist-
 ently described it in  several parts of his work, and particu-
 larly in his Letter to the French Ambassador, at  Madrid, as
possessing an incalculable activity.  And it is by this, and the
supposed rapidity of its extension, that he endeavours  to  ac-
count for the nearly simultaneous appearance of the disease at
places so distant as Cadiz, Seville,* and other towns and vil-
lages  along the  river  Guadalquiver; an effect which could
have been produced only by miasmata becoming abundant in
those low situations, and  acquiring maturity nearly  at the
 same  time.
  Another proof of the non-contagious nature of this epidemic
is derived  from  the fact, (admitted  by Professor Berthe, and
all the contagionists) of its not having  spread in the towns or
  * Dr. Pascalis asserts, that the epidemic first broke out " on the 23d of July,
 in the  suburb of Triana, in Seville,  a little before it was noticed at Cadiz."  See
 Medical Repository,  vol. 9, p. 389.
                            40 
314
villages, which are at  a small distance from the low grounds
of the  Guadalquiver, particularly the elevated village of Al-
cala de los Panaderos, which is distant only  three  or four
miles from Seville, and takes  its name from the  occupation  of
its inhabitants, who are Bakers, and  make all the bread con-
sumed  in Seville.  '" There was,  consequently,"  says Mr.
Berthe,  (see  p.  157,  8.)  " a  daily  communication  between
Alcala  and Seville,  through a considerable number of indivi-
duals,  and  this  communication  was  never  interrupted, not
even during the time when the distemper was committing the
greatest  havoc in the town;"  and when, out of a population of
80,000 persons in Seville, above 76,000  were attacked by the
Yellow Fever.*  He adds, that,  according  to  the  report  of
the physician at  Alcala, twenty-four persons had had the dis*
ease in that village, who all brought it  thither; (" l'ont  ap-
porte du dehors") that  eighteen  of these had died;  and yet,
that in  no  instance had  the fever been communicated there,
from one individual to another.^  Professor  Berthe also men-

  * When  Sir James Fellows returned to England, in 1806,1 mentioned to him,
 what Professor Berthe had stated respecting Alcala,  and he  confirmed the stater
 ment, as a tact, of which he had been informed, on good authority, in Spain ;
 adding, that the like had happened, in 1804, at  two  villages near Malaga, prin-
 cipally  inhabited by  Bakers,  who supplied that city with bread;   the persons
 who brought and  delivered the  bread at Malaga, sometimes remained there all
 the following night, and, in that  case, were afterwards very commonly  attacked
 with the Yellow Fever, at their own houses;  but the fever was never propagated
 by tliem to any other person.   He made a visit to one of these villages, (Turriano)
 situated  upon the declivity of a hill, westward of the  Agual Medina, about five
 miles from Malaga—a situation which,  being like Alcala, removed  from all pro-
 bable  sources of marsh effluvia, may account  for the non-appearance of contagion
 in those who sickened there, much better than a supposition mentioned by  Sir
 James,  of its having resulted  from the burning, in the Bakers' ovens, of certain
 aromatic herbs, collected in the mountains.  Had they burnt all the spices of the
 Molucca islands,  I am persuaded they would have proved as useless, for any such
 purpose, as the fires made  in the streets of Cadiz were found to be, in 1800.
   f M. Berthe endeavours to account for the  non-communication of the disease at
 Alcala,  by supposing that the fires of the Bakers' ovens had  produced a greater
 ventilation in that  village, though, in another place, he acknowledges that the fires
 made in Cadiz, to produce  a similar effect, were not of the least benefit; and, in
 towns where the  true plague has become epidemic,  the Bakers, instead of being 
315
tions the small town  of Scipiona,  as one in which the fever
did  not  appear, thougli but a  few miles  from  San Lucar,
where  a sixth part of the inhabitants died  of it.   Scipiona
had, however, the advantage of being higher and  at a greater,
distance from the low grounds adjoining the river. M. Berthe
also  mentions  the large elevated town  of' Medina  Sidonia,
between Cadiz and Gibraltar, at the distance of eight miles
from the salt pans of La Isla de Leon, as another  to which the
epidemic did not extend.*
 .  Another fact,  stated by  M. Berthe (at p. 69) on the autho-
rity of a principal magistrate at Cadiz, (Le Procurador Mayor
Don Miguel de Irribaren)  is, that,  on the day after the great
procession, which I have mentioned at p.  309, the  number of
sick  was increased  by between five and  six thousand new at-
tacks :  and these are  supposed to have been the  effect  of con-
tagion  received during the procession.  But it is utterly impos-
sible that  any contagion  yet known, should have operated so

 exempt, have been found the greatest sufferers.  This is mentioned, in regard to
 the plague at Toulon, in 1721.  See Traite  de la Peste, 4to. p. 49,  50.  In my
 copy of this work, there is a marginal note to this part of it, in the hand-writing of
 Br. Russel, in which he states, that "Bakers were remarkably  subject to the
 plague at Aleppo, not from any peculiarity in the contagion, but  from circumstanr
 ces favourable to infection."
   * It ought to be mentioned, that in the following  year, 1801,  when the Yellow
 Fever is understood  not to have  appeared in any sea-port town of Andalusia, it
 prevailed, to  a considerable extent, in a particular quarter of the inland town
 of Medina Sidonia, and as may be presumed, from the agency of marsh miasmata,
 rendered active by causes which I am not able to explain, not  being sufficiently
  acquainted with  the local  circumstances of the place,  and the state of its atmos-
 phere, at that time.  There was, however, no suspicion of any new, importation, of
 contagion, and even if the  epidemic of the  preceding year at Cadiz, &c had re-
 sulted from contagion, and that contagion had been capable of subsisting in a dormant
 state, over the winter, and becoming active in the following summer, the effects of
 its activity would, doubtless, have been manifested in the places  where there had
 been most of it, and where its ravages  had been greatest in the year  1800, and
 not in a town where it had not  existed.  On that occasion, however, guards were
 employed to obstruct all communication with the sickly part of Medina Sidonia,
 and  as the miasmata could only reach to a certain extent, the fever did not pre-
 vail in  those quarters which were too remote, and the guards  naturally had the
 credit of having kept the epidemic within certain limits. 
316
 suddenly, though it has been ascertained that marsh miasmata,
 in particular situations, do sometimes produce fever  within
 even less than  twenty-four hours;  and that these new casts,
 as well  as the epidemic,  generally resulted from the latter
 cause is abundantly  manifest  from  its  similitude  in every
 respect to what have been heretofore noted  and ascertained to
 be the peculiar characteristics  of marsh  and Yellow  Fever;
 especially tbe following:
   1st. Its having been preceded by that state of weather which
 notoriously renders marsh effluvia most abundant and noxious,
 That this w as the  case, to  a remarkable degree, is admitted
 by all: and Professor Berthe was  so  sensible of it,  that,  at
 p. 366, he does  not scruple to admit, that if no contagion had
 been introduced at Cadiz, in 1800,  the causes of disease there,
 and in other parts of Andalusia, were   such  that a  violent
 bilious epidemic, or marsh fever, must have been produced by
 them, similar to that which was,  at the same time, produced
 by these causes at Cette, and other places along  the Mediter-
 ranean coast.  He is, indeed, not willing to consider the fever
 at the latter places as exactly similar to the epidemic of Cadiz,
 &c. because he wishes to have it believed, that contagion had
 co-operated with the ot'her causes in producing this epidemic,
 and he represents the fever at Cette, as not having been con-
tagious.   But, after attentively considering his  owrn descrip-
tions of both,  it is evident that,  at the utmost, they could only
have differed  in  (a small) degr.ee, and not in their nature.*
   2d. By the greater prevalence and mortality  of the  dis-
ease, in  situations nearest to the sources of marsh miasmata.f
  •Don Kodr. Armesto considers the Mediterranean fever as resembling that of
 Cadiz, and says, the same epidemical constitution of the  atmosphere extended along
 the Mediterranean, as far as Leghorn and Genoa, adding that, in the latter, " where
 150 persons died every day of Yellow Fever, no  American  vessel  could be accused
 of importing it, as Genoa was, long before,  closely besieged by  land, and blockaded
 by sea." ,
 ^ fDr. Berthe, for himself and his colleagues,  makes a general admission of this
fact at p. 161.  " The epidemic, (says he) was singularly rapid in its progress, and
 alwuys most destructive,  in low and humid situations."  « I might, (tie adds) cite
 on this subject the ravages committed by  the distemper in  several; villages built on 
317
This was strongly  manifested in the Barrio of  Santa Maria,
which is stated, even by Mr. Berthe, to have been " le  pre-
mier  Foyer," of the disease, which,  (he adds)  in  that spot,
produced " une mortalite effroyable,"  (see p. 162.)   The ma-
lignity  was,  indeed,  such,  that  the  proportion  of  deaths
among those  who  were  attacked,  exceeded,  by  ten times,
that of some other situations.  Here the  disease  not only be-
gan first, but lasted, after it had ceased  in all other parts of
Cadiz.  A  similar difference, in  respect of  situation,  was
observed at Seville, where, according to M.  Berthe, (p.  103)
only one in  eighteen of the sick died in the wider and more
elevated streets, while, in those  which were damp and low,
as in Triana, and Los Humeros,  the mortality amounted  to
one-third, and  even to  one-half; and this difference was ob-
served, not only in regard to  streets, but to single Iwuses, in
some of which, from  their situation, the disease  was much
more fatal  than in others.   Such  wide  differences would not
have accompanied a disease produced  by contagion.
  3d.  By  the  influence of  extreme hot  weather, in exaspe-
rating  this  epidemic,  and  of cold  wreather,  in mitigating,
and finally  producing  a cessation  of it.  These  effects were
generally observed; and  Professor Berthe  has  mentioned
them distinctly,, and in very strong terms,  particularly at
p.  154 and p.  324.
  By the marked severity with which it universally attacked
all  strangers from  colder climates, particularly those from

■Jie  banks of the Guadalquiver, and compare them with the very different results
which it had in other villages at a small distance, but farther from the river, or stand-
ing  on rising ground, at a greater or less elevation.  We have procured the most ac-
curate accounts in this respect, which it is useless to mention in detail, as they all re-
semble each other."  This is in exact conformity with the experience of former
times.  Dr. Lecaan, who, in the reign of Queen  Anne, was physician to a British
army sent to Spain,  in his " advice" to that army, p. 5, says, " It is generally obser-
ved, that all over Spain, dwelling houses or towns built near any riverside are al-
ways unhealthy, and much worse near a marshy ground, where fevers or ag-es are
very common,and more frequently mortalov difficult  to cure thanin any other part
of the world" 
S18
England, Germany, and Prussia, as specified by M. Berthe,
at p.  175, 323, and those from Canada,  as mentioned in the
publication made by the  Spanish government.   And, on the
other hand, by its invariably sparing negroes,  Creoles,  and
persons  who,  after residing for  some years  in situations be-
tween the tropics, had recently come from them,  as is  men-
tioned by Professor  Berthe, at pages 166,  7,  8,  and 9;  also
p. 323.
   With  all  these prominent features, it is impossible not  to
recognise  in  this epidemic, a marsh  or Fellow Fever, and
consequently,  a fever destitute of  contagion.
   A  similar fever less violent, and  much more limited in  its
attacks, occurred again at Cadiz and Seville, in the  months
of August and September, 1801,  and, for some weeks, excited
 considerable alarm ; but the weather proving to be neither so
 hot nor dry as in the preceding year, the fever did not increase,
 and w as finally deemed a Tabardillo,*  or bilious  remittent,
 such as occurs to a greater  or less extent, almost every  year,
 in the southern  parts  of Spain, as  well as  on the  coast of
 Barbary.
   Though the Yellow Fever had, in the year 1800, prevailed
 at Malaga, and some  other Spanish  towns on  the Mediter-
 ranean  coast, it was with much less violence and  mortality
 than in Andalusia.   It recurred, however, at the first of these
 towns,  with great malignity, in  1803, so  as to occasion  the
 deaths  of  12,000 persons :  and,  in the following year, it pre-
 vailed  there  again with almost  unexampled violence and fa-
 tality ; it being computed that more than twenty-six thousand

    * If I am not mistaken, the Tabardillo (though ©ften used in a more general sense
   strictly means the fever, which Burlet, (in his Dissertation sur les Maladies des Es-
   pagnols, Ann. 1714,) has named Tritseophia Syncopalis ; having paroxysms which re-
   turn every day, but correspond alternately with each other, as in the double tertian.
   Rivers'ms calls it Tertiana maligna pestilens.  It  is said not unfrequently to prove
   mortal at the second or third paroxysm. Dr. Pascalis says that, during the epidemic
   of 1800, (lie Spaniards,  not being aware of the absolute unity of the disease, consider-
   ed the milder cases of it as Taberdillos. See Medical Repository, vol. 9, p-  379. 
319
 of the inhabitants of Malaga,  died  in  that  summer and au-
 tumn, of this fever.
   In 1804, as  well as  in the preceding  year,  this  epidemic
 appeared first, and prevailed most generally and destructively
 in a low Suburb,  called  the  Barrio  de Percliel,* and in other
 contiguous low parts of the  town, liable to great humidity by
 inundations, and percolations of water from the river Guadal-
- medina.  And, as the  summer  of this  year, in the south of
 Spain, France, and Italy, resembled, and even surpassed that
 of 1800, by its excessive heat, and great want  of rain,  so the
 Yellow  Fever  prevailed,  not  only  in  Malaga, but  Cadiz,
 Gibraltar, Carthagena, Alicant, and even as  far eastwards as
 Leghorn, and  in all nearly at the same time.
   It  seems, however, to have appeared a few days  earlier at
 Malaga, than at  any of the other places, probably because,
 from local circumstances, the heat of this city  (and especially
 with  the Terral, or land wind)  is often  greater than  in  any
 other part of  Spain.   (See  Carter's journey from Gibraltar
 to Malaga, vol. ii. p. 406.f)

   * Malaga is situated at the foot of a mountain, and in a very low valley, through
 which a stream passes, called the Guadel-Medina.  This is properly a torrent, which
 is sometimes nearly dry, but sometimes is so full as to overflow its low banks, and
 inundate several parts of the town on one side, and the whole of the suburb called
 tbe Barrio  d' Perchel, situated on the other side.  I have been informed by Sir
 James Fellows, who visited Malaga in 1805, that the sites of the houses in this su-
 burb, and in many parts of tHe town, are from two to three feet below the bed of the
 river; and that, when  the stream is  full, the water enters into all the lower apart-
 ments copiously.
   -{- He tells us at the next page, that in 16S7, " 20,000 inhabitants of this city died
 of the plague, which visited them again twelve  years after and carried away the
 greater part of the citizens."  Probably this plague was an epidemic Yellow Fever,
 like that of 1804.   The only objection to this supposition ft, that Mr.  Carter men-
 tions the plague of 1637, as appearing in the month of May,  which according to the
 old style then used, would have extended to the 10th of June.  But an  extraordina-
 ry concurrence of circumstances has, in that part of Spain, sometimes produced in-
 tensely hot weather, even at an  earlier period.  The like happened at Charleston,
 So ith Carolina, in the year 1732, when a most violent and destructive Yellow Fever
 ap-u-ared there in the month of  May, though Uiat disease commonly does not begin
 to prevail epidemically in that city till August. 
320
   Early in August, the deaths had  become very numerous at
 Malaga, and had  produced great alarm : but a diminution in
 the heat of the atmosphere having lessened their number;  the
 physicians, on the 14th of that month, subscribed a certificate,
 declaring that  " no epidemic then  existed  in  Malaga, and
 that the disease which had appeared, was only a sort of inter-
 mittent fever of a malignant character,  similar to that which
 prevailed in other parts of Spain ;  and that its malignity was
 already so much abated that only five out of twenty then died,
 though, at its commencement, it had proved fatal  to fifteen
 out of twenty!"  (a strong proof, indeed, of malignity!) It
 happened, however, that almost immediately after this certifi-
 cate, the weather again became intensely hot,  and the deaths
 increased so rapidly, that, on the 21st, they amounted to 148
 in that single day.  The fever was then deemed not only con-
 tagious, but pestilential; and effectual measures were unfor-
 tunately taken  to cut off  all communication between  tbe city
 arid the country,  by which the miserable citizens were com-
 pelled to  remain  exposed to  the morbid exhalations, which
 caused  the disease, and  ultimately to perish by it,  (as  the
 greater part  of them  did)  and, in the mean time, they were
 deprived of the necessary  supplies of food.
  As the disease  had made its first appearance this season at
 Malaga, and as no  body ventured to doubt of its contagious
 nature, all the other Spanish towns (fifteen  in number, besides
 villages)  where it soon began to rage, were presumed to re-
 ceive the contagion from the former city ;* and (which is per-
haps, still more extraordinary) Arejula,  who  admits (p. 153)

  * Dr. F. Pascalis meations (Medical Repository, vol.9 p. 391) that the physician
 who, at the beginning of the epidemic, in Malaga, in 1804, first announced its true
 character, "became so disgraced as to be compelled to exile himself.  In three days
 he arrived in Cadiz, where bis servant soon died with Yellow Fever "  This happen-
 ed exactly at the time when other sufficient causes had rendered the miasmata ac-
 tive at Cadiz, and, the Yellow Fever soon becoming prevalent, as in 1800,  it was as-
 cribed to this servant, and, of course, to contagion, not miasmata, received by him at
 Malaga. 
321
 that this was the true Yellow Fever of America, pretends that
 the contagion of it was introduced at Malaga, by two brigs which
 entered that port, not from America, but from Marseilles, on
 their way to St. Domingo ; so that the deaths of 120,000 per-
 sons by this disease, during that year, in Spain only, are thus
 derived from  a French port,  where  quarantine  regulations
 are  executed with the great exactness, and where no such dis-
 ease existed.  But, after having so often proved that this fe-
 ver  is void of contagion, and incapable of importation, I shall
 not  be  expected  seriously to  examine this  charge  against
 Marseilles, nor the allegations respecting other places  said to
 have become infected by sommunicating with Malaga  ; all of
 them,  so far as I have  been able to ascertain their local cir-
 cumstances,  having had  within  themselves  such sources of
 marsh miasmata,  as  in such an extraordinary season might,
 with the experience of former years, have been expected to
 prove  highly morbific*  Instead, therefore, of exhausting the
 patience of my readers, by describing sources of  marsh mi-
 asmata  in Spanish towns, where their existence  has  been
 proved by the frequent recurrence of marsh fevers, I will pro-
 ceed  directly to a place where these sources are less obvious,
 I mean
                         GIBRALTAR.
  And here it is to me a matter of regret, that in  describing
the situation, and local peculiarities of this interesting spot, I
I am, in regard to  many circumstances, compelled to rely on
my own  observations, made at times, when,  not  foreseeing

  * Carthagena, besides other sources of miasmata,  has within about a quarter of a
 mile of its bastion, a very extensive swamp, called the Almojar.  Mr. Townsend, at
 p. 137, of the 3d volume of his Travels in Spain, says of the diseases of  Carthagena,
 that  " the  most endemical are  intermittent and putrid Fevers.  These arise from
 thep'oximity of the extensive swamp, already  mentioned, containing many hundred
 acres, which might easily be drained, so as to produce the most luxuriant crops."-—
 He adds, " in the year 1785, during the three  autumnal months, they lost 2500 per-
 sons, and, in the. succeeding year, 2300 more; yet the Almojar remains undrained."
 To  these deaths may  be added 14,940 others, produced in 1804 only, by the same
 marsh fever, aggravated into the form of Yellow Fever.
                              41 
322
their connexion with this subject, my  examinations and in-
quiries were not so minute and particular as they would other-
wise have been.
   The town of Gibraltar is built upon a narrow strip of nearly
fiat ground, extending  along the foot  and western side of a
stupendous rock, (in some places between  2000 and 3000 feet
high) which, at its summit, is very sharp, and runs as a longi-
tudinal ridge, nearly a  mile and a half from north to south.
   This rock,  on its eastern side, forms an abrupt and almost
perpendicular descent, from top to bottom; but, on the western
side, towards the town, its  declivity is but moderately steep,
presenting,  according to my best recollection, an  inclination
of about thirty-five degrees.   So that all the rain  discharged
from the clouds, attracted and arrested by the summit of the
rock, and falling upon a declivous surface of, I  believe, at
least 400 acres, excepting what escapes by evaporation, or is
absorbed by  the scattered palmettos, grasses,  and plants
which find means to grow on the rock, must descend to the
town in addition to that which falls directly upon its own sur-
face.  But a part of this rain water is intercepted  at the bot-
tom of the  declivity by a large  ancient stone Aqueduct, five
feet deep, and covered by an arch ; having on that  side, which
is nearest to the acclivity of the  rock,  a considerable  number
of apertures, called weep holes, through which the  descending
water, after percolating through the sand, enters the Aquae-
duct,  for the  Use of the garrison.  This Aquaeduct begins
about half way between the south portgate and the new bar-
racks : and is continued close along the side of the road, into
the middle of the town.  It, however, now receives less water
than formerly, because  General O'Hara, to form a parade for
exercising the troops, caused a ridge of sand which ran paral-
lel with the Aquseduct,  and  through which water was perco-
lated into it, to be levelled and covered by a mixture of slate,
hard clay, kc. which have formed an impenetrable  surface, so
that a considerable portion  of the falling  water,  which used
to find its way-into  the Aquaeduct, now runs over  it, into the 
323
 town.  How far this change may have contributed to increase
 the quantity, or virulence of the miasmata, in the summer of
 1804, I am unable to decide.
   The whole Peninsula of Gibraltar consists of a rock, co-
 vered more or less, in  particular spots,  witfr earth.   Conse-
 quently, the town itself is  placed on the  rock which extends
 even to the water's edge ; and this being nearly impenetrable
 by water, must, in that respect, produce the effect of a  sub-
 stratum of hard clay, and hinder the escape of moisture,  ex-
 cepting only those excesses of it,  which the soil cannot absorp
 or retain,  and which must, consequently, descend to the ocean,
 whose level is,  I believe, thirty or forty feet below that of the
 streets,  running generally with a  small descent  towards it.
 The town, therefore, though elevated  in  regard to the sea, is
 very low when  compared with what may be called the moun-
 tain behind it:   and, as the great quantities  of vegetable and
 other matters constantly brought into the town,  to supply the
 various wants of the garrison, and the other numerous inhabi-
 tants, must even from their refused or useless  parts, afford
 matters sufficient (with water) to produce abundant miasmata,
especially when assisted by the fragments of vegetables growing
upon,  and frequently washed down, from the mountain,* we
might, I think,  very reasonably expect in that climate, and in
such  a situation, that marsh fevers would  sometimes become
prevalent.!  It  is, however, I believe,  true that agues do  not
often occur in  the town of Gibraltar; probably,  because in
ordinary seasons, the quantities of rain water which either fall

   * Sir John Pringle, in his work  on Hospital and Jail Fevers, (p. 46)  says, " I
 have observed, in a fixed camp, that the rottenness of straw concurred to affect the
 health of the men, as was visible by a general convalescenceupon ^hanging the ground."
   * I have already  referred to Dr. M'Lean's testimony that fatal  miasmata arise
 where there are no very certain appearances of marshy soil, and to the instances
 of this which he adduces from the fevers at Cape Nicholas Mole and St Mark's,
 Many others might be added to these, if necessary. Even Dr. Chisholm, at p. 122,
 of bis second volume, has mentioned a production of Yellow Fever, in 179S, at
 Fort Edward, in Martinico, by percolations of water,  through the sides of a bank,
 lodging under " the  floor of the barrack." 
324
directly upon the  town, or find their way into it, from the
declivous surface of the rock or mountain, are so great, as to
wash into the sea, the decomposing  organized matters con-
tained in the soil,  before they have had time to form noxious
miasmata,- and it seems to be only in seasons when there  is
but little rain for six or eight  weeks,  that such miasmata
can, in  Gibraltar, acquire maturity  and force  sufficient  to-
manifest themselves extensively.
  But, besides the materials necessary or conducive to the for-
mation of miasmata,  there is, at Gibraltar, sometimes a co-
operation of  causes suited to render them extremely powerful
and virulent, especially when,  as in 1804, an intensely hot le
vant or easterly wind prevails during a great part of the sum-
mer,  with  no rain excepting  a few slight showers,  just suffi-
cient for the extrication or evaporation  of these miasms in a
state the least diluted, or most concentrated with such a wind
intercepted by the perpendicular acclivities  of the mountain
on  its east  side,  the atmosphere of the town  of  Gibraltar
would remain nearly stagnant,*  and  the exhalations from the
earth, instead of being blown upon the ocean, would be left to
accumulate in the narrow streets,  and produce the most vio-
lent form of  marsh fever.   To these  causes, we may add the
great augmentation of temperature, occasioned by the  rays of
an unclouded summer's sun, reflected upon the  town, during
the hottest part of the day, from the  acclivities of the rock.—
Even the ordinary temperature of  the atmosphere in this town
appears  to be  very  great.  Dr.  Lind  (on Preserving the
Health of Seamen) says, " the heat at land, in Gibraltar,  ex-
ceeded that in the ship upon the  water, by eight or ten degrees
and also that of Oran in Africa,  by six degrees;" and  he adds,
" that the  common heat,  during the summer,  in the garrison

  * Dr. (Lind, on Preserving Health in Hot Climates, p. 117) writing of Port Maho,
 which is almost surrounded by high mountains, in the Bay of Mexico, savs, "the
 stagnated air  thence becomes so unwholesome, that men, after being there a  few
 days, are suddenly seized with violent vomitings, head-aehes, delirium, &c. and, in
 two or three days more, the dissolved mass of blood issues from eveiy pore." 
325
of  Gibraltar,  is  from 79°  to 87 degrees.   See p. 168.  We
need  not, therefore,  wonder, that though agues do not often
occur  at  Gibraltar,  the more violent forms of marsh fever
frequently prevail there, during  the summer and autumn,  as
is well known to be the case.
  The  late  Dr.  Donald Monro,  in his Observations  on the
means of preserving the  Health of  Soldiers,  vol. 1,  p. 23,
says, " at this place (Gibraltar) June, July, August, and Sep-
tember,  are  constantly hot,  and the two last sultry ;  and  in
these months the garrison, and inhabitants, are subject to bilious
and putrid* disorders ; but  new  comers  seldom  escape, and
have them in  a violent degree.
   This statement by  Dr. Monro, having been shewn by me to
Sir James Fellows, on the  3d of June, 1806, was by him con-
firmed, on the ground of his  own experience, at Gibraltar,  in
the preceding year,  and also on that of documents which he
had collected  there respecting the state of  health of the garri-
son in former years.
   Mr. Pym,  Garrison Surgeon at Gibraltar, and long a resi-
dent there, mentioned to me  on the 27th of November,  1808,
that, during the hot months, persons died there every  year of
fev ers, which, by his description,  resembled the bilious remit-
tent  or  Yellow Fevers of the West Indies ;  the patients often
becoming yellow  before death ; and, it appears from the 3d
volume of Dr. Trotter's Medicina Nautica,  (p. 420 and seq.)
that  a similar fever prevailed, to  a  considerable extent, at
Gibraltar, in the autumn of 1799.J

   * The words " bilious and putrid," as here used, were  apparently intended to
 signify fevers resembling the Yellow Fever of the West Indies, though, perhaps,
 less exasperated.  *
   f In the year 1766, orders from his Majesty being sent to the governors and com-
 manding officers at Gibraltar, Grenada,  Antigua. Jamaica, Senegal, and North Ameri-
 ca, " io transmit  a report of the most eligible season  for landing troops in each of
 their respective districts, so as to avoid, as much as possible, the inconveniences of the
 climate," answers were returned to this requisition by the several governors, under
 their signatures,  after proper consultations and inquiries: and a copy of these an-
 swers having been transmitted, by the Adjutant-General, on the 29th of May, 1809, 
326
   With such evidence of the morbid effects of marsh miasmata
 at Gibraltar,  there  can be no  doubt that, however produced,
 they often exist in that place, during the summer and autumn j
 and when, by the unprecedented heat,  and drought of these
 seasons in the year 1804, the marsh fevers of  Cadiz, Malaga,
 and other towns, but little removed from Gibraltar, had been
 converted into the most violent epidemical Yellow Fever, can
 it be surprising that this should also  have happened at the lat-
 ter of these places ?
   Many stories, contradicting and refuting each  other, were
 confidently propagated respecting the supposed introduction,
 at Gibraltar, of the contagion to  which this was by many at-
 tributed.
   Among  these stories, one derived it from Cadiz, by means
 of a Spaniard, named Sancbo.   Another from Malaga,  by a
 different Spaniard,  named  Santos.  Others designated indi-
 viduals,  with  different  names, from these  places,  as having
 done the mischief.  That some persons arrived, and sickened
 at Gibraltar, after having imbibed the  noxious exhalations of
 Cadiz, and Malaga, may be true, and, also, that this happen-
ed about the time when miasmata, similar to those which had
occasioned the epidemic in those cities, were beginning to op-
erate at Gibraltar, may also be true ;  but this is all that can
be said with truth.
  The accounts are almost  as  contradictory, in regard to the
particular  time and  spot at  which the first case or cases of
this fever appeared  in the town  of Gibraltar.  This contra-
diction, which could not have happened,  if the  disease had
originated from an  imported contagion, would naturally oc-
cur in  regard to an epidemic  arising  from miasmata, which
beginning to act, often at several places, and always in dit-

 to the army Medical Board, for the re-consideration, I copied the  following ex-
 tract, relating to  Gibraltar, (which  has also been noticed  by Dr. Monro) viz
 " Gibraltar, from  the middle of November to the latter end of March, the best
 time for landing,- June, July,  August,  and September, the  worst,- the garrison
 being wry subject in these months to bilious and putrid fevers." 
327
 ferent persons, about the same time, and  producing in them
 diseases of various degrees of violence, it  must have been
 difficult, (as it has been found to  be  in  New York,  Phila-
 delphia, &c.) to draw a line of separation, between the com-
 mon bilious remittent, and  that which, by being a little more
 severe, were mistaken for  a new fever;  especially as these
 marsh  epidemics commonly begin with  the milder  forms,
 and increase by almost insensible gradations.  Hence some
 accounts represent the epidemic in question as having first
 appeared at Gibraltar about the tenth of August,  and others,
 as  having begun about the 8th or 10th  of  September, and
 this in different individuals,  as well as  places.
   It appears, however, that the fever  began to attract par-
 ticular  notice in several houses near the governor's parade,
 a  little before   the middle  of September,  and  soon appear-
 ed in so many  others, that  it was found  utterly impossible,
 as might be expected, in  an epidemic  from such a  cause, to
 trace any sort  of connexion, in regard to its progress', and
 though  most of my information has been  obtained from gen-
 tlemen  who had believed in the existence of contagion, yet
 that information warrants me in asserting, that no one fact
 has  been substantiated, to prove that there was a single in-
 stance,  in  which  the disease had been communicated from
 one  individual  to another:  Indeed, it  must  have been dif-
 ficult, in a place so confined and crowded  as  Gibraltar was,
 to have  distinguished between  the  effects of miasmata and
 those of contagion, otherwise than  by the greater rapidity
 with which fevers, from  the first of these causes,  general-
 ly appear to spread within  certain limits, as then happened
 at Gibraltar.   But I do  not find that any experiment was
 devised, or pains taken,  for the purpose of ascertaining the
 truth, had  it been practicable, on this point.   Dr.  Nooth,
 an army physician, of great experience, as well as learning,
who was then  at  the  head of  the medical  department in
 Gibraltar,  had, during his  long services  in  different  parts
of America, become well acquainted with marsh fevers, in 
328
their several  forms,  and  he was soon  convinced that  an
exact similitude  existed between  the most violent of these,
and  the disease then prevalent at Gibraltar, and, consequent-
ly, that the latter was void  of contagion; and, though  per-
sons less  acquainted  with  these fevers, and, therefore, less
qualified to decide  respecting that of Gibraltar,  very gene-
rally, concluded the latter  to be contagious;  and, probably,
for no better  reason  than the fallacious one of its  spread-
ing  epidemically, Dr. Nooth,  as I am informed,  did  not
see any cause to change his opinion on this subject.
  In regard to the symptoms of this  fever, they were, iii
every respect, similar to  those of the  epidemics then and
lately prevailing at Cadiz, Malaga,  kc. and, therefore,  all
my observations on the latter w ill be applicable to the former.
It began at the time when  marsh fevers are  commonly most
prevalent,  and was preceded by that intensely hot and  dry
weather, which renders them most violent, and which would
have destroyed a typhus or contagious fever : and  it was ex-
tinguished  like  other marsh fevers,  by the  rains and  cool
weather of December, which  would not have extingnished any
contagious fever yet known :  like the  yellow and other marsh
fevers, it attacked, with the  greatest  violence and mortality,
persons from cold climates;  and either did not  affect, or  af-
fected but slightly, persons who had resided for a long  time
between the tropics, and had  but lately quitted that residence.
Thus it appears, by the official returns, that the 10th regiment,
lately arrived  from  the East Indies,  by the  way of Egypt,
though 748 in  number, besides commissioned officers, lost only
twenty-eight men during  the epidemic; and of these,  the
greater part were unseasoned recruits  sent to  Gibraltar from
England :  whilst, on  the other hand, the regiment  of De Roll,
consisting  principally of Germans, who had  not previously
served in any  hot climate, lost 187 out of 605  men: almost a
third of their  number.  The  mortality was  greatest  on  the
ad of October, when  nearly  150 died.  After the  1st of No-
vember, it  diminished greatly. 
329
    Strangers arriving at Gibraltar, while the fever prevailed,
  were most commonly attacked with it on the 2d,  3d, or 4th
  day, after their arrival; a space much too short for the opera-
  tion of typhus contagion.  Mr. Pym, Surgeon to the garrison,
  and now Deputy Inspector of Hospitals,  who had  read and
  believed Dr. Chisholm's account of the alleged introduction of
  a new  and  highly contagious fever  at Grenada,  by the ship
  Hankey,  imagined the epidemic  at  Gibraltar  to resemble
  that fever;  and  he endeavoured, in  a conversation with
  me, to  explain  how it  might be  distinguished  from the  or-
  dinary  bilious fever of Gibraltar; and  this was  by an  ag-
  gravation of  symptoms similar to  that which  Dr. Chisholm
  has mentioned as  having distinguished the supposed Hankey
  fever  from  the  ordinary Yellow  Fever  of the West Indies.
  Expecting,  as I do, to demonstrate, in my seventh appendix,
  that 110 fever,  of any kind, was derived from the Hankey, and
  that no such contagious fever as is  supposed, ever existed, it
  cannot be necessary that I should here discuss that subject.
    In the year 1810, a state of weather, similar to  that of 1804,
, in  regard to  heat and  drought, subsequently to a very  wet
  spring, occurred  at Gibraltar, Cadiz, Carthagena, &c.  and
  re-produced the Yellow Fever at all these places ; but,  as this
  state of weather began later, and  lasted  a shorter time, than
  in  1804, the disease was not,  in  many cases, so violent,  nor
  did it prevail so extensively, or so long,  as in that year.  The
  worst  cases at Gibraltar appeared in a  few transports, upon
  their arrival  from  Carthagena, where their crews had been
  exposed to more virulent miasmata than those at Gibraltar.*

    * Most of these cases fell under the care of Mr. M'Arthur, Assistant-Surgeon of
   the th Veteran Battalion,  who, in giving an account of them, dated October 29,
   1810, writes as follows : " After carefully observing the symptoms and progress of
   the fever that lately raged here, and comparing it with the accounts of the malignant
   Yellow Fever that prevails in the West Indies, I am clearly of opinion, that it is ex-
   actly the same disease.  In its symptoms and charaeter, it almost accurately corres-
   ponded with the description of that disease given by Mosely  N B.  Dr. Moseley's
   description was written long before the Hankey was built, and is generally well suited
   te the severer forms of the Yellow Fever in America.
                               42 
330
   In the town of Gibraltar, some persons died of the fever in
 three or four days, but many of tbe cases were milder, and so
 much like the ordinary bilious remittent,  that  some doubted
 whether it was similar to the fever  on board the transports.
 Others imagined that  there were two sorts of fevers  in the
 town, one contagious,  and introduced  by  some  means  or
 channels unknown, from the transports; and  the  other,  an
 indigenous, marsh, or bilious fever.  Nearly the  same varia-
 tion, in the degrees of violence, occurred in the fever at Cadiz,
 and would naturally occur to marsh  fevers, and  to no others
 in such a season.   The following is translated from a decla-
 ration, dated Cadiz, November  2, 1810,  and signed  by Sir
 James Fellows,  and nine Spanish physicians, viz.:
   " We, the undersigned physicians, having deliberated  on
 the questions proposed to us  by the  Supreme Junta, relative
 to the nature and symptoms of the disease now  prevalent,
 have agreed that it is the same in kind as that which raged
 here in 1800  and 1804, but that it is less frequently  malignant
 and  contagious; we having observed, in many  of the  sick,
 disorders  of  a different character, which cause the reigning  '
 fever to be less intense and infectious."
   How a contagious fever, in one set of patients,  should be-
come less contagious and intense, because otliers had different
disorders  at  the same time, I do  not  understand—probably
these other disorders  were remittent fevers, or Taberdillos.
These Spanish physicians, however,  seem to have become less
 confident than formerly, in the supposed contagion of  their
 epidemic; and I am well informed, that but a day or two be-
 fore  the date of this declaration, Sir James Fellows had de-
 cidedly expressed his belief, that it was not contagious, though
he formerly entertained  a different opinion of  the  epidemics
in Spain and at Gibraltar.*

   * Whether Sir James Fellows would ever have entertained such an opinion of
 these epidemics, had he been left, by Dr. Haygarth and others, to the unbiassed con-
 clusions of his own reason, may, I think, be questioned. And I  think it right to
 mention, as an instance  of Dr. Haygarth's confidence in his own judgment, respect 
331
   Probably my readers will agree with me, that my view on
this  subject may now be closed with propriety.   I might, in-
deed, have taken  into it  hundreds  of facts, in  addition to
those which have been recently noticed, and of similar import;
but I think too highly of their understandings to suppose that
such additions can be necessary.
   There  are but  few things more obscure  or fallacious  than
the  subject  of febrile  contagion.    The matters,  (whatever
they  may  be) which  produce  contagious fever,  being like
marsh miasmata, imperceptible  by our senses,  and like them
applied to the body  through the medium of the atmosphere,
we can never directly  trace  either  of these morbific  agents
backward  to   its  source, so as, by that  means, to  ascertain
whether it had emanated from a person labouring under fever,
or from  the earth.   Fortunately,  however, the fevers, occa-
sioned by  these several causes,  are distinguishable from each
other by certain  characteristic  marks and peculiarities, with
which, by  long experience, and numerous observations, we
have  been made  acquainted,  and thereby enabled,  with cer-

ing a disease which he had never seen, (and of which his notions were most errone-
ous) and of his solicitude that others should adopt  and act exclusively upon  his opin-
ion, that, in a letter to a member of the late Army  Medical Board, and dated De-
cember 16, 1804, he wrote as follows, viz.:   " Can you think it proper to leave up-
on the medical staff, a single person who doubts whether this pestilence, (the fever
at Gibraltar) and all the calamities which it has occasioned, were solely produced by
contagion ? Every doabt of tbis kind will hinder the vigorous measures which will be
required for the thorough  cleansing all the houses, boxes, furniture, and clothes,
from every particle of the infectious poison.  Every hint suggested to discourage the
necessity and utility of such purification,  will destroy the salutary confidence whieh,
in truth, ought universally to prevail." I hope, and, indeed, believe, that Dr.
Nootb's retirement from active service was with him  a matter of choice, and not an
effect  of this letter ; but I must think that Dr. Haygarth ought at least, to have
had some personal knowledge of the disease in question, and of the facts connected
with its origin, before he attempted, on that ground, to deprive the public of the ser-
vices of gentlemen  who did possess that knowledge,  together with as much intellect
as himself,  and who were therefore, better qualified and entitled to form opinions on
the subject.  I certainly do not impute to Dr. Haygarth any other than benevolent
intentions in this exercise of his zeal;  for I believe such intentions have often actua-
ted the most violent zealots, whilst persecuting others, even to death, to compel their
■issent to articles of faith. 
332
tainty, to refer each of these fevers to its separate cause.   \V«
are,  moreover, often enabled,  in some degree,  to ascertain,
by a proper attention to facts,  which of these different causes,
or rather which of their  sources,  has been sufficiently  ap-
proached by an individual or individuals, for the production of
disease; and thus to discover the father, by the  features of the
child, and by  the exclusive  opportunities of access which the
father has enjoyed.
   My  readers will recollect, that all these means have been
employed by me  in  regard to the yellow, and its kindred marsh
fevers, especially  in the view,  which has been just closed, by
which it has been clearly seen, that they are all the offspring
of one parent;  and a solid  foundation has been thus acquired
for presuming,  that the  yellow, like other  marsh,  fevers is
void  of any contagious  quality.*  It has also been seen that,
in  many thousands of instances, the Yellow Fever has  clearly
manifested and proved itself to be completely destitute of contagion.

   * Those who have imagined that marsh fevers might become contagious, have,
 probably, never reflected upon the monstrous effects which, in that case, would ne-
 cessarily have ensued. If the small-pox, measles, &c. bad not been rendered con-
 tagious,  these  diseases would have  existed only in the persons first attacked by
 them, and  the  purposes, which they were intended to fulfil among mankind, must
 have failed. But the cause of marsh fevers exists to such an extent, and so perma-
 nently, that, probably, the loss of  human life occasioned by it, without any  aid from
 contagion, exceeds that of all other diseases incident to mankind : and if fevers pro-
 duced by marsh miasmata could acquire a contagious power, and thereby produoe
 other fevers, in addition to those which their original cause will, doubtless,  continue
 to produce abundantly, and without end, such enormous additions, to the widely-
 extended and powerful mischiefs of marsh miasmata, would  long since, in the  ordi-
 nary course of things, have exterminated the human race. For the coldest habitable
 regions  would not, in that case, have afforded an asylum to  mankind, as they now
 do, from the evils of  marsh miasmata. Because that monstrous  production  of fever,
 from  the contagion of marsh fever, would be enabled to reproduce itself as a con-
 tagious fever, even in Lapland.  And of what  description can we suppose such  a
 fever would be ?  Does any one conceive that a fever, resulting immediately from the
 action of marsh miasmata, would resemble one  produced by a different cause, i. e.
 the contagious quality which had been acquired by a marsh fever ?  This, and many
 other absurdities, might have been avoided, by attending to one  great fundamental
 truth; viz. that no disease is ever contagious, unless it has originated from contagion.
 And that contagious  diseases can only be produced by their respective contagions. 
*■
                              333

And, as truth is invariable, and the same disease,  in suitable
circumstances, is always or never contagious, we may safely re-
ly on this immense mass of evidence, and conclude, that the few
instances of a contrary appearance, (and there are but very few
which have not already been shewn to  be founded  in  error or
misrepresentation) were  observed and reported imperfectly,
or under the influence of prejudice,  or deception.*   This con-
clusion will, I hope, produce important  benefits to mankind,
notwithstanding  the outrageous  criminations by  which Dr.
Chisholm  has endeavoured to obstruct all free inquiry, and
frighten  or overwhelm his opponents on this subject.    (Letter
to Haygarth, p.  159.)   Great as  the evils  may be,  of mis-
taking  a contagious for a non-contagious disease, those pro-
duced  by  the opposite error, are,  at  least,  of equal magni-
tude : though, under  the influence of terror, the former have
been seen with  microscopic eyes,  and the  latter,  in  a great
degree, overlooked.
   Without insisting npon those expensive delays and embar-
rassments, by which useless quarantine laws shackle the com-
merce,  and naval operations of a  great maritime country, I
   • I have already given instances of very erroneous inferences in favour of the sup-
 posed contagion of Yellow Fever,  from facts  which, rightly understood, were capa-
 ble of proving it to be non-contagious.  The following is an instance of such au
 inference, from a fact which at the utmost,  is but equivocal, viz. Dr. Dancer, of
 Japaica, in a note to his " Observations on the Contagiousness  and Importation of
 Yellow Fever, in the New York Medical Repository, vol. 7, p. 253," says, " agree-
 ably to the  information I have  received, from several Country practitioners, the
 crews of ships stationed at the out-ports  are generally healthy until one or more
 perso?is fall sick." A truism which seems applicable to ships at the in-ports also.
 He  adds, " but, as soon as a single instance of Yellow Fever occurs, the disease
 spreads from one person to another, till it goes through the whole  ship, and after-
 wards from ship toship."  But this, which  Dr. Dancer mistakes for a proof of conta-
 gion, is only, what might be expected from miasmata, among ships lying within
 their reach.  From  various circumstances, their  morbid effects appear sooner in
 some persons and situations than in  others.  Some will, therefore sicken  earlier
 and others later; and Dr- Dancer's mistake consists in  supposing that the person
 who first was attacked, gave the  fever to  the second, &c. while,  in fact,  they all
 drived it from one common  source. The like mistake has been  made by many
 others; and even by Dr.  Lind, at p. 184, 5, of his work ou Preserving Health m
 Hot Climates. 
334
may ask, if it be an harmless error which misleads mankind
respecting  the cause  of an epidemic, and not only  induces
them to employ vexatious precautions to guard against imagi-
nary dangers, but also to  neglect  the only proper means  of
future  preservation,  by  meliorating  the  condition  of  the
places  they inhabit ?    Dr.  John  Hunter has well observed
that, " by  supposing  a fever produced  by marsh  effluvia to
be the  effect of contagion,  an army may be left to perish,  in
an  unwholesome  situation,  which  might have been saved by
removing, to one  where such effluvia did not exist."  (Dis-
eases of  the Army,  p. 320.*)   And it is notorious that, dur-
ing  the late epidemics  in the  south of  Spain, an unfortunate
exercise  of civil authority,  occasioned the loss of many thou-
sands  of lives, by  compelling the  inhabitants  of the towns,

' *  It is not always in  the power of a general to choose or change his situation, es-
pecially when his army is weaker than that of the enemy.  But when tbis is the
case, there is good reason to believe that the morbid effects of marsh miasmata may,
in a very considerable degree, be obviated, by administering the Peruvian bark, with
 apsicum, or ginger, allspice,  and  bitters, copiously, to those  who are in  apparent
health.  In September, 1809, when an application was made to me by the Surgeon-
General, with the sanction of his Majesty's ministers, to join Dr. Blane in the mission
then proposed for Walcheren, I fully intended,  if possible, to procure a fair trial of
these prophylactic means,  upon the  British troops there. And when  I was  hin-
dered from joining in that  mission, by causes which it would be improper to men-
tion here,  I communicated my ideas and wishes on this subject to the Secretaiy of
State for the War Department; in which, however, a change was then taking place;
and from that, or some  other  cause, my communication remained without effect. "It
would have been my desire that each soldier should take night and morning a drachm
of the bark in powder, with half as  much of powdered ginger, or allspice, or an
equivalent  portion of capsicum, in a moderate glass of rum, brandy, or gin, or half a
 pint of porter, for the space of a fortnight; and this  I would have repeated, after
the interval of a week,  again and again, till  the beginning of December, when the
noxious influence of marsh effluvia would have ceased  to operate, until  the month
 of May, and  then I would have recommenced a similar course, but with smaller
doses of the bark, &c which would, I think,  have been sufficient, if begun so early
 in the year.  By  such  means I certainly should have expected to save many lives,
 and obviate the necessity of abandoning that island.  And this  expectation would
 have been  founded upon several facts published by Dr. Lind, Dr. Itobertson, M. Al-
 phonse  Le Roi,  &c. and  upon others not published,  which  have either occurred
 within my own knowledge,  or been communicated to me, upon unquestionable
authority. 
335
 where it prevailed, to remain in their morbific  atmosphere,
 lest, by quitting it, they should infect others.
   These, however, are but part of the evils resulting from a
 dread of contagion, where it  has no existence.   Few in this
 country have heard or can conceive how often, and to what
 an extent,  the strongest and best ties which unite and benefit
 mankind,  have been  cruelly broken,  within the  last twenty
 years, in some  parts  of America and  Spain, by  persons act-
 ing under  the  terror of imaginary dangers; and  driven by
 it, to abandon  their homes, their occupations, and  even their
 nearest relatives and dearest friends,  in the hour  of sickness;
 and, by this desertion of the duties of humanity, this denial of
 that assistance, and  those  consolations which  might have
 been afforded, without the smallest danger, to render these
 visitations  of disease  incalculably  more afflicting  and fatal
 than they  otherwise would have been.  Don  R.  Amesto,  in
 the work heretofore mentioned, asserts that the barbarous and
 anti-social belief of the importation and contagion of Yellow
 Fever, has, from its baneful influence in  Spain, caused many
 unfortunate victims to be abandoned, and left to starve in their
 beds.  That others have been shot at the very doors of houses
 in which they endeavoured to find an asylum ;  and that many
 others were carried alive to their graves."  Let  the zealots,
 who have  contributed to this  monstrous inhumanity,  reflect
 upon it,  and if their intentions have,  as  I  hope,  been good,
 let them,  at least, maturely examine and re-consider the
foundations of their belief, before they again endeavour to
 carry it into action.  It neither requires,  nor indicates even a
 mediocrity  of understanding, or learning,  to adopt the com-
 mon notion of contagion and foreign derivation, in  regard to
 epidemics;  nor  does the facility, with which these notions
 are  propagated, afford the smallest presumption in  their fa-
 vour.  By  much the greater part of mankind do not possess
 either sufficient industry  or knowledge for the due  examina-
 tion of a subject so intricate, and complicated, nof have they
 so much of the power  and habit of close, and  accurate, rea- 
336
soning, as is necessary to decide respecting  it.   Every one,
however,  can believe, and the belief of contagion affords a
ready  solution of all  difficulties, without the trouble of in-
quiry or even of thought;  and we need not,  therefore, won-
der that contagion, like witchcraft, shouM have been univer-
sally believed, (though as little understood) and often with as
little foundation.
END OF PART IV. AND OF THE ESSAY ON YELLOW FEVER. 
PART   FIFTH.
CHAP. I.
    OBSERVATIONS ON  TYPHUS, OR CONTAGIOUS  FEVER.

Though the Greek noun Tvp»i (stupor,) was applied by Hip-
pocrates to several diseases, all of  them very unlike the fever-
in question,  (which probably was unknown in Greece,)  I
shall not object  to  the  name, as distinguishing those fevers
which  accord  with Dr. Cullen*s  definition  of this  genus.*'
But I think  there is great  reason to object to the vague and
loose  application of it,  which is  now become frequent,  to
designate generally all low or slow fevers, arising from great
fatigue, cold, and damp habitations, unwholesome, or insuf-
ficient food, anxiety, grief, fear,  and  other depressing pas-
sions,  and debilitating causes, which have no connexion with
contagion, nor  any  power  of producing a contagious  disease.
I believe in the existence of a fever, sui generis, strictly con-
tagious, (unconnected  with  any  of the exanthematous dis-
eases,)  and,  therefore,  according to my  view of the  subject,
derived exclusively from its own specific cause,  or  contagion.
In this, which I consider as the only  contagious fever, there
are, I  think,  some varieties; but without any  differences
sufficient  to form  more than one species.—The  facts and

  * Cullen. Gen. Morb. p. 71.  " Typhus morbus contagiosis ; calorparum auctus ;
pulsus parvus, debilis,  plerumque frequens ; urinain parum mniata ; sensorii func-
lioacs plurimum turbatse ; vires mullum imminutse.''
                         43 

reasons which have led mc to this belief,  will have been seen
in the   second part of this  volume, at p.  89, and seq.  and
they  are  sufficient,  in  my judgment,  to  outweigh  all the
great authorites  to  which they are opposed, and render it
absolutely incredible  that  any inanimate  matters,  even those
excreted by living animals, should by  any  natural, or artifi-
cial decomposition and recomposition, ever require  a power
strictly contagious, or in other words,  be  enabled,  like living
animals and vegetables, to assimilate  other  matters  to their
own nature, and thus multiply and perpetuate their existence.
Some writers of considerable reputation,  sensible,  perhaps,
of this difficulty, have  made a distinction  between contagion
and infection, and have ascribed  the production of typhus
fever,  and  some other diseases,  to  the latter.  One  of these
writers, Dr.  Adams,  (in  the quarto edition  of his Observa-
tions on  Morbid Poisons, at p. 6,)  after  adopting  this dis-
tinction, says of " infectious  diseases,"  that they  " do  not
require for their production matter similar  to  their effects,
but may  at any  time be generated, by  crowding  together the
sick or  wounded, of  any   description."*   He  then mentions

  * Scores of justly distinguished'authors have  made  similar assertions, without ar.y
decisive fact  or evidence in support of them, so far as 1 can discover ;  probably rely-
ing on the  authority  of those who had written antecedently.  Had this assertion
been true, the sick and wounded at  Walcheren  ought to have'produced at least as
many cases of typhus fever, as had previously occurred in the same year, among the
British troops at Corrunna, by actual contagion.  The sick, at least, if not the
wounded,attbe former place, having been more numerous, and in many cases more
crowded.  But, contrary to general expectation, not a single instance of typhus fever
appears to have been thereby occasioned. That such a production of typhus fever
might have been expected, according to the common opinions, will appear from a
letter written to the Deputy Secretary at war, by the Physician General, Sir Lu-
cas Fepys, (after he had visited the hospitals in  the Eastern District,) dated, " Army
Medical Board Office, September 14, 1809." in which he fays, ' the disease afflicting
the troops returned from Holland,  is the bilious remittent, and intermittent fever
liable to degenerate into typhus and contagious fever ; but it has not, so far as I have
witnessed, that character at present, nor is there any dysentery." See Military Pa-
pers, letter E. p. 52.                   ,
  Other eminent physicians have not only  believed this liability of marsh fever to
degenerate into contagious fever, but imagined that such degeneration had actually 
339
" hospital, prison, or ship fever,  camp dysentery,  and  some
peculiarly malignant ulcers,"  as  being  infectious  diseases;
adding,  that «• though  these diseases when formed,  may pro-
duce their like effects  in  others,  yet we can  always trace their


begun to take place.  Thus Dr. Blane, in his letter to the Physician General,  dated.
 Middleburg, October 3, 1809, says " the fever known by the name of typhus,  with
which armies in ordinary circumstances are chiefly affected, has been rare,"----"as
yet, among the troops here  1 am sorry to say, however, that both diseases begin to
 shew themselves, particularly at Flushing, where the accommodation  is far inferior
to that at Midd leburg."  Military Papers, E. p. 103.  And in  another letter,  dated
the  6th, he explains the causes  which render the situation of the sick at Flushing
" much worse ;" adding, " they  are  also over crowded and dirty."  E. p. 98.  After-
wards, in a joint letter from Dr.  Blane, Dr. Lempriere, &c. to the Secretary at War,
dated October  the  10th, 1809,  we find this observation, viz.   "The malady  is not
contagious in itself, but liable to assume  that new form of fever,  wherever  ventilation
is defective,  the patients crowded, or where other local causes of impurity prevail.—
This has been strikingly proved in some instances, particularly  at Flushing, where
we found the accommodations too confined and  crowded."  E. p. 107.   That these
gentleman in this instance mistook a few cases of low,  or slow nervous fever, for a
contagious or typhus fever, (as has been done thousands of times,) was manifested af-
terwards, by the facts stated at p. 215—19 of  this  volume.  And certainly if the gen-
eration of contagious fever in the way, and by tbe means in question,  had been pos-
sible, the supposed  instances of it would not have been confined to Flushing ;  other
places having been very sufficiently crowded,  as is  proved by a letter from the gener-
al in chief, Sir Eyre Coote, Jo  Lord Castlereagh, written on the 17th September,
1809, immediately after a personal inspection  of  the different regimental, as well as
general hospitals.  " Middleburg, (says be,) from  ibe size of  its building, affords the
best accommodations,  but even  in that town tbe sick are so crowded, as  to lay (lie)
two in one bed, in several places, and have no circulation of air."--" At  Veer, a lar°e
church contains about 400 patients,  tbe other places are miserably small, and exces-
sively crowded   At Armuyden  tbe accommodation for the numerous sick is wretch-
ed."
   I  have admitted at the begining of this note,  that tbe  number of wounded men at
Walcheren,   was greatly d^proportioned to that of the  sick.  But  there  is suf-
ficient evidence  to prove, notwithstanding all that has been written and believed to
the contrary, that patients of the former description  do not generate contagions
fever any more than the latter.  Dr.  Blane,  who was physician to the fleet under
Lord Rodney, mentions that tbe battle of the 12th of April, produced an addition of
810  men to tbe list oi wounded.  But tliough tbe whole fleet was  detained at sea
until  about the end of that  month, and the last  division of it did not reach  Port
Royal, in Jamaica, until the  25th of May,  and though the discharges from so many
severe  wounds,  must in that climate have  become highly foetid, " yet" says Dr.
Blane,  (p-  7fi)  " there was less sickness and less death  from disease in this month 
340
 origin in  causes  different from  their effects."   That  Dr.
 Adams, who is accustomed  and qualified  to reason,  should
 have believed any thing  so unphilosophical,  and incongruous,
 would have been incomprehensible to  me,  if so many otliers
bad not discarded  common sense on  the subject of contagion.
 To  represent a disease  which is notoriously  contagions,  and
propagated  by contagion,  as capable  of being also produced
by other, and those very  different means, is to multiply causes
unnecessarily,  and, therefore, unjustifiably; and it moreover
destroys the natural, and just influence of causes upon their
effects, by making the same disease result from very dissimi-
lar  causes.    In this  way,  the  infections  diseases  of  Dr.
Adams are supposed to acquire all that is  wonderful in conta-
gion, I mean the power of reproducing,  and  perpetuating
themselves,  without deriving any thing  from  that original
product of divine wisdom and  power, to which I am forced
to refer  the beginning  of all strictly contagious  diseases ;
and  while thus enabled to  multiply themselves,  ad infinitum,
similar diseases  with  the same  reproductive powers,  are
supposed  to  originate  from  time to time,  in thousands of
other persons, without  any legitimate or  suitable  cause, or,
in the  language  of Dr.  Adams, by  the  agency  of  matter,
dissimilar to its effects: and these monstrous products, of an
equivocal incomprehensible generation, are to be  considered
as similar in their natures and effects,  to those resulting from
specific contagions.   Were  it possible for  typhus  thus  frc-

 (April), than in any of- the former 23 months, in which I kept rccoi-ds of the fleet,
 and less than in any subsequent month, till the fleet got to the coast of America."
And  that an accumulation of wounded men is no  more productive of fevers of any
kind in cold weather, than in hot, as just mentioned, 1 need only copy what Dr. Lind
has stated at p. 213 of bjs work on the  Health of  Seamen, concerning the Magna-
nime, ship of the line, viz.  « She was seventeen weeks at  sea, and for a whole
month of that time, during very  bad and stormy weather, had on board the  men
wounded in the general engagement on the 20th of November-: notwithstanding
this long continuance at sea, and the violent  storms she  encountered, yet of 700
men,  5 persons only were reported to us to be sick, besides the wounded, and these
chicsfly in cluonic disorders."'* 
341
quently,  and easily, to originate without contagion, and at
the  same time  acquire and  multiply itself, by a Contagious
quality,  who could ever hope to escape that disease ?
   If Dr. Adams had supposed typhus  fever to be not conta-
gious,  his  opinion that it might be produced by a great accu-
mulation  of  sick and  wounded,  in close or  ill ventilated
places, would not  to  me  appear,  a  priori, improbable; as
the  atmosphere may become  unwholesome, either by not con-
taining a sufficient portion of the vital part of it, or by the
addition  of noxious  vapours  dispersed  therein; and it might
be very naturally  expected that fever would occur among the
disorders resulting from such  a deficiency  of  oxygenous  gaz
on one hand, or such noxious additions on  the other;  though
we are not  entitled to believe that this  really does  happen,
without some evidence of the  fact, and  of this (as has  been
observed at p.  89  and seq.) there is  none within my know-
ledge,  excepting  that  which relates  to  fevers produced by
exhalations from the earth, and excepting that connected  with
specific contagions.
   Though   contagious  fever  has  probably existed for many
ages in this, and some other northern countries, its history is
involved  in  great obscurity,  because  it  was  not, until  very
lately,  observed and distinguished with any  tolerable accu-
racy.*  Even Sydenham did not consider this feA cr as pro-
   * One of the most early and unequivocal accounts of typhus which I have met
with, is in the first volume of the "Acta Medicorum Beroliniensium," of which I
have the 2nd  edition,  printed at Berlin, in 1719.  The first article, the title of
which is "Anni prater lapsi,  1716, Status epidemicus speciatim faistoria febrium
petechialium,  tunc temporis  grassantium," containing an account of a contagious
petechial fever prevalent " in Pomerania citeriore," p. 10 " Ultra fluvium Pene,
Grypswalda?,  Stralsundse atque in  insula Rugia, (Rugen) magnus incolarum nu-
merus,  hac maligna febre afnictus fuit. Regnavit dirum hoc contagium per  totam
fere  hyemem anni prseterlapsi 1715, ultimumque suum non ante effudit impetum
 quam sequinoctium vernale,  anni 1716 superaverat, solstitiumque cestivale plenius
attigerat.,'> This account, or, as it is called " Methodus, &theses practice, secun-
dum quas febres accutce petechialcs,  anno,  1715, post solstitium hyemale & dein
porro in nosocomiis  castrensibus &  alibi tractatse fuerunt," was written by the Ar-
chiater regius  ; and to these, " nonnihil de suis quoque addidit, Doctor Schwartzius."
 It is stated at p. 18, that both these physicians died of this fever ; the  treatment 
U2
ceeding  from  contagion,  but as  depending  on  a particular
state, or constitution of the atmosphere.  Huxham and Prin-
gle, as I have formerly mentioned, w ere the first who gave us
distinct  and just  notions of contagious  fever, though  Dr.
Ebenezer Gilchrist, of Dumfries, had previously written two
papers on it, under the name of " Nervous Fever," one in the
fourth volume of the Edinburgh Medical Essays and Obser-
vations,  printed in 1737 ;  and the other in the fifth volume of
that work,  printed in  1744.   And though  he was  silent con-
cerning its contagious nature, his descriptions, separated from
the theoretical reasonings  adapted to his time,  are generally
correct.   He states " this fever to be  very different in its na-
ture and changes, from other fevers," and to have  "some-
thing peculiar in it which  neither the ancients nor moderns per-
haps had described, if at all thought of."  Vol. 5, p. 507.   He
adds, at the next page, " as our fever seems to be peculiar to
this age, it is not a little surprising that much more  had not
been said upon it.  Some scattered hints are to be found in
late authors, both just  and ingenious, but not sufficient  to make
out a system of the disease."  He did not, however, mean to
represent this as  a hew disease,  because in the preceding vo-
lume, at p. 348,  he had  stated it to have  "been tltese  many
years fatal in Britain."   He appears to have treated the fever
judiciously, and to have formed just opinions of the effects of
opium, bark, and wine, in certain circumstances.
  Typhus is properly the disease of cold climates, and in this,
as in almost every other particular,  it is  in direct opjiosition
to the yellow fever.  The late Dr. John Hunter, in a paper on
the gaol, or hospital fever, (Medical Transactions, vol. 3, p.
348,) says,  " I have never seen the fever earlier than the month

 which they chose for themselves,  is also mentioned; and, it is not surprising, that
 bleeding and emetics,  repeated at advanced stages of the disease, should have
 brought on hiccuping and petechise, and have occasioned death.
  The description of the symptoms, and of the effects of some of the remedies
 employed, which will be chiefly found between pages 10 and 25, are judicious, and
 afford unquestionable proof of the existence of this fever in the army,  and lower    p
 classes of  the people, in certain parts of Pomerania. 
343
  of November, and I believe it seldom appears so soon.   It be-
  comes  frequent  about Christmas,  and increases during the
  months of  January  and February.   If March  and April are
  warm,  it grows less  frequent; but if they are cold,  it con-
  tinues nearly as  common as  in the preceding months, which
  w as the case in the two last winters, both of which wrere unu-
  sually cold.   When the weather begins to grow warm, it gra-
  dually disappears."   P. 350.  He  adds, (p. 366,) "I  would,)
  observe, that for upwards of two years, that I remained in Ja-
  maica,  I never saw  one instance of the hospital fever, tliough
  the  military hospitals were often as much crowded as they are
  in Europe."   "The  heat proves a prevention  of the  disease,
  as much as cold forwards  its production."*
    The influence of heat in mitigating, and finally  extinguish-
  ing contagious fever,  was very fully manifested  in  regard to
  the  troops  which sailed  from Cork, under the command of

   * Numerous  facts might be mentioned in confirmation of this general  assertion.  Mr.
  Howard has repeatedly noticed the greater prevalence of  jail fever,  during winter,
 than in  summer; and Dr.  Trotter, in the first  volume of his Medicina  Nautica,
 197,  observes  that " as coid weather, and a winter season, favour the action of ty-
  phus infection,  we know that warm weather, and a summer season,  assist in its extinc-
 tion."  And of this be gives several decisive instances and proofs.   Dr« Blane had'
 previously made a similar observation, at p. 23.3 of his work on the Diseases of Seamen,
■ Dr. Lind also has mentioned  facts, in which heat produced  similar effects, though he
 appears not  to  have understood the cause; at p.  319 of his volume on Preserving
 the Health of Seamen, he observes, that "this infection (of typhus fever), after eveiy
 method used to  destroy it has  proved ineffectual, will often of itself,  gradually abate,
 and at length entirely vanish."   Tins he adds, " I often observed in our prisons, during
 the last  war, where,  after  committing great ravages among the French prisoners,
 the infection often stopped of a sudden, and they were sometimes  so entirely free
 from  it, that in the month of  September, 1762, when I was employed by the govern-
  ment, to  muster the prisoners of war  in the castles of Porcbester and Winchester,
 which in the preceding year had suffered much by the jail distemper, I did not find
 one person labouring under that distemper, amorg 7000 prisoners, many of whom had
 been  confined for several years."  (See Lind on the Health  of Seamen, p. 320, 321. j
 H ere there is good reason from the month ("SeptemberJ in which this entire cessation
 of the disease was found to  have taken place, to conclude  that it had been produced
 i»y the heat of the preceding summer months, though Dr. Lind assigns no  cause for it'
 which seems indeed to have been an extraordinary oversight and omission, especially
as at p. 233 of the same volume, he had inferred from several facts, " that a cold damp
 air increases the power and vigour of contagion ;" meaning that of typhus fever. 
344
major-general White, for St.  Domingo,  in February,  1796.
Two hospital ships, in which I  had embarked, and sailed from
England with the army,  under sir Ralph Abert rombie, hav-
ing by storms been rendered unable to continue the  voyage,
and tbe last of them having landed me on the south-west coast
of Ire,  I embarked on board a very large hospital-ship,  the
Bridgewater, (formerly an Indiaman,) destined to receive  the
sick of general White's division, among which a severe typhus
fever had prevailed to a great  extent, and with great morta-
lity, previous to our sailing from Cork, where most of the sick
were left at our departure; but many of the soldiers,  appa-
rently well, being  exposed to the contagion which existed in
many of the transports,  or having imbibed  it previously,
whilst detained at  Cork, fell sick  on the passage, and were
from time to time removed into the Bridgewater, which soon
became full of patients, under typhus fever, which w as com-
municated to several of the orderly men,  and nurses, to some
of whom it  proved fatal.  It became evident, however, that as
we  reached, and proceeded in the warmer latitudes, the cases
of fever gradually diminished in number, and became  much
milder; tliough, from the shortness of our passage,  and the
Cool season in which it was made, the full effect of heat  in ex-
tinguishing contagious fever, could not have been produced,
and, therefore, it was not surprising that a few patients with
the same fever, in a milder form, and apparently divested of
its contagious power, were sent on shore to the hospitals,  im-
mediately after our arrival at  Barbadoes.  These had proba-
bly imbibed the contagion before our arrival  within the  tro-
pics, and its effects, though moderated, were not wholly pre-
vented by a change of temperature.  One of the last persons
attacked, was my own servant, who  had indeed  been suffi-
ciently  exposed to the contagion on board  the Bridgewater.
But in his case, as well as in all the others which occurred be-
tween the tropics, the fever was slight, and not being commu-
nicated in any instance, at least after  our arrival at Barbae
does, it there terminated. 
345
   In voyages to the East Indies,  ships remain for a  ntuch
 longer space of time between the tropics,  and being also ex-
 posed to an higher temperature, the  power of heat in destroy-
 ing typhus fever, is in them more decisively manifested; an
 entire cessation of the disease, (however prevalent) commonly-
 taking place before they can reach the Cape of Good Hope.  It
 has indeed never been known, as I  am informed, that a single
 case of this fever had  occurred on  either side  of the Indian
 peninsula.
   But without  going  from home,  or farther back than the
 year  1809, we may find strong evidence of the  power even of
the moderate summer heat of our climate, in  extinguishing ty-
phus fever.   It is well known that the contagion of this dis-
 ease, had been imbibed by many of the soldiers who returned
 from  Corunna, in the beginning of that year; who, being at-
tacked either on board of the transports, or soon after landing
in this country, the disease was communicated to nearly 10,000
persons belonging to the army, (including those in the artillery
and ordnance departments,) and this  within  little more  than
two months.   I had  a short time before obtained leave  to re-
tire on half-pay ;  but finding that there was no army physician
in the western district, I offered my services  there, and ob-
tained by doing so, an opportunity of observing the influence
even of our vernal warmth, in  mitigating  and checking the
fever, which  ceased I believe completely, at least in regard to
new  cases, before the end of May, and  even  sooner in the
western and  warmer districts.
   Whether heat interrupts or suspends the influence of typhus
contagion,  by dissipating  the corpuscles, of which it consists,
or by rendering the body less susceptible of their impressions,
or both, 1 will not venture to decide;  but certainly, those who
by birth and residence, have been  long habituated to  inter-
tropical climates, are, when they remove into the cold, parti-
cularly susceptible of the  action  of typhus  contagion,  if ex-
posed to it; and this has been found to be the case of Negroes,
to a  remarkable degree,  particularly in  the New England
                           44 
346
states, and in Nova Scotia, where the people  of  that race,
who were exported at different times  to  Sierra Leone,  had
been very extensively  attacked with contagious fever;  and
indeed many, of them  were ill, and some died  of  it, in their
passage to Africa;. but in all cases it was very soon  extin-
guished after their arrival at Sierra Leone, if not previously.
Dr. Trotter has observed, at p. 205, of the first volume of his
Medicina  Nautica, that the  natives  of  Africa " are verv
liable" to the fever in question; adding, that " in ships the}
are commonly  the first sufferers."  So that in this respect
also, the yellow and typhus fevers are directly the reverse of
each other; as they are moreover in the following particulars,
viz.  Typhus is aggravated by that degree of cold  which  ex-
tinguishes yellow fever.   It never prevails epidemically.   It
commences much less violently than yellow fever, and is  pro-
tracted to a greater length.   It manifests no  disposition to
remit, unless the patient  has  imbibed marsh miasms, whilst
even in the violent forms of yellow fever, there is generally
about the 3d or 4th  days, a very sensible, and often a  very
delusive cessation or abatement of the febrile commotion,  and
of all the inflammatory symptoms.   In both, however, it  is of
high importance towards the cure,  that the patients should be
removed to, or kept in  a pure wholesome atmosphere.
   In  regard to' their effects on  the  human body, Typhus is
generally accompanied with less mortality, and the derange-
ment which it occasions in the  system, is much less permanent
and mischievous, than that which accompanies or results from
even the remittent fever of Europe.—Witness the events  pro-
duced by the former disease in the  British Army, subsequent-
ly to  the return of the troops from Corunna, in 1809,  and
those which attended, or followed the expedition to Zealand,
in the same year.   In regard to the former, it appears that
the deaths did  not exceed one in ten of the sick,  though the
accommodations were in many situations but ill suited to that
disease; and  a considerable number of the medical persons
employed by Mr. Knight, were but ill qualified to direct the 
347
treatment of the  sick ;  the  whole were,  moreover, restricted
by his parsimonious regimental hospital system, from direct-
ing those allowances, and indigencies, in regard  to nourish-
ment, wine, porter, &c.  which are highly important to patients
under Typhus fever.  On the  Zealand expedition, however,
and  without these advantages, the deaths were but a small
fraction less than one in eight, the recoveries w ere  much more
tedious, relapses, perhaps, one hundred times more frequent,
and very often followed  by permanent obstructions, or morbid
alterations of the Viscera, ending in Dropsy, or other chroni-
cal affections; which rarely occurred as the consequence  of
Typhus, in  the troops from  Spain; who were  in  general  fit
for duty in  six or eight weeks after  becoming convalescent,
which was never the case w ith those from Walcheren.
   Whilst I was employed with the troops from Spain  labour-
ing under Typhus, I thought it very desirable that so good an
opportunity of ascertaining the time which the contagion
thereof  may remain latent after its application to the human
body, should not be lost, as  so many other opportunities had
been; and I therefore obtained,  chiefly through the kindness
of Mr. Grant, deputy inspector of Hospitals  in the  Western
district, returns of the orderlies and nurses who had  attended
the sick in question, and had been afterwards attacked with
the same fever;  and afso  an account of the time when the
attendance of each began, and of the interval which succeeded
previous to the attack.  I found, however, that it  was neces-
sary  in these returns to  make a distinction bctwreen the order-
lies and nurses, who had returned in the transports from  Co-
runna, and, consequently, had, at least in some instances, been
exposed to the contagion, previous to their attendance on the
sick  here,  (as was proved  by the different results  in these
cases, from  those  of {be persons who had not left England.)
And, accordingly, this distinction  was made  in most of the
returns.   In all  of them,  however, there was an omission  of
the persons who had only been temporarily employed : though 
518
their  number exceeded that  of  the regular orderlies  ami
nurses; but in regard to their cases it was difficult to ascer-
tain dates.
  Having selected such of these  returns as appeared to be
most  correct and  suitable, I  found that they produced  the
following  results;—viz. of thirty-five orderlies  and  nurses
who  had returned  from Spain, and, therefore,  might have
been previously  exposed  to  contagion,  it appeared that  one
was attacked on the first day after  beginning to attend  the
sick;  one on the 2d,  one on  the 6th, two on  the 7th,  one on
the 8th, one on the 9th, two on the 11th, one on the 14th,
one on  the 15th, one  on the 16th, three  on the 17th, one on
the 18th, two on the  20th, one on  the 21st, one  on the 22d,
two on the 23d,  two on the 24th,  two on the 25th,  one on the
26th,  three on the  27th, one on the 28th, one  on the 36th,
dne on the 38th, one  on  the 40th, and one on the 44th days.
Of ninety-nine  orderlies and nurses who had not been out of
the kingdom,  nor, as  far as was  known, exposed to febrile
contagion, it appears  that one was attacked on the 13th day,
one on the 14th, two  on  the  15th, one on the 16th,  four on
the 18th, two on the 19th, three on  the 20th,  six on the 21st,
four on the 22d, four  on the 23d, two on the  24th, six on the
25th, four on the 26th, four  on  the 27th, eight  on the 28th,
five on  the 29th, three on the 30th,  three on the 31st,  two on
the 33d, three on the  36th, four on the 37th, one on the 38th,
four on the 39th, one on the 40th,  two on the 42d, three on
the 44th. one on the  45th, five on tbe 47th, one  on the 48th,
three on the 52d, two on the 54th, one  on the 58th, one on
the 60th, and one the 68th days.  It results, therefore, from
this statement, that among the ninety-nine orderlies and nur-
ses, who had probably not been exposed to the contagion be-
fore  their attendance on the  sick  commenced,  the  earliest
attack was  on the  13th day,  and the latest on the 68th; but
t)iesc returns were made up  about  the 20th of April, and  it
appears that some who had escaped till that time, were after- 
349
wands attacked;*  and, therefore, though there  maybe rea-
son to conclude that febrile contagion docs not remain inactive
so long after being received into the body,  as marsh miasma-
ta, I  see  none for  believing that an interval of five or  six
months, may not sometimes elapse  before the -actual produc-
tion of fever by it; especially if the summer should intervene
previous to an attack ; in which case the occurrence of  fever
would, I think, almost always be postponed until  the following
winter,  and  often  completely obviated :f and I  cannot help
strongly suspecting, that such a postponing of the disease hap-
pened to some of the troops from Corunna, in 1809. It will be
recollected  that  sickness prevailed to a very uncommon extent
in the army  at home,  during the early part of the preceding
year; and though it did not consist exclusively  of contagious
fever, that disease made a considerable part of it, until it became
extinct at the approach of summer.  It will also be recollected,
that many of the regiments in  whom this  sickness occurred,
were, after  its  cessation,  employed  under Sir John  Moore,
 and Sir  David Baird, in Spain, where  Typhus fever cannot
 exist in  the Summer, and  where,  I believe,  it  never appears
 even in Winter, unless  by  an  extraordinary introduction  of
 it.   Such an introduction took place in that year by the Spa-
 nish  army under the Marquis de  Romana, which had been
 removed from Holstein  and  Denmark, (where  Typhus  is a

   * Many circumstances or causes may accelerate the actual production of Typhus
 fever in persons who have imbibed a sufficient portion  of the contagion; particularly
 the  effects of Cold, Drunkenness, excessive Venery, deficient nourishment, and in-
 deed of every thing occasioning debility, especially, in slender, feeble constitutions,
 in which the disease will also commonly prove most severe : and hence, contrary to
 what happens with Yellow Fever, those who are in the decline of life suffer more
 from it than the young, and  females more  than males.  On the other hand,  a  robust
 young man,  who after exposure to  febrile contagion, prudently avoids all debilitating
 accidents, or excesses, may, by the strength of his constitution,  and of its conserva-
 tory energies, not only resist for a long time, but finally overcome, such a portion of
 infection as in most cases would have soon occasioned disease.
   f In case heat would  produce, in regard to Typhus contagion, an effect analogous
 te that of cold, upon marsh miasmata, when the morbid action of the latter is sus-
 pended, until the following Spring or summer. 
350
frequent disease) back to their own country in British trans
ports; and though this  fever did  not appear  in  that army,
after their arrival in Spain, until  the  Autumn and Winter, it
certainly began then to prevail therein to  a considerable  ex-
tent.   It will be remembered that in  the  latter part of that
campaign, the  British army, twice crossed that of Romana,
and on  both occasions  Mr.  Warren,  Deputy Inspector of
Hospitals, informed me  that he had observed a considerable
number of the Spanish Soldiers to be labouring under Typhus
fever.   He added that the disease aftemvards appeared among
the French troops, as might well have been  expectrd from
their having occupied the barracks, quarters,  and hospitals,
which, in  a long line  of march, had  just before  been used,
as well by Romana*s as  by the  British army  under Sir John
Moore.  This fact Mr.  Warren stated, on what  he thought
good information, and  particularly that  of a British medi-
cal officer, who had remained with the British Hospital  left
at Lugo.
  Whether at either of these crossings  the British army  re-
ceived any febrile contagion from the  Spanish, • or whether
they found any of it  on board the transports in which they
returned from Corunna,  some of which had, as I  understand
been employed in removing the Spanish army from Denmark,
is not, I believe, well ascertained; but I think it highly pro-
bable that in many cases,  the cold, rain, and excessive fa-
tigues  to which the British soldiers were exposed, during ;i
considerable part of Sir John Moore's retreat, and after their
embarkation, might have brought into action the latent infec-
tion of the preceding  spring, the  morbid  influence of which
had been suspended by the summer  ; and I believe that typhus
fever has, on some former occasions, suddenly made its appear-
ance from similar causes.*  Circumstances to  be explained in

  • The learned and Reverend Stephen Hales, D. D. in bis treatise on Ventilators,
(8° 1758) states at p. ntf. that the convicts from Newgate often carry the Gaol dis-
temper with them, " to Virginia, before it breaks outP  As Dr. Hales, had some
time before taken great pains to introduce the  practice of frequent Ventilation in 
351
another place,  coinpel me to desist from any farther observa-
tions on  this subject, and to conclude the present chapter, by
subjoining extracts  from tw-o letters, written to me by  Mr.
Grant, dated Plymouth  Dock, the  24th and  27th  of April,
1809, viz.
   " Before the arrival of tbe troops from Corunna,  this  gar-
rison was extremely healthy.   Typhus did not exist  in it, nor
were there scarcely  any  sick in the hospitals, confined to  bed;
but  the  effects of contagion  very  speedily  developed  them-
selves amongst the orderlies,  and others,  employed  in fatigue
duties, connected with the hospitals..  They seem, however, as
speedily to have disappeared,  as we have scarcely a dozen febrile
diseases now  in the garrison, and these are orderlies who have
been taken ill since collecting the inclosed returns.   The disease
also became  latterly very - slight in its attack.   In answer to
your question, respecting the yellowness of  skin,  I have not
seen  many  instances of it  in this  garrison; the proportion
not exceeding 2 to 100 :  scarcely an hospital that has had two
or three  cases.   One of  the medical  officers who  died,  Hos-
pital Mate Williams, was of this description."
   Extract trom the  second letter,  viz.—
   " It may  be also aiding  your enquiries  to remark, that in
the naval hospital here,  where some of the sick from Spain
 the ships employed in transporting criminals from Newgate to America,  and had
 collected good information  on the subject, it is to be regretted that he did not men-
 tion this fact more circumstantially, and especially that he did not inform us, wheth-
 er this complete suspension, for probably two or three months, of the action of Ty-
 phus contagion, after it was received into the body, happened in cold or hot weath-
 er.  That it was not always suspended so long,  is evident by a fact which the same
 respectable author had mentioned in the preceding page, of the breaking out  of this
 distemper,  " in  Mr. lleid's convict transport ship the Laura, notwithstanding the
 ship was frequently refreshed by  Ventilation."  The Convicts (says he) were put on
 board, the latter end of April, in seeming good health, and continued so until they
 anchored in Stromness Bay, in the Orcades,  when between the  11th  and fifteenth
 of May, a  great part of the people fell sick of the Gaol distemper, in the compass of
 two days."  He adds in the next page, that the contagion  was in that case supposed
 to have  been brought on  board the Laura by the convicts from Newgate  But we
 have no means of ascertaining how long they had imbibed it before  they  were remov-
 ed from that prison. 
35^
were  accommodated, 24  nurses, and seven labourers,  wer.
taken ill of fever, in attendance upon them ; of which number,
four nurses, and three labourers have died.   Previous to this
occasion, I am informed by the medical officers of that estab-
lishment, that it was a rare occurrence for the servants of the
hospital to  be taken ill with  fever, in  attendance  upon the
sick.
  " At Pendennis"Castle, Falmouth, where some sick  from
Spain also  debarked,  tl e p ogress of contagion was  more
rapid, extensive, and  fatal, (in proportion to its field of ac-
tion) than in any of the other hospitals in this district.  All
the medical officers  and servants  stationed there, (the North
Hants Militia,) were  speedily taken ill, and one-fifth of the
regiment,  viz.  103, of which number,  11 died." 
CHAP. II.
               OBSERVATIONS ON DYSENTERY.

 By the trreek name of this  disease, (Aurevseix)  signifying 3
 pain,  or griping of the bowels,  Hippocrates intended to de*
 signate both ulcerations and hemorrhages from the intestines*
 and every kind of flux, with, or without blood,  from them«
 After his time, however, this name seems, in its application*
 to  have been restricted to an ulceration, or supposed ulcera-
 tion,  of this part of the alimentary canal,  with gripings and
 tenesmus,  producing or attended by mucous, or bloody stools*
 Now,  however,  an  intermixture of blood with the stools*
 though of frequent occurrence, is not deemed a  characteris-
 tic  of dysentery, nor is ulceration of the intestines;  but wheii
 the disease has been of long continuance,  they are often found
 after death, to have been ulcerated, and even sphacelated.  A
 spasmodic constriction of the colon, retaining  the  natural*
 but hardened,  fauces commonly attends this disease;  and Di*«
 Cullen superadds, as  a  part of character " contagious  piy
rexia," though  this addition seems objectionable, in regard
 to contagion, which I am convinced is not generally,  if ever*
 connected with dysentery.  Sydenham,  when treating of the
dysentery  of 1669, says,  " After  having attentively  con*
 sidered the various symptoms of this disease, I discovered it to
be a fever, sui  generis,  turned inwards  upon the  intestines.**
 Dr. Balfour, in his account of this disease,  as it occurs ifi
Bengal, has called it an  "intestinal remitting  fever;"  and
Dr. Rush,  who supposes it may be connected wilfc jail fevefy
                            45 
                               354
  as wrell as with the fevers from marsh effluvia, omits the word
  remitting, and calls it " the intestinal state of fever."  (Medi-
  cal inquiries, &c. vol.  iv.  p.  167.)  He  moreover contends,
  that after a fever has  been thus thrown upon  the intestines,
  so as  to occasion  dysentery,  it  may, by a  retroversion, be
  translated to the skin,  and there produce rash,  prickly heiat,
  and eruptions of various kinds.*
    Dr.  Akenside, in  his  Commentarium  de  Dysenteria, in-
  stead of Sydenham's belief that this disease was a i(febris in-
  troversa," seems to consider it as an introverted rheumatism,
  or,  as  Dr.  Rush would call it,  the intestinal state of rheuma-
  tism; and with  this notion, the former supposes that like or-
  dinary  rheumatism,  dysentery may  be  either accompanied
  with fever, Or divested of it.   He supposes,  also, that it al-
  ways begins  with the  smaller intestines,  and  gradually de-
  scends to the rectum, and that rheumatism and dysentery arc
  frequently converted into each other.
    Sir John Pringle considers  "all the epidemic  dysenteries,"
  as being "of the same nature;" (see p. 223,) and in  support
  of  his own opinion on this subject,  he appeals to  the experi-
  ence of the  late Dr. HuCk Saunders; " not only in Germany,
 but in  Minorca, America, and the  West  Indies;" in all of
 which,  notwithstanding the differences of  climate, this disease
 appeared  « with the  same symptoms,  (though  with  more or
 less violence,  according to the heat,) and yielded to the same

  * If such a translation of dysentery to the surface of the body can be effected by
 art, It should, I th.nk, always be attempted, as speedily as possible,  because the attempt
 ■will be more.likely to succeed while  the disorder is recent, and because the danger
 of a disease in tbe skin, is much less than of one in the intestines.  In a case of severe
 diarrhea, with which I was  partially acquainted, and which was suddenly stopped by
 opium,  Peruvian bark,  and sudorifics, near a dozen large  biles  were produced on
 different parts of the body, within three or four days ; and when these had suppurated,
 others supervened  in succession, for .several months, but gradually diminished in
 size,  though not in number, until near the time of their total disappearance;  since
which, the patient,  though more than sixty years of age, has  for six years enjoyed
 better health, than in any former part of his life.  I barely mention the fact,  leaving
others to judge, whether this improvement in the patient's health,  resulted in any de-
 gree from the biles, which to him were a new, as well as a troublesome occurrence. 
S55
 medicines."  That this is true of epidemic  dysentery, I can
 readily believe; being  convinced that this disease never  pre-
 vails epidemically,  unless it proceeds, from marsh miasmata,
 whose morbid influence is then, from particular circumstances
 or  causes, directed and "exerted upon  the  intestines, rather
 than upon the heart and arteries.
  This connexion between dysentery and marsh fevers, has
 been suspected and believed,  by several respectable authors;
 but I do  not recollect  that the identity of  their  causes has
 been any where so decisively manifested, as it was at the towrn
 of Sheffield, in the state of Massachusetts, during the  summer
 and autumn of 1796, according to a very circumstantial and
 apparently accurate statement,  made by William Buel,  the
 principal  physician of  that town, who  had previously given
 an account (published by Mr. Webster) of the febrile disorders
 which prevaled there, during the three preceding years.  The
 statement regarding the y^ar 1796, may be found in vol.  1, of
 the New-York Medical Repository, p. 439—459, and the fol-
 lowing are extracts from it, viz.:
  " The part of the town in which the  sickness prevailed, is
 almost a perfect level.  The river  Housatonak, whose width
 is generally between 30 and 40 yards,  runs  through  it in a
 serpentine direction, and with a very gentle current."—" On
 each side of this river, there is a considerable extent of luxuri-
 ous meadow-ground,  whose surface is  generally overflowed,
when the snow melts in the spring, and sometimes by freshets,
at other times in the year.  This meadow-ground is all much
interspersed with coves or pools,  which  are left after the sub-
 siding of  the flood, full of stagnant water;"—and this  " is
in the course of the summer evaporated from some to dryness,
 and from  others nearly so."—" Beside the meadow adjoining
the river Housatonak, there are several other streams, which run
through large tracks  of flat,  and very marshy land.  On one
of these streams, towards the north part of the town,  there is
 a inill-pond, which appears to have been  the common centre
 of the sickness  in 1796? and the  preceding  sickly  years*'* 
S56
■• This pond overflows a large track of land, which was for-
merly covered with a luxuriant growth of timber, and other
vegetable productions, which are all nowr dead, and in a state
of dissolution, in consequence of the action of air and  water
upon them:"—" whenever  a dry  season  occurs, the  water
recedes from almost the whole  of the  land last flowed,* and
leaves the whole mass of dead  animal and vegetable substan-
ces, lying on its surface, exposed to the action of a scorching
sun."
  " The faetor which  arises from  this drowned land, when
made bare by  dry and hot weather, is extremely disagreeable,
and offensive to all who approach its borders."—" The stench
is smelled by the inhabitants at times even to the distance of
half a mile: an exposure to the effects of this noxious effluvium
contiguous to  its source, not unfrequcntly in the  year 1796,
produced immediate nausea and vomiting."  The writer, after
observing that the spring of this year had been uncommonly
wet, adds, " we had such an excess of rain  even through the
month of June, that all our streams, ponds, coves, and marsh-
es, were kept  full, and even our dryest land was  highly sur-
charged with  water."  But from the  beginning of July for-
ward,  we  began to  suffer  from the  other extreme;  we very
seldom had rain, and uniformly the w eather w as intensely hot,
particularly in the month  of  August:"—" the drought w as
so great, that  vegetation was much injured;  grazing grounds,
particularly, were parched almost to  dryness."
   After  these  explanations,  the writer gives  a particular  ac-
account of a considerable number of cases of dysentery, w hich
occurred before the 20th of July, within what he afterwards
describes as " the sickly circle;"  adding, that within a  few
days other persons, within the same limits, were  attacked
with bilious or  marsh fever.   « From this time,  (says he)
instances of this fever frequently occurred, so that it was ap-

   • By the  *' land last flowed,"  the writer means a large extent of ground,  over
 which the mill-pond had recently been extended, by raising the mill-dam seven feet
 above its former height. 
357
 parent  both disorders were  endemic."—"In  a short time,
 both prevailed to a degree truly calamitous and alarming."—.
 "Let (says the writer) an imaginary circular line be described,
 from a point on the south-eastern side of the above-mentioned
 mill-pond,  whose radii  shall  be one  and one-half mile in
 length;  this circle will embrace about 100 families, and about
 600 inhabitants ; it would comprehend  the whole territory in
 which the  sickness prevailed, with so  much exactness, that
 there would be  considerably short of 10 families without  its
 limits in which  there was sickness, and there  certainly were
 not 10 within which were exempt."  Of about 450 persons in
 the eastern half of this imaginary circle, " at least 250 were
 affected with sickness; of the 150 who dwelt nearest the pond,
 there w7ere not 10 who escaped."*
   " The dysentery frequently came w while the patient was
 affected with bilious fever.  In  this case the type of the fever
 soon became obliterated,  and the accompanying febrile symp-
 toms were similar to those in original dysentery.  The change
 of the fever into dysentery,  did not, however,  secure the pa-
 tient from the  tendency to relapse, so peculiar to that disorder.
 But the convalescence of those who had simple dysentery on-
 ly,  was generally short, and the recovery perfect.
   " Sometimes the fever  came  on upon  the dysentery.   The
 type of  the fever was not in  this case easily ascertained, un-
 til an abatement of the dysentery took place, when, as the
 dysentric symptoms subsided, the fever would appear in its pro-
 proper form.   The two disorders  appearid to be complicated;
 that  is, they both seemed to  exist at the  same  time, rather
 than to act in alternation.  The fact is certain,  that in  cases
 of accession of  dysentery upon the  fever, the latter disorder
 always showed itself in its true form, after the symptoms of
 the other had subsided.

 •It is not to be supposed (hat marsh miasmata, arising from the mill-pond, exclu-
sively produced disease at the distance of a mile and an half; other sources of them
were interspersed throughout the whole circle here imagined. 
338
  " In the sickness which makes the subject of this communi-
cation, there is every reason to ascribe identity of cause to the
two disorders.   They were  circumscribed in  a very  striking
manner,  by precisely the same limits.   They  both  began and
ceased to prevail at the same time.  Neither disorder occurred,
(except in a few instances of both disorders  about the  pond,
at the south part of the town,) at any considerable distance
from the  limits, but in persons who had previously resided
within them.   There  were instances of both  disorders affect-
ing persons in  different  parts of the country,  who  had  resid-
ed within these limits.  A stay of only one night in  the cen-
tral part of the sickly territory, in some instances  produced
these disorders.
  " The facts which I have stated, prove sufficiently, that
neither of these  disorders was propagated  by specific conta-
gion, at least beyond certain boundaries, otherwise they must
have extended,  for there was no interruption of communica-
tion.  I have remarked before, that I  w as myself convinced
that neither disease was propagated by specific  contagion,
even within these boundaries.  In  all cases w  hich came under
my observation of sickness without the limits, and acquired by a
residence within them,  there  was  no instance of either com-
plaint being communicated from the person affected."   Here
it should be observed,  that the town  in which these  disorders
Were produced, is situated near the northern boundary of Mas-
sachusetts,  where the summer heat is commonly much more
moderate than in Pennsylvania, and other states,  in  which
the yellow fever has often prevailed.
  This connexion of dysentery with marsh  fevers  has been
also noticed, in different  parts of the United States,  and in
many other parts of the globe.*   Dr. John Vaughan mentions
the  former disease, as prevailing over certain low  districts*

  * Dr. Cleghorn  (Diseases of Minorca, p. 134,) says, " Sometimes  a tertian is
 changed into a dysentery, or a dysentery becomes a tertian; and when  one of these
 diseases is suppressed, the other often ensues."  He adds, that it is not uncommon
 for " the fits of tertians to be regularly accommnanied by gripes and stool?." 
359
adjoining the Delaware, and evidently resulting from marsh
effluvia.—See N.  York  Med.  Rep. vol.  iii.  p.  223.  Dr.
De Rosset,  also, in giving an account of the Bilious Yellow
Fever, of 1796, at Wilmington, in North Carolina, (which
I noticed at p.  248-9 of this volume)  mentions it to have been
preceded  in  July and August,  after excessive  heat, by the
dysentery*  which  " soon became general, proving fatal in
many instances."   He  adds,  "towards the close of August,
when the first  cases  of bilious fever occurred  to  me, the
dysentery began to decline ;  and scarcely one new case of it
occurred after the fever became more prevalent.  It may be
here remarked, that every person who had laboured under
the dysentery, without  an exception within my  knowledge,
escaped the fever."
   It is remarkable that here,   as  well  as at Sheffield, the
morbid influence of marsh miasmata first manifested itself in
the form of dysentery.   This, I believe,  does  not always
happen.   Dr. James Clark,  in his  Treatise  on  the Yellow
Fever at Dominica, says, (page  103) that " the dysentery
generally prevails at the same time that the remittent and in-
termittent fevers do,  in the West Indies, and  probably from
the same cause."  Dr. Trotter observes,  that on the coast of
Africa and the West Indies, dysentery " is joined with inter-
mittent  and remittent fevers."  (Med.  Nautica, vol. i.  p.
378.
   Of the East Indies I  have no personal knowledge; but it
is notorious  that marsh fevers and dysentery are there com-
monly produced by  the same cause, and at nearly the same
time :* that both often occur in the same person, and they are
said to be not  unfrequently  complicated  With  chronic inflam-
mation of the liver, to which the greater heat of that climate
seems to dispose the  inhabitants in a  remarkable degree.

   • Dr\ Ffirth says, that of the crew of the ship in which he went to Batavia, 76 in
 number, all, except eight, had either marsh fever or dysentery ; that "the fever ap-
 peared to alternate with dysentery ; when  he weatueB was bad, the latter prevail-
 ed ; when good,} the formtr." 
                            366

 But, without leaving Great Britain, we may find evidence ot'
 the influence of marsh miasmata in producing dysentery, from
 its appearing in those places,  and at those seasons, in which
 they were known  to  be morbidly  active.   Even London,
 though now almost exempted from their effects by a change of
 circumstances, was formerly very  much  infested by them;
 and  Sydenham remarks, that  the dysentery  never prevailed
 Until the latter part of summer, and that  it  disappeared  at
 the approach of winter, resembling marsh fevers in  these
 respects.  He has,  indeed, omitted to notice those peculiari-
 ties of the season which render marsh effluvia most powerful,
 because he ascribed diseases not so much to the sensible as to
 the occult qualities of the air, which  he  called its constitution.
 Dr.  Willis, however, has (as Sir John Pringle observes) sup-
 plied this omission,  in regard to the  dysentery which prevail-
 ed in London in the autumn of 1670, by  mentioning  that it
 began after  an exceeding hot and dry summer; " post sesta-
 tem  impense calidam 8{ siccam."  (See Pharma.  Ration, sect.
 iii. chap. 3.)  Sir  George Baker, also, (de Dysenteria Lon-
 din.  am 1762) mentions that this disease,  in  the latter year,
 appeared as an epidemic, about the end of July, after very hot
 and  dry weather;  and that it raged until November.   Sir
 John Pringle also observes, (p. 251) that  in  this year 1762
 " the summer heats and drought were  of a longer  continuance"
 than he ever  observed in  this country, and that in the autumn
 more cases of dysentery  " occurred, than  in  all the sixteen
 years that"  he  "had resided  here."—And  Dr.  Huxham,
 Without appearing to  suspect the influence of  marsh effluvia,
 has remarked the prevalence of this  disease as a consequence
 6f hot summers.  " Post  fervid am sestatem, constanter fere
 sequunter cholerse, dysenterise, alvi fluxus."   (De Aere  &
 morbis epidemicis, t. ii.  p.  176.)
   But that I may not unnecessarily  extend these  quotations
 I shall content myself with referring to Sir  John Pringle's
" Observations on the  Camp Dysentery,"  among which are
the following, viz. 
361
   " I have  never known the dysentery  epidemic, unless in
 summer or in autumn, when the primae vise are most liable to
 be disordered."   (Diseases of tfie Army,  p. 224.)   He might
 have added, and when  marsh miasmata are most  powerful.
 Again, at p.  226,  " Frequently the beginning of a flux will
 have all the appearance  of an autumnal fever; for the patient
 will be feverish,  with disorder in his stomach and bowels, for
 two  or three days before the purging comes on; but  after
 that, the fever sensibly  gives way."   And again, at p. 253,
 " Hitherto we have  seen how similar the  causes are, of the
 remitting and intermitting  fevers, and  of the bloody-flux.
 Nay, the affinity extends even to  the  occasional or exciting
 causes ; such  as when,  in the end of summer,  or in autumn,
 the men are exposed to night damps* and fogs,  especially after
 a hot day, or  lie  upon wet ground,  or in wet clothes, part of
 them will be seized with that kind of fever,  and part with this
flux; and perhaps  some of them will have a disorder com-
 pounded of both.  Add to this, that those fevers begin to be
 frequent  in  camp whilst the dysentery still subsists; that the
first  symptoms are often similar, such as the rigors,  and disor-
 der of the stomach;  that the remitting and intermitting fevers
 of a bad kind have sometimes ended in a bloody-flux ; that such
 countries as  are most subject to  those autumnal remitting fevers,
 are likewise most liable to the dysentery ; and that the analogy
 continues even to the method of cure, in so far as the principal part
 of it consists  in clearing the primse  vise.   Upon the whole,
 the nature of  the two distempers appears so much alike, that, at
 first sight, Sydenham seems to have expressed  himself justly,
 when he  called this flux  " the fever of the season turned upon
 the bowels."  But upon  a nearer  view we shall find this no-
  * It is remarkable that, notwithstanding all that Laneisi  and  others had written
of the influence of  marsh effluvia  in producing fevers, Sir John seems to overlook.
their effects, aud ascribe them to cold and moisture. Hence,  though he considers
dysentery, and remitting or intermitting fevers, as having  similar causes,  he makes
no mention of marsh miasmata as occasioning either, even where they prevail most
extensively, as in Flanders, fkc.  It is, indeed, true that he supposes the moisture to be
 rendered more hurtful  by the effects of putrefaction in raarshesi
                              46 
362
 tion more ingenious  than solid,  since the circumstance of it*
 being contagious, shews that the dysentery is essentially differ-
 ent from those fevers."
   Here we find  that this justly-distinguished physician, after
 stating facts  and reasons the most forcible, for considering
 marsh fevers and dysentery as produced by the same cause,
 gratuitously assumes the latter disease to be contagious, and, on
 that assumption, in opposition to these facts and reasons,  in-
 fers that the latter disease " is essentially different from those
 fevers."   We shall, however,  soon  find reason to think that
 contagion is not a quality belonging to dysentery, unless it be
 in cases which are occasioned by, or complicated with, typhus.
 fever, if,  indeed, such cases  ever exist; and we may there-
 fore conclude, that marsh  miasmata, acting in a particular
 direction,  are a frequent  cause of dysentery; indeed, there is
 good ground  for believing that it never becomes an epidemic,
 without their co-operation.
   The causes which determine the morbid influence of marsh
 effluvia towards the intestines, so as to excite the disease in
question,  rather than intermitting or remitting fevers, do  not
seem to be yet well understood.  Dr.  Blane thinks, when per-
sons are pre-disposed to that morbid action which may termi-
nate either in fever or dysentery, that the latter disease " is
more likely to arise from an irregularity in eating or drink-
ing:—a  fever  from being  exposed  to  the weather,"  &c.
There can, however,  be  no doubt,  but the latter  of these
causes, (supposing  it to include  the application of  cold and
wet  to the skin,)  is  often productive of dysentery, either
alone, or  in  conjunction with miasmata  and other causes.
Indeed, there  are but few7 persons who have not some time been
made sensible  of the sudden effect of such applications, in pro-
ducing diarrhoea at least.; though I am far from thinking that
improper food, by irritating and disordering the  bowels, does
not also co-operate  in exciting dysentery ; and under the head
 of improper food, I would  include sharp, acid fruits, when
eaten to  excess, such  as pine apples, which  Dr.  Moseley 
363
  mentions  as  having caused the  disease.  I think,  however,
  that in this,  as  wrell as other cases of dysentery, which were
  chiefly in  his contemplation, marsh  effluvia must have been
  the principal cause; for at p. 214 he notices  the  stools,  as
  being " more frequent,  and all the symptoms more aggravat-
  ed, at those hours when the current fevers are in their exacer-
  bations,  and the reverse when those fevers are in their remis-
  sion ; besides the alternate succession of one disease to another,
  which (says he)  I  have frequently observed:" and this,  to
  my apprehension,  clearly  indicates  the influence  of marsh
  miasmata, though he adds that it cannot " be doubted but
  this fever of  the  intestines, like most others, is  caused by ob-
  structed perspiration."*
    But besides the production of dysentery by the operation of
  wet and cold, conjointly with miasmata or other causes,  this
 disease has, in many instances, been apparently  occasioned by
  their operation alone.
    Of this Sir John Pringle  gives a  remarkable instance,  at
 p. 19 of his Observations on the diseases of the Army, viz—
 "  On the 26th (of June,  1743,) in the evening, the tents were
 struck, the army  marched all night, and next morning fought
 at Dettingen.   On the night following, the soldiers lay on the
 field of battle without tents, exposed to a heavy rain.   Next
 day we moved to Hanau, and encamped on good  ground in an
 open field;  but it was then wet,f and for  the first  night or
 two, the  men wanted straw.   By these accidents,  a sudden
 change was made in the health of  the army; for the summer

  * An obstruction of  perspiration,  to with  (in  conformity with.the principles
of the Humoral Pathology) the dysentery  is here  ascribed, probably is not a cause
of it, as occasioning a retention of matters  which ought to have been excreted (and
for  which nature has provided other outlets when  wanted,) but  as being generally
accompanied with a morbid distribution of the  blood, and an improper determination
df the living power inwardly to the intestines, followed by increased, or inflammatory
actions in their vessels.
  | Dr. F. Home (at p. 26 of his Medical Facts and Experiments,) says there were
"two rainy nights, after the battle of Dettingen," which " produced the bloody
flux." 
364
     had begun early, and the weather had been  constantly warm,
     &c."—" Now the pores were suddenly stopped, the body was
     chilled,  and the humours tending to resolution from the pre-
     ceding heats, were turned upon  the bowels, and produced  a
     dysentery,  which continued a considerable  part of the cam-
     paign.   In  eight days  after the battle,  about 500 men were
     seized with that distemper, and in a few weeks nearly half the
     men were either ill, or had recovered of it."
       Dr. Trotter mentions a  lamentable  dysentery, which was
     produced on board the  Berwick, ship of the line, in October,
     1780, in consequence  of the  hurricane  on the 5th of that
     month, by which the clothes and bedding of the seamen,  and
     indeed every part of the ship  "  were soaked in w ater,"  and
     many of the men " slept for nights together on the wet decks,
     overcome with fatigue, and debilitated from the want of food."
     In seven weeks  thirty  of the best men died  of this disease, in
     some cases  complicated with scurvy, and " near 300 of the
t     ship's company were  ill,"  when  she  arrived at Spithead.
     (Med. Nautica,  vol. i.  p. 378, &c.)  Dr. Mosely says,  "  it
     has often happened that hundreds of men in  a camp have been
     seized with the  dysentery, almost at the same time,  after one
     shower of rain,  or from lying one night in the wet and cold."
     (See his Treatise on Tropical  Diseases, 3rd edition, p. 268.)
     I suspect, however, that in such  cases,  the  disease is not ex-
     actly like that which principally  results from marsh effluvia;
     that it has a greater similitude to diarrhoea, and if accompa-
     nied with fever, that this is nearly related to that of catarrh.
       Another supposed cause  of dysentery has been alleged by
     so many respectable authors, that it would be improper in me
     to reject it, though I have never seen any decisive or convinc-
     ing evidence  of its operation  in this way: what I mean  is
     typhus fever, or its contagion.   Dr. Blane,  at p. 394  of his
     work on the Diseases of Seamen, says, " when this (typhus)
     fever  prevailed on board  of  any ship that arrived from  a
     northern climate, it was soon after succeeded by, or converted
     into, a dysentery;  for the ships that arrived either from Eng- 
36o
land or North America, with  the greatest stock of feverish
infection, were the most subject to fluxes, after being two or
three months in  the West Indies."  Dr. Trotter asserts that
typhus fever was combined with dysentery in the  transports
which  conveyed  the army under  Lord Moira to Ostend, in
the year  1794 ;  (see p. 378) and  Sir John Pringle says, (p.
227) " The most fatal sort of fever, which so often attends
the dysentery of the army, though not essential  to  it, is  the
hospital  or jail  distemper."—" This fever (he adds)  com-
bined with the bloody flux, was generally mortal."   But sup-
posing, as I am  willing to do, that Sir John Pringle has com-
mitted no mistake concerning the true nature  of the fever in
question, it may, notwithstanding, become  a matter of doubt,
whether the dysentery in  these cases, was the consequence of a
typhus fever inverted or thrown  upon the  intestines, or whe-
ther the patients had been exposed both to  marsh effluvia and
febrile contagion at  different times, and  that  each having
produced its  effect separately, the fever and flux were thus
accidentally  combined ?  In  either of these cases, however,
we may understand, and perhaps believe what the same author
asserts at p. 103, i. e. that " the  putrid effluvia of the dysen-
teric faeces, are  not only apt to  propagate flux, but likewise
to breed  the  jail or hospital  fever,  with  or without bloody
stools :"  for the excretions of patients under the action of con-
tagion, may  reasonably be  expected to become contagious ;
though I  cannot believe that dysentery ever possesses  that
quality, when it is not derived from, or connected  with  that
cause.
   G. Fabricius Hildanus, in his Treatise de Dysenteria, cau-
tions persons in health  not  to  approach the  places where
dysenterical  excrements are  deposited,  lest they should be
infected ;  adding, that the  exhalations of such excrements
affect the bowels of persons in health, by some occult quality.
Afterwards, Seiinertus mentioning the dysentery, which oc-
curred in 1624,  after great heat and drought,  says that  one
person was infected by another, and that whole families died 
366
of it.  But there seems to be good reason for believing, that
the disease here mentioned was occasioned by marsh effluvia,
and that their effects were, as they have been on so many oc-
casions, mistaken for those of contagion; and this was proba-
bly the case with Sir John Pringle in Flanders, whenever the
disease prevailed as an epidemic, which was always at a time
of the year when febrile contagion  must have  been nearly
inactive, and when marsh effluvia were most powerful.   Sy-
denham no  where intimates that his  epidemic  dysentery was
contagious, and Willis distinctly asserts that it was not. Even
Sir John  Pringle admits (p. 235)  " that this  disorder is not
so catching as most others of the contagious  kind;" but adds
that he "  always found it in some degree infectious, especially
in military hospitals," whenever it was " epidemic ;" and this,
according to his own explanation in other places, was always
in the summer and autumn,  when  marsh effluvia  were most
abundant and active, and when febrile contagion  must have
been least so, and therefore when it was most easy to confound
their effects.   It is moreover absolutely incredible, that marsh
effluvia should produce contagion, when they  disorder the
bowels, and  not produce it when they occasion intermittent
and remittent fevers.   Mr. Boag doubts whether dysentery is
ever  contagious  in  the  East  Indies;* and all the medical
gentlemen from that climate  with whom I have  conversed,
have entertained similar doubts, or rather believed it not to
be so.  Dr. Mosely says, " as to contagion from infection in
dysentery, I  must confess I never saw an instance of it;  nei-
ther do I believe there  is any such  thing." (p. 267.)  M.
Bruant, physician to  the French army in  Egypt,  says the
dysentery was not contagious in the great hospital (the house
of Ibrahim-Bey,)  at  Cairo, where he officiated  with  three
other physicians, though it had long been crowded  with sick."
See Hist. Medicale de L'armee d'Orient, 2de partie.  And in

  * See  Medical Tracts, fkc.  vol. iv. p. 13. He thinks the climate  of that country
unfavourable  to the production and propagation of contagious diseases,—observing
that even the  small pox gradually disappears as the summer advances.
U. 
367
 regard to my own experience, I have no hesitation in declaring,
 that with thousands of soldiers in that disease, under my care
 at different times, and often much  crowded in hospitals, bar-
 racks, and transports, I never have been able to discover any
 sufficient reason to believe that the disease was communicated
 by any of them to any nurse, orderly man, or other person.*
   I shall conclude this chapter by  a very few general obser-
 vations on the treatment of dysentery.
   As in  this disease there is manifestly a morbid determina-
 tion of  febrile or inflammatory action upon the intestines, I
 think, and have always  found it beneficial,  speedily to coun-
 teract this  disposition,  and   produce an  opposite determi-
 nation ;  so far at least as to create a salutary distribution of
 the blood, and of the living power, throughout the body, and
 especially upon its surface, by suitable diaphoretics, combin-
 ed  with  opium  in  small doses;  by  the application of flan-
 nels,  immediately to the  skin, and more especially round the
 abdomen; and in urgent cases by  the warm bath, (continued
 for the space of an hour, if the patient can  bear it so long,)
 wTarm fomentations,  and especially blisters  upon  the  belly,
 taking care at the same time to promote sufficient evacuations
 by stool, to relieve the intestines as much as possible from all
 irritation and uneasiness, which they might  suffer by a reten-
 tion of hardened fseces, or scybala, and other matters.   For
 this last purpose, the neutral purging salts, with manna,  arc
 proper, or a mixture  of the oleum ricini, with the juice of a
 ripe orange, and a little mucilage of  gum-arabic, which will
 agree better with most stomachs, and prove equally  effica-
 cious; emollient purgative clysters may also be  employed.
 Should the disease be attended with considerable fever, care

  *I have  now before me a statement which I made on the 5th of Maj, 1806, of
eertain facts communicated to me on that day, by  Dr. Macdonald, who  was a staff
suigeon with the army in the Netherlands, under the Duke of York, in 1793 and 4,
derisively proving,  that a dysentery  which prevailed to a great extent, and in the
worst form among  the French prisoners, accumulated at  Ghent to the number of
 ■carry  4,000, did not manifest the slightest contagious property. 
368
   must be taken not to  increase it by the too frequent use of
   diaphoretics and opium.  When the disease, by long protrac-
   tion, has occasioned  ulcerations  of the  intestines, and more
   especially  when it is  complicated with an  affection  of  the
   liver, calomel should be  preferred as  a  purgative,  and it
   should also be employed w ith opium, so as to excite a sore-
   ness of the mouth.
     The food  in dysentery  ought  to be light,  and easy of di-
   gestion ; indeed, the  stomach  will commonly bear no other.
   The  amilaceous matter of the  Maranta arundinacea,  or  In-
   dian arrow-root, boiled  with milk,  barley,  and chicken-wa-
'   ter, salop, tapioca, &c. are generally the most acceptable,
   as well as salutary.  But if the patient should have any par-
   ticular craving, it may almost alwys be safely indulged.
     The best means of obviating this disease, especially in ar-
   mies, deserve consideration; and, among  these means, there
   is, I believe,  none which would  prove more  generally effica-
   cious, than constantly wearing flannels round the belly,  and
   next to the skin : the allotment of muscular fibres to that  part
   of the body  is very sparing, and so is its power of resisting
   cold.  In  Germany, Italy, Spain, and Portugal, people of the
   lower order, very generally  wear sashes of woollen stuffs
   round their  waists;  and I have  observed a  similar practice
   among the Turks and Arabs, which, however it began, has
   probably been continued from  a  conviction of its beneficial ef-
   fects in preventing disease.  Dr. Grainger, at p. 36 of his
   Essay on the more Common West India Diseases, (2nd  edi-
   tion) makes the following just observation.  "One should
   imagine it would be hardly necessary  to advise to cover the
   bellies of the diseased (under  "  fluxes"  with warm blankets;
   and yet for want of this simple precaution, I  have known ma-
   ny negroes lost." 
CHAP. III.
             OBSERVATIONS ON THE PLAGUE.

CJposr my return from Egypt,  in 1802, I employed some time
in reading, and making extracts from, such scarce books, and
manuscripts, relating to tile plague,  and sweating sickness,
as I could find in the British Museum,  the libraries of Uni-
versities, (particularly that of Oxford)  and other collections,
partly  for my own  satisfaction,  and partly with an  expecta-
tion of publishing  something on these diseases,  they having
previously engaged  my  attention in some degree.  This ex-
pectation, however, has not  been  fulfilled ; because, though
my researches  were  not unproductive of curious matters, I
have doubted whether they  would prove so generally interest-
ing, or so practically useful, as to render a publication of
them desirable ; and  in regard to what I had either seen or
thought of the plague,  I hoped that Drs. Buchan and Price,
army Physicians, who underwent the disease in Egypt, would
render any contribution from me of no importance, by giving
to the  public the results of their  own  more extended expe-
rience on that subject.  But as this hope is now almost extin-
guished,  and as  opinions which  I  think erroneous have been
extensively propagated by high authorities, some  of which
confound the plague  with  Typhus, and others  with yellow
fever, I cannot allow the present volume to go into the world,
without adding some facts and conclusions, tending, as I hope,
to stop the progress of error; and founded, not only on a con-
                            47 
370
 siderable share  of reading,  and  some personal  observation;
 but on valuable communications,  with which  I have been fa-
 voured,  by medical  gentlemen,  who  were  employed  in the
 Pest-houses of Egypt, and  some  of them for a  longer time
 than  myself.
   In regard  to the history of plague,  I shall  here introduce
 but a  very  small part of what I had collected  and written on
 the  subject.  In the Hebrew, Arabic,  Greek,  Latin,  and all
 other  Ancient  languages, with  which  we  are  acquainted,
 words are found signifying generally,  (like the English word
 Plague) an extensive  and destroying  malady, when  applied
 to diseases ; and Galen, who  was for many centuries the oracle
 of  medicine,  has sanctioned this application  of the term ; for
 he expressly says* that epidemic and plague,  are not names of
 any particular disease; but that the former  designates  a dis-
 order  attacking many persons in a district;  and  that when  it
 proves mortal  to great numbers, it then becomes a plague : and
 with these vague significations the words in question  were
 long used.  But in modern times, writers who  aimed at more
 accurate  discriminations, have appropriated  the word plague,
 and its correspondent terms in other languages, to signify ex-
 clusively  a  peculiar and very fatal  disease  distinguished by
 symptoms,  to be hereafter mentioned, among which  Glandular
 swellings in the groin, axillse, and neck, are the most constant
 and remarkable.
  I  am convinced, by facts the most indisputable,  that the dis-
 ease just mentioned, and  to which alone I shall  apply the
 name  of plague, is not only distinct from all  others, (or sui

  *  Ow yctp JV vorvfixTii;  ye t<vo? ovopci eV<v eV/iJ^ov  aj"  Xoi/u&fos, «AA'
 oti 7reg an  7rohXo>.$ tv 10:  ytvijjxt %api(i>,  reurt eV/^sj^tov ovofici^eTM 7Tgo-
 b-eX66vtos fr'aira too 7r6*Mv$ «v«<f£«v,  Xotftht yivereci.  Vid.  Foesius CEco-
nom.  Hippoc. p 638.
  I am informed by Mr. Brown, the African traveller, that Koubeh,  and Webe, 01
 Vebe, are terms now used by the Egyptians to designate the plague.  Tbe former
signifies a great mortality from disease, and the latter a grave ; and conjoined these
words imply a disease which sends many people to their graves. 
                                  371

generis)  but  that  it  is,  morever, specifically contagious, and,
consequently, incapable of being any where produced, except
from its  own contagion;  and I think it highly probable that
this  disease has subsisted almost from  the commencement of
human existence, and been continued from generation to gene-
ration,  by  its peculiar contagious quality; though,  from the
want of proper  discrimination, which is found in  all the an-
cient medical writers, and  which  might  well  be expected in
regard to those diseases,   which were ascribed  to supernatural
causes, there is, I believe, no clear,  definite, and certain des-
cription of  the plague,  anterior to that which Procopius* gave

  » Procopius, a Greek Byzantine historian, was secretary to Bulisarius,  and attended
him in the wars of Persia, \frica, and Italy, after which he became prefect or governor
of Constantinople.-  It is in the second  book  of his History of the  Persian  IVar,
(Chap. 22,) that he gives an account of  this plague. I have made the following  trans-
lation of those passages in which he describes the disease, viz. " Persons were seized in
this manner: they suddenly became feverish, some whilst asle p, and others, in their
ordinary  occupations.  Tin body did not change colour,  nor grow hot, nor inflamed,
even with the fever, which was so moderate from the beginning, and until evening,
that neither the patient, nor his physician, by feeling the pulse, apprehended any
danger ; for no one could have suspected  death from  it:  A tumor rose, in some on
the first, and in others on the second  day, but sometimes later, not only in the groin
but also  within the  axillse, (armpits)  and sometimes behind, or under the ears, or
in some  other part as might happen.   These symptoms have hitherto appeared very
constantly, in all who were attacked by the disease;  other symptoms were less con-
stant.  I  cannot say  whether from any differences in the bodies of the sick, or from
the will  of him who sent the disease."   " In some there was a profound coma, in
others a violent delirium."  " Some died very speedily, others lived several days. The  :
body was spotted with black pustules of the size of a lentil, in  some who did not live a
single day ;  but died immediately : others were carried  off by a spontaneous vomiting
of blood  This I can declare truly, that the most able Physicians often prognosticated
the deaths of numbers who shortly after recovered surprisingly ; and, on the other
hand, they have pronounced the recovery of many who were doomed to speedy death:
so that in this distemper there was  no reasoning which could assist human judgment;
no one being able, in most cases, to foresee the event.  Bathing was beneficial to some,
but toothers it did harm.  Many died who were  left without attendance, while others
in the like  circumstances unexpectedly recovered. Again, all methods of treatment
succeeded with some, though, in short, no certain means  were discovered,  either to
cure or prevent the disease."  To pregnant women the disorder was  certain death,
for those'who miscarried died, and those who were delivered perished with their-off-
spring."  " It generally happened that those whose buboes grew large and suppurated,
recovered from the disease, which seemed to spend its violence upon these tumors;— 
372
   of the great plague thafbegan about the year 542, and  lasted
   more  than  half a  century, destroying  a  great part of man-
   kind,   as far  as the world  was  then known.    But there is,  I
   think,  great  probability, that this disease was known  to tin*

   whilst ii  those whose buboes remained without suppuration, it had an unfavourable, ter-
  mination." " i'lusdisease lasted for four months at Byzantium, ((Constantinople) though
  it raged ruoM. dm iug three only.  In the beginning few died  beyond the usual  number;
  but the evil soon increased to such an extent, that the deaths amounted to 5,000 dui/y, and
  at length to 10,000 and upwards.  At first, care was taken to  bury the dead in the vaults
  of their families, but afterwards they were thrown into the sepulchres of others, some-
  times irom ignorance, but often  by violence.  In the end an universal confusion pre-
  vailed ; servants being left without masters, and masters, once  very opulent, deprived
  of servants by death or sickness.  Many houses became  desolate, and bodies some-
  times remained in them unburied, because none of their inhabitants  had  survived.-"
   Agathias, another Greek historian,  who lived about the  same Ume,  and wrote an
 history of Justinian's reign,  beginning where that of Procopius  ends; mentions another
  vio'ent eruption of the plague at Byzantium, where, he says it had never entirely
 ceased, from its commencement in the  5th year of that  Emperor.  He  says, it de-
 stroyed myriads,  and with symptoms  like those which  at  first distinguished it.  See
 the  <lreek edition, with the Latin version, and  notes by Bonaventure  Vulcanius,
 printed at Leyden, 1594, (4°) Lib. V. p. 148.
   A farther account of this plague was given by  Evagrius Scholasticus, an ecclesiasti-
 cal Greek historian, who lived in the same century.  Me calls it, the inguinal plague,
 and says it began two years after the  taking of Antioch, by the Persians (under Cos-
 roes,  \.  D  540,)  and that whilst he was writing  it had  invaded  that city for the
 fourth time,  having then lasted 52 years, and  almost depopulated the  world.  The
 following is a translation of  his description of the disease ; viz.  "In some persons,
 seizing the head, it rendered the eyes sanguineous,  and the face tumid ; then falling
 on the (elands of  the) throat, it put an end  to  life, in  all  who  were thus seized."—
 Some were afflicted  with discharges  from the'- bowels ; in others  an abscess formed
 in the groin, and, being followed by a raging fever,  the patient died on the second or
 third day with bis body and  mind apparently sound.  " Some  were seized with deli-
  rium  and  expired.  Carbuncles  arising on the body, extinguished life in  many.  Oth-
 ers  recovered once, and afterwards died of the same  disease.  The modes of con-
 tracting the disease were various,  and baffled  all  calculation.  Some perished by once

   *  In modern times, patients under plague have been speedily suffocated by  such au
 affection of the  sub-maxillary glands.
  Omens, at p.96 of his  Descriptio Pestis, after nentioning parotid swellings adds,
 " Atq; otquot  sibmaxillaribus obnoxios vklen- mihi contigit  ob  enormem intumescen-
tiam partium laryngi proximarum, et inde product am suffocationem omnes e vita mi-
gi-arunt.   llorreiidum sane aspectum, a tumore vastissimo deformes oribus hiantibus et
lingua exserta anxio anhelantes, prrebuerunt miserh" 
873
 Jews at an early  period of their history,  and that it was the
 disease mentioned in 1st of Samuel,  chap. v. verses 6 and 9;
 and ch. vi.  v.  19,  under the  name of "Emrods" (or He-
 morrhoids)  according to  the English translation;  which
 seems entirely  gratuitous; the  Hebrew word being (ApMin
 or  Apholim)  and  its  root  (Apol.)  signifying  an  eleva-
 tion, eminence, or hill, it properly denotes a tumor,  or swell-
 ing, in some secret  part;  and I believe, there is no sufficient
 authority for referring these tumors to the anus, rather than
 to the groin, where they would constitute buboes, and indicate
 tbe  plague;  a disease which is much more likely  than  the
 piles to  have spread extensively and destructively among the
 Philistines  at  Ashdod, and  to have been communicated by
 them, when they restored the ark to the  Israelites, at Beth-
 Shemesh, and have there caused the deaths of 50,070 men;"
 who w ere thus afflicted, as is said, " because they  had looked
 into the ark of the Lord."  These swellings would have been
 as much in the " secret parts" of men wearing clothes,  when
 placed  in the groin, as if placed in the other situation.   It
 may indeed  be  alleged as an objection to this construction,
 that, among the dreadful curses denounced in the 28th Chap-
 ter  of Deuteronomy, v.  6,  the  Hebrew word which denotes
 Pestilence  (Deber)  is  different from  that which in the 27th
 verse, has been translated Emrods.   But there is no force in
 this  objection, unless  it can  be ascertained,  that the  word
 Deber  then signified the true plague,  and if that  be ascer-
 tained,  it will prove this disease to have  been known to the
 Jews at  an earlier period, or soon after they left Egypt.
   From several  passages in the writings  of Hippocrates, it
 seems probable,  at least, that the true plague had fallen un-
 der  his  observation.   He  mentions, at the 55th verse of the

 entering into infected houses." "Some  by only touching the  sick"  w Many whe
remained with  the sick and freely handled them as well  as the dead5 bodies, wholly
 escaped the malady."  Hist. Eccles. lib.  iv. c. 29. 
374
4th book of his  Aphorisms,* that  fevers  accompanied  with
buboes are all dangerous,  except  cphemeralf fevers;  and  this
passage is repeated in  the  7th section of the 2d book of Epi-
demics, with this addition,:}:  " and  buboes occurring in fevers
are more dangerous, especially if in fevers which  arc acute,
they subside soon after their appearance:" and these observa-
tions may be considered, as correctly applicable to the plague.
It is also Nprobable, that  the disease which is described  as||
prevailing  among the fullers  in tbe 5th book of his Epide-
mics;  7th Section  (page  1155 of Fcesius's edit. E.)  and also
in tbe 7th  book of  the same, 7th Sect.  (p.  1229. H.) was the
plague : and this probability is heightened by this considera-
tion, that,  if the plague  existed in  the  country, no class of
men would  be so liable to  be  infected  by  it  as fullers,  who
were then  very  much employed  in cleansing the woollen
clothes almost universally worn in those days.

  * Hippocrates Aphor. 1.  iv- 55.   Oi  iv\  Gx&oiat vvperti  vxv?es hum) tAj/v

  +• By the exception here made in regard to ephemeral, he appears to have meant
those short and mild fevers, of one  paroxysm, which so frequently attend the suppu-
rative process in buboes, caused by absorption.  These buboes are well described by Ga-
len, in the 15th book of his Methodus Medendi; of which description tbe following is a
translation. "Thus also, from an ulcer coming on  a finger, either of the foot or of
the hand, the glands in the groin and the axilla, swell  and inflame, upon first receiv-
ing the blood returned from the extremity of the limb : and about the neck, and the
ears, glands have often swelled from ulcerations either upon tbe head, or the neck, or
some of the neighboring parts.  They call glands thus swollen buboes."
   J 0.'  tvi ZaZuiTi  wgerai  Kctxtv ■arAsjv ray i<pt)(A.'epm, nett  'ot ivi i&v^t-
roia-i QuQZvts J4«x/ev*s  ev ro'iTtt 'o%ig-iv i%u£Wi Trctgux/Mi' <rctvTcs. Hipp. Epid.
Lib. 2. Sect. 7. Foss. p. 1025.
  || " Among the fullers tubercles arose in the groin, which were hard,  and not pain-
ful; others also of the same size about the pubes,  and in the neck.  There was fever,
at first attended with coughing.  On the third or fourth day the bowels were affected
with diarrhce ;  heats supervened, with diy tongue, and thirst.  The alvine discbarges
were very bad ; they died."  In this translation 1 have taken  the liberty of altering
the passage, ?"f mj,  jttJjvJ  rerx^roi. which is obviously defective, into t§<t*i pe* r,
T£T#gT«3, which I cpneeive to be the only proper reading.
• 
375
   These are the parts which favour most the supposition  that
Hippocrates was acquainted with the plague.  Galen, indeed,
mentions (in  lib.  de Therm,  ad Pison.) that Hippocrates put
an end to the  plague at  Athens, by lighting fires; but,  after
the definition, before quoted,  of the plague by this  author, we
can have  no  certainty  that the disorder then  prevalent  in
Athens was the true plague.
   It does not appear,  however, that Hippocrates knew either
the peculiar nature of the  plague,  or its contagious property.
I have not indeed met with any passage  in his writings which
clearly show7s, that he was aware even of the existence of  such
a quality in disease as contagion.*
   In  regard to the description given by Thucydides of the
plague at Athens, in the Peloponnesian  war,  I  must observe,
that whatever  its merits may be  in other respects, it is too
vague and inaccurate  for any medical purpose; for it does not
unequivocally designate any known disease.   The parts  of  it

  *  Galen was manifestly  convinced of the contagious quality of the plague when he
used these expressions, c-vvSixTptQetv to7s Xotf*.vTrov<riv Ivtcr^xXci, xvoXxvFxt
yxg je/vJVvo$, a>rvtg ipapxs tjvo? »" otydxXfitxt Lib. I.e. 2. de Different.  Fe-
brium.  The last observation respecting the contagion of Opthalmia is become remark-
able, since this quality has been ascertained  to exist, in that species of it which has been
imported from Egvpt. Galen  morever acknowledges that he left Rome and returned
to his own country (Pergamus) to avoid the  contagion of plague. Aristotle also believ-
ed the plague to be contagious ; for he asks.
  Prob. Sect. 1. prob. 7.  &'&  rivore  o Xotfux; jtwvjj rav vo'cvwv fjuxXtsx raws
vXtiFtx^ovrxg To7$ 6egX7revop.evot$ vpoirxvxvtf4.vX.YiFtv.  jj ort ftovi) rav vo<ruv
Hom?  f?)v xzrxa-i use  $tx rooro Wcca-tv  ezrtfyepet rov  Xoiftov. otrot (frxoXac,
'{%ovri<; vpxzrupxa&t,  kx) yxq (fix ro uzretcx-xvpLX tjj~5 vu'e-y t*} s "&&£<*- f4>v
tepx-arevo/neyu*  ytvotievK rx^eac, dmo  roo ■srgceyp.xroi;  eeXtincavrxt.  Also,
  Probl-Sect. VII. 1.  Atac r) xzro /ttev  vovuv hiuv voe-ouirii ot  vXfiTtx^ovre^
xsro Se iiyteioct; ouSeis itytoi^erxi ; which is a plain mention of contagion, though
not applied to any particular disease.
  Aretceus, in tbe last chapter of his second Book of Therapeutics, observes, that ele-
phantiasis is as contagious as plague.
   " Aea h fyn&tovi re,  %xt %v*2'txiTM$xt, eu fcfwv *>"  Xoipu,  xvxttw,
yue Is jU£T«Je<G-<v ftjiS'i't} £.»$*)'." 
376
most applicable to the plague are the alleged contagious pro-
perty of the disorder, and the mention of small  pustules and
sores, as marking the bodies of the sick.  QXvxrxivxv yj^xii  kx)
tMeo-tv efjjvflWs.  There is, however, no intimation of any glan-
dular tumours, which must have occurred in the true plague ;
and all  things considered, the disease  seems most likely to
have been a marsh fever, combined with  scurvy, modified and
aggravated by an accumulation of eight  times the usual num-
ber of inhabitants, afflicted by famine,  despair, and  all  the
calamities of war.   It is remarkable,  that the disease began,
and prevailed most, at those seasons when marsh miasmata
are always most powerful; and though said to have been con-
tagious,  it was not communicated even to the neighbouring
towns of Peloponnesus and Boeotia:  a plain indication of its
having been produced, and propagated by local causes.
  Among the definitions of plague given by  nosologists,  that
of Dr.  Cullen*  seems to be one of  the least  objectionable.
But even this is faulty, by  including typhus fever, which pro-
bably never occurs in this disease, and is  as distinct from it, as
from small pox or measles.  It may indeed be possible that  a
person who has been exposed to the contagion, both of plague
and typhus,  should be  attacked by both diseases together;
but in this case, the infection of each would doubtless remain
distinct, and only be able to  propagate  its" peculiar disease;
because one is communicable by immediate contact only,  and
the other, so  far as we can judge, exclusively through the me-
dium of the atmosphere.
  The definition of Pestis, by Sauvage, accords with that of
Cullen, and is liable to a similar objection.   Linnseus, substi-
tutes a most acute Synocha Typhus fever; a substitution which
will often be at variance with fact,  as in most cases no such
fever  is present.   Vogel errs in a greater degree, by arrang-
ing plague among simple continued fevers, stating it to be epi-

  * Pestis.  " Typhus maxime contagiosa, cum sumraa debilitate."--" Incerto morbi
die eruptio Bubonum vel Anthracura." 
377
  demic and most  acute ;  and superadding a  great number of
  symptoms, neither essential nor constant to the disease.   Sa-
  gar's definition is less exceptionable than Vogel's,  but it  is at
  least objectionable,  as including  typhus fever.
    Orrgeus,  who  was sent  with  superior  medical authority,
  by the late empress,  Catharine of Russia, to advise and assist
  during the plagues at Jassia (or Yassy)  and Moscow,  has re-
  fused to admit fever of any  kind among the characteristic dis-
  tinctions of plague;  and assigns his reasons for doing so, at
  pages 71, 2,  and 3,  of his Descriptio  Pestis, (4°, printed at
  Petersburgh,  1784,)  where, though he acknowledges that feb-
  rile  symptoms occur in most cases of plague, he  maintains,
  that fever does not essentially belong to the disease,  nor  con-
  stantly attend it.   And that it w ould be just as reasonable to
  give the name of fever to that acceleration of pulse, and other
  effects of morbid excitement,  occasioned  by  acrid poisons,
  fumes of charcoal, &c.  as to the febrile symptoms which often
  attend the plague.   And certainly fever, properly so  called,
  does not constitute the  disease, nor is it in all  cases  percepti-
  ble,  even as a symptom;* but the latter part of this observa-

    In very mild cases of plague, buboes arise and suppurate or disperse, and the
 disease terminates without any manifest  febrile symptom.  I saw some such cases,
 in tbe pest-houses at Aboukir, in 1801, and a greater number have been ob erved by
 others in different  situations.  The like happens sometimes in the mildest cases of
 inoculated  small-pox ;  on the other hand, I believe (though such cases did not fall
 under my observation) that the morbid impressions from the contagion of plague are
 sometimes so powerful as to extinguish  life,  before any such reaction of the system
 can take place, as would produce an appearance of fever.  In general however, and
 excepting these extreme cases, there is so much of reaction,  or of effort, by what ha9
 been called the vis medicatrix naturae, that febrile  symptoms, more  or less violent,
 as well as variously modified,  do (as in small pox) occur to  persons attacked by the
 plague, during a part of its continuance. See Waleschmidt de sig. Pest. Kolsat, 1712.
 Haller (Disp. ad morb. Hist, et Curat,  v.  5. p. 555.) " Pestis, proprii loquendo febris
 vocari  nequit;  est enim ssepissime sine  febre,  et sub varia  larva  sua ludit  ' dra-
 mata."
  Diemerbroek observes (de  peste,  p. 12) " Pestis sine febre paucis  incipiebant et
finitur; pluribus sine febre quidem incipiebat, sed qua; tame i  non  diu post insequeba-
tur," &c  He  adds, in a note, " Pestem  esse quid diversum a febre, "t frb^m ejus
esse symptoma, durante hac pestilente  constitutioae  multoties observavimas,  ac
                                48 
378
  tion would apply to every other symptom of the disease, no
  one of which  invariably and manifestly occurs  to  every pa-
  tient ;  so that if, in defining the plague, we were to reject all
  the symptoms which  are not constant and inseparable, we
  should have none  left to denote the disease; fever,  therefore,
  though of no particular form or  species, may perhaps be ad-
  mitted as  part of  the  definition,  and this  with a swelling of
  some of the lymphatic glands, or with exanthema,  including
  carbuncles,  may serve generally to designate the plague, if
  accompanied by that particular  contagion which is its cause
  and essence,  and without which there can be no plague.
    The limits prescribed for this publication, will  not allow me
  to  describe the several  forms, modifications,  and degrees of
  fever which  accompany the plague in different seasons, situa-
  tions, and individuals.   They are in fact as numerous and va-
  rious as the human constitution is  capable of exhibiting.   In
  the young,  robust, and plethoric, we find synocha,  or ardent
  fever,   with  the usual  inflammatory   appearances,  and  in
  feeble  or debilitated constitutions  we have  the  appearance
  of low  nervous  fever.   The intermediate degrees and com-
 binations are,   however, much  more frequent than cither of
 these  extremes;  indeed,  the  cases  of ardent  fever com-
 monly  bear a very small  proportion to the otliers, perhaps
 because the  action  of this  contagion is found generally to de-
 press or diminish  the  living power.  In all these  cases  the
 patient's constitution and circumstances have a great, if not an
 exclusive influence upon  the  febrile and other symptoms;
 with this exception, however, that in persons who have pre-
 viously been  sufficiently exposed  to  marsh effluvia,  the fever
 to which this contagion  acts as an exciting cause,  generally

proiwle nonnulli pestem male per febrem definiunt, cum febris non sit  de ip.sius essentia,
 ut infra probabitur cap. 12. annot. 2."
  Dr. Sotira, at p. 3. of his Memoir snr la Peste, observee en F.gypte,  in describing
the varieties of that disease, says, "Finalement, il yen avait quolques-uns attaqnes
d'un leger mal de tete, avec un degout passager, sum fievre, qui souffraient uu pieo-
tement sous l'aine, a l'en<;roft ou le bubon pestilentiel fse manifeste.  Peu a peu le-
bubon se prononcait, pour  disparaitre, ou pour sup/mrer long-terns  ;i;>ivs," \c. 
379
 takes  on the form either of  a quotidian  intermittent,  or of  a
 double tertian."*
   I have assumed  this disease  to be essentially and specifically
 contagions,  and I  shall presently mention sufficient proofs and
 grounds for the assumption.   But I think it expedient first to
 offer  some  observations,  concerning  the  channels  through
 which  its  contagion is received by the  human body; because
 the production of  buboes, in my opinion,  depends entirely on
 this fact,  that the contagion after  being applied  by contact to
 the skin,  is  exclusively  received through it,  and conveyed by
 the lymphatics into the blood vessels,!  as in tne  case °^ inocu"

  * Dr. Price  informed me that in all or nearly all the Sepoys or other East Indians
attacked by the  plague,  who had  fallen  under his care in Egypt, the accompanying
fever was of the intermitting form ; that the paroxysm began with cold and shivering;
and it was during the cold stage that most of these blacks died.  They had  probably
all been exposed to  marsh miasmata, in the neighbourhood  of Rosetta;  and  to
this circumstance I should ascribe the occurrence  of  this form ef fever among
them.
  f The  facts which prove the necessity  of actual contact with some infected person
or thing to communicate the plague, are so numerous, and many of them so notorious
that it must be unnecessary for me to enter upon a detail of them, after what Dr. Itus-
sel and others have published, and after the experience of tbe British army in Egypt,
which invariably demonstrated this necessity, by shewing  that all  those who avoided
contact invariably escaped the disease, whilst those who did otherwise in suitable condi-
tions, were very generally infected.  Nor was there, so far  as I have been able to dis-
cover, any instance, in the French Egyptian army, of a communication of the disease
without contact,  though the Physicians  to that army, who have written on the subject,
do not, I believe positively assert tbe impossibility of  such communication.  But Al.
Des-enettes, the chief Physician to that army, at p. 248, when writing upon this con-
tagion says, « on a vu un  simple fosse, fait en avant d'tm camp, en arreter les ravages ;
et c'est sur des  observations de ce genre, que  est fonde  Visolement avantageux des
Francs dont la pratique a ete suffisamment, detaillee par divers voyageurs."  And Dr.
Pugnet one of the phvsicians of the same  army, (whose experience in this disease was
very extensive) at p. 130  of his Me moires, sur  les Fievers Pestilentielles  kc. du Le-
vant/not onlv  supposes the necessity of contact, but adds that even tbis w,l not suffice
without an aptitude in tbe receiver of the contagion.   He indeed afterwards inUmates,
that from the crowded and confused state ofthe  army, he had  not been able to aicertmn
«sile contact de la personne malade,  ou de ce qu'il a toucbe est indispensable, pour,
 donner la maladie," kc.  It is apparent, however, that he did not know of any other
wav in which  the disease bad been communicated , and  the physicians employed  at
Moscow, during the plague, which destroyed nearly 60,000 inhabitants of that city,  ,n 
380
lation  for the small pox;  and hence we may account for the
morbid state  of the  lymphatic system,  which  has been ob-
served, in the few cases of dissection,  where proper attention
was paid to its condition.  The effects of morbid poisons, and
other noxious  matters  when absorbed,  upon  the glands con-
nected with the absorbents, have been sufficiently manifested;
and it  is from this  cause  that  the axillary glands of one  or
both arms, when the small pox has been introduced by inocula-
tion, become swelled about the time or a little before the com-
mencement of the eruptive fever; and  (as is well known) it is
also by an absorption of venereal poison, through  a particu-
lar organ,  that the inguinal glands,  to which that poison is
directly conveyed by the absorbents,  become affected ;  and it
is because the contagion  of  plague is not  commonly applied
and  communicated through  the same organ,  that pestilential
buboes near the groin  are not  often, if ever,  formed  in  the
very  same  glands as  the venereal,  but in the  femoral and

1771, appear, by abundant experience,  to have left no room for doubt on tbe subject.—
Dr. de Mertens, in the English  translation of his account of that calamity, says, "the
contagion was communicated solely by contact of the sick, or infected goods."   " It was
not propagated by the atmosphere."  He adds, " when we visited any of the sick we
went so near them  that frequently there was not more than a  foot distance between
them and us ; and tliough we used no other precaution than that of not touching their
bodies, clothes, or beds, we escaped infection."  M. Samoilowitz, who was surgeon to
the great military hospital,  where the  plague in question first appeared, and who be-
sides tbe most extensive experience in Moscow, had been  greatly employed for that
disease, in Poland, Aloldavia, and Wallachia, asserts, in the preface to bis " Memoire
sur la Peste,"kc. that " il est certain que la peste ne se develloppe, et ne se propage
que par  le contact ainsi  que  je  le demontre dans mon  memorie;" which indeed
he afterwards does, by numerous facts.   But after all these observations, I would
not be understood  as maintaining that  the  air expired from the lungs of a pa-
tient under  the  plague,  and  loaded   with humidity,  may  not contain  some
contagious matter, capable, if  immediately received into  the mouth and lungs of
another peason (by a very near approach of their faces to each other) of  being'absor-
bed,  and taken  up by the lymphatics spread over these internal surfaces, or perhaps
by the lungs, so as to produce the disease :  This would,  I think,  be nearly equivalent
to contact, and attended with no more  difficulty than there is in  an absorption by the
skin.  Orr seus says, p. 151, " cammwussima affectionis via per contactum observata."—
He thinks, however, that the disease may be taken by the breath ; but  if this were true,
the other would not be the most common way, because people frequently  can and do avoid
contact but cannot avoid breathing with the sick. 
381
other glands which are connected with the lymphatics coming
from the lower extremities.  Orrseus, indeed, mentions a fact,
which, without his  appearing to  be sensible  of it, demon-
strates  tbe production of pestilential buboes by absorption.
He says,  p. 154,  " In quibus eschar* carbunculorum, post
superatam pestem acutam, diutius neglectae restitarunt, partes
adjacentes  valde  intumuerunt, et in  non  nullis  bubones de
novo  suscitabuntur."    These  secondary,  or  new buboes,
could  only be caused by an  absorption from  the protracted
and neglected carbuncles.*
   While the lymphatic system and its uses were but very lit-
tle  known, and  pestilential  buboes  were  considered  as an
effect of the vis medicatrix  naturae,  and as being intended to
facilitate  a critical  separation and discharge of the  pestilen-
tial virus from the blood,  we need not wonder that a morbid
absorption was not suspected to have been  their cause.   But
it seems extraordinary that in recent times, and with modern
discoveries, not only Samo'ilowitz should suppose buboes to be
formed by the contagion of the plague thrown outwardly from
the blood, (See  his Memoire, p.  112,)  but  that a  similar
 opinion should have seemingly been entertained by M.  Desge-
 uettes, the chief physician of the French army in Egypt.  I
 conclude at least that this must have been his opinion, because
 he states buboes to have been produced by an inverted action

   * Platerus had also observed  the production of buboes, by the influence of carbun-
 cles, though he probably did not suspect the way by which that influence was exerted.
 He says (Praxeos Medicas, t. ii. p. 79)  " Sed et fit ut bubones in peste correptis, non
 semper, a venenata ilia vi" (veneni pestiferi) " in corporis emunctoria excussa, verum
 ob carbonis vicini ardorem doloremque  infiuxum hunc in adenes commoventis, uti in
 aliis quoque inflamationibus accidit proveniant."  He afterwards mentions the forma-
 tion of carbuncles,  particularly in pestilential fevers; adding,  " a quo anthrace ab in-
 itio lineam rubram ad bubonem, qui plerumque ilium comitari solet" " porrigi same
 observavimus." The  red lines here  mentioned are now known to proceed from
 an inflammation of the absorbents ; and they were observed, even by Galen; see the
 note to  page 556. He adds,  concerning these buboes,  " cernitur autem aliquando
 ipsa quo que vena per totum  membrum  rubra et calens, et distenta." kc.  But
 though secondary buboes may be produced by an absorption from carbuncles, the
 latter can never produce them on patients in whom carbuncles do  not occur, or only
 occur subsequently to the buboes, as is often the case. 
38J
 of the  absorbent system,*  contrary to every thing analogous
 with-which I am acquainted.  And in the very next paragraph,
 after mentioning carbuncles as being eminently contagious, he
 says (that  in  opposition to buboes) they are produced by di-
 rect  absorption:—" par absorption  directe, c'est  a dire dans
 l'ordre ordinaire, et par la voie la plus courtc,  et le plus  sim-
 ple contact."   To me, however, it seems most probable, that if
 cither buboes or carbuncles result from any thing thrown  out-
 wardly by  arterial action, or by  any effort of nature, it must
 be the latter,  rather  than the former,  which are so produced.
 I have insisted  the more  on this subject, because  the truth
 concerning it seems to be of some importance in regard to the
 prognosis, as well as treatment of the disease.
   Dr.  Price informed  me that  in all the bodies  of persons
 who  had died of plague,  which  he dissected  in  Egypt, the
 glandular system  was  morbidly  affected;!  and  Dr.  Sotira,
 who was physician to the French army there,  observes,  that
 according to his information* those who died of that disease,
 and had been examined by the French medical officers, besides
 a morbid state of the  brain and spinal marrow,  were found to
 have "tout le systeme des glandes  lymphatiques engorge."
 See Memoire sur la Peste Observee en Egypt,  &c." p. 8.
   With these, and  other proofs of  morbid absorption  by the
 lymphatics, it is not surprising  that  buboes  should be  the
 most frequent of  all the symptoms which  occur in this multi-
 form disease.  On a general computation, I think it would ap-
 pear  that glandular swellings have been observed in nearly
 three-fourths of those who were supposed to  have had plague,

  * " Les bubons pestilentiels sont des engorgements des glandes lymphatiques, qui
s'operent evidement par un mouvement inverse du systeme  absorbant." Hist. Me-
dicate de L'armee d'Orient, p. 109.
  f Dv. Price informed me, also, that in all the bodies which he had disseeted, the
liver w'asgreatly enlarged: but these, excepting one, had all been born in the East
Indies ; and on my asking, whether he did not think-it more likely'that an aflection of
that viscus should have existed previous to the attact of plague,  than that such enlarge-
ments should have  been so suddenly produced by that disease, he answered in the af-
firmative. 
383
 and many are erroneously supposed  to have had it, when it
 prevails extensively and destructively,  and as no sufficient
 examination takes place in many of the more violent cases,
 where buboes often do not appear till the approach of death ;
 and there are others, where the rudiments, or germs, are dis-
 coverable  only after death, and  by such applications of the
 fingers as  arc both dangerous and unpleasant, it  may be in-
 ferred, that but very few if any  persons have undergone this
 disease, who  either had not glandular swellings, or in whom
 they would not have occurred,  if life had not been extinguish-
 ed, before there was sufficient  time and  reaction of the'sys-
 tern for their  production.  I  do not, however, think it im-
 possible that so much of the contagion of  the  plague as will
 suffice to produce the disease, should find  its way into  the
 system by the absorbents, without producing  a swelling of
 the glands, though facts prove that  this does  not commonly
 happen.  Whether in any of those mild cases,  where buboes
 have appeared without fever, and which have  been supposed
 to be most liable to re-infection, the contagion had affected the
 glands, without finding  its way  into  the blood  vessels, I  am
 unable  to determine.  I am also unable to explain why the
 fermoral or inguinal glands, should he much oftener affected
 than those  of the axilla; a fact which has been generally ob-
served, and which seems to make it probable, that the conta-
 gion of the plague has  been more frequently taken up by the
 absorbents of the lower extremities, than  by those  of  the
hands and  arms.   This might well be the case with persons,
who, like the inferior inhabitants of warm countries,  seldom
w ear shoes and stockings . but there is some difficulty in un-
derstanding how  it could happen to others, unless stockings
by absorbing and retuning the  contagion, favour, rather than
obstruct, its approach to the skin.
  When the disease is  likely to  prove mild, its commence-
ment is commonly first  indicated  by hardness of the glands,
and  in many cases this  occurs with,  or  soon after, the first
 febrile or other morbid symptom :  often, however, and espo- 
384
 dally in cases of great debility, no glandular affection is dis-
 coverable for several days,  nor even until the near  approach
 of death.   So much has been written by various authors (and
 particularly  Orrseus,  at p.  95 and  6,) in regard to buboes,
 their appearances,  situations,* numbers,  sizes, &c.  that as  I
 am not giving a treatise of plague, I  may be  allowed to pass
 over these topics.
   For similar reasons,  I shall offer  very few observations  re-
 specting the  anthrax or carbuncle, of which Orrseus seems to
 have given the best account.f   Their occurrence is, I believe,

  • " Des qU'un bubon parait soit aux aines ou aillieurs il se place tousjours de cote, au-
dessus ou au-desousde la glande et jamais sur la glande meme comfne les bubons ven-
criens.  Ceux des aines prominent  ordinairement deux doigts au-dessous des glandes
inguinales."  Memoires ur la Peste, par M.  D. Samo'ilowitz,  M.  D. &c. p. 138.
  fOmeusp. 96. " Carbunculi nihil  aliud sunt quam siderationes partiales cutis, et
ei proximse cellulosa," (membrana:) " anigredine crustaj  mortua; sic nuncupati."
  He makes a distinction of carbuncles into the moist and dry, which I do not recol-
lect to have been made by any other writer, though it appears a very proper and ne-
cessary  one.   The former is that which seems to agree  best with what authors have
described as the pestilential carbuncle.   Orrseus describes it  thus :—" Febre pestilen-
tiali jam oborta, vel interdum sitmd cum ea, pars qualiscunque corporis, nunc majo-
ris, nunc minoris  ambitus ardere, dolere, rubescere, et tumescere incipit: (in aliis non
nisi macula rubra, vix supra superficiem cutis prominens, conspicitur,) non diu post, in
medio tumoris  una vel  plures, hand  procul  a se invicem distantes  pustida,  quasi
capitula acnum,"  (pins'  heads)  " majuscida, altitudinem  linese," (1-12 of an inch)
" raro superantes, pallidiusculse k sanie  turbida replete exsurgunt, qua: post  breve
 intervallum crepant; cutis vero subjecta livescens & mox ingrescens sphacelum jam
factum indigitat.   Nigritieshsec paulatim in omnes  dimensiones  ulterius serpit, cum
peripheria semper inflamnaata.  Sape ex  carbunculo in variam directionem praesertim
ad tractum majorum vasorum & tendinum, vibices sat insignes protenduntur." Samo'ilow-
itz (p. 142) says, that the only parts in which the carbuncles do not happen are  " les
parties recouvertes de poils, ainsi que celles ou se manifestent les bubons."  He is pro-
bably wrong with respect to the latter for  Orrseus (p. 98) says, that sometimes
the  moist carbuncle " bubonibus implantatur;"   Samoilowitz  is  incorrect,  too,
as to the progress of the carbuncle; for after saying,  (p  143)  that "les  pestiferes
eprouvent deja une  douleur tres vive k Vendroit ou ils doivent se placer :"—He
mentions, that " il faut ausitot visiter Vendroit qu'il  indique.  Ony  trouvera d'abord
un ,tres petit bubon,  ou  pustule  rempli  d'une serosite jaunatre,  sans oucun
signe  dHnfiammation."   Now  this   is what I  believe never  takes place, for
the excessive pain  felt  at the part is only the effect of very considerable inflam-
mation  existing in it, which usually arises to such a degree of violence,  as at last
to destroy the vitality of the  part:  this progress,  too, through tbe  various de-
grees of inflammation and mortification is in the moist bubo by no means so rapid as is
\ 
385
totally unconnected with that of buboes,—I mean that buboes
have no  influence on  their production.  When  they appear
very early,  they assume a dark brown or black  colour, and
remain  forty-eight hours  or more,  without being circum-
scribed  by an  inflamed margin;  they'generally  indicate the
greatest danger.
   Exanthemata are of several  species :—one is  a vescicular
eruption,  sometimes of the size of a pea, or larger,  appear-
ing  without  any  determinate situation, of a  yellowish  or li-
vid colour, and with an inflamed margin ; they were formerly
known to the people of England by the name of Mains:  when
three or four of them arise near  to each other, they often be-
come  confluent, and, by uniting, produce what Orrseus calls a
dry carbuncle, to  which  from the  first they have great  affini-
ty ; those which  are of  a livid  colour, flabby, and  confluent,
may be considered as a very unfavourable symptom.
   Another exanthematous eruption attending the plague, may
be considered  as  petechial;  it renders the skin  spotted, and
assumes different colours, sometimes reddish, but it  more fre-
quently approaches to blue, purple, or brown.   The dark co-
loured spots were  in this country called, and' deemed  to be,
tokens  or signs of death,  and  found   to be such   in Egypt.

commonly supposed ; for the inflammation of the carbuncle may proceed to a cer-
tain height, and  then stop before any mortification has begun,  and  this after the
inflammation has existed for a day or two.  Thus Orrseus (p.  lls>) " Quam pri-
murnyeim," (accompanying the plague,) "funditus sublata fuerit, rudimentum car-
bunculi inflammatum dissipatur; interdum (uti in me ipso accidit) humor  purulen-
tus quasi sub vesiculd grandiori derepente obortd colligitur, k evacuatioije per incisi-
onem facta, fundus cutis ruberrimus, k minime sideratus per suppurationem levio-
nem sanationem facile adnvltit"
  The dry carbuncle (says Orrseus p. 97) " e contra sine ullis inflammationis indiciis
e macidis" (petechiis) " latioribus confiuentibus enascitur,  quee sape ante febrem
aderant: hac vero" (febre) "jam accensa  cutis nigerrima facta arescit, corntga ur,
et . . .  vicina depascitur;" rubor " marginis" "fere null us est." He adds, " Per-
iculossisimus est & vix multi eo affVcti ex  naufragio  vitse emergunt, dum exhumido"
.  . .  " maxima jegrotorum pars convalescit,  nisi in partibus nobilioribus .  . . locatus
fuerit," kc. or unless it shall grow to a vast size, and prodme suffocation, or exhaust
the patient's strength.  This dry carbuncle  is not very painfuk
                                 49 
38b
These petechial spots do  not change their form or character
like the vesicular eruptions.  Orrseus mentions, at p. 113, a
case in which these spots made  their first appearance in  great
numbers, immediately after death.
  Of the contagious nature  of the  plague, I should hardly
have thought it necessaiw to adduce  any proofs,  after all that
has been experienced, and written of its dreadful effects, had
it not lately become  fashionable to entertain doubts, at  least,
on the subject,  without any other foundation or reason,  so far
as  I  can discover, but that of the escapes of  persons who
sometimes are  seemingly exposed to this contagion, suffici-
ently for the production  of disease.  I  have certainly  not
been inattentive to facts of this nature,  nor unwilling  to al-
low them their full force;  and the opinions and modes of
reasoning, which I have entertained in regard to yellow fe-
ver, have led  me to endeavour, as  far as possible, to  ascer-
tain how far the multitudes of opposite facts could  be explain-
ed,  by  supposing the operation of any  local or atmospheri-
cal  cause, distinct from personal contagion, and particularly
that of marsh miasmata,  to  which plague has recently been
ascribed by writers whose  opinions are justly of great weight:
I have however,  found  insuperable  difficulties in the way of
every supposition which does not admit the influence of  a spe-
cific contagion.
  When I took  charge of the pest houses  at Aboukir, in
1801, Dr. Buchan, my predecessor, and every  other medical
officer employed in that dangerous service, had already caught
the  disease ; and  of these officers, twelve' in number,  seven
had died,  besides a considerable number of nurses, and other-
attendants on the sick; though if there be any spot on earth
exempt from the operation of marsh miasmata, it would, I
think, have been that upon wThich these pest  houses were pla-
ced, together with the surrounding dry, barren sands, within
which,  those who  took the  plague in  this manner, had  in
effect been  confined.  The cause which had thus created a
specific disease  in every medical officer  exposed to its action, 
387
must have  been  peculiar  and powerful,  and there was not
the  smallest reason  to suspect the  presence of any  morbid
influence, except that of pestilential  contagion, nor  could
marsh  effluvia,  had they been present,  have occasioned such
a  disease,*  nor,  indeed, could  any thing  else within  our
knowledge, other than its own specific contagion.
   The medical  officers of the French  army  had previously
experienced the effects of this contagion  to  a  much  greater
extent.  Dr. Sotira,  one  of its physicians,  after expressing
his astonishment that there should  be  men " assez  bizarres
pour ne pas croire a la contagion  de la peste,"  among  other
proofs of its  possessing that property, mentions  the loss which
was  sustained from  this disease by that army in the seventh
year  of what  was called the French  Republic, " d'environ
quatre vignts officiers de saute" of about eighty medical offi-


  * There are many irresistible proofs, that the cause of plague is  perfectly distinct
and unconnected with that of yellow, and other marsh fevers.  Were it the same, we
should certainly find the former disease most prevalent between the tropics, instead of
being, as it notoriously is, totally excluded from so great a part of the globe ; and we
certainly should not find its progress suspended  in Egypt during  the hottest months,
when marsh miasmata are most active and  powerful; nor should we find the nat ves
of Africa and of the East Indies, who are  least susceptible of morbid impressions from
the latter, and  in whom marsh fevers,  when they do occur, are mildest, not only ta-
king the plague frequently, but dying of it in far greater proportion than  any other
race of men ; as was found to be tbe case by the British East Indian army in  Egypt, and
as Desgenettes, Pugnet, Sotira, and the other French physicians, declare  to have hap-
pened to the negroes who fell under their observation  Dr. Sotira, indeed, asserts,
that all of them who had the disease died of it very soon.  The circumstances which in-
fluence the production  of marsh miasmata appear to have no share in causing the
plague ;  its ravages being as great in the high, arid and barren parts of Syria, as among
the8 canals, and upon the rich soil, of Lower Egypt;  and  indeed.it prevails least in
those parts of Lower Egypt which are most productive of marsh effluvia ; and particular-
ly the Delta.   I have said nothing of the very important and essential differences which
must always subsist between the plague and yellow fever, notwithstanding all the inge-
nuity and labor which have been employed to give them an apparent similitude.  Nor
have 1 noticed the certainty with which the Franks  secure themselves from plague by
shutting «A provided  the known precautions  are not neglected or transgressed, as
sometimes happens.  Would such precautions exclude marsh  miasmata, or would a
ditch wa doff their morbid  influence, and as  Desgenettes  asserts, have  secured an
army from the plague ? 
388
cers;  a loss which, he says, was the more deplorable, because
it could not be repaired.  He adds, that in the two following
years, it w as thought expedient to employ Turkish barbers, to
dress buboes, carbuncles, and blisters, as well as to bleed and
apply frictions of oil, under the inspection of French physici-
ans and surgeons,  and that by these means only twelve medi-
cal officers died in twice the former space of time.*   As the
deaths  of the first year afforded a strong proof of contagion in
the disease, their great subsequent diminution manifested the
probability of escaping it, by abstaining from the actual contact
of infected persons and things.
   When the  plague re-appeared in the  British Indian army,
during the autumn of 1801, and the succeeding winter, more
precautions were used by the medical officers employed in the
pest houses, to guard against contagion,  and a greater  pro-
portion of them  escaped :  but still a majority of these gentle-
men took the disease, and to more than half of them it proved
fatal.    I could fill  volumes  with valid and well-attested proofs
of the  contagious  nature of plague.   But I must refer those
who may entertain doubts on this subject to the facts  publish-
ed by  the French physicians  who  were in Egypt, and by
Orrseus, Samoilowitz,* and others,  who saw the plague  in
Russia, Moldavia, Wallachia,  Poland,  kc.

  * See Memoire sur la Peste observee en Egypte, he. par Gaetan Sotira, Docteur
en Medecine, Medecin de l'Arme d'Orient, &c. p. 5. He also mentons, that more
than half  of the Turks,  who were thus employed to asist the French surgeons, took
tbe plague, which in several instances proved mortal ; though among a considerable
number of other Turks employed at Rosetta  by the French, to bury the dead,  only
one caught the disease.  This is one of the many facts  which indicate that there is
much greater danger  in handling the bodies of infected persons whilst alive, than
after death.
  + L)r teamo'ilowitz, who for many years officiated  as an  army surgeon in places
where he had nuir.eious opportunities of seeing persons under the plague, and who
when that disease was so destructive at Moscow, in 1771,  was most extensively em-
ployed there,' has filled  nearly one hundred  pages,  in the  early part of his  volume
" Sur la Pesce."  with-proofs of its contagious influence ;  and, among these, he men-
tions, t'iat having succssivciy volunteered his services as chief  surgeon, in three of
the principal hospitals at Moscow all the assistant surgeons who were employed under 
389
   Though nearly two thousand deaths, by plague, occurred to
 the French  army whilst in  Egypt, it was thought expedient,
 for a time, to deny the existence of the disease;  and both the
 general,  Buonaparte,  and  the  chief physician,  Desgenettes,
 exposed  themselves to  some dangers,  in order  to  allay the
 general  apprehensions  of the soldiers  on  this  subject;! and
 among other  expedients, the latter, after dipping  the poinf
 of a lancet  in the pus of  a  bubo, on one  of the convalescents,
 slightly pricked his groin and his arm, near the axilla, taking
 care,  however,  to  wash himself immediately with  soap and
 water, which, as he says, were brought him for that purpose;
 a small inflammation was  produced  in the  spots which  had
 been thus pricked, which lasted three weeks, but produced no
 worse consequence.   Whether the disease of the convalescent,
 from whom the pus was taken, had passed beyond the stage in
 wiiich it is  contagious, as is probable, or whether the pus was
 applied in too small quantity, or washed off too soon, I will not
 decide. Desgenettes, indeed, acknowledges,( p. 89) that this ex-

 liim, fifteen in number, took the disease,  and of these all died, excepting three ; whilst
■the physicians who walked among the sick, but carefully avoided all contact with them
 or their clothes,  &c. generally escaped.
  Samo'ilowitz was himself three times attacked by  the disease, a  circumstance
 which he ascribes to the dispersion of  bis buboes without  suppuration, the first and se-
 cond times.—See p. 39, 40, &c. also p. 35.
  Dr. Pugnet, among other instances of pestilential contagion, says, " Huit Francais
 a Caipha,  se sont successivement communique le germe de cette maladie, en se tran
 mettant une pelisse ; cinq sur six, a  Gaza, en se disputant un habit de drap, la de-
 pouilled'un de leurs compatriotes; quatre a Jaffa en mettant a leur usage des  mou-
 choirs de Col qu' un Pharmacien de troisieme classe, mort, avait apporte d'ltalie.   Ces
 quatres heritiers, furent en meme temps, atteints de bubons  a V  entour  du Col et
 perient du troisieme  au sixitme jour." See p.  2.29, 230.  These four instances of
 persons becoming infected by tying round (heir  necks handkerchiefs  which had im-
 bibed the contagion, and all getting  buboes round the neck,  are strong proofs of the
 production of glandular swellings by absorption through the lymphatics, leading
 to the glands which thus become affected, as I have lately mentioned.
  \ Desgenettes, as an explanation of the motive by which he was actuated  in regard
 to the plague on this occasion, and also in refusing ever to give that name  to the dis-
 ease, says, " Je crus devoir dans cette circonstance traiter l'armee entiere comme un
 malade, qu'il est presque toujours inutile and souvent fort dangereux, d' eclairer sur
 sa maladie, quand elle est tres critique." 
390
periment proves nothing against the transmission of contagion,
which, says he, has been demonstrated by a tliousand examples.
" Elle n* infirme point la  transmission de la contagion, de-
montree par mille  exemples; ille fait voir  seulement que les
conditions  necessaires pour qu' elle  ait lieu, ne sont pas bien
determiners."  Whether Dr. White,  who entered  the pest
house of the Indian army, at El Hammed, early  in January,
1802, was  misled by this experiment, I know not; but, from
a persuasion  that the plague was not contagious, he immedi-
ately rubbed some pus, taken from a pestilential bubo, upon
the inside of his left thigh, and the  next morning inoculated
himself in the wrist, with matter running from another bubo.
Four days, however,  had scarcely elapsed  from  his entering
the pest house, before he was seized with shiverings, followed
by febrile heat, &c. which he flattered himself would prove to
be an intermittent.  But he died of the plague before the end
of the third day;  and thus, unfortunately, added another to
the proofs—alas !  too many—of- the  contagious nature of this
terrible disease.
  We probably do not know so much of the facts and circum-
stances which either favour or retard the transmission of pes-
lential contagion from  an infected person (or thing) to those
who are uninfected, as would enable  us, in all cases, to assign
the true cause, why persons often escape harmless, whose ex-
posure to contagion has seemingly been such  as ought to have
subjected them to the disease; much seems to depend on tbe un-
fitness df the atmosphere to become a vehicle of this contagion,
and on the necessity of an actual application of it to the human
body,  and of a subsequent  absorption through the skin, all
which must render its introduction into the system more diffi-
cult and precarious.  Volatile contagions, particularly  those
of small pox and  measles, will necessarily be taken into the
lungs of one who breathes the air in which they are diffused ;
and the lungs,  being peculiarly  fitted to imbibe a vital part
from the inspired air, they, in doing this, may probably imbibe
Gontagion  also 5 and therefore we  might  naturally expect. 
391
 what  seems to happen,  that persons who have never been at-
 tacked by these diseases should seldom escape, when suffici-
 ently exposed to their contagion :  whilst, on the other handy
 we find that those morbid poisons which being fixed, can only
 be received  by  contact, through the skin,  very often  fail in
 producing their effect; this is particularly true of the virus of
 rabid  animals, that of syphilis,  &c. which are not  always of
 the same force, nor are the absorbents equally disposed to re-
 ceive them in all men, nor at all times even in  the  same man.
 Dr. Pugnet, though he is justly convinced  that nothing  will
 produce the plague but its peculiar contagion, thinks the suscep-
 tibility of the human body for it is greatly increased by a, moist
 and moderately warm atmosphere—that children, females, and
 persons of delicate,  feeble constitutions, are most apt to become
 infected ; and that  those who  are naturally robust  and vigor-
 ous seldom take the disease, unless weakened by excessive fa-
 tigue, or by excessive indulgence with women, or intoxicating
 drinks.  See p. 205.   Dr. Sotira entertains nearly the same
 opinion.  Desgenettes remarks, p. 248,  that the plague seem-
 ed more particularly to  attack those who were exposed to sud-
 den transitions  from a hot to a cold atmosphere, and vice ver-
 sa :  such as bakers, cooks, and blacksmiths ;  and  that men
 addicted to excesses with women,  and spirituous liquors, ve-
 ry seldom recovered from the  disease.
   It has been supposed by  Orrseus, Pugnet, and others, with
 some  probability,   that abundant transpiration through the
 skin, may hinder the absorption of pestilential contagion, and
 even wash  it outward from the  pores  ;* and on this supposi-
 tion, the former has strongly recommended the taking of exer-
 cise sufficient to produce a copious discharge of  sweat, after a
 real or supposed exposure to the contagion  ;—and it  seems to

  • If the contagion of plague be thus washed outward upon the skin,  might it not
descend to the legs or thighs,  and after the  sweating has ceased, be there taken up by
the absorbents, and in this way, render inguinal, femoral, or craral buboes more fre -
quent than those in the upper parts of the body * 
392
have been on this supposition, that Desgenettes,  after his vis-
its to the pest houses, always mounted his horse, and rode un-
til he found himself in a free prespiration.   Seep. 90.
   Another probable cause of unexpected  escapes from pesti-
lential contagion may be the short  time which persons under
the disease continue in  an infectious state.   Our knowledge
on this subject is very deficient.   It has been ascertained that
variolous patients do not infect others,  at soonest, until their
pustules begin  to maturate, and they are probably most infec-
tious when these are  in  a state of desquammation;  whilst
persons who have the measles, to  my  knowledge, have com-
municated the  disease before any eruption was  discoverable.
Ithas not, however, been sufficiently ascertained when patients
under plague first acquire the power of infecting others, nor
to what stage  of the disease they retain  this  power.  I was
confidentially  informed, when at Aboukir, of an instance  in
which no infection resulted from a most intimate connexion
with a female, a single hour before she was attacked by the
plague.   Dr.  Sotira thinks the  disease is most, if not exclu-
sively,  communicable during the  existence  of fever;  and
Pugnet thinks the disease ceases to be contagious so soon as
the fever terminates.*  Dr.  Desgenettes, in his Resume,  p.
248, says the body whilst warm, and especially in the febrile
state, seemed  to give  out contagion most easily.   Orrseus,
however, at p. 151, represents the  disease  as being infec-
tious only when at its acme :—" Contagium  ah iis solum, qui
in acme pestis constituti sunt propagari videtur." And by the
account which Sonini has  given of  his own case, (See Essais
Philosophiques, &c. p. 177, and seq.) it seems  probable that
when the disease has so far advanced, as  that the buboes sup-
purate, the body ceases to give out  contagion.

  * If the contagion of plague depends exclusively upon the febrile action which most
frequently accompanies it, those cases of the disease in which there was no fever, (such.
as  that of a cook at the pest houses of Aboukir,) may be supposed to have been in-
capable of giving the disease to others. 
393
  But besides all these impediments to  the communication of
disease by persons ill of the plague, (and which will  account
for many of  the supposed extraordinary escapes,) there are
others arising from the influence of atmospherical heat  and
cold,  which,  in their extremes,  either  render the contagion
dormant, or suspend that susceptibility or affinity of the hu-
man body, without which  it cannot produce disease in ordina-
ry circumstances.  Pestilential  contagion probably exists at
all  times  in   Lower  Egypt, Syria,  and many of the great
cities of the Levant, and  it is frequent  on board Turkish and
Greek vessels.  It appears to have been  first introduced into
the British  hospitals at  Aboukir, by the  carpenter of the
Dictator, of  64 guns, who was sent in  a boat to visit a Greek
vessel at sea, and thus caught the disease.*  This was  about
the beginning of May, and the  disease  was readily propagat-
ed, and prevailed with its usual mortality, during the whole
of that and the following  month, after  wliich it was commu-
nicated with  greater difficulty,  and when communicated, the
disease was  much milder, though one  case fell under my ob-
servation, towards the end of July, which proved fatal*   The
disease was,  howTev er, this year protracted in Egypt several
weeks beyond the time when it usually disappears, which is
commonly supposed to be about the 24th of June,  the Nativity
of St. John  the Baptist,  and its cessation at that time,  is by
superstitious christians ascribed to his  benignant interference.
 On this occasion the effect of heat in lessening  the susceptibi-
lities of individuals, or their aptitudes for taking the disease,
was  most evident in those who had lately  arrived from cold
climates, and who were comparatively most  affected by the
 summer's heat.   This was my  case, and my escape from the
 disease is doubtless attributable to my  being in that condition,
 for  I employed no  unusual precaution, nor ever avoided feel-
ing the pulse of a patient having the  plague, when  my doing
 so could be of any benefit.
  * I  afterwards discovered the plague on  board a Greek ship employed by the Bri-
 tish" government  in the Bay of Aboukir, and reported the fact to Lord Keith,
                             50 
                           394
  There were, however, persons in Egypt who had been long
accustomed to greater degrees of heat, and who were there-
fore not rendered insusceptible of the disease, and some few of
these caught  it, after it bad become extinct  in  the  British
army,  and when  a  person  recently  landed from England
would not receive it,  though he slept in an infected bed; and
it was  from this cause, that in  tbe autumn of the same year,
the disease began  at  Rosetta nearly  two months before the
usual  time, i. e.  on  the 13th of September, when I first dis-
covered it in two natives of the East Indies, attached to the
Indian army ; and it was  propagated with some rapidity for
six or eight weeks, among persons who were either born in, or
had just come from, a climate much hotter than Egypt, whilst
the British troops directly from England did not receive,  and
probably  could  not  have  been made to  take  the  disease.
These  facts are in perfect concord with wdiat I have mention-
ed of the influence of  beat and cold upon the human body, at
p.  115 and seq.   It has indeed been alleged, as a reason why
the plague first appeared in,  and was afterwards confined to,
Rosetta, in the autumn of 1801, that it was  the only open
port to which vessels from  Turkey and  Greece resorted,  and
that by some of these  the disease probably had been imported,
because it did not, as is pretended, occur during the preced-
ing season at Rosetta, or at least that if any case of it did
occur  there, it  was  concealed.  This is, however, certainly
erroneous; for to my knowledge,  several persons at Rosetta
bad been attacked by the plague previously to the arrival of
the Indian  army, and  had, without any  concealment, been
sent to the pest house near the town.
   It is by this effect of heat, that the plague seldom appears
in Upper Egypt, and never farther south than the Cataracts,
(as I was assured by Mr.  Brown, the African traveller,) and  •
that it ceases earlier at.Cairo than at Rosetta.   Indeed, it was
 this effect which had enabled the Indian army  to escape th«
 plague until  it reached Rosetta, 
395
  The cold in Egypt is never sufficient to stop the progress oi
the plague, and it is therefore commonly most prevalent there
some weeks before and after the vernal equinox:  but in Russia
Poland* and even in Great Britain, the winter has  commonly
produced an almost complete cessation of it.   This happened
to the .great plague at Moscow in 1771, tliough the mannei*
and extent in which the houses are there warmed, and the cold
air excluded,  counteracted the effects of severe frost, so far,
that some cases of the disease  occurred during  the  whole
winter.  De Mertens tells us»  however, that after the month
of October, there was a great diminution in the number of at-
tacks, and of their mortality ; and this is more accurately pro*
ved, from the statement given by Orrseus at p. 48, by which*
it appears that the deaths in September were 21,404, in Oc-
tober  17,561, in November 5,235,  in December 805,  and
in January  330.  Samoilowitz  also informs us, that though
the hospitals then contained many persons who had  been newly
entered for the  service of the  sick, as barbers, nurses, &c.
scarcely any  of them had  the disease after  the month of No-
vember, and never but in its mild forms.  Desgenettes has al-
so observed of the plague in Egypt, at p. 248, that " les vents
du nord, lex extremes du froid & du chaud, la font cesser presr
que  entierement."
   These facts will enable us, in a great degree,  to understand
why, notwithstanding the contagious nature of the plague, an
exposure to its contagion is frequently harmless; and it is for-
tunate for mankind that divine providence has made its com-
munication to depend upon the co-operation of so many fa-
vourable  circumstances,  and particulaily that of a suitable
temperature; that of its application by actual contact proba-
bly  continued for some time ;  and that of certain aptitudes
and susceptibilities in the human subject; for without such re-
quisites,  or such obstacles to the propagation of this disease,
the  earth might have long since become desolate.
   The contagion of plague, like  the poison of rabid animals,
 varies considerably in regard to the interval between its ap1 
39G
 plication to the human body,  and the manifest production of
 disease : three, four, or  five days, seem most  commonly  to
 intervene.   Samo lowitz states the interval between infection
 and sickness, as extending from two  to fifteen days inclusive-
 ly ; but in one or two instances which occurred at Aboukir, I
 was  inclined to believe that the disease had  been produced
 within 24, or at most,  36 hours  after the contagion had been
 applied to the body.*
   In regard to the means of  obviating the disease, by those
 who cannot avoid touching infected persons, or garments, &c.
 I have not much to propose.   Pugnet  says, that in the plague
 atDamietta, he used no other precaution  than that of immedi-
 ately washing his hands, after they had been  applied to an in-
 fected person, or thing, and  taking care that his own  clothes
 should not touch those of the sick, or any thing likely  to im-
 part contagion : in other respects he breathed the atmosphere
 of the pest houses freely, both with an empty and a full stom-
 ach.   Desgenettes  says (p. 90)  that   he lived as well  as  his
 situation would permit, and used spirituous liquors in small
 quantities at a time ; that on leaving the pest houses, he care-
 fully washed his hands with vinegar and  water, or soap and
 water, and galloped home to excite a moisture  on his skin; that
 he then changed his linen and clothes entirely, and washed his
 body  all over with luke-warm water  and vinegar.   In addi-
 tion to these precautions, it might, perhaps, be well to cover
 the hands with gloves of oiled silk, or oiled fine linen, or w ith
 a thin  coat of bees-wax, softened by oil, during the time  in
 which  they  are likely to come  into contact  with the  in-
 fected  matters.   Mr.  Baldwin  has asserted,  that dealers in
 oil generally escaped the plague; but Orrseus asserts,  (p.  59)
 that those whose occupations were  much connected with ani-

  • Diemerbrooeck,  p. 52, col. 1, quotes a passage from Franciscus  Valleriola, in
which that author says that he has frequently seen persons falling down with the plague
a few hours after having been exposed to tbe contagion of it:—" cum aliquis intcgre
sauus accessu ad peste correptum (hominem) peste quoque inficiiur, atque paucis post
hpris eoncidit, quod fieri  szepe videmus." 
397
mal fats, such as candle and soap makers, curriers, &c. were
the most liable to be infected.
   When the pestilential contagion has been received into the
system, it seems in a peculiar degree to exert its morbid influ-
ence upon the brain and  nerves, producing (the slighter cases
excepted,) shiverings,  tremors of the limbs, and affections of
the head, such as stupor, vertigo, coma, or delirium, with sud-
den and  excessive prostration of  strength, and depression of
mind ; and it is by this mode of action, that it renders the bo-
dies of those who die of plague, remarkably soft,  flaccid,  and
Variously discoloured, with  a  permanent  flexibility of the
limbs, as in those  who  are killed by electricity, or by  any
cause which  destroys, or exhausts the excitability or living
power.  The prognosis, therefore, is always unfavourable, in
proportion as the symptoms  denote a greater degree of mor-
bid affection in the brain and nervous system.
   It is not my intention to enter upon a particular account of
the various  symptoms  of plague, for which, indeed,  my own
observations have been too limited ;  but I cannot avoid notic-
ing that peculiar appearance of the eye, which Dr. Russel
has called  the  muddy dull eye,  mixed with  something  (not
very intelligible) of lustre; an appearance which has also been
noticed by Orrseus, (p. 109) and others, as  being peculiar to
this disease.   Dr. Price informed me, that by minute exami-
nations he had satisfied himself,  that this appearance of the
eye was occasioned by the different colours of the fluids  con-
tained in,  and  distending the  vessels of its external coat,
which fluids were sometimes bloody, 'at  others .yellowish,
bluish, or dark coloured, and caused the vessels to appear as
variously shaded  streaks, or lines, which  sometimes were
circular, at  other times diverging like radii from a centre,  and
in some cases by running together, they produced irregular
spots,  the ultimate  effects of all which,  he  thought,  aptly
enough expressed by the  term of a muddy eye.
   Dr. Price  also mentioned a peculiar  appearance  of  the
tongue, which sometimes occurs  in this  disease, and which 
398
  has been called the streaked, oi fiery tongue, as produced by
  alternate streaks, or patches of white and red.
    In regard to the proportions of death from plague, it varies
  greatly in different seasons and temperatures; but I am afraid
  that when the disease prevails extensively, and  with its usual
  violence,  more  than  one-half  of those attacked by it,  have
  commonly died, under the most judicious modes of treatment,
  and with the best accommodations.   De Mertcns says,  (p.
  45) that until the disease was mitigated by frost, at Moscow,
  in 1771, scarcely four patients in a hundred recovered: but
  this must have  been a most uncommon  degree of mortality.
  Desgenettes says that the  French Egyptian  army lost 700
  men of this disease,  during their expedition  into Syria,  in
  the year seven; and  that  in the  year eight, about one-third
  were cured; and he expresses great satisfaction in recollect-
  ing, that of 700 men under this disease,  in  the citadel of
  Kairo,  in the year nine,  more than one-third had escaped.*
    The deaths  from this disease generally  occur between the
  2nd and  5th  days;  those who survive  the 7th day,  arc sup-
  posed to  be in the way  of recovery.   Orrseus describes  an
  acute inflammatory form of plague which produced apoplexy
  or suffocation,  and terminated fatally in 24 • hours.   (In this
  bleeding might probably have been useful.)  Savaresi, one of
-  the French physicians  in  Egypt, says the disease sometimes
  occurred  there with a fever, which he  calls a synochus, and
  killed the patient  in 24 or 36 hours, before any buboe, car-
  buncle, or eruption  had manifested itself.   Some cases  oc-

    * Desgenettes Hist. Medicale, &c. p. 250, says L'an ix, ou nous avons eu dans la
  eitadelle du Kaire jusqu' a 700 pestiferes,  nou avons en le douce satisfaction d'en voir
  guerir au dessus du tiers, & dans quelque circonstances pres de la moitie : les jeunei
  negres & les Syrians au service de la republique ont particu-lierement souffert de
  la peste.
    Small as this success may be" thought, it is great, compared with the results of the
  treatment, when sweating was practiced in the fullest extent.  Hieron. Mercurialis
  de Peslil, p. 11, says, " Qui versati sunt in curandis segris hoc tempore,  (plague of
  157G,) facile cognoverunt, ex centum cegris etiam decern et plures fuisseserrn'os." 
399
 cnrred in the British and Indian armies, in which the powrei;s
 of life seemed to be suddenly overcome by the disease,  and in
 which death took place within a few hours, without any ap-
 parent effort or reaction of the system.  I  believe, however,
 that when persons are said to have suddenly dropped down
 dead from an attack  of the plague, that the disease had com-
 monly subsisted some hours at least, though not avowed, or
 perhaps  known; and in those  cases where persons supposed
 to be convalescent suddenly expire,  it is probably from some
 over exertion, too great for the exhausted state of their excita-
 bility by  the previous disease.
  Two cases of re-infection, or second attacks of plague,  fell
 under my observation in Egypt;—one occurred in Mr. Web-
 ster, then an Assistant Surgeon, and the other  in a soldier of
 the 27th regiment, each of whom had a buboe; they were, how-
 ever, but slightly indisposed, the weather having become hot.
 Dr. Buchan had a second attack, but with only a small car-
 buncle, as he informed me; Dr.  Price  also had  a second at-
 tack without either buboe or  carbuncle, but, according to his
 account, with a violent affection of the.head and nervous sys-
 tem.  In general, I  think, second attacks are milder than the
 first, though Dr. Price informed me of his having seen a lad,
 who under such an attack, died on  the second day.  Pugnet
 says, p.  140, that reinfections,  when  they occurred, were
 oftenest in persons who  had been mildly treated by the first
 attack ; and that several of these had the disease very violent-
 ly the second time, immediately after using the beds or blan-
 kets of persons who  had died of it.
  Having, as I believe, already at pages  61 and 387-8  suf-
 ficiently  shewn the impropriety of  attempting to assimilate
 the  plague with yellow fever, it seems expedient that I should
 do the like in regard to the endeavours which have been made
to confound the former disease,  at least as it has appeared in
this country, with typhus fever.
  Sir John Pringle,  at p. 319 of his work on the Diseases of
 the Army, says, " I shall  not enter upon the distinction to 
400
 be made between a pestilential fever and the true plague ;*  the
 ancients are not clear upon this  head,  and .those of the  mo-
 derns who  contend for a real  difference,  have not  been  able
 so to ascertain it, as to end the dispute.j   I  shall,  therefore,
 only remark, that though the jail and hospital fever may  dif-
 fer in specie from the plague, yet  it must he accounted  of the
 same genus, as  it proceeds from a similar cause, and is attend-
 ed with the like symptoms." !  ! !  Where  this distinguished
 writer  could imagine that he had observed any likeness in the
 symptoms of these diseases,  or  any  ground  for  considering
 them as the effect of a similar cause, I  am unable to conceive.
 The late Dr. George Fordyce, however, believing that  Sir
 John Pringle had not done enough, in considering the plague
 and typhus fever as diseases of one  genus, has strongly  inti-
 mated  that  the former disease never existed  in this country,
 and that the latter was always mistaken for  it.  In his  Dis-
 sertation on Simple  Fever, this  author makes the following
 observation respecting the plague, viz :—
   " This infection has sometimes been  brought into Europe,
 as was the  case at Marseilles; but that  disease  called  the
 plague, which ravaged this country, on considering the histo*

  * The connexion,  real or supposed, between a particular state,  or  constitution of
the atmosphere, and the extraordinary prevalence of plague, has induced persons, in
different ages, to consider fevers  which either preceded, or followed such an event,
as partaking of the nature of the plague ;• and hence, fevers  which had  neither the
characteristic symptoms, nor the contagion of plague, have been denominated pesti-
lential fevers. Sydenham, on the ground of this connexion, has not only  described a
pestilential fever of 1665 and 1666, but also a  variolus fever, (of 1667, 8, &c.) as  he
called it,  because in his opinion, it " depended upon that epidemic constitution of the
air, which (as he says) at  the same time produced the small pox,-" though this fever
was not attended with  any eruption, nor with any of the symptoms connected with an
eruption; and though it did not possess that peculiar contagion, which is essential to small
pox. In regard to the production of any disease, specifically contagious by any " constitu-
tion of the air," it can only have been imagined ; and, therefore, those appellations
oi pestilential, and variolous, were highly improper and fallacious.
  ■f A little common sense,  according to my conceptions, would easily " end the dis-
pute."  A disease is tbe plague, or it is not the plague.—If it be the plague, it should
 receive that name ;—and if not the plague,  it should not be  called pestilential, by
 those who would, attach correct and precise meanings to words, 
                           401

lies of the disease, seems to have been a fever produced by in-
fections of the first class which have been enumerated.   (" In-
fectious matter produced in the body  of a man afflicted with
fever, or produced by a number of men living for a certain
time in  a small  space." p. 121.)   For the inhabitants of this
country, (lie adds)  it is undoubtedly of great moment  to de-
cide this point, but  it  wTould  make too great a digression.
The author may perhaps lay the evidence before the public in
an appendix."  .Unfortunately, however, the author is dead,
and  no  publication of this  evidence has been made, or is, as I
understand, ever likely to be made ; I must, therefore, con-
clude, that the judicious editor of the posthumous part of Dr.
Fordyce's work, either  did not find the evidence in question,
or did not think it worthy of publication ;  for otherwise, con-
sidering the importance of the subject, we may presume that
it would not have been suppressed.  But another physician,
respectable by his  own  talents,  character, and rank  in our
profession, as  well  as by those  which his father possessed
 when alive,  has adopted, and endeavoured to support this
 opinion,  that the  destructive plague  which formerly com-
 mitted  such ravages  at various times in London,  and  for the
 last time in 1665,  was no other than our ordinary typhus or
contagious fever; an opinion for which I am unable to disco-
 ver the smallest foundation.   Those  who believe the physi-
 cians of the 17th century to have been so egregiously mistaken,
 must necessarily suppose they were unacquainted  with the
 true plague,  or that this  disease  has so much similitude with
 typhus fever, as to  make it difficult to distinguish  one from
 the other: that the first of these suppositions is at variance
 w ith the truth, must be evident  to all who will  refer to the
 descriptions of the plague, given by medical  writers in those
 limes,  and more especially to the instructions prepared by
 the College  of Physicians,  and given to the Searchers at the
 beginning of the plague of 1665, in London, which point out
                         •51 
402
 most clearly and distinctly  those  symptoms  and  appearances
 which characterize the true Egyptian, or Levant plague ;* and
 which, without the grossest inattention, would  have rendered
 it impossible  even  for the most ignorant, to have  been mis
 taken in  regard to tbe disease  generally, though  they might
 have been liable to err in a particular case,  where, from  the
 causes heretofore mentioned, the appearance of glandular swel-
 lings, exanthemata, kc.  was either obstructed or retarded.
 And  in regard  to the supposition of a similitude in the two
 diseases,  I  am not a little surprised that it should  have been
 entertained by any one who had ever read  even  a tolerable
 description  of the two  diseases;  and  I should be  astonished
 if it were countenanced by  one who had actually seen them.
   That the plague,  as  it formerly  prevailed in London,  was
 not  a typhus  fever* must be  evident from the  notorious fact
 of its having always  been most extensive  and fatal in  the
 summer  months,  particularly August and September, when

   * The searchers appointed by authority in 1665, were required, by  the College of
 Physicians, " to take notice, whether  there be any swellings, risings, or blotch, under
 the ear, about the  neck, on either side, or under the arm-pits of either side, or the
 groins; and of its hardness, and whether broken, or unbroken ?"
   2ndly, " Whether there be any plains, which may rise in any part of the body, in
 the form of a blister,  much bigger than the small pox, ot  a straw colour, or livid
 colour, which latter is the worser ; either of them hath a reddish circuit, something
 swollen, about it which circuit  remains after the blister is broken,  encompassing the
 sore ?
   3dly, " Whether there be any  carbuncle, which is something like  the blain, but
 more fiery and corrosive, easily eating deep into the flesh, and  sometimes having a
 Mack crust upon it, but always compassed about with a very fiery red or livid fiat, and
j hard tumor, about a finger's breadth more or less; this, and the blain, may appear in
 any part of the body ?
   4tbly7 " Whether there be any tokens, which are spots  arising upon the skin, chief-
 ly about tbe breast and  back, but sometimes,  also,  in other parts ;  their colour is some-
 thing  various, sometimes more reddish,  sometimes inclining a little  towards a faint
 blue, and sometimes brownish, mix' with blue; the red ones have often a purple  circle
 about them ;  the brownish,—a reddish ?
   5thly, " Whether the neck and the limbs are rigid or stiff, or more flexible and lim-
 ber, than in other dead bodies ?" 
*m       m
                            403

there is a cessation of typhus fever : and the fact of its having
been rendered nearly, if not completely, extinct, by the cold of
winter, when typhus is commonly most active and prevalent;
for though  intertropical heats exterminate or  exclude the
plague, and the summer heat of Egypt suspends its progress,
the warmest weather in our country,  is not too warm for tbe
greatest ravages of the plague.
   That other diseases prevailed in London during the summer
and autumn of 1665, and were confounded with the plague, I
am disposed to conclude,  because it  was then  commonly be-
lieved that this  disease,  when raging so extensively and  de-
structively, had the power of  converting all other diseases to
its own nature;  and w ith this notion,  fevers which had none
of the distinguishing marks of the plague obtained that deno-
mination ; but there are  numerous  facts and  reasons which
warrant  a  belief that these  were  marsh,  and  not typhus
fevers.  It will  not be expedient that I  should here adduce
proofs (now well known) of the frequent and extensive preva-
lence of intermitting and remitting fevers, in aiwl about Lon-
don, before the sources of miasmata were removed, or rendered
unproductive, as they have been,  in  a great degree, for near
a century.   Morton affirms* that remittents were very destruc-
tive from 1658  to 1664; and  that sufficient causes  for their
recurrence existed in 1665, may be presumed from the long
continued dry and hot  weather which took place in the sum-
mer of that year,  though neither Sydenham nor Hodges have
distinctly mentioned it.* The fever accompanying the plague

  * At page  13 of Loiinologia, fkc. Hodges observes, « the whole summer was re-
freshed with moderate breezes, sufficient to prevent the air's stagnation and corrup-
tion :' &c and " the heat was likewise too mild to encourage  such corruption and
fermentation as helps to taint the animal fluids," Sec  It is probable,  however,
that, by these loose  expressions, the  author only meant, that the  air did not
stagnate, and that the heat was not so excessive  as to  produce the corrup-
tion, &c. which are here mentioned;  for,  at page £0, he thinks it proper
to 'advertise  his readers,  «< that  this year was most  luxuriant iu most  fruits, 
404
 of that year was very commonly a remittent.   Hodges, whose
 authority  on this  point  is better  than any other  within my
 knowledge,  mentions,  at p. 49 of his Loimologia,  that in this
 pestilence  " persons  frequently died without  any preceding
 symptoms   of horror,  thirst, or concomitant  fever;"  and  of
 this he gives two instances,  in which the disease undoubtedly
 was the  true  plague, adding, that although sometimes "  no
 appearance could  be discerned, even of a lurking fever, yet,
 for the most part some fever did shew itself."   (p.  50.)    And,
 at p. 51,  he  observes,  that  " the fever accompanying this
 present pestilence was of the worst kind,  both on account  of

 and  especiallly cherries and grapes,  which were  at  so  low a  price  that  the
 common  people surfeited with them;"  which,  in regard to  grapes  at  least  (
 would not  have happened in this country without a summer of more than common
 heat.  It is, indeed, mentioned as such, distinctly, by  Mr. R. Hooke,  in  a letter
 to the Honourable Robert Boyle, dated July  8th, 1665, in which,  after notioing the
 adjournment of the Royal Society by  reason  of tbe plague, be says,  "I cannot,
 from any information I can learn of it, judge what its cause should be, but  it seems to
 proceed only, from infection or contagion, and that not catched,  but by  some  near
 approach to some infected person or stuff; nor can I at all imagine it to be in the
 air, thougli there is one thing which is  very different from what is. usual in  other hot
 summers, and that is a very great scarcity of flies and insects."  See Bdyle's works,
 (1772) vol. vi. page 501.  And  in regard to the stagnation of the atmosphere, and
 want of rain, Dr. Edward Baynard, (Physician in Bath) in page 252 of Sir John Floy-
 er's " Ancient ■d/vvpoXsTtx revived,"  (printed in 1702) writers, " I was at Chiswick,
 and sometimes in  London, in the time of the great plague in the year 1665, and I
 very well remember," " during the time of the plague, there was such a general
 calm and serenity of weather, as if wind and rain also had been banished the realm,
 for many weeks together, 1 could not observe  the least breath of wind,  not enough
 to stir a weathercock or fane; if any, it was southerly."  That there was an unusual
 drought in that year is farther manifested, at page 256 of tbe History of this Plague,
 by the following observation :  " It pleased God to send a very plentiful year of corn
 and fruit, but not of hay or grass; by which means bread was cheap,  by reason of
 the plenty of corn;  flesh was cheap,  by reason of the scarcity of  grass ; but butter
 and cheese were dear for the same reason ;  and hay, in the market just beyond White
Chapel Bars, was sold at 4^ per load."   In several places of the same work, (suppos-
 ed to have  been written by Defoe) particularly at pages 145 and 146, the weather,  in
 that summer, is stated to be  " very hot "  And in  the then state of London and its
 viciniiy, this hot and dry weather might well be expected to occasion more than the
 ordinary proportion of intermitting and remitting, but not of typhus, fevers. 
405
 its state  and periods ; sometimes imitating  a quotidian, at
 others a tertian;  sometimes seeming to retreat, and at others
 attacking again, with redoubled fury.  There was never  (he
 adds) a total cessation, but sometimes a remission for an hour
 or two, although every exacerbation was worse than the for-
 mer."  All  this is very similar to an epidemic marsh remit-
 tent, and  as unlike  typhus  fever as  possible.   The  same
 author, in a letter addressed to a person of quality, and sub-
 joined  to his Vindicise Medicine & Medicorum,  printed in
 London,  ann.  1666,  after mentioning the irregularity of  the
 fits, or paroxysms, of the fever, in those who were ill of  the
 plague, adds, that «they seemed most to resemble a double
 tertian;"  and  that " in  many,  when the virulency was  ex-
 pelled and spent, these fits did keep and observe their types,
 and became  either pure or  bastard tertians."—Or, in other
 words,  that after the contagion of the plague had ceased to
 operate  in the body, the  influence of marsh  miasmata, pre-
 viously imbibed, continued to produce its usual effects.
   In regard to the treatment of  the disease,   I shall offer but
 a few observations.  It appears to have been a very early and
 general opinion among the physicians of this and other neigh-
 bouring countries, that those who were attacked by the plague,
 small pox, and other contagious diseases, had imbibed a mor-
 bid poison, and that it was necessary, above all things, to assist
mature in  expelling that poison from the body,  and this princi-
pally by sweating, which Morton called, "regiam viam" or
 the king's highway.  In " certain rules, directions, or adver-
 tisements, for this time of pestilential contagion," " first
 published for the behoofe of the city of London," in " the
 visitation of 1603," " by Francis Herring, Doctor in Phy-
 sick, and  Fellow of the College of Physicians," and re-pub-
 lished, upon the recurrence of the plague  in 1625,  copious
 sweatings  were directed  to  be  excited by strong  sudorifics,
 with warm beds and bed clothes, " so soon as any of them 
406
 ("the poorer  sort  of people")   apprehend  themselves to be
 taken with the plague,"  and  these were  to be  repeated  every
 eight hours;  and they  were to  " continue this course for  four
 or five  days;" and whilst sweating,  it was  enjoined not  to
 " let them rest,  or  sleep."*   The same opinions,  or modes of

   * To discover the motive for this strange injunction, we must  recollect that pati-
 ents in the plague  are  often comatose, or  morbidly disposed to  sleep;  and as those
 who were so affected had commonly died, it was conceived that the poison of the dis-
 ease  was enabled to exert its pernicious influence, more powerfully in a sleeping than
 in a waking state ;  and,, therefore, that it was of the greatest importance to hinder
 sleep, especially while attempts were making to dislodge the enemy by sweating, and
 also when nature was supposed  to have endeavoured to produce a similar effect by
 buboes.  In an old work entitled,  " De la maniere de preserver de la pestilence, et
 d'  en guerir, par  Benoit Textor, Medecin," printed at Lyons, in 1551,  the  author,
 at p. 130, makes this observation: " C'est un accident de  grande importance,  et per-
 petuel ou  inseperable de cette maladie, que le long et profond dormir, contre lequel,
 pour cette cause, il est necessaire de soigneusment batailler, tant s' en fault qu' on le
 doive hiepriser."  And he afterwards explains himself more on this  subjeet,  at page
 150, in these words :  " Quand  le bubon and  le charbon sortent, le dormir est fort
 dommageable, d' autant qu' il retire au dedans la malice du venin.  Et neantmoins c'est
 alors que les malades y sont plus enclins, et qu' il y  ha plus a faire a les empescher de
 cela."  " Or en ce cas quand ces enflures se font, veu  que par un tel moyen nature se
 efforce  de  poulser ceste matiere aux parties exterieures, alors pour luy ayder,  le veil-
 ler est requis au malade, s' il le fut onques.   A eela on taschera  par paroles recrea-
 tives, par jeux,  par bruits,  parcrys.  On crier a bien  hault aux aureilles  du mal-
 ade  mesmes,  par voi.v aigue, on  sonnera  des  bassins,  et dautres choses aupres
 deluy, on cornera,  on frappera avec des bastons,  on ouvrira et fermera les portes,
 ou quelque coffre et armoire h lestourdie, on usera de pinsemens  rudes,  de ligatures
 fortes es extremitez comme es doigts,  ce quon appelle bailler le  moyne, on  ployera
 doloureusement ces parties, on luy tirera les cheveux, la barbe, et principalement les
 poilzjles parties honteuses, on  luy tirera bien fort le nez et les aureilles, ou luy ouvrira
 les yeux par force,  ou y  jettera du  vinaigre, on les gratignera asprement, on le
 frappera, on le scourra, on  l'e.vnosera a la  lumiere, on  le tourmentera  en toute
 maniere, on  rovandera  en  la maisoji ou procedera prudemment par toutes ces
'faconsdc  faire selon  le persontiage.  D'autre part pource que par le trop verier les
 esperits vitaux se dissipent, dont souvent s'ensuit grande debilitation, pour cviter c<:
 danger, si les malades demeurent trop  longuement  sans pouvoir  dormir, ou y pour-
 voyera, &c-"  Certainly nothing but the most extravagant apprehensions of  danger,
 from sleeping in the  plague, could have induced a physician of  good character seri-
 ously to adv;se such violent,  extraordinary, and indecent means to produce watch-
 fulness, knowing as he djdfhow much it  contributed to exhaust the powers of life 
407
treatment wrere  adopted in the " advice set  downe  by  the
College of Physicians, by his Majesties  speciall  command,"
which was printed in 1630, along " with certaine statutes"
concerning the plague in that year.  By this it was directed
" that there be good fires kept in, And about the visited houses,
and their neighbours ;"  and  "to make fires rather in pannes,
to remove about  the chambers,  than  in chimneys, the better
to correct the ayre of the houses."  After which directions
are given for the repeated administration of the most powerful
sudorifics, upon the  ground  of  opinions delivered in  the  fol-
lowing  sentence, viz.—" For as  much  as  the  cause of the
plague,  standeth  rather in poison,  than in  any putrefaction of
humours,  as other agues doe, the chief est way is to move sweat-
ings,  and to defend the heart by some cordial thing.
  On the 13th May, 1665, the College of Physicians were re-
quired by " a Committee" of the  Privy Council,  appointed  '
by the king, " for prevention of the spreading of the infec-
tion of the plague," to inspect the  " Rules given by the, Phy-
sicians of former  times, and imprinted for the  public benefit,"
and to make such alterations  as they should " find the (then)
present times "and occasions to require and to cause such their
directions to be as speedily prepared and printed as possible;"
and the  College in their answer  or address to the said Com-
mittee, on the 25th of May,  signified that  they  had  done as
was required of  them.  And  among the directions  then pub-
lished by the College, after the mention of bleeding, purging,
and  vomiting,  they  say "  these  three great remedies rarely
have place in the plague, but are generally dangerous, ami most
of all purging, by any  strong medicines;  and are therefore
not to be used, but upon some extraordinary urgent indicant,
or just occasion,  and with the greatest caution,  which only
an able physician can judge of."  They  afterwards deliver it
as their opinion,  that " the poison is best expelled by sweat-
ing,  provoked by posset ale," " and London treacle" to  the 
408
 quantity of ^ij mixed ;  the Patient to " be put to bed to sweat
 well  covered  in a blanket,  without his  shirt, for twenty-four
 Jiours, every fifth hour renewing his cordial, but in half the quan-
 tity" first taken,  " between whiles refreshing him w ith posset
 drink, oatmeal caudle, or thin broths, made jelly wise, or harts-
 horn jelly," and, if necessary, warm bricks, wetted  with vine-
 gar, and  wrapped in flannels, were to be put to  his feet, and
 care was to be taken that he " sleep  not till the sweat be over."
 Blisters  were at  the same time to  be applied, " behind  the
 ears,  about the wrists,  near  the  armpits,  on  the  insides of
 thighs,  and near  the  groin,"  to " draw forth  the venom."
 The buboes, or swellings of the lymphatic glands, were to be
 " always drawn forth,  and ripened,  and  broke with  all speed."
   I have mentioned these facts to illustrate the motives, as well
 as the means, by which  persons, were as I fear, often sweated
 to death in the plague,  small pox,  miliary fever,  and above
 all, in the  sweating sickness,*  and with so little suspicion of

    I may at some mture time endeavor to dispel the obscurity in which the cause and
nature of the sweating sickness seem to be involved, but at present I shall only observe
that the efforts to produce sweat, and the mischiefs thereby occasioned in this disease,
were probably greater even than in the plague ;  and to throw  some light upon the ef-
fects of that treatment in the latter disease, I venture to introduce a paragraph, which
with others, I have extracted from a curious manuscript,  part of Sir Hans Sloane's Li-
brary, No  349, now in the British Museum.  It is intituled " Aotfioypx<ptx, 0r an
Experimental relation of  what happened remaikble in the last Plague in  ihe City of
London," by " William Boghurst, Apothecary," &c.  He was  also the author of Lon-
dinologia, sive Londini Encomium MS. also in the British Museum; and his epitaph,
at Meereworth, states, that he " was an honest just man, skilful in his profession, and
in the Greek and Latin tongues, delighting in the study of antiquity," &c.
  In chapter 21, at page 121, when going to treat of the cure of the plague, Mr. Bog-
hurst says, " Before I begin tbis, I must needs  say something concerning a doubt
which bangs in my mind, which I have hinted at a little once  or  twice  before,
%'iz. whether  strong s-weats often repeated  be an autbentical,  canonical  rule,
which will serve for all sorts of people or cures.  I wish somebody of more skill would
resolve the  doubt: that which makes me doubt and stick concerning this, is that I have
seen so many this year of strong, lean, raw-boned  nervous, (sinewy) people, of much
spirit and little humour, thathave been very laudably sweated,and scarce one in twenty 
1
                             409  .

the mischief, from a violent excitement and expenditure of the
living power, produced by stimulating cordials, heated rooms,
excessive  covering, deprivation  of sleep,  kc. that  all  who
escaped death under  such  treatment, were supposed to have
been saved by it.
   Opinions equally erroneous  were entertained of the nature
and treatment of buboes, and exanthematous eruptions, which,
being considered as critical  eruptions, though often occurring
at the commencement of  the disease, it was thought necessary
to bring them as speedily as possible to a state of suppuration,
by the most stimulant applications, in order, as was imagined,
to extract the morbid poison, and even to employ scarification
or excision for the carbuncles.  Sydenham was indeed so fully
convinced, that buboes and carbuncles were  intended by na-
ture  to  produce salutary evacuations,  that he considered an
attempt to discharge the morbid poison by artificial sweating,
as an endeavour to force it into other outlets, than those which
nature had selected for tbis purpose.  It seems highly proba-
ble, that the buboes which accompany the plague, are no more
the effect of  an  effort of nature to  evacuate morbid matter,
than those which  occur in the venereal disease, or, after the
introduction of variolous contagion by inoculation ; and it has
been proved, in a multitude of instances, that no harm has re-
sulted from the spontaneous resolution or  dispersion of pesti-
lential buboes without suppuration.  Such  instances have been
often seen, and attested, by the most accurate and respectable
writers on this disease; and thougli it may be  proper to pro-

afthem have lived, but dyed all within two or three days ; and the sooner, by how much
more freely they sweated, and were worst after sweating ,  being much more subject to
lightness of head, staggering, faintness, bleeding at the nose, quinzies in the throat; and
some had the tokens come out presently, which made me desist from much sweating
such persons, and then I had many patients lusty men, who lived and never sweat at all,
and are living to testify the same; and I observed that they that sweated freely of their
own accord seldom lived" The spontaneous sweatings here mentioned were doubtless
 the effect of a morbid predisposition to that discharge, connected with debility, which fre-
quently occurs in this disease, though in many patients, who have tlie plague, there is
 an umsual dtyness of skin, and indisposition to perspire;
                             52  n 
                              <no

 mote their suppuration by emollient, and moderately stimulant
 cataplasms,  kc. where a natural disposition to that issue is
 evident; there can, I think, be  no  danger in  favouring their
 dispersion,  or resolution, by the usual  means,  when we  ob-
 serve a spontaneous tendency to  such a termination.*  I know
 that the sudden  retrocession of buboes,  previous to suppura-
 tion, and whilst other symptoms  indicating danger, subsist un-
 abated, is often followed by death.   But tbis mortality is not
 in such cases produced by any change in the  buboe itself, or
 by the retention of any matter which ought to be discharged,
 but by  such an  extreme diminution of  tbe living  power, or
 other injurious  effects  of the disease, as is  incompatible with
 the continuation of a  suppurating process*, and also  with the
 patient's recovery; and therefore,  this retrocession is to be
 considered not as the cause of death, but as an indication,  and
 consequence of that condition of the patient, from which death
 necessarily  resulted;  and on the other hand, when these glan-
 dular swellings rise, and suppurate  favourably, they indicate
 such a state of the living power,  and of the system, as is likely
 to overcome the disease, without the supposed benefit of an
 evacuation of morbid poison by  that suppuration.  The same
 reasoning appears applicable to carbuncles,  though in their
 gangrenous  state, and when  not surrounded by  concentric
 inflamed rings,  they require  hot stimulant applications,  and
 afterwards such as will promote a suppuration,  and a separa-
 tion of the carbonaceous crust.f

  * Mr. Boghurst, atp 141 of the before mentioned MS. says,  " Though many bu-
boes after they came to be very big, never come to break at all, but sink away  again,
and by degrees wear quite away ; yet doth the patient grow well, and continue so, not-
withstanding their not  breaking .- yet you must not make it your design to repel, divert,
or discuss them, but only to suppurate them ; and if you see them not more forward, or
digest so fast as is convenient, then you may apply a vesicatory, just underneath them,
that so the pernicious ichorous matter may have vent ;  and these blistering plasters had
better success always, than cupping, or burning, or potential cauteries "
  f Boghurst mentions, at p. 146 of his MS. that in the year 1665, some persons used
to make incisions round each carbuncle, and apply vinegar and salt to the fresh wound ;
<' but to what purpose, (says he) I know not unless they delighted to torment people ; for 
411
   In regard to the treatment of the disease, generally, I have
 little to offer ,* and, until we know more of the wrays and means
 by which nature endeavours to overcome  it,  I am afraid we
 can do but little for her assistance, otherwise than by restrain-
 ing all  violent and dangerous  symptoms,  all excessive and
 debilitating evacuations, and supporting, when necessary,  the
 powers of life, by a moderate use of wine, sether, opium, vola-
 tile alkali, and Peruvian bark.  The instances of persons who
 have strangely recovered from the plague, after having wan-
 dered alone about the country, particularly in Egypt, exposed
 to cold and wet,* seem to indicate, that even the most mode-
 rate sweating is, at best, useless: but on the other hand,  the
 unsuccessful trials made by Dr. Price, of the cold bath, afford
 no encouragement to repeat  such applications to  the surface.
 In some few cases, where the disease occurs in the vigorous
 and robust, and  is accompanied with  highly inflammatory
 symptoms, bleeding might, I think, prove beneficially, if em-
 ployed within a few hours from the attack; though in general,
 very bad effects appear to have resulted from this evacuation.
 Mild emetics are said, in some cases,  to have proved benefi-
 cial, given at the very beginning of the disease.
   Mercurial preparations were tried in Egypt, and probably
 thought  not to have been previously employed in  any  other
 country  for  the  plague,   Diemerbroeck, however,  mentions,
 at p. 268, their  having  been  long before employed by Am-
 brose  Pare, who bestowed some  commendations upon them,
 (lib. 21, cap. 29,) with what justice,  I will not decide.   Put
 during the plague at  Marseilles, 1720, Viedier states, that he
 employed mercurial frictions, and pushed them as far as pos-
 sible,  "ausi loin qu'on les  peut porter," without prqducing
 any good effect.  See Traite de la Peste, p. 522,

it put them to as much pain as if they had been on the rack." He adds that a French-
man, after cutting round the carbuncles, used to pluck out the eschar with pincers, be,
fore it was " ripe" for a separation.
  • Desgenettes mentions two remarkable cases of this kind, at p. 149, 150, aiwlthey
are not the only ones which have been well a(,tpsted. 
412
   Orrseus also asserts, p. 154,  that he had employed mercu-
 rials in various  forms and doses, both internally  and  e.rter-
 Qially, and that they did no good.   " Nee minimam utilitatem
 prpestarunt."   Pugnet, likewise, as he  states,  employed the
 same medicine, both internally and externally, without the
 smallest benefit,  oven  in the  cases for which it seemed most
 suitable, excepting a few instances where buboes were degene-
 rating into cold indolent tumours,  and appeared to be improv-
 ed  by applying  mercurial ointment along  the  course  of the
 lymphatics leading to them.   He adds, that it did not obviate
 infection, as several persons  caught the plague, whilst under
 salivation for venereal complaints.  Sotira also declares, that
 he  employed salivation in three persons  ill of the'plague, and
 that two of them  died.   Dr. Price,  who probably tried saliva-
 tion to a greater extent than any other person in  Egypt, seems
 to have formed a  better opinion of its effects;  and for the same
 fallacious reasons which have induced many persons to con-
 sider it as beneficial in yellow fever, viz. the recovery of some
 patients, in whom he was able to excite a salivation, and the
 deaths of all those in whom he attempted to excite it, without
 success.  He admitted, however,  in a conversation with me,
 that he had always found it extremely difficult to affect the sa-
 livary glands of persons under the plague, and was never able
 to do it by mercurial inunctions alone:  and when  I observed
 to him that a considerable time would be necessary to produce
 salivation by the  means which he had employed : i. e. unction,
 ami calomel internally, and that it seemed probable, that those
 who lived long enough to be salivatc-1 in this way, must have
 previously passed fcver the dangerous part of the disease, and
 have been therefore likely to recover, if no salivation had ta-
 ken place;—he admitted that my observation was probably
just,  and that the deaths of those  in whom a salivation was
 not produced, had always taken place before the time which was
 commonly required to affect the salivary glands.  I have,
 therefore, no difficulty in believing, that the supposed  benefit
 from salivation in the plague, depends upon fallacy similar to 
413
that respecting  yellow fever, which I have stated between
pages 74 and 80.
  In regard to  the frictions with oil, which were  strongly
recommended  by Mr. Baldwin,  I am afraid that but little
benefit is to be expected from them in this disease; like mer-
cury, they appeared to be an old and discarded remedy,  re-
produced as a  new one.  Benoit Textor, in the publication
lately  mentioned, so long ago as 1551, says at p.  33, in re-
gard to sweating for the plague :
  " Celuy qui ha besoing  de suer doit estre fort frotte- par
tout le corps, principalement avec huile de camomille, ou avep
camomile & huile ou avec l'herbe  dite nepeta, &c."—" Que le
personnage se face bien couvrir k chauffer des quarreaux ou des
briques aux piedz, ou appliquer dessouz les aixelles k es aines,
vessies remplies d'aue chaude." " Riverius also recommended
frictions over the whole body, with oil warmed, night and morn-
ing, in the plague.   See Prax.  Med. lib. xvii. cap.  1.  These
frictions were, however, tried extensively by the French physi-
cians in Egypt, and Avith very little, if any, benefit; though in
a few  cases they  seemed to give temporary ease and relief.
Pugnet, indeed, says  they were not  only useless but caused
anxiety and disturbance to the sick, that of 15 patients to whom
these frictions were applied under the French physician Carrie,
one recovered with difficulty, and all the rest died; and that
where they seemed to do good, the  disease was always mild,
See p. 261.   With so much reason to doubt of their utility,
there is a strong objection to their use; arising from the very
great danger of communicating the  disease to the unfortunate
person by whose hands they may be applied, and thus de-
stroying many lives, without much probability of saving one*
           END OF THE FIFTH.  AND LAST PART^
I 
0 
APPENDIX.
No. I.
   The following is Dr.  Physic's communication, which  I  promised
 at p. 24 to insert in this appendix:  viz.—
   " Some Observations on the Black Vomit, communicated by Dr.
 P.  S.  Physic, of Philadelphia,  to  Dr. Millar.'*  Extracted from the
 5th volume of the New-York Medical Repository,  1802,—page 129.
   "Having, in the  years  1798 and 1799 had  frequent opportunities
 of dissecting the bodies of persons who died of the yellow fever in the
 City Hospital, I had thoughts of publishing a  circumstantial detail of
 the several appearances in each  case.  On perusing, however, the
 descriptions given by late authors,  I find but little to add to  them, ex-
 cept some observations  respecting the black -vomit,  which do not ap-
 pear to have been particularly noticed.
  " The common opinion  was,  and for any thing I know to the con-
 trary is, at the present time, that this black matter  is poured out by
 the fiver.  The dark-coloured appearance of  the bife in its accumulated
 state, approaching more to the colour of the  black vomit,  than any
 other secreted fluid, would very readily induce a person to  conclude
that they  were  the same, if he did not  compare and examine them
 carefully; and, likewise,  attend to several other circumstances."
  By such an examination the  following differences have  been ob-
 served.-—
  " First,—If the darkest-coloured bile be spread thinly over a white
 surface,  such as the skin,  it loses the colour it had in its accumulated
 state, and appears of a yellowish-green colour; but, if the black vomit
 be treated in  the same way,  it retains its  black, or dark-brown ap-
 pearance.
  " Secondly,—The bile in the gall  bladder  has its common bitter
taste, but the black vomit is insipid, or nearly so.  This fact has been
ascertained by several persons; and  among others, by the late Dr.
S. Cooper.  I have inquired of a number of patients just after they
had vomited it, they almost all declared  itito have no  taste; and the
organs of taste were proved to be perfect in these people,  by  trying
whether they could distinguish between different tastes.  It  occasion-
ally happens, that violent efforts made in vomiting, will force some
bile out of the gall bladder into the  stomach, and then the black vomit
will have a bitter taste like bile.  Dr. Cooper twice found  it  intensely 
416
bitter owing t6 this circumstance, which, however, is  a  rare occur*
rence.
  " Thirdly,—The black vomit differs very much from any mixture
that  can be made of the dark-coloured bile,  with any of the fluids
found in the stomach, or intestines.  If bile be mixed with the mucus
of the stomach, or, if some of it be  added to the black vomit, if
mixes with these uniformly,  and imparts  a yellowish-green tinge to
them.   The nearest resemblance to black vomit that could be made,
was, by mixing some of the mucus of the stomach, a little blood,  and
some bile, together; but the difference was still very obvious.
  "Fourthly,—The stomach has been found  full of black  vomit,
when,  in the same subject,  the  fluid in the gall  bladder and  biliary
ducts,  was very different from it in its colour and appearance.  I have
found the  gall bladder filled with a fluid of a brick-dust colour; in
some others it contained a  fluid of a light  green colour;  and, in
others,  a transparent and colourless fluid, resembling the white of an
egg, only that it was of a thinner consistence.  In some  instances,
again, a purulent-coloured fluid was found in them.  Some of th«
same kind of fluid which the gall-bladder contained in these last-men-
tioned instances,  was generally found in the duodenum;  the stomach
in the same body containing black vomit.
  " Fifthly,—The pylorus, in several instances, has been found closely
contracted, and yet, the stomach contained black matter.
  " The above observations have appeared to me to overthrow-the  idea
of the black vomit being secreted by the liver.  The question, however,
still remains j-^from whence is it derived ?  I believe it to be a secre-
tion from the inflamed vessels of the stomach and intestines ;—and for
the following reasons :—-
  " First,—It is found in these viscera, when it cannot be detected in
any other organ, or cavity connected with them.
  " Secondly,—It is often found  of so thick a consistence, that it does'
not mix with  the fluids of the stomach : in such cases,  it adheres to
its inside, forming a black coat of considerable thickness;  and, when it
is once scratched off, it  cannot be made to adhere again in the same
manner.
  " I have, in one instance,  observed this  black  substance in two al-
most circular patches, each about two inches in diameter, adhering to
the stomach ;  and all the other parts  being free from it.   In this case*
there was no black matter loose in the cavity of the stomach nor intes-
tines.  On scraping it off, the spots  which had been  covered by it,
were found inflamed, and  these spots only.   Now, it can hardly be
possible for this black  substance to  have got into such a particular
situation, had it been secreted by the liver;  and some of it, in  that
case, would have  been  observed in the gajl  bladder,  gall ducts, or
duodenum.
  " It must not be conjectured,  that the black vomit irritated the sto-
mach, and produced the inflammation: on the contrary,—Dr.  May
frequently  repeated an  experiment,  which proved it to be very bland.
He dropped  it into his  eyes, and never experienced any more incon-
venience from it than if water had been used.   When the hands have
been irritated in dissecting, which once occurred to myself, I beileve it 
417
 has arisen from some acritl substance having  been swallowed by tbe
 Pa!lept JUSt before death> as elixir vitriol, volatile alkali, &c.
   "Fourthly,—I have  seen the inside  of the inflamed  stomach as
 black  as the black  vomit,  resembling it in colour exactly.  In most
 ot  these cases, no  black matter  was found in the cavity  of the  sto-
 mach.   The vessels only which were inflamed were distended with it.
 1 his colour differs  very much from the dark purple of a part in a state
 ot  gangrene; and I never observed any putridity  attending it.  This
 blackness  has, in some  stomachs, been universal, in some in spots
 only ;  the  other spots being in a state of high inflammation, giving the
 mside of the stomach a  chequered appearance.  These spots, in one
 instance, were seen resembling each other in shape and figure exactly;
 and were,  m every  respect alike,  except in colour; the one being  red,
 the other black.  Here some  of the  inflamed vessels only had gone
 into the act of forming black matter, but did not excrete it.
    ' The secretion of black vomit  appears to  be one of the most
 common modes  in which violent  inflammation of the stomach has  a
 disposition  to terminate.  Death, however, in general, takes  place
 before it entirely disappears.   I  have seen many  cases, which shew
 that the inflammation is diminished  by the secretion;—of which, it
 will be sufficient to mention the  following.  On opening a stomach,
 one-half of it was coated with adhering1 black matter,  while the other
 half was free from it; on  scraping  it off clean,  and comparing the
 part underneath  with the  other half of  the stomach which had not-
 secreted any black matter,  the difference in the degree of inflamma-
 tion was very striking, being much  the  least in  the  part which  had
 been covered with the black substance.
   " In some cases, where the vomiting of black matter had been con-
 siderable in quantity, or  continued for several days, the inflammation
 was found very faint indeed; and in  some, the inside of the stomach
 appeared as if covered over with a vast number of small  glands,  like
 mucuous folicles crowded together."
  The author had also promised at p. 40, to give  " the substance of
 another Memoir concerning the  Black Vomit, written by Dr. Isaac
 Cathrall, of Philadelphia; which, however,  by reason of the room it
 vould necessarily occupy, the editor of the latter parts of this volume
 has  been forced to omit; preserving, however, the following extracts,
 from an inaugural Dissertation on Malignant  Fever,  by Dr. Stubbins
 Ffirth, (now, or late, of Philadelphia,) relating to the  appearances on
 the dissections of a considerable number  of persons  who had died of
 the yellow fever: viz.—
  " The brain was generally found in a  diseased state, the meninges
 being considerably inflamed, the dura mater being; sometimes aggluti-
nated to the pia mater, in consequence of the increased action of the
 arteries thereof.   The blood vessels were turgid with blood, appearing
as though  they  had been  injected ;  the substance of the brain  was
harder and firmer  than  usual; the ventricles frequently contained
water, sometimes to the amount of several ounces; in  some cases, the
rupture of a small vessel  had taken place, and an effusion of blood  was
found between the pia and dura mater. 
418
    "The stomach was  always found diseased-K,great  inflammation
  being observable throughout, and erosions of the villous coat frequent,
  nay, in  a number of cases, whole portions thereof, of the size of a
  dollar, were detached, and  found floating in the black  vomit.   The
  blood vessels were, in general, very much distended; and, in one case,
  their smaller extremities filled with a fluid similar to the black vomit
  in appearance, taste, and  smell.  This inflammation  was frequently
  continued to the small intestines; the  duodenum was the most affect-
  ed, but the jejunium  and ilium also suffered a part; nay, the large in-
  testines by no means escaped free, for I have often found them consi-
  derably inflamed.
    " The spleen and pancreas were generally found in  a healthy state;
  the kidnies were also generally sound; but the bladder was, in a num-
  ber  of cases, inflamed; and in some so  contracted,  that the cavity
  would not hold four ounces.
    " The liver  was generally, I  might say almost always found in a
  healthy and natural  state."—" I do not find  amongst my papers any
  ' evidence of its having been diseased, except in three  of the patients
  that I examined, and, in two of them it had been of a chronic nature."
  " The gall bladder was always found in a healthy state, containing its
  usual quantity of bile, and of a natural colour.  I have  preserved spe-
  cimens of black vomit,  and of bile,  taken from  the same patient,
  shewing  the difference, which is obvious from first sight.   From eve-
  ry circumstance,  I feel myself authorised to, and I do positively, as-
  sert, that black vomit is not an altered secretion of the  liver;  is not
  changed  bile; and does not come from the liver, whatever others may
  assert to  the  contrary."  To prove  this, he  says, 1st.—" It is never
  found in  the gall bladder, the hepatic, or the cystic ducts, or the duc-
  tus choledochus communis."  2ndly.—The bile is found natural in
 the gall bladder, when the stomach is distended with black vomit."
  3rdly.—" I have found the stomach distended with black vomit, when
 the pylorus valve completely obstructed  all passage from the duode-
 num to the stomach,  or  vice versa; at the same time, the liver was
 perfectly  free from disease, and the bile in the gall bladder natural in
 colour, taste, and consistence."  4thly.—"I  have seen arteries of the
 stomach  distended with a fluid similar to black  vomit,  and not to be
 distinguished from it by any means whatever : a  portion of the villous
 coat of the stomach separated from its adhesion to the others, and the
 space filled with, black vomit, poured forth by the termination of the
 small arteries."   See  Dr. Cox's Medical Museum, vol.  1st. p.  116
 — 118.
   In  some few cases of mortality from the yellow fever, the stomach,
 after  death, is said to have been  found without marks of inflamma-
 tion.   But I  do  not recollect that any of these were described so par-
 ticularly as  they ought to have been,  or with such explanations as
 could enable us to  ascertain  either the accuracy of the observers, or
 the causes of such deviations, if real, from  the condition in which,
 according to my best information, that viscus  has been seen in at least
 49  out of 50, of the bodies  of persons dead of yellow fever, which
 have been examined.  In support of this  observation, I could adduce
 numerous proofs; but thinking them unnecessary,  I shall only sub-
join a few lines from an official statement, published in the Moniteur 
419
"du 17nivoseanxi," (7th of January,  1803,) concerning the death,
&c. of the Captain General Leclerc, (brother-in-law of the then First
Consul of France,) at St. Domingo, who is therein declared to have
been attacked with fever  " le 8  Brumaire  an xi."—-"Et  le medecin a
declare ce meme jour, que c'etoit la maladie de Siam, dans toute son
intensite,"  Sec.—"Le  10,  le -vomissement a ete plus frequent, & est
devenu noir."  During the vomitings,  it  is stated that the skin ap-
peared black, with a yellow tinge; and that blood escaped by the eyes.
He died in the night between ihe loth and 11th, " Brumaire."  This
statement is signed " Peyre, Medecin en Chef."   The medical  offi-
cers who examined the body after death, declared that they had found
" I'estomach extrSmement fihlogose, la tunique interne sfihacelee, et en-
duite d'une hunieur noirdtre et visqueuse."  (The stomach very much
inflamed ; its inner coat sphacelated, and covered with a blackish vis-
cid fluid.)
  We are informed by  Dr. Caldwell that «the existence of intro-
suscefitio  intestinalis,  was the  only actual  discovery  made by the
knife of the anatomist, during the epidemic (at Philadelphia) in 1805.
This affection was confined to  the small intestines, and was found to
exist in several cases of  the disease.  I believe,  (says Dr.  Caldwell,)
the discovery was first made in  private practice, by Dr. Stuart, and
afterwards by Dr.  Parish, at the City Hospital."—" The course of the
intro-susception was always from above, downwards  the upper  por-
tion of the intestines being the receiver, and the  lower portion the re-
peived."   Dr.  Caldwell's Essay  on the Pestilential or Yellow  Fever
at Philadelphia, in 1805, p.  179.
  Probably these  intro-susceptions were produced by violent  strain-
ings to vomit.  How  frequently they happen in cases where the  dis-
ease proves mortal, will  deserve, as far as possible, to ^e ascertained, 
APPENDIX
NO  II.
 3 he  author, at p.  98,  after giving decisive proofs "that  if putrefy-
 ing animal  matters are  not completely harmless, they  are, at least,
 innocent of  the charge of producing contagious fever,"  has referred
 those who might desire farther evidence on this point, to his second
 appendix, which was intended to contain " rather a redundancy, than
 a deficiency of such proofs."  But as the present volume is already
 extended beyond the author's expectation, and as the facts allotted for
 tbis appendix appear almost superfluous after those  formerly  stated,
 the editor ventures to omit by much the greater part thereof.
   The following statement  is extracted  from a letter written  to  the
 author by Mr. Lawrence, Anatomical  Demonstrator  at St. Bartholo-
 mew's Hospital; whose character, talents,  and professional acquire-
 ments, have already, at an early part of his  life, greatly and justly
 advanced him in the road to eminence.  It was  dated February  21,
 1809.
   " In a constant attendance at the dissecting room of St. Bartholomew's
 hospital for more than ten years, I have never seen any illness produc-
 ed by  the closest attention to  anatomical pursuits, except such as might
 be expected to follow  from a similar  confinement and application to
 any other employment.  When it is considered that most of the stu-,
 dents come from the country, and that many spend much time in dis-
 section,  being employed also in writing,  reading,  &c.  during the rest
 of the day;  it will not be a matter of surprise  that their health should
 occasionally suffer: but the indisposition has never appeared to derive
 any peculiar character from  the exposure of the subject  to putrid  ef-
 fluvia.  Of course, you will except from this  observation, the effects
 which  may arise  from the absorption of noxious matter from wounds
 received in dissection.   It has not appeared to  me, that ill consequen-
 ces of that description, follow more frequently from the  dissection of
 the most putrid, than from that of recent bodies.   The following par-
 ticulars will afford the most complete proof,  that the exhalations from
 decomposing animal  substances are not necessarily  injurious to the
human body.  John Gilmore, together with his wife, and two sons,
lived for ten years in a  room under the anatomical  buildings  of  St
Bartholomew's.   The whole  family slept, as well  as spent the day, in
this apartment, which received a very  small quantity of light, in con-
sequence of its single window opening against a high wall.   The room
was at  the end of a passage,  in which several tubs containing bones in
a state  of maceration were generally placed,  and with  which other  di-
visions cf the cellars communicated, containing large  excavations for 
421
 receiving the refuse of the  anatomical rooms.   The latter were no,t
 separated from the general passage by any door.
   " The  animal matters  thrown into the receptacles just mentioned,
 are, I believe, converted into adipocire,  and the fetor is consequently
 not so offensive as if they went through the putrefactive process; but
 the whole  place was constantly filled with a close cadaverous smell,
 very disagreeable to any persons who went down from the fresh air.
 During the whole day,  Gilmore was  employed about the dissecting
 room, in removing the offals, in cleaning macerated bones;  in short,
 in an almost  constant handling of the most putrid matters.   He  al-
 ways enjoyed good health, was fat,  and possessed very great bodily
 strength.   Fie left his  situation in consequence of an apoplectic  at-
 tack, and died lately, at the age of 69. after two other similar affec-
 tions.  His wife  survives, enjoying  a good state of health.   Neither
 of his sons  appears to have  suffered from  any unwholesomeness  of
 their abode.  They are both hearty and strong, although they have
 been employed some years in attending the dissecting room.   But the
 whole family left the cellar soon after the father's first attack."
  During the time that  our  very numerous fleet of transports lay in
 the bay of Aboukir, many bodies of sailors who had either died, or
 had  been drowned, were washed on the shore,  where  they remained
 unburied, exposed to the heat of the sun.   In riding  to Rosetta, it
 was  necessary to keep along  the shore; and I passed 18 or 20 corpses
 in this situation.   They were in various states  of putrefaction; but
 the stench from them all was offensive in the highest degree, and often
 extended to  more than 100 yards.   My  curiosity led me to approach
 close to most of them,  that I might examine the changes they had
 undergone.  Some were swelled up to an enormous size,  and the skin
 seemed so distended, that it appeared ready to  burst.  These were
often of a dark-brown colour;  some had not yet come to that state;
 others had passed it; and the skin having burst in several places, the
 air had escaped,  and they had become more or less desiccated, and of
 a black colour.   Every person  who had occasion  to  pass from the
 camp to Rosetta, was obliged to  come  within  reach  of  the vapours
 emitted by these  bodies.  There  were  orderly  dragoons constantly
 passing; yet,  neither myself nor any one else, so far as I  could learn,
 was attacked with fever,  in consequence  of our  exposure to these va-
 pours ; and my professional situation would probably have enabled me
 to learn if any such consequence had followed.
  Orraeus Descriptio Pestis, &c. p. 47.  After  stating that,  towards
 the decline of the plague in Moscow, in February, 1772,  the  College
of Health received information " hinc inde in domibus emortuis &  in-
fectis.....cadavera clanculum inhumata vel aliter occultata repe-
 riri;"—and that  they ordered all the houses to be searched, offered 20
roubles to informers, " et quae (cadavera) in locis spatiosis  non sat
profunde inhumata fuerunt, eorum sepulchra terra multa contegere,
caetera vero  nuda reperta  in cizmeteria transfiortare."  He  says,
" Hac  ratione circiter mille  cadavera in habitationibus, ipsis reperta
fuerunt.  JVotabile omino fuit  neminem  ex  vesfiillonibus, vel aliis in
negotio hoc periculoso -versantibus infectum,  nedum  morbo aliquo 
J 00
corrufitum fuisne, quamvis tanta ab omni infectione incoluiiiitas vix ac
ne vix quidem sperari posse videbatur."
   The good health commonly enjoyed by  tallow chandlers and .soap
makers, is  now too well known to require  any evidence from me in
confirmation of it, notwithstanding the very  offensive and putrid exha-
lations  to  which  they, and particularly  the former,  are exposed.
Glue and catgut makers are  exposed to vapours  equally corrupt and
disagreeable.   When riding on the Uxbridge road, near the 4th mile-
stone, on the  14th of August, 1810,  I was assailed  by an offensive
smell of-putrid animal matters, which I soon discovered to have come
from a set of works near the road, employed in the making of glue ;
adjoining to which were several huts  belonging  to the labourers and
their families, most of whom I saw, and  they  all, both adults  and
children,  had the appearance, and, as I was informed, the enjoyment
of good health.   I  have heard the same of catgut manufacturers.
   In the Edinburgh Medical and Surgical Journal  of October  1,
1810, may  be  seen an account, given by Dr. Chisholm, of a manu-
factory  (of  which I had some knowledge  from  the  time of its  first
establishment,) at  Conham, near  Bristol, destined for the conversion
of animal flesh into a substance resembling  spermaceti, by cutting up
dead horses, asses, dogs,  Sec. and putting  their  muscular  parts  into
boxes  with holes for the admission of water, and afterwards placing
them in pits filled with water, while the entrails  and  useless parts of
many hundreds of carcasses, were left to putrify on the surface of the
ground.   And it appears  from Dr. Chisholm's statement, as well as
from other  information which was given to me  on the subject,  that
though  the effluvia of these putrefying animal matters were highly
offensive to  the  overseer  of this manufactory, and  to the workmen
employed under him, as well as to others within their reach, no injury
was  done by them  to the health  of any person, during the two years
in which these operations were continued.
   In regard to the morbid effects  supposed to result  from the putre-
faction of fish, they appear,  so far at  least as regards fever, to have
had  no existence, but what was derived from the ^discriminating cre-
dulity of such writers as Forestus.  That a large  whale was formerly
cast  ashore, and suffered to putrefy on the sea coast,  near Egmont, in
North Holland, (a place-nearly surrounded by marshy or low grounds,)
I am willing to believe ; but that the  fever which is said by Forestus
(tome 1, lib. 6)  to  have followed that  event, was produced  by tbe
■whale, rather than  by marsh  miasms, I  cannot  believe;  because
whales have not been found capable of producing  such effects in later
times,*  and because fevers from marsh effluvia  constantly fall under
our observation.

*u* .S1eetjieaccountg'venbyDr-Go»,<lonofa  whale which putrefyed very harmlessly at
the island  of  Santa Cruz, published in the appendix  to Dr.  Chisholm's Letter to Dr.
f™f u  ' \ ^T25.3-  The same aPl,endix contains  an account of the putrefaction of
1,000 barrels ot salted beef, at the same island, which were finally ordered to be thrown
into the sea: and were thus disposed of without having occasioned sickness to any person
'"ted     SG'  Store'01' neighborhood where this putrefaction had taken place and suh- 
423
  About the year 1788, a whale was stranded on the coasi of France,
near Havre de Grace,  andM. Baussard, in an account of it, published
in Rozier's  Journal  de Physique, for March, 1789, says, " Penuant
que j' etois occupe adissequer ce gross  animal, une Lueur Phosphor-
ique exhaloit de l'interieur de son corps, et une odeur tres fsetide de la
tete."  " Les  exhalaisons  m'ont occasionne des inflammations aux
narines, et a la gorge  et  certains  parties huileuses de la tete m'ont
mis les mains dans un  etat pifoyable."
  No mention  is, however, made by M. Baussard, of any febrile af-
fection occasioned either to himself or any other person by the putre-
faction of this fish; and that no  such affections do, in fact, result from
that cause was farther  proved by the information which I obtained on
the 2d of October, 1807, at the Greenland Dock, where the late pro-
prietor, Mr. Ritchie,  (who had just sold his property to Sir Charles
Price and his associates for 35,000/.) informed me that for a consider-
able time all the Greenland ships had been used to boil their blubber at
this place, for which purpose five coppers, with proper coolers, 8cc.
had been  erected.  Mr.  Ritchie had lived more than 50 years in the
neighbourhood of this  dock, was well acquainted with  the boiling pro-
cess, and assured me, repeatedly, that though the blubber is often hi a
very offensive state, emitting an  highly putrid smell,  neither himself,
nor his people, nor the crews of the Greenland ships, who perform the
whole boiling, &c. nor the neighbours,  have ever, to  his knowledge,
suffered in their healths from that operation; that his people, and him-
self, have always been  healthy, and that  be believes no crews are more
healthy than  those of the Greenland ships.   This account  was
confirmed by the master of a  Greenland ship then in the dock, who
said he had been employed in  the whale fishery  for the last 22 years,
excepting one year, and had been used to boil down  the blubber for 16
or 18 years of that time./  He said besides, that the Greenland ships,
on their return home, often smell very offensively to strangers, though
to themselves the stench  is  imperceptible; that the casks  in which
they carry out their water are those in which they have brought home
the  blubber; and that the water generally is found extremely offensive
for  some hours after the bung is taken out; in  which state,  however,
the  men are accustomed to drink it;  and, that notwithstanding all this,
he does not conceive that any men are more healthy than the crews of
those ships.  That the stench from  the blubber is universally admit-
ted  to be  greatest when  it is boiling; and that these  effluvia, so far
from being at all unhealthy, are, on the  contrary, reckoned so whole-
some that it is very common for sick persons to come to the copper, as
soon as they  rise from their bed,  and  to hold their  heads  over the
steam, as close as they  can.
  Mr. Ritchie informed me, that what remained of the blubber,  after
the  boiling was finished, was now very commonly bought  for agricul-
tural purposes; that  it  was usually taken away by the  purchasers just
after the boiling, and was  allowed to lie  by a certain time, till it was in
a proper state to be used as manure; when it was laid upon the ground
und found to fe very useful. 
424
   The use offish as manure is no new invention :* herrings, pilchards,
and mackarel, have been long employed for this purpose in those parts
of  Great Britain where they are caught in the greatest abundance, and
so are the various species of mollusca.  In some parts of Cambridge-
shire,  &c.  a small fresh-watev fish called stickle-back, (gastyrostcus
aculeatus, Lin.) becomes so plentiful, that, leaving their native ditches,
they form  vast shoals in the rivers, and being  caught in nets,  or bas-
kets,  are strewed over the ground, in the proportion of twenty bushels
per acre.  No morbid effect, however, so far as I can discover, has
ever been known to result from the putrefaction of fish, or other animal
matters  employed in  this way, though fevers ought to have resulted
from it, if producible by the natural decomposition of animal substan-
ces.                                 /
  Putrid human excrement seems equally incapable of producing fe-
ver. A nightman, who had been extensively employed for thirty years
in this metropolis, assured me, that though  his  labourers frequently
fell into  asphyxia, or died off,  as  he called it, they had always reco-
vered on being brought into the  open air; that no fever had ever en-
sued from  such accidents, nor, as he believed, from this kind of occu-
pation;  that sometimes,  from intemperance,  and  getting cold, they
had feverish indispositions, but not more so than  other labourers; ^and
that, when steady and sober, he thought them  remarkably healthy;
that their eyes were sometimes affected, so as- to produce  temporary
blindness,  from which, however, they commonly recovered in a few
days;  and  that this, with asphyxia, were the only disorders to which
he  considered them as particularly liable from the nature of their occu-
pation.
  The receptacles of  human ordure belonging to  the great hotels in
Paris,  being commonly very  capacious,  and  very seldom emptied,
those mephitic exhalations which here produce asphyxia, and are there
called  "filomb," seem to be highly concentrated, in these receptacles,
because  they produce death to the nightmen not  unfrequently, but,  in
other respects, their effects resemble those which are produced in this
metropolis, as may be seen by a report,  entitled,  " Observations sur
les  fosses d'aisances et moyens de prevenir les  inconveniens  de  leur
vuidange,"  par M. M. Laborie,, Cadet de Vaux, et  Parmentier, (who
had been employed by the French government to ascertain facts on
this subject) published in the Journal de Physique, Sec.  An. 1778, p.
444.—See  also Ramazzini de morb. artific. cap.  xiii.


  • In the " New English Canaan, containing an abstract of  New England," written by
Thomas Morton,  " upon ten years knowledge and experiment of the Country," and'
printed at Amsterdam Ann. 16.3'J, are these passages; viz.  (V 86,)  " The Coast about)-
deth with such multitudes of codd,  that the inhabitants of New England doe dunge their
grounds with codd." P. 89- " There is a fish (by some called shadds, by some allizes)
that at the spring of the year passe up the rivers to spawn in the ponds, and are taken in
such multitudes in eveiy river that hath a pond at the end, that  the inhabitants dunge their
ground with them.  You may see in one towneship a hundred aci-es together set with
these fish, every acre taking 1000 of them : and an acre thus dressed will produce aw!
yeald so much corne as 3 acres without fish.-'  This practice has been mentioned by sev
eral other writers. 
APPENDIX
NO. HI.
  Thb purpose of this appendix has been stated,  at pages 108 and 109
  of this volume.   It will contain a faithful abstract of Mr.  Hoi well's
  narrative of his own sufferings,  and those of his unfortunate  compa-
  nions in the black-hole, at Calcutta,  and more especially of the facts
  connected with the supposed production of fever by the crowding and
  suffocation which occurred in that situation *
    Fort William, at Calcutta, had been surrendered to  the Suba  of
  Bengal, in the afternoon of the 20th of June;  and, between 7 and 8
  o'clock of the same  evening, Mr.  Holwell, who had then  become
  chief in council, with the other  civil and military officers ot the India
  company,  their servants and soldiers, amounting in all to 146 persons,
  were forcibly  driven into a prison, called the black-hole, which was a
  cube of about eighteen feet, " shut up by dead walls on the east and
  south, (the only quarters from which the wind could reach them) by a
  wall and door to the north,  and open only to the west, by two windows
  strongly barred, from which they could scarcely receive any the least
  circulation of air."  Li this state,  these unfortunate  persons, previ-
  ously exhausted by fatiguing exertions to defend  the fort, and with only
  standing room, (i. e. 26^ inches by 12 inches, to  each person, upon the
  average) in a  very sultry night, soon fell into an excessive perspiration,
  v/hich was followed by  extreme thirst;  and this became the more  in-
  supportable, as their bodies were more and more deprived of moisture.
    To  gain more room, they stript off all their clothes; and, to relieve
  the fatigue of standing upright, they all sat down  on their hams, or rose
  up  at  given signals : but they were so wedged up while sitting down,
  that it required considerable efforts to rise, and several who were too
t  weak to make such efforts, were either  trodden  to death or suffocated.
  "Urinous effluvia" soon pervaded the  interior of the prison, which at
  last became very powerful, and,  to use Mr. Holwell's words, " affected
  them as if they were forcibly held with their heads ever a bowl full  of
  strong volatile spirit of hartshorn, until suffocating." (p.  26.)  In the
  mean  time, also, the atmosphere was gradually  more and more vitia-
  ted; so that (p. 15,) "before 9 o'clock every man's thirst grew intole-
  rable,  and respiration  difficult.   In this  distressing  situation, the pri-
  soners cried loudly for water; and when water was  at length  brought

j  "  * See " A genuine Narrative of the deplorable Deaths of  the English Gentlemen,
  and others,  who were suffocated  in tbe Black Hole,  in Ko.t W' ! t\~:, at Calcutta, in
 " the  kingdom of  Bengal, in the niid'i siicc.v ■': . ■ tbe "20th 'h-,  "5,  In, Le iter to a
  Friend, by J. '/■■  Holwell, Esq. London, printed for A. Mil ar, in the St ad, 1758."   (
54 
426
 by some of the guards, with such eagerness did they struggle to get it,
 that not only the greatest part of the water handed in hats through the
 bars of the prison was spilt before it reached any one's lips, but manv
 were trampled down and suffocated, while others, particularly those
 who stood near the windows, were pressed to death.  It was soon, how-
 ever, discovered, that draughts  of water were of little service towards
 quenching a  thirst produced and kept up by such causes; they now,
 therefore, became clamorous for air, and endeavoured to force the
 door of the prison; but finding their attempts vain, and, preferring an
 immediate death to the lingering extinction which they apprehended as
 their doom, they grew outrageous,  and abused (p. •25,] the Suba and
 his officers, and their own guards, by the most opprobrious names, " to
 provoke the latter to fire in upon them; every man that could, rushing
 tumultuously towards the  window, with  eager hopes of meeting the
 first shot.  Then a general prayer to heaven to hasten the approach of
 the flames to the right and left of us, and put a period to our misery."
 After  such violent exertions, they whose  strength  and spirits were
 quite exhausted, laid themselves down, and expired quietly upon some
 of their companions; others, who had yet some strength left, made a
 last  effort for the windows, and several succeeded by leaping and
 scrambling over the hacks  and heads of those in the first  ranks, and
 got hokhof the bars, from  which there was no removing them after-
 wards.  In this manner, which  is more easily conceived than describ-
 ed, was the remainder of the night passed; and when,  at the dawn of
 day, an order was brought for their release, only 23 persons remained
 alive out of 146, and these were so weak that it took more than 20 mi-
 nutes to remove the  dead piled  up against the door, so as to procure a
 passage out for one at a time.  Of all those who survived, Mr. Holwell
 probably suffered the most in the course of that night, and certainly he
 had the narrowest escape from death; being one of the first who en-
 tered the prison,  he had placed himself at  a window,  and continued
 there more than three hours, until his "legs were almost broken with
 the weight against them," and he was " at last so pressed and wedged
 up by those who were clinging  to the bars over him, as  to be deprived
 of ail motion."   Unable to endure this torment, he begged the people
 about him, " as the last instance of their regard," " to  make way that
 he might retire from the window to die in quiet," and  with difficulty he
 passed through them to the platform on the opposite side of the room.
 Here his distresses rapidly augmented, and, "in less than ten minutes,
 he was seized with a pain in the  chest, and palpitation of the heart, both
 in the most  exquisite degree."  " He retained his senses, however,
 and not willing to bear any longer so much pain, without attempting to
 obtain the relief which he knew  fresh air alone would afford, he pushed
 towards a window, and by an effort of double the strength he,had ever
 before  possessed,  he found means to  seize one  of  the bars,  and to
fix himself in the second rank of those who were standing at it.—
The relief now felt was counterbalanced  by new evils;  for as  others,
in like manner, climbed and strove to get air, he presently  had  to
sustain the weight of a heavy  man, whose  knees were pressing on
his back, with the body resting on his head; a Dutch serjeant had
also seated himself on his left  shpulder, and a black  soldier  on  his 
427
   right, all which nothing could have enabled him long to support, but
   the props  and pressure  equally  supporting him all  around."----
   In this position did he  remain from half after 11  till about 2 o'clock,
   when,  being exhausted by the repeated exertions  he had made to dis-
   lodge these incumbrances, and  finding that he must  either quit the
   window, or sink were  he was, he resolved on the former,  having tru-
   ly, for the sake of others, suffered infinitely more for life, than the
   best of it is worth.  With  great labour he  forced his  way from the
   window, (several,  in the inner ranks, appearing to him  dead,  while
   standing, and  only prevented, by the throng about them, from fall-
   ing) and having gained the platform a second time, he lay down on it,
   and in a short time lost all sensation.   Here he remained until near
   six o'clock in  the morning,  when the Suba,  having been  informed of
   the suffocation of most of the prisoners,  sent to  inquire  if Mr. Hol-
   well had  survived : and being told that there was an  appearance of
   life remaining, and that he might  recover  if the door were  opened
   very soon, an order came instantly for the  release of  the prisoners.
   In the mean time, Mr. Holwell had been  brought to the  window,
   where he revived in a few minutes, and was shortly after restored to his
   senses.  As we have no information respecting the circumstances and
   consequences" of this transaction, excepting that which was published
   by Mr. Holwell, and as his account of those consequences of neces-
   sity relates principally  to his own case,  (for he was immediately sepa-
   rated from all  but three of the survivors,) I have thought it proper to
   describe minutely his sufferings, that  the reader might the better un-
   derstand and decide, how far Dr. White,  (in the Philosophical Trans-
   actions, vol. lxviii.) and Dr. P. A.Wilson,  (in his treatise on febrile
   diseases, vol.  i. p.  407) were justly intitled to adduce  this transaction
   as an  instance and proof of the generation, of " a most malignant
   and infectious  fever,"  (these are Dr.  White's words) by "the crowd-
   ing together of a number  of men  in camps,  hospitals,  jails," Sec.
   It is true that Mr.  Holwell,  at p. 31 of his narrative, mentions his be-
   lief that very few of his companions  had  retained their senses during
   the time in which he was  senseless, or  if they  did, that they  " lost
   them soon after they came  into the open air, by the fever  they car-
   ried out with them :"  he also mentions, at p. 34,  that when taken out
   of prison he found  himself in " a high putrid fever," and so weak as
   "not  to  be able to stand;"  and he  informs us,  at p.  38, that  in the
 a  ensuing night,  he was " covered from head to foot with large prvutul
^ biles," which  he  considered as "the  first symptom of his recovery;
   for, until these appeared, his fever did not leave  him."  During the
   next night, his three  companions,  also, "Woke  out in biles all over
   their bodies ;  a happy circumstance, (he  adds)  which, as  I  after-
   wards  learned, attended every one who came out of the  black  holey
   From these expressions, it  has been  pretended that the  atmosphere
   of the prison being contaminated by the respiration, and perspiration,
   of so many persons, and by  "the 'intolerable stench arising from the
   dead bodies,"  (as is mentioned by Mr.  Holwell, at p.  32) had  gene-
   rated contagion, and-that this had produced in all the  survivors that
   formal disease which is properly denominated fever.  But, on a close
   examination of Mr. Holwell's  statement, this  will not  be found  to 
428
have happened, even though suffocation, from- a -want of the vital
part of the atmosphere, breathed by  these unfortunate  persons,  had
been superadded to the other evils of their situation, and had irreco-
verably destroyed nearlv  six  in seven of their whole number;  for,
with vital air enough to  obviate suffocation, orowding, with all its con-
sequences, would  not  have caused any of their deaths.   That they
should have lost their senses  by being suddenly brought into a pure,
open atmosphere,  can  surprize no one; such  a transition might well
produce even greater changes upon men in  their  situation, without
the aid, or existence, of fever, properly so called.   And  it appeal's
evidently, from  Mr. Holwell's statement, that he,  and probably the
others, very speedily recovered their senses :  for he being carried im-
mediately before the Suba, (or viceroy) who  had heard or suspected
that his prisoners had buried or concealed money and valuable  effects,
in the Fort,  and wished, by  violent  threats,  to  extort  a  confession
thereof from Mr.  Holwell, the latter manifested such presence of
mind,  and power of reasoning, as could not  have  been expected of
one who had been so recently brought back to  life, even if no tem-
porary suspension  of intellect, or any other disorder than debility, had
occurred.  We are informed, however, that the Suba, giving no ere-*
dit to Mr. Holwell's denials,  ordered him to  remain confined under
the care of Mhir Muddon, general of his household troops, and he was
consequently removed  that morning,  with his three companions, in a
common carriage of the country, drawn by oxen, to tbe camp, " above
three miles from the fort:" and soon after loaded with fetters; and it
was here that he passed the night, and was covered with biles, which
put an end to his supposed fever, in less than  24 hours from its com-
mencement.  That Mr. Holwell, who had  suffered so greatly, and in
so many ways, during the preceding night, should have found him-
self exhausted,  disordered, and feverish, the following day, appears
very natural; and perhaps it  was not unnatural that using the word
fever in  a loose, and popular sense, he  should describe himself as
having been  in  one.  But that  his disorder  was not strictly a fever,
and much less what has been understood by the term oi putrid fever,
will, I am confident, be readily admitted by  every physician of ordi-
nary candour and discernment.  Indeed, Mr. Holwell may be  pre-
sumed to have had no other  reason for giving the name of "putrid"
to the febrile commotion which took place in  him, than a supposition
that any disorder occasioned by the heated and putrid  atmosphere of
the black hole, must necessarily partake of putridity.  But if a putrid  ^
fever had really occurred, it is not credible that he  could have been
removed above three miles, exposed to the unclouded sun in that cli-
mate,  and yet relieved  from  this fever in less  than twenty-four hours.
It appears also  (at p. 38)  that Mr. Holwell and his  companions were
marched  back to  Calcutta the next morning " in their fetters, under
the scorching beams of an intensely hot sun," which certainly would
require exertions too great for men^ of whom one had been in a pu-
trid fever but a few hours before,  while the others were not then re-
lieved from that with which they were said to have been attacked, and
which only left them upon the occurrence of bile's in the evening, after
this fatiguing march.  And certainly if Mr.  Holwell's  disorder, and 
4,29
    that, of his  companions, had amounted to fever properly so  called,
    such fatigue, if,  against all credibility,  they were capable of enduring
    it,  must have been followed by consequences very different from any
    which appear to have been produced.  Two days after this march,
    these  gentlemen were embarked in a large open  boat, and sent as
    prisoners up the river, to  Muxadabad, then the capital  of Bengal;
    this voyage lasted 13 days,  and, during the whole of it, they were ex-
    posed to one regular succession of heavy rain or intense sunshine,"
    with no  defence  against either; and their only  food during most of
    the time, was rice and the muddy water of the  river :  they were be-
    sides "so distressed for room, that they could not stir without bruis-
    ing their own or each others biles;"  moreover Mr. Holwell,  on a par-
    ticular occasion,' was forced out of the boat,  and made to walk in the
    scorching sun about noon, more than a mile and a half from the ri-
    ver ; " his legs running in a stream of blood, from the irritation of his
    irons, and himself ready to drop  at every step  from excessive  faint-
    ness, and unspeakable pain."   " By this cruel travel" he became so
    exhausted, that his guards  were forced to carry him part of the way
    back,  and support hhn the  rest of it.   All these sufferings,  however,
    did  not  produce  fever.  Mr.  Holwell, indeed, tells us, (p. 47) that
    five or six days after this, " he was attacked by a fever on the night of
    his  arrival"  at Muxadabad, attended with considerable inflammation
    of his leg and thigh;  yet he adds that " all terminated the next  night
    by a regular fit of the gout in his right foot and ankle ;" a sufficient
    indication of the  laxity and  incorrectness with which Mr. Holwell has
    used the term fever.
     Such  are  the  facts relating  to this singular transaction,  and to me
    they prove decidedly, not that febrile contagion may be generated, by
    crowding many persons into a small space, without sufficient ventila-
    tion, but the  reverse.   For certainly the few who were recovered from
    the combined efforts of crowding and suffocation, escaped  with less of
    indisposition than could have been  reasonably  expected,  considering
    the cruel treatment which some, and probably all of them,  afterwards
    sustained: and  it cannot be fairly  pretended, that tbis  indisposition
    amounted, in a single individual, to that disease which is strictly de-
    nominated, fever; much less to contagious  fever,  of which,  indeed,
    there was not the slightest vestige or appearance.   In none of the in-
    stances where crowding has been supposed to have generated febrile
    contagion, was it ever carried to  the extent of suffocating, I wiH
    not say the  greater, but  even  a small part of those subjected  to it:
£-,  and as in this case, (where, out of  146 persons, 123  were thus de-
    prived of life) neither contagion,  nor even a fever,  without contagion,
    was produced among the survivors, notwithstanding the concentrated
    exhalations from  so many  dead bodies, running speedily into putre-
    faction,  (as their various excretions had done before) we may consi-
4   der this  as a most decisive  proof  that febrile  contagion is not capable
    ef  being generated by causes of tins description. 
1ITEND1X.
No. IV.
Thk  subject of this Appendix, viz.—The Black  Assize at Oxford,
anno  1577, and that  of the  Old Bailey, anno 1750, are mentioned at
pages .110 and 111.
   Though I have taken considerable pains to throw light upon these
remarkable events,  the  former, I fear, must always remain in great
obscurity.  The best account of it which I have  been able  m find, is
that given in  " The History and Antiquities of the University of Ox-
ford," by Anthony  A. Wood,  M. A. of Merton College,  first pub-
lished in English, from the original MS. in the Bodleian Library, by
John  Gutch, A.M. printed at Oxford, &c. 1796.  At p. 188  of the
2nd volume of this work, we are informed by the author, that  at this
time, i. e. the 19th-20th of Queen  Elizabeth,—" lived in Oxford a cer-
tain book-binder, named Rowland Jencks, who, in his famihar dis-
course, would not only rail against the commonwealth, but the religion
now established, and sincerely by  the generality in the university em-
braced :" that " he made it his  chief employment to vilify the govern-
ment now settled ; profane God's word;  speak evilly of the ministers,
•£cc."—" In this course  of life, he continuing for some  time, taking
glory, as it were, in it, the university to whom the said person belonged,
(because privileged) took cognizance of him and his actions;"  and
"  a convocation of doctors, regents, and non-regents being  held, May
1st, it was  ordered that  he should be seized on, and sent to London
to be  examined by the Chancellor of the University, and the Queen's
Council."—Which was  done.   "  But after he had been  examined at
London, he was sent to Oxford  again  to  be committed to prison, and
stand to a  trial the next assizes following," &c.
   "The assizes, therefore, being come., which  began the  4th  of
July,  and continued two days  after, in  the  Court-House at the Cas-
tle yard;  the said Jencks  was  arraigned, and condemned,  in  the
presence of  a great number  of people, to  lose his  ears.  Judg-
ment  being passed,  and the prisoner taken  away,  there arose such
an infectious damp, or breath  among the people, that  many there
present, to the apprehensions of  most men, were there smothered;
and others  so  deeply infected, that they lived not many hours after."   4
Here Mr.  Wood introduces an  old  ditty written upon that event,
and  printed in black letter, in which death  is made to boast of his
feats on that occasion.  " The  persons  (continues Mr. Wood,) that
then died,  and were infected by   the said dump, when sentence was
passed, were Sir Robert Bel!, Chief Baron of the Exchequer; Sir 
431
Nicholas  Barb am,  Sergeant  at  Law;  both stiff enemies  to  the  Ro-
man  Catholic  religion ;—Sir Robert  Doiley,  High-Sheriff;  Hart,
his Under-Sheriff;  Sir William Babington,  Knight;  with five  Jus-
tices of the Peace ;"  and  a considerable  number of  gentlemen  who
are named, " besides most of the  jury, with many others that  died
in a ^ day or two after.   Above  600  sickened in  one  night,  as  a
physician* that  now lived  at  Oxford  attesteth.; and the day after, the
infectious air being carried into  the next village, f sickened  there an
hundred more.
   " The 15th,  16th, and 17th days of July sickened also| above 300
persons,  and within 12 days  space died an hundred scholars, besides
many citizens.   The number of  persons that died in five weeks space,
naniely, from the 6th of July  to the 12th of August (for no longer did
this violent  infection continue,) were 300 in Oxford, and 200 and odd
in  other  places,  so that  the whole  number that died at that  time
were 510 persons,  of whom many bled till  they expired.   The time,
without doubt, was very calamitous and full of sorrow; some leaving
their beds, occasioned by the rage of their disease and pain, would beat
their keepers or uurses, and  drive them from their presence;  others,.
like madmen, would run about  the streets,  markets,  lanes, and other
 places;   some  again  would  leap  headlong  into  deep waters."—
" The physicians fled,—not to avoid  trouble which  came more and
more upon them, but to  save themselves and theirs.]]  The doctors
 and heads of houses, all, almost to  a man, fled,  and not any college or
hall was there,  but had some taken away by this infection."  Those
 who  thus died, he  says, " were troubled with a most vehement pain
 of the head  and stomach,  vexed with  the phrenzy, deprived of  then-
 understanding,  memory, sight,  hearing, Sec."—" At the time of  then-
 deaths,  they would be very  strong and vigorous, but if they escaped
 it they were to the  contrary."§—" That which is most admired is, that

   »Dr. George Ethryg is the physician here alluded to-  He practiced at that time in
 Oxford, and in the second hook of his " Hvponuumata qusedam in  aliquot  Libros Pauh
 iEginatse," &c. printed in London, anno 1580, he states, that on the night in which the
 disease first made its appearance, about 600 were attacked by it, and in the next night
 100 more in the neighbouring villages.
   t The  carrying of the air to the neighbouring villages, seems to be a mistake.  Those
 who sickened  in them, had all been exposed to the cause of the  disease,  whatever it
 was, in the Court House, or in the Castle, as is stated in the  register of Morton College,
 of which  an extract was published  in the  Philosophical Transactions, vol. 50, p. 699—
 70 ' and in which, at  p. 701, are these words:—" Nam illi solum ethic et aft&decum-
 bent teRroti qui en castro et guilda, quam apellant aula quinto et sexto hujus  mensis
 adsunt "
   * This is also stated in the register of  Merton College.
   II This seems to have been an unnecessary, as well as culpable  desertion of duty by
 the physicians; the disease having never manifested any contagious property  wluite-
 ver apprehensions  might have been entertained on that subject at first.   Besides the
 facta'erted in the Register of Merton College, that those only sickened who were
 present L. on the 5th and 6th of July, and that  no medica  attendants, nor  v,s,tors
 were  ticked  Mr John Stow, in his  Chronicle of England,  London.  1631) alter
  "vn^ that '''there ied in Oxford 300 persons,  and  in other  places 200 and odd
 fmmthrethof Julv to the 1*1. of August," fadds, "after wh.ch died not any  of that
 sickness,/or one of them infected not another."
   § This  account of the disease is in exact conformity  with the  Renter of Merton
 College. 
432
 no women were taken away by  it, or poor people, or such that admin-
 istered physic, or any that came to visit*  But as the physicians were
 ignorant of the causes, so also of the cures of the disease."  He adds,
 " many  supposed that the cause of this infection proceeded from the
 nasty and pestilential  smell of the prisoners when they came out of the
 jail, of whom, two  or three being overcome  with it, died a few days
 before the assize began,  as  a  notef written in  these times testifreth.
 If so be, that was the cause, (he adds)  why  then were none destroyed
 at the  frst appearance of the  said prisoners, which was the  5th of
 July, when, as 'tis  generally said,J  none died till  after sentence was
 passed, which was  the day following?  Certainly, we cannot to  the
 contrary but think, that the said smell or stench, was more violent the
 first time when the prisoners appeared,  than when they had received
 air several times before."  Here, however, he introduces the observa-
 tion  of Bacon, Lord Verulam,  mentioned at p. 109 of this volume.
 He afterwards informs us, that  " some thought this Oxford mortality
 was  the same that Leonard Fuschius calls Sudor Anglieus.  (sweating
 sickness,)  which began first in  England, anno 1485, 1st Henry  VII."
 &c.: but this  Mr. Wood thinks " not  likely, because the nature of
 that  disease  was almost  quite  different from  the other."  He adds,
 " Some  again have thought, and do think, that  it was devised by  the
 Roman catholics, who used the art magic in the design ;  and that al-
 so, as a certain note||  witnesseth, it  sprung  " ex artificionis Diaboli-
 "cis, et  plane papisticis flatibus e Lovaniensi  barathro  excitatis, et ad
 «nos scelestissime,  et clam  emissis."   This notion, however, he re-
 jects, as well  as that of Sanderus, who (de  Schismate  Angl. lib. iii.)
 calls it " ingens  miraculum," and a just judgment on the cruelty of
 the judge,  for sentencing the book-binder to  lose his ears.§
   The most important, and at the same time the most obscure part of
 this account, is that which relates to the  circumstances and means con-
 nected with the production of this disease.  Stow, after mentioning the
 arraignment and condemnation of Jencks, "for his seditious tongue,"
 says, " At which time there arose amidst the people such a damp, that
 almost  all were smothered; very few escaped  that were not taken at
 that instant ;■—the jurors died presently," &c.   Annals of England-
 imprinted at London, by Ralfe Newberry,  1601.

  •This is also stated in the Register of Merton College; and Stow  also  asserts,
 (Loc.  Citat.) that  no woman or child  died of the disease; in which he  is supported
 by Sir Richard Baker, in his chronicle of the Kings of England, p  353, and by Cam-
 den, in his Annal Reginse, Elizabeth, 1577, (Ed. Th. Heju-nii, 1717,)  p.  316,—vol. 2.
  f This is mentioned by the author from the entry in the Register of Merton College,
 to which  he belonged; and this register, with which he was well acquainted, appears
 to have been his only authority  for stating, that two or  three of the prisoners had died
 before tlte assize began, as I cannot find any thing of that sort mentioned by any other
 writer.                                                    •  '  J
  * This is  stated by Camden, and I believe,  by  Ilollingshed,  to whom I cannot now
 conveniently refer.

  II The author here  alludes to the  Register of Merton College, and proceeds to copy
from it the words placed between inverted commas.                          *
  § Mr.  Wood informs us, that after « Rowland Jencks had suffered the sentence
passed upon him,  he  went to Donay, (in Flanders) and there  became  baker  to  the
English College of Seculars, and livedt o be a very old man." 
*                433
   Camden,  (Loc. Citat.)  after mentioning the bringing up of Jenckv.
 for judgment, adds, "vencnoso  et peslilcnti halitu, sive fadore.incar-
 'ceratorum, sive ex  solo ita  correpti sunt, plerique omnes qui  ade-
 rant  ut," &c.  And  sir Richard Baker, at the page lately quoted, after
 mentioning  the  same proceedings against Jencks, adds, " Suddenly
 they were  surprised with a pestilential savour, whether rising from the
 noisome smell of the prisoners,  or from  the  damp ground* is uncer-
 tain; but  all that were  then present, almost  every  one,  within forty
 hours died,  except women and  children."
   The most probable meaning of all these accounts would seem to be,
 that  about the time when  sentence was passed on the prisoners, a nox-
 ious  vapour, in some degree perceptible by  the  senses,  and proceed-
 ing either  from the prisoners, or the earth, had been suddenly  diffused.
 through the hall, and that in consequence thereof, a great part of those
 who  were present  had been almost  immediately attacked,  and that
 many died within a few hours.
   There is, however, no cause of disease with which I am acquainted,
 whose effects would  have been such as are here described*   Pestilen-
 tial contagion cannot be suspected,  because that would  have required
 contact, and because the  symptoms of the disease were not like those
 pf the plague, nor was it contagious.  And there is as little reason to
 suspect the contagion of typhus or jail fever, (especially at that season
 of the year,)  there being no instance recorded,  or known, of its pro-
 ducing disease so suddenly, nor of that  disease when produced, ter-
 minating so  speedily in death.   Nor were the symptoms such as  oc-
 cur  in jail fevers :f nor does the contagion of that fever  spare women,

   * This expression, and that of Camden, seem to  point at marsh effluvia,  which, at
 that  season  of the year, would be more  likely to  occasion disease,  than typhus con-
 tagion, and in  a shorter space of time, and chiefly upon vigorous men ; probably, also,
 the situation of the place was  suitable for their production.  The old Shire  Mail, in
 which sentence was passed on Rowland Jencks, was placed  in the yard of Oxford Cas-
 tle,  (once deemed impregnable,)  which stood  on the west side of the town, at a small
 distance from the river Isis,  whose banks, especially at that time, were low.  The pri-
 son was also within the castle, at abo::t 200 yards distance from the hall, and consisted of
 a multangular tower, called St. George's,  (on the west side of the castle,) together
 with  an adjoining  church, which also bore the  name of St George, and  two square
 rooms, all connected one with the other, and made  the common  gaol for the  county,
 by a  statute in the  reign of Henry the 3d.   See Grose's Antiquities of England, vol iv.
 p. 182-3: also, King's Vestiges of Oxford  Castle, p. 28.  In  the appendix to Thomas
 Hearne's Preface to Gulielmi Neubrigensis Historia, &c.  p 88, is a p< int representing
 the catsle of Oxford, and on the other  side of the river is a mount,  at the foot of which,
 are the ruins of an old building, which are thus described in a note to the plate : viz.—
. " Reliquiae domiis  in qua  assiza olium tene hantur, donee ob pestem stibitanvani, ad
 alium civitatis locum regnante KlizabetM transferre placuit." But though I think marsh
 miasmata a more probable cause of the disease in  question than typhus contagion, I  am
 far  from believing  that they would have produced effects such as are said to have occur-
 red at this black assize.
   I In addition to, arid confirmation of the account of the symptoms of this disease, as
 stated by* Mr  Wood, from the Register  of Merton College, I will here subjoin  that
 which  was  given to Mr. Bernard Gilpin, who  after founding a grammar school at
 Houghton le  Spring, in Durham, educated several young men there, and afterwards
 maintained them at the University of Oxford, which brought him into a correspondence
 with  their college tutors,  one of whom wrote a letter in  Latin, giving an account of
 the disease in question of which an extract translated,  has been preserved in  "The Life
 of Bernard  Gilpin, by  William Gilpin,  M  A." 2nd  edition, London, 1763,  p. 120.
  The  translated  account of this disease is in these  words, viz.—"Those who are seizrd
 with  it are in the utmost torment; their bowels aue burnt  up ; t!uy call earnestly for
5--« 
*34
i
 children, and poor people, as the cause of this disease is stated to have
 done,  (but on the contrary:)—nor  do the stoutest  and most robust
 soonest perish by it, as the Register of Merton College declares to
 have happened in this disease.   (" Et ut quisque fortissimus, ita citis-
 sime moritur.")
    Whether the facts connected with the production and nature of this
 disease have been misrepresented,  or,  whether it proceeded  from a
 cause which has  ceased to operate in later times, I leave for the  deci-
 sion of others.
    The sickness  which  I have mentioned at  p.  110,  as  occurring at
 Exeter, almost nine years after, viz. in 1586, appears to have been the
 true jail distemper,  according to the account given of it by Hollings-
 head, vol. ii. p. 1547, where he  says, "At the assizes kept at the citie
 of Exeter, the 14th daie of March,  in the eight and twentieth year of
 her majestie's reigne,  before Sir Edmund Anderson, Knight, Lord
 Chief Justice of  the  Common Pleas,  and Serjeant Floredaie,  one of
 the Barons of the Exchequer, Justices of the Assize in the county of
 Devon and Exon, there  happened a very sudden  and strange sickness,
 first among the prisoners  in the jail of  the  castle of Exon, and then
 dispersed (upon their triall) amongst sundrie other persons."—" This
 sickness  was very sharp for the time, and few  escaped which at the
 first were infected therewith.  It was  contagious and infectious, but
 not so violent as  commonlie the pestilence is; neither doth there ap-
 peare anie outwarde bleer or sore."—" The origin and cause thereof,
 diverse men are of diverse judgments.   Some did impute it, and were
 of the mind  that it proceeded from  the  contagion of a gaole,  which,
 by reason of the close aire and filthie s-tinke, the prisoners newly come
 out of a  fresh aire into  the same, are, in a short time,  for the most
 part, infetted therewith; and this is commonlie called gaole sickness,
 and many die thereof."  He then proceeds to relate the case of thirty-
 eight Portuguese seamen,  who  had been some time before taken at
 sea, coming with  fish from Newfoundland,  and "  cast into the deep pit
 and stinking dungeon" of the " gaole of the castle  of Exon;"  and " had
 no change of apparell," but being left  to he " upon the ground, with-
 out succour or reliefe, were soon infected;" (probably by the conta-
 gion previously existing in this dungeon,) "and all,  for the most part,
 were sicke, and some of them died, and some of them was (were) dis-
 tracted ;  and this sickness verie  soon after dispersed itselfe among all
 the residue of the prisoners in the gaole, of which disease many of
 them died,  but all brought  to great extremities,  and verie hardlie es-

 drink ; they cannot l>ear the touch of clothes;  they  intreat the standers by to throw cold
 water upon  them; sometimes they are quite mad ;  rise upon their keepers; run naked
 out of houses ;  and often endeavour to put an end to their lives   The physicians are
 confounded, declaring they have met with nothing similar, either in their reading or prac-
 tice. Yet many of them give  this  distemper a name*, though they have done nothing to
 shew that they are at  all acquainted  with its nature.  The greater part of them lam
 told, have now left the town, either out of fear for themselves,  or, conscious that they
can do no good  This dreadful distemper is now generally attributed to some jail
infection, brought into court at the assizes : for it is remarkable, that the first  infected
■were/those  only who had been there.  Few  women or old  meu have died.  God be
thanked,  the rage of this pestilence is now much abated.  It  is still among us, in some
degree, but its effects appear every day weaker." 
435
caped.  These men, when they were brought before the foresaid jus-
tices for their triall, manie of them were so weake and sicke, that they
were not able to go nor stand, but were carried from the gaole to the
place of judgment, some upon hand-barrows, and some between men
leading them, &c.   He adds, that these miserable men were brought
in at  "one  end of the hall, near to  the judge's seat,"  where  their
wretched  condition excited  general commiseration, and particularly
that of the chief justice,  " who, upon this occasion,  tooke a better or-
der for keeping all prisoners thenceforth in the gaole," &c.   He adds,
" And howsoever  the  matter  fell  out, and by what occasion  it hap-
pened, an infection followed upon manie, and a great number of such
as were  there in  the  court, and especially such as were  nearest to
them,  were soonest infected.  And-albeit the infection was not then
perceived, because everie man  departed,  as he thought, in as  good
health as he came thither; yet, the same by little and little, so  crept
into such upon whom the infection was ssizoned, that after a few daies,
and at their homecoming to their own houses, they felt the violence of
this pestilent sickness, wherein more died that were infected, than es-
caped."   He then gives the names of  some of the principal persons
who were thus cut off; among whom were  Serjeant Floridaie, one of
the judges; three knights; and several esquires and justices of the
peace; and many constables, reeves,  tythingmen,  Sec.  In this case,
the disease appears to have been propagated by tliose who were first
attacked, so that " it was dispersed throughout all the whole shire."
And, on this subject the author makes an important, and I believe just
pbservation, concerning the  time which the infection remained dormant
in the system; viz.—" It resteth for the most  part, fourteene daies
and upwards, by a secret infection, before  it breake out into his force
and violence"  All this is very unlike the disease  from which the
black assize at Oxford obtained that appellation-
   I am next,  according to the promise made at p.  111 of this volume,
to enter upon an examination cf the facts relating to the supposed pro-
pagation  of typhus or jail fever,  at  the Spring sessions of 1750, in
the Old Bailey, by contagion from Newgate.
   I have already mentioned that Sir  John Pringle's  Observations on
" Hospital and Jayl Fevers,"  were published (probably written also,)
immediately after, and to take advantage  of the sickness  which then
occurred.  In his dedication of  that publication to Dr. Mead, he says,
"Whilst I was revising the notes I  had made on  the Diseases most
incident to an Army,  the jayl distemper having  broke out in such a
manner,  as to alarm  the town,  I  thought I could not comply more.
seasonably with your  desire of having them published,  than by com-
municating at present, that part of my observations  which related to
.this disease."  He says afterwards,  that he the more willingly  em-
braces this occasion of writing,  "as at this time every body is  inclined
 to listen to the subject" &c.;  adding, "I am  certain,  that however
 rarely our jayls produce such  visible  noxious effects, they are often
 one of the more insidious sources of slow and malignant fevers, which
 generally prevail in large and crowded cities.   Thus, in the late case
 of infection:—from the quantity of the contagious matter, the close-
 ness of the  air,  and crowds of  people to  render its  corruption more 
43<i
  quick,  a distemper arose so suddenly,  and was so  violent, genera'.,
  and fatal, that  every body now refers it to its true cause ,•  whereas,  if
  the number of malefactors had  been fewer, the multitude less,  and
  the air freer, so few would have been seized, and that with fevers of a
  slow and less alarming kind,  that the cause might have been intirely
  overlooked."
    By thus  confidently  representing  the Old Bailey sickness  as the
  product of jail infection, Sir John Pringle obviously secured a  very
  general attention to his publication, and gav2 it unusual importance at
  that time.   But I think too highly of his  probity, to magine that he
  would, from such considerations, intentionally'mislead the public; and,
  therefore,' I am the  more surprised, that he should have thus assum-
  ed to  know, and decide upon, '• the true  cause" of this disease,  and
  upon  " the  quantity of contagious matter" supposed to  produce it,
  without having seen any one of the persons who had been  attacked by
  the  disease; and without having, in the smallest degree,  ascertained
  the existence even of a single atom of contagious matter, at that time,
  in Newgate.
    But, though  Sir  John Pringle, in .this .his first publication,  confined
  himself to general, and gratuitous assumptions, respecting this trans-
  action, he afterwards, in his work on the Diseases of the Army, first
 published in 1752, gave a statement of what he considered as the prin-
 cipal facts relating to it; and, as this statement seems to be the founda-
 tion of almost all that has been since written, and believed by others on
 this  subject, I shall here subjoin it, from  the seventh edition of that
 work,  which contains, I believe, his latest additions and  alterations;
 introducing, in the form of notes, such correction's and explanations as
 seem necessary.  The statement is at p.  330, and seq. in these words,
 viz.—" In the year  1750,  on the 1 Ith of May,*  the sessions began at
 the Old  Bailey,  and continued for some  days; in which time, there
 were more  criminals tried, and a greater multitude present in  the
 court, than  usual.  The hall in the  Old  Bailey, was a  room of only
 about 30  feet square.f  Now, whether the air was most tainted  from
 the bar, by some of the prisoners, then ill of the jai\ distemper, or, by

  * The sessions began, as is proved by all  the diurnal, and monthly publications of that
 time,  on the 25th of April, old style, and ended on  the 30th.  Sir John Pringle intended
 here to designate the time  according to the new style,  which was afterwards established
 bylaw, as is evident, by his .having annexed the letters N. S. to the  11th of May, in
 his account  given in the first edition of his volume on  the Diseases of the Army.   But
 even ih'.s left him in an error of five days.  The Universal Magazine for April, 1750,
 con* din* the following passage :—"Wednesday, the 25th, the sessions began at the  Old
 Bailey;  wi.en 23 prisoners were tried ;"  &c.  and it  added, that on "Thursday," the
 26(h,  ten persons were tried;  and among them "Captain Edward Clark, for shooting
 Captain  Thomas Innes,  in a duel, in Hyde Park," March the 12th. These "entlemen
 were  captains in the royal navy, and Captain Clark's trial exciting great°ctuiositv,.
 produced a very crowded court, and lasted a great part of  the day ;  so that only nine
 other prisoners were tried   And i( was on this d;,y,  the 26th, as will be seen presently,
 that the cause of the disease, whatever it  may have been, was applied to the persons
 who afterwards sickened, and who appear to have been all ^hen present, and only then.
 There was, indeed, so far as 1 can discover, no trial during tlie sessions of that month,
 which excited any great curiosity, or occasioned any crowd;  nor will Sir John Pringle's
reasonings or descriptions apply to any other day.
  \ According to the measurement of Mr. Dance,  Clerk of the Works to the  city
of London, this hall was  40 feet in length, and 31 feet in breadth. 
437
iliic general uncleanlines* of such persons, is uncertain ;*  but it is pro-
bable that both causes concurred.   And, we may easily conceive, how
much the air might have been vitiated by the foul steams of the Bail-
dock,  and of the two rooms opening  into the court, in which the pri-
soners were the whole  day crowded together,  till they were brought
out to be tried.f   It  appeared, afterwards,  that those places had  not
been cleaned for some years.  The poisonous quality of the air was ag-
gravated by the heat and closeness of the court,  and by the perspirable
matter of a  number of people, of all sorts, penned up  for the most
part of the day, without breathing the free air, or receiving any refresh-
ment.:}:   The bench  consisted of six persons,   whereof four died, to-
gether with two or  three of the counsel,  one of the under-sheriffs,
several of  the Middlesex Jury, and others  present, to  the amount of
above forty; without making allowance for those of a lower rank, whose
death  may not have been heard of;  and without including any that did
not sicken within a fortnight  after the sessions.
   " It was  said,\\  that this fever, in the beginning, had  an inflamma-
tory appearance, but  that after  large evacuations the pulse sunk,  and
was not to be raised by blisters, nor cordials; and the patients soon be-
came delirious.   Some had petechise, and all that were seized with the
fever died, excepting two or three at most.   Some escaped  without a
fever, by a looseness  coming  on, and which was  easily  cured.  How


  * This question, of all others, ought not to have been left, and much less represented,
as being in  a state of uncertainty ; since all  our reasonings and conclusions  will almost
exclusively depend upon it.  Sir John Pringle  certainly had no good reason to suppose
that any person in Newgate was " then ill of the jail distemper,  and  much less any oj
the prisoners at the  bar,-  and his language is therefore fallacious.  In regard to "the
general uncleanliness of such persons," I shall indeed wonder if any one, after reading
this volume, can  believe it to have  been capable of  producing the disease under con-
sideration.
  f In a note to this passage, Sir  John Pringle mentions  his having heard, that about
100 prisoners were tried at these sessions,  and he supposes  that they  "were'all kept"
in " the bail-dock, and the two rooms opening into the court,"—" as  long as the court
sat,"—-which is, 1 believe, an error:  for though care  is taken, that a sufficient num-
ber of prisoners shall always be in readiness for trial,  the whole number is not, accor-
ding to my information, brought up  at once,  when it is known that they cannot all  be
tried in one day.  Sir John Pringle seems also to have formed erroneous ideas of the
situation of the bail-dock,  &c.  It will be  seen by the plan of the Sessions House,  or
Justice Hall,  in the Old Uailey, between pages 438 and 439, that the bail-dock is pla-
ced without, and in front of the house, and is a kind of vaulted cell or dungeon,  below
the surface oi the court yard, where the prisoners are kept,  until called successively
into court, a few minutes before their respective trials  are expected to commence.
And while in the bail-dock, they must be too far reimoved, and too much separated
from the hall,  to infect the court, even if they were all labouring under jail fever.  In
regard to the  "two rooms opening into the court,"  and which he  supposes to have been
crowded with prisoners, they must have been merely partitions within the bail-dock,
to separate the men from the women.
  ± The heat and closeness of the  court, with the quantity of pe.rspirable matter from
those who were " penned up in" it, for a few hours, will bear no sort of comparison
with the state of  the Black Hole ut Calcutta, where we have, seen  that nothing like
contagion, or a regular,  and much less a mortal fever was produced.
  || This, and other expressions, demonstrate that Sir John Pringle did not attend a
single person labouring under  this fever';—for, if he had  done so, it would  not have
been necessary for him to recur  to hearsay; and he would certainly have given us a
distinct  account of the  symptoms, especially as all those who did attend in this sickness,
had strangely neglected this duty ; so that we have nothing b'.it loose hearsays on a point
of great interest  and importance. 
438
jf   far this sickness spread among the nurses, and other attendants on the
     sick, is not known."*
        Sir John Pringle has  mentioned in a note, that the persons on  the
     bench of the judges were, "  The lord mayor, three of the judges, one
     of the aldermen,  and the recorder.   Of these (he adds) died Sir  Sa-
     muel Pennant, Lord Mayor;  Sir Thomas Abney, and Baron,Clark,
     Judges; and Sir Daniel Lambert, Alderman.   It was remarkable that
     the lord chief justice,  and the  recorder, who sat on the lord mayor's
     right hand, escaped, whilst he himself,  with the rest  of the bench on
     his left, were seized with the infection; that the Middlesex, Jury, on the
     left  side of  the court  lost  many, whilst the London Jury opposite to
     them received no  harm;  and that of the whole  multitude, but one or
     two,  or at  most,  a small number of those who were on  the  Lord
     Mayor's right hand, were taken ill.   Some, unacquainted with the dan-
     gerous nature of putrid effluvia, have ascribed both this circumstance,
     and the sickness  in general, to a  cold taken by  opening a window., by
     by which a stream of air was directed to the side  of tbe court on  the-
     Lord  Mayor's left  hand.f   But it is to  be observed, that the window


      _  * I am sorry to observe, that tVere is an appearance of disingenuousness in this expres-
     sion.  The author, in his first edition, had said, " This sickness, as far  as appears, spread
     no farther ; which was perhaps owing to the season, and  to the weather,  at that time
     colli, from northerly winds."  A circumstance, however, which would have favored its
     spreading, had the disease been a jail fever.   In  the 5th edition, (printed in 1765,) the
     author says,  "This sickness, as far as was known, spread no farther; there being at
     that time no disposition in the air, nor other circumstances to  propagate the infection."
     Here it is manifest, that he  was convinced no person had taken the disease from  any of
     those  who were first attacked,  and  that  he was anxious  to  obviate the infer-
     ence suggested by that  circumstance, that the disease was not the jail fever, by  saying
     what  lie could not liave known, that there was then " no disposition in  tfie air," &c.
     when, in fact, the unusual coldness of the season, was suited " to propagate the infection."
     Whether Sir John Pringle was convinced of the insufficiency of  these  allegations, to ex-
     plain why the disease had not been communicated by any of the sick, 1 know not; but he
     Afterwards thought proper, in  his 7th edition,  printed in 1774,  to suppress these allega-
     tions, and represent it as being uncertain, whether  the disease had, or  had not, been  com-
     municated by  a  contagious quality, or rather as being  uncertain how far it had been
     " spread &c.;  affording room for a belief that it had in fact been  spread among the
     nurses," &c- though the extent of  its spreading  was  unknown.  Twenty four years
     had then elapsed, and with  the dispositions which  were  manifested hy Sir John
     Pringle  on this subject, it may be safely  inferred, that he  had never in  all that  time
     been able to gain any information, rendering it probable that the fever under considera-
     tion, had been propagated in a single instance by contagion.   For a single well-ascertain-
     ed fact of this nature, would  have answered his purpose, by proving that  the disease was
     ajail fever, and have rendered unnecessary all his other laborious and ineffectual endea-
     vors to attain this object.
       \ In the Gentleman's Magazine for May, 1750,  (p. 235,) the following paragraph rela-
     ting to this subject may be found, viz :—" As there was  no uncommon sickness  among
     the prisoners that came to the bar,  or in Newgate, some attentive observers do not supr
     pose it to be a case of infection.   But that the court being so much heated by the crowds
     which came to hear the extraordinary trials of Captain Clark and others, and there being
     a very cold piercing East Wind to attack the sweating persons, when they came  out of
     r.ourt, and many of them dining in public, and drinking perhaps a glass extraordinary,
     to comfort them after fjitigue, a fatal fever might ensue."  The writer of this paragraph,
     though  he  properly ascribes the fever to a piercing cold East wind,  seems not  to have
     been sufficiently informed of a most important fact, connected with the place and manner
     in which this wind was applied, so as  to produce disease :—I mean the  opening of  a large
     window in front, and on the left hand of the court,  at the North-West  corner of the build-
     ing, one of the three distinguished by the letters N, N, N, in the annexed plan.  This
     was done in consequence of the great heat and wiint of air, produced by the crowded state
  »   of the hall, during Captain Clark's trial.   It appears, that before this expedient  was re-
     sorted to, the court, as well as the audience, had been greatly incommoded and overheat- 
*   V 
 Tlanof the Old' JSailey,as it existed previously to ils destruction during the riots inljtio-
copied'exactly Prom the originaUh-aurvng in thevofsefsion of IrevrqeDancelEsq.Archi'bccl
lor Clerk oftheWbrks.to the-titv oFLondorv.by wliom tins Copy was given- to the Autlior
 .17 The divisions within- the Court-Hall are -marked according to its presetil stale; but
 the-jLuilun- has been informed bvJUZ.Dance- that these do not differ, or. at least. not mo
 lerialty. from those-which-existed hi the Former jBuildwg.. 
   EXPLANATION of the PLAN of the OLD BAILEY.  a

 a  Covered passage, by which the prisoners are brought from Newgate
       to the Old Bailey.
 b  Bail Dock, in which the Prisoners are kept till they are called into
 -*?■    Court.
 c  Small Door, (under the Window) by which Prisoners enter  the
       Court from the Bail-Dock, pteparatory to their trial.
 d  Plate where they stand before they go into the Prisoners box.
 e  Box for Prisoners under trial.
f  Bench for the Lord Mayor, Judges and Mdermen.
g  Places of retirement from that Bench, taken from the corners of
       the room.  They are about seven feet high, and that on the right
       of the Court is left open at top.                           S
 h  Boxes for the Sheriffs.                                       f|
i  Bench for the Counsel.                                        *
k  Table for Do.
 I  Spaces serving as passages.
m  Box for the Middlesex Jury.
n  Box occasionally used for the London Jury.
o  Boxes or Seats for  Officers, Clerks, Sfc. of the Court.
p  Box for Law-Students, Sfc.
q  Box for the Witnesses.
r  Standing place for persons who attend to prosecute or give evidence.
s  Columns.
t  Doors opening into different parts of the Court.
u Windows, of which the  three facing  the Judges are large Sash-
       Windows.
x Passage outside of the  Court, over  which are the Galleries for
       Strangers who come to hear the Trials. 
 
439
Vas at the furthest end of the room from the bench, though the judges
suffered most.   Nor could the kind of fever, nor the mortality attend-
ing it, be attributed to  a cold;  it is  therefore  probable,  that the air
from the window, directed the putrid streams to that part of the court
above-mentioned.  Indeed,  it must be  granted, that septic particles
passing into the blood,  become more active and fatal, if the  infected
person catches cold, or, by any accident suffers a stoppage of perspi-
ration, or of any of the other discharges of excrementitions  and noxious
matter.
   Before I particularly notice the  latter part of the preceding note, I
think it proper to introduce some other testimonies on this subject.
   In Foster's Reports and Cases on Crown Law,  (printed at Oxford,
 1762, folio,) I find, at p. 72, the following statements, viz-.—
   " At  the Old Bailey sessions in April,  1750, one Mr. Clark was
brought to his trial; and, it being a  case of great expectation, the
court, and all the passages to it were extremely crowded, &c.
   " Many people who were in court at this time, were sensibly affected
with a very noisome smell;  and, it appeared soon afterwards, upon an
enquiry ordered by the Court of Aldermen,* that the whole prison of
Newgate, and all the passages leading thence into the court, were in
a very filthy condition, and had long been so.
   " What made these circumstances to be at all attended  to, was, that
within a week, or ten days at most, after the session, many people who
were present at Mr. Clark's  trial, were  seized with a fever of the ma-
lignant kind; and few who were seized recovered.
   " The symptoms were much alike in all the patients;  and, in less
than six weeks time, the distemper entirely ceased.
   " It ought to be remembered, that at the time this  disaster happen-
ed,  there was  no sickness in the gaol  more  than is common in suck
places; this circumstance, which distinguished  this from most of
the cases of the like kind which  we have heard  of, suggesteth a very
proper caution:—Not  to presume  too  far upon  the health of the
gaol, barely  because the gaol fever is not among the prisoners."
   In addition  to the preceding statement, it will be proper for  me to
introduce the testimony of the Rev. Stephen Hales,  D. D  and F. R„
S. whose character as a  divine,  and philosopher, needs no encomium
from me.  He  attended as  a witness to Captain Clark's  character
upon the trial in question; and, in the second part of his Treatise oil
Ventilators, (printed in  1750,) at p.  161, after  quoting a considcra-

ed ; and, upon the opening of the window, a stream of cold air forcibly rushed in, and pas-
sed straight forward along that side of the hall which was nearest to the street, and on the
left hand of the Lord Mayor.   And the mischief done,  or sickness produced, appears to
have been confined to those whe were placed in the direction of this stream of cold air ;
which, therefore, contained and conveyed the morbid'influence, whatever it was, that occa-
sioned tlie fever.  This important conclusion, my readers will, I hope, bear in mind, till I
can resume this topic.
  * This  mention of the Court of Aldermen  made me  wish to have the books  of tlm,
court examined ; and a gentleman, who by his office, had access  to them, obligingly look-
ed them over for the whole time between 1743, and 1770,  without being .able to rind any
entry respecting this subjict, or tbe health of the prisoners, except some orders for the
pavmentof money, for putting up and working a ventilator at Newga.e, which was done
inconsequence of the sickness in question, under the direction ot'the ll'V. Dr.  Hales and
Sir John Pringle. 
uo
blc part df Sir John Pringle's  account of it, he adds, " As the mo*'.'
putrid vapours are the most subtile and volatile,  so I observed them
to be in the court,  at  the Old  Bailey, May the  11th, (erroneously
adopting  Sir  John Pringle's date) 1750, when  I  was obliged to  be
there, and found the smell  of the air  in the gallery on the right side
of the court,  sensibly more offensive than  below,  when I was called
down  among  the crowd  to give evidence.  And  accordingly, those
who were situated highest in the court, as the Lord Mayor,  Judges,
Middlesex  Jury, and those in  the  gallery on the left hand of the
court, were chiefly infected with the fatal contagion ;  on which (left)
side  a wide sash-window  facing the Judges was open ; at which an
Easterly wind entered,  which might blow down the  most venomous
vapour which  was near the ceiling,* and condense, -in some degree,
and check the subtile infectious vapour,  heated  by a crowded court
for many hours,  from ascending  so  fast  from  among those on the
bench, and in the left hand  gallery:  whereas,  on the  right  hands /
where no  window was open, the same heat might cause the enven-
omed vapour  to  ascend  quicker to the lofty ceiling;   as it  is well
known such vapours constantly  do in  rooms full of crowded  assem-
blies."
   Assisted by  these statements and explanations, I will now  proceed
to overthrow the baseless fabrics, to erect which  so much labour  and
ingenuity have been wasted.
   Those who ascribed the fever  in question to jail infection, must have
supposed, and ought to have proved, either that the prisoners by whom
the contagion was said to have been diffused in tbe court, were then
actually labouring under jail fever, and capable of  generating its con-
tagion, or, that this contagion existed so copiously in the place whence
they  had  been brought into the court, (Newgate) as to infect their
clothes sufficiently to enable them to infect others at the distance of 25
feet,  which seems to have been the space between the Lord Mayor's
seat,  and the box allotted to the prisorers on trial. (See the plan.)  But
it is not known that any of the prisoners who were brought into court
bad any sort of febrile indisposition,  nor is  it known that any case of
jail fever then  existed, or had recently existed,  even in Newgate.  In-
deed, the contrary seems to have been generally admitted and believ-
ed, and with great reason; because, after so  many persons  were at-
tacked with fever, in consequence of their attendance at the Old Bai-
ley,  on the 26th of April,  so much attention was excited and directed
to the state of Newgate, that  if any  thing resembling jail fever had
been found in a single case, it  would have been  reported and made
known;  instead of which,  we only are  told that  upon an examination,

  * It is truly wonderful that Dr Hales,  who, on other occasions, and particularly at  p.
15G, has justly observed, that the " cooler heavier external air," by rushing into a warni
room, displaces, and forces upwards the  lighter, should here  employ so much ingenuity
to deceive himself, and reconcile his own facts with Sir John Pringle s suppositions.  Let
any one pour quicksilver into a tube containing spirit of wine, and see whether the former,
when it enters at the top, will remain uppermost, and press down the latter.   His reason-
ing concerning what happened on the right side of the court, is equally fallacious   He
says the air on that side, and especially  in the gallery, was "sensibly more offensive ;"
and, therefore the " infectious vapour" ought to have been there  most abundant; and  yet
all the mischief was done on the opposite sidei 
441
sit was found that the prison, « and the passages leading thence Into the
 court, were m a filthy condition."   It has been asserted, however, that
 though there was  then no case of jail fever in Newgate,  there might A
 be such a remnant or accumulation of febrile contagion formerly ge-1
 Derated there,  as to contaminate the clothes of the prisoners, and ena-
 ble them to infect the court, without being themselves made sick by
 that concentrated  infection, which, even when diluted and diffused,
 was still powerful  enough to cause the deaths of persons at a consider
 rable distance; and such assertions have been adopted and repeated
 under the sanction even of great  medical authorities :  and the better
 to account for  this wonderful immunity  in these distributors of death,
 it has been  pretended,  that persons might gradually acquire the habit
 of  bearing  unharmed the  impressions of that contagion, which has
 proved so  destructive  to others; and, therefore,  that we are  not  to
 conclude, that febrile contagion did not  exist in a very concentrated
 and virulent form  in Newgate, from the circumstance of its not having
 occasioned  sickness to  any  person who was confined therein.  In my
 judgment,  however, these assertions and reasonings,  as applied to the
 contagion of typhus  fever, have no foundation in  truth.  All our ex-
 perience proves, that the longer persons are exposed to the action of
 this contagion, the more, certainly, will they be attacked by the fever :
 that the escapes of medical men are entirely owing to their remaining
 but for a short space within its reach at any one time : that persons
 who may resist its impressions for  a day, are not likely to  resist them
 for a week; and that those who resist them for a week, will rarely con-
 tinue to do  it for a fortnight:—I mean in places where the contagion is
 not dispersed and rendered innocuous by frequent changes  of the  at-
 mosphere.   But even if the assertions which I am now controverting
 were true,  they would not answer the purpose for which they were em-
 ployed,  in regard to the events of the Old Bailey sessions.  Sir John
 Pringle,  in a note to p. 330, mentions what is indeed generally known,
 that " it has been the custom some days before every sessions,  to re-
 move all the malefactors from other gaols into that of Newgate."  And
 this appears to have been  done previously to the sessions in April,
 1750;  and  as the  persons thus removed  could not have gradually ac-
 quired the  supposed habit and power of bearing the contagion alleged
 to  have been at that time accumulated in Newgate, they must  have
 "been as liable to its morbid influence, as those who were said to  have
 been infected by it at the Old Bailey,  and infinitely more so, because
 they must have been exposed to it at the source,  and in its most con-
 centrated form ; whilst the latter could only have received it at a second
 hand, when diffused from the clothes of prisoners, and greatly diluted.
 And as none  of the persons so brought into Newgate appear to  have
 been attacked with jail fever, either before or after the sessions, there
 is the strongest reason to believe that no  such  contagion  at that time
 existed in Newgate,  &c. consequently that none could have been car-
 ried thence  to infect the court at the Old Bailey.
   But if we were to suppose (for the sake of argument)  that the jail
 fever did at that time prevail in Newgate, and to as great an extent as
 it was ever known to  have  done,  there would still be  good  reason le
                                  56 
U2
 i   conclude that it did not occasion the fever which was consequent upon
||,  Capt. Clark's trial.
      In a note to p. 438,  I found sufficient ground for concluding, that
    whatever the cause of that fever might be, it must have been con-
    tained in and applied by the stream  of cold  air which  entered by the
    open window, and reached the persons who, being placed in that par-
    ticular direction, were afterwards exclusively attacked with the dis-
    ease.   This was also the avowed opinion of Sir John Pringle  and Dr.
    Hales.   But if we suppose the jail infection  to have been brought into
    court by Capt.  Clark, (a strange supposition considering his  rank in
    life, and the cleanly decency at least, with whicdf  he must have been
    clothed) that contagion would have  been much more likely to  operate
    previously to the opening of the window, when,  as there was  little or
    no circulation of air,  it would have been less diluted; but if it had
    operated at that time, its operation would not have been directed and
   limited to those particular persons  on  whom the cold easterly wind
    afterwards blew, but to  those  who were nearest  to hin*i on all sides;
    and we may therefore presume, that the fever in question was not oc-
    casioned by any application of  jail infection,  previous to the opening
    of the window, and  certainly it could not have been produced by  that
    cause after the admission of such a strong current of air, as must by
   its  quantity and coldness have so much diluted, elevated, and dis-
   persed the  contagion, as to render it  harmless, even if, in addition to
   Captain Clark,  scores of prisoners had been in court.*
      Another  insuperable  objection to  the  supposed production of this
   fever by contagion arises from the space between the bench on which
   the judges were seated, (where the cause of the disease proved mor-
   tal to four out of six then present) and the box wherein the Prisoners
   are placed when under trial, and which is the  nearest approach they are
   ever allowed to make towards that  bench.   This  distance, as  I have
   already mentioned, and  as will appear by the  engraved plan of the hall,
   is about twenty-five feet; and we are warranted by all the experience
   of modern times in believing, that the contagion of jail or typhus fever,
   from a person actually under the disease in its worst form, will not pro-
   duce fever in other persons at the distance x»f three yards, in a room
   of  moderate dimensions, where the air was not previously infected.f

    * Had there  been any contagion in Newgate capable of infecting the court at the Old
   Bailey, we might have justly expected that it would  have done so on the first dav,
   when more  than twice as many prisoners were tried,  and when no window appears t»
   have been opened, to dilute  and disperse the infection.   It is'not, however, pretended
   that the jail infection operated at any time .during the sessions,  excepting the day when
  a stream  of cold air  was admitted, sufficient of itself to produce the fever,, without
  any aid i'om contagion, and sufficient also to render contagion harmless, even if it had
  been present.
    f Dr. Haygarth, in h'.s letter to  Dr.  Percival, on the Prevention of infectious fevers
  (Rath, 1801,) says, page 8, " In  1777, 1 began to ascertain, by  clinical observations,
  according  to what law the variolous infection, and in 1780, according to what law the
  febrile infection is propagated.  1 found that the pernicious effects of the variolous mi-
  asm  were limited to a very narrow sphere.  In the open air,  and in moderate cases,
  F discovered that the infectious distance  does not exceed ludf a yard.  Hence it is pro-
  bable, that even when the  distemper is malignant,  the infectious influence extends but
  a few yards from the poison.  I soon, also, discovered that the contagion of fevers win
  confined to a much narrower spliere." 
                                    to

                                 443

   With this knowledge of the very limited action of the contagion of
jail or typhus fever, when present, and with so many valid reasons for
believing that none was present,  at the sessions, the 26th of April,
1750, we are certainly bound to  ascribe the fever which was  a conse-
quence of that session, to some other cause; and none presents itself
so obviously, and with so many probabilities, as that which Sir J. Pringle
thought proper to reject;  I mean the sudden admission of a continued
Stream of cold air, impelled forcibly by the external wind, upon per-
sons  who had  previously been  greatly overheated,  and  were conse-
quently in  that state which renders a sudden and copious  application
of cold, either externally, as on  that occasion, or internally  by large
draughts of spring or iced water, in very hot weather, or by the eating
of iced creams, Sec. in particular circumstances, so often productive of
a mortal disease.   Even  Dr. Hales was aware of danger from a free
admission of fresh  air  by ventilation, as maybe seen  at p. 144, 153,
and 155 of the work lately quoted, and at the last of these passages,
after  representing " it as  a matter of great importance  to use means
to change the air in  crowded  rooms, he adds, that this must be done
by a  constant gentle succession of fresh air;" which " must not be let
in at  open full  windows, especially in cold weather;" and this injunc-
tion he repeats in other places.  Almost all the circumstances which
are known to render the application  of cold hurtful, seem to have co-
operated at the Old Bailey, during Capt. Clark's trial, particularly the
length of time in which its  application was  continued; its being ap-
plied by a wind, or current of air; its being a transition or sudden and
considerable change from heat to cold;  and its being applied partially
to a  particular part of the body, while the rest was kept in greater
warmth than usual:  we know but little of the causes which might have
assisted to produce  debility on that occasion, and thus to render the
impressions from  cold more injurious;  excepting  that oi fasting,
which, from the  duration of the trial, must have been unusually pro-
longed ; nor are we acquainted with what  might have happened after
the court had adjourned, to increase the morbid influence of the cold,

  In a report made by the committee of the dispensary at Newcastle, published in Dr.
Clark's collection  of papers respecting fever wards, (Newcastle, 1802) the following
paragraph occurs, at page  12, viz " The most malignant fever does not render the at-
mosphere infectious farther than  a feu'feet from tlte patient, or from the contagion preserf-
ed in clothes, furniture, &c. and  daily observation confirms, that a person must remain  a
considerable time within the sphere of infection to  receive it; for physicians and surgeons,
who avoid the current of the patient's breath, and  the effluvia arising from his body
within the bed-curtains, do not receive the contagion in their ordinary v.sits ; a:ul lliey
never  convey it to others ; the  infectious effluvia, received in their apparel, being spee-
dily rendered  innoxious by being diluted with pure air." In a report, also, lrom the
institution for the cure and prevention of contagious fever in the metropolis, May 5th,
1805, it is stated, that " the house occupied for the purposes  of the institution stands in
the midst of a row, in contact with dwelling houses on both  sides;  that 420 pati-
ents"  (with typhus fever) "have been received into it," &c " yet the neighbourhood
bas continued altogether free from the disease,"  &c.   After which the following oi>s -r-
vation  is added, viz.  " Were  not the general  prejudice on this subject  strong, this
fact, indeed, might have been clearly anticipated.  For if, as we have learnt from ^ex-
perience,  contagions, diluted by the free admission of air, are not communicated from
room  to  room in a house nor even from bed  to bed in tlie wards of an hospital, it
scarcely required a positive experiment to prove, that houses even in contact, were
not liable to infect each other."   . 
444
\whichbad been a* read) applied.  We know enough, however, to make
it probable, in the liig/i^t degree, that this was the cause ol the foyer
which ensued, and proved mortal to so many persons.   Sir John Prin-
gle has, indeed, delivered an opposite opinion, but on grounds  which,
in my judgment, have little solidity; he observes, in the note lately
quoted, that  the window which admitted the cold air, " was at the
farthest end of the room from  the bench, though the judges suffered
most;" it  should, however,  be remembered, that this  window was
much higher  than the heads of any of those who were  on the left hand
side of the court, and, consequently, that the stream of cold air passed
harmlessly over those who  were nearest to the window, and, gradually
descending by its superior  gravity, went uninterruptedly, and with full
force, to the judges, (on that side) who being most elevated, were mobt
exposed to its impressions, though farthest from  the window ; a cir-
cumstance which Sir John Pringle  did not think  of  any importance,
though .immediately after  he stated it as probable that the air from
the window directed the putrid streams to that part of the court where
th\e judges were seated."  Certainly, if the current from the window
wis sufficient to convey the supposed putrid or infectious matters to
the judges, it must have been sufficient also to communicate the effecte
of its own diminished temperature or coldness.
   In regard  to his other ground, viz. that neither " the kind of fever,
nor the mortality  attending it," could " be attributed to a cold;" it
may be answered that they are much less attributable to jail infection.
Unfortunately, we  know but little of the " kind of fever"  then  pro-
duced; a circumstance for which  Sir John Pringle himself is blame-
able :  for,  though he appears never to  have seen a case of it, he
might easily have  procured, from  other physicians,  a  sufficient ac-
count  of its'  symptoms,  (which Mr. Foster states to have been much
alike in all the patients,) and have enabled us to  judge how far they
were similar to  those  which he has described as belonging  to jafl
fever.   But. without doing  this, he admits that " it was said that this
fever in the beginning had  an inflammatory appearance,"  which is ex-
actly that of a fever from  cold, and the very reverse of a jail fever.  In
opposition, however, to  this admission,  he adds, " that after  large
evacuations the pulse sunk, and was not to be raised again by blisters,
nor cordials,  and • the patients soon became delirious."   It will not,  I
presume, be expected, that I should undertake to account for particu-
lar effects,  loosely stated on the ground of hearsay, without any com-
munication of other facts and circumstances, which, if known, might
probably remove all difficulty and obscurity respecting them.  I need,
therefore, only observe, that I do not  consider it as necessary, that
fevers produced by the sudden application of cold, should, in all cir-
cumstances,  ages, and constitutions, bear large (probably excessive)
evacuations,  without a  sinking of the  pulse, or without subsequent
delirium.   And in regard  to petechia, which were reported to have
been observed in some few  cases, I need only refer to p. 97 of the Ap-
pendix to Sir-John Pringle's work, where he notices, " the undeter-
mined meaning of the  word Petechise;" adding, its v ambiguity  is
such,  that  I  must regret my having at all used the term."  The au-
thor had before said, j» the preceding page, that even these spots 
U8
 yvhich he had called  petechise, though sometimes accompanying the
 jail fever, had no "title to characterise that disorder."
    Sir John Pringle also mentions that some escaped without a fever, by
 a " looseness coming on, which was easily cured."  This fact I con-
 sider as eminently indicative  of morbid  affection from  the applica-
 tion  of  cold,  which  is  often  observed  to take that  course;  and by
 doing so, to obviate the occurrence of fever, and other worse  conse-
 quences : but I  have never known such an escape from typhus fever.—•
 On  the  contrary, I believe that where a sufficient dose of that conta-
 gion has been imbibed, the supervention  of diarrhoea from any cause,
 would render its operation  in producing  fever, more speedy and cer-
 tain, by inducing debility.
    It is much to be regretted, that neither Sir John Pringle, nor any
 other  writer  within my  knowledge, has stated the precise interval
 between the trial of Captain Clark, and the commencement of fever in
 any  one of the persons then  present.  He only mentions that none were
 taken into his account who did not sicken within the first fortnight after
 the sessions.  With this  latitude, there might have been barely time
 for  the  production  of fever by jail infection.   But, though  this was
 the  longest  interval, they might, for any thing which  he says to the
 contrary, have all sickened within half the time, and that,  in my judg-
 ment, would have afforded the most decisive proof of a different fe-
 brile cause; and this probably was the fact, at least in some  of the cases;
 though  the extract which I have given from Foster's Reports,  Sec. is
 almost as vague on this point, as Sir John Pringle's statement; for il
 only asserts,  " that within a week, or ten days  at most, after the ses
 sion, the persons in question were seized with a fever," Sec*
   In regard to the mortality from this fever, which Sir John Pringle
 thinks to&-great  for a fever from cold;  he surely ought to have re-
 collected, that this objection would apply with greater force to his sup-
 position,  that the fever had originated from contagion ;  for the most
 concentrated or  virulent jail infection  ever known in this  country,  did
 not,  so far as I can recollect, produce a fourth part so many  deaths
 among an equal number of sick; and  it therefore must be incredible,

   * We are left in equal Uncertainty concerning the time which the disease had subsisted
 even in a single case,  before  its  fatal  termination.  We are only informed by the Lon-
 don, Gentleman's, and  Universal Magazines,  for May, 1750, of the  days on which
 most of the persons died,  with intimations of their having been at the  preceding Old
 Bailey sessions.   The London Magazine mentions Sir Daniel  Lambert,  and one or two
 others, as having died on the 13th of May,  and other deaths as occurring on nearly
 all the succeeding days,  until the  21st.  The  Obituaiy of the Gentleman's Magazine
 states, " Sir Daniel  Lambert,  knight and alderman," to have died on the 13th,  " of
 a violent fever" which certainly is not a description of typhus.
  Dr. Adams (misled by Sir John Pringle, in regard to the commencement of the
 sessions,) states in his Inquiry into the Laws of Epidemics,  (p. 12 and  13) that on the
 11th of May, 1750,  the prisoners at the Old Bailey were sufficiently in health to attend
 their trials  ; yet, from the effluvia they brought with them  ontlteXSth,  died one magis-
 trate,  on the 14th the undersheriff, on the 17th one judge," &c  Here Dr. Adams mani-
 festly believed, and intended that others should believe,  that the effluvia supposed 1o
 have been  thus brought into court on the 11th, had not only produced a violent  dis-
 ease, but that this disease had also proved fatal, all in the space q/*48 hours from the time
 of  its communication.   A monstrous error: it being  probable,  that jail  infection never
produced disease and  death in so few w^eks as the number of days in which the doctor
supposes all this to have happened. 
446
that such unexampled mischief should have been occasioned, where
the febrile contagion, supposing it to have existed, was too weak to pro-
duce  disease, even  in those who were said to have brought  it into
court, or in Newgate, whence it was said to have been derived.. And,
though  the mortality in question was  greater than I should have ex-
pected,  from a fever produced by the sudden application of cold, yet,
so many things are  capable of increasing and aggravating the morbid
effects of that cause, particularly by inducing local and mortal inflam-
mation in some important organ or viscus, that it is much less surpris-
ing that a fever so produced should occasion an unprecedented mor-
tality than it would have been, if so many deaths had resulted from a
jail or typhus fever.
  I have not insisted on the non-communication of the disease by any
of those  persons  who sickened  after being at Captain Clark's trial,
because that  fact, though it increases the probabilities, does  not af-
ford any decisive  evidence that the fever  was not a typhus,  as most
of the sick .were above the ordinary  class, and may be supposed to
have occupied apartments  so  large, that the  propagation of the fever
was not  a necessary consequence.
APPENDIX.
. No. V.
  The author, at p. 119, intimated an  intention of inserting  in this
Appendix certain extracts from the " Memoires sur les Hospitaux
de Paris,  par M. Tenon,"  respecting the Hotel Dieu of Paris; but
the editor finds it necessary to refer those to  whom these extracts
might have proved interesting, to  M. Tenon's original work, particu-
larly to the preface, and to  pages 135, 138,  141, 163, 165,  194,
197, 198, 199, 207, 208, 209, 223, a&d 287. 
APPENDIX.
No.  VI.
  The author,  at p. 151, has referred his reader* to this Appendix,
a for Proofs" of the " Exemption of the inhabitants of (or adjoining
to)  Peat Bogs  from  Intermitting  Fevers."   The same necessity
which compelled  the  editor to omit what was intended to constitute
the  preceding  Appendix,  (i.  e. the unusual number of pages to
which the volume has already extended) has determined him to refer
the  reader to.Dr. Jameson's Mineralogy of the Scottish Isles, vol.2,
p, 127 ;  and to the Essay on Peat, by the Rev. Dr. Walker, Professor
of Natural  History, in the  University of Edinburgh,—published in
the  Transactions of the Highland Society of Scotland, vol. 2,  p. 23.
The author  had moreover intended to place in this Appendix certain
MS. communications stating the non-occurrence  of marsh fevers at
Strabane, and some other places in Ireland, adjoining to Peat Bogs,
except in persons who had previously been exposed to marsh miasms,
by  residing in  other  situations.  In  such persons, particularly  one
from  the state of Maryland, intermitting fever is  stated  to have oc-
curred some months after leaving America, and to have proved very
obstinate.
<**
APPENDIX*
NO. VII.
Having explained the purpose of this Appendix at pages 203 and
204-, and meaning to leave no doubt subsisting in the mind of any per-
son ;iualified to decide on the credibility of Dr. Chisholm's account of
the supposed generation of a new Pestilential Fever on board the ship
H;dikey, on the Coast of Africa, I beg leave to premise a short, but
faithful statement of the transactions which are  supposed to have been
connected with  that monstrous production, founded principally upon, 
448
 the African Memoranda of that very intelligent  and meritorious offi-
 cer, Captain Beaver, of the Royal  Navy;* and upon authentic docu-
 ments, published in Wadstrom's Essay on Colonization.
   Several gentlemen having associated for the establishment of a  co-
 lony at  the island of Bulama, near the mouth of Rio Grande, on  the
 Coast of Africa, and obtained the approbation of government, a num-
 ber of colonists and labourers were engaged, and embarked  in two
 chartered vessels, viz. the Calypso, of 298 tons,  and the Hankey, oi'
 260 tons, besides a sloop of 34 tons, purchased by the association;  all
 of which, with sufficient stock  of provisions and stores, sailed from
 Spithead, on the 12th of April, 1792: the Calypso having  onboard
 149 settlers, or colonists, consisting of men, women, and children;  the
 Hankey  120;  and the sloop 6;  making in the whole 275.  These ves-
 sels were, however, separated in a few days, by a storm, and the Ca-
 lypso having touched, on the 3rd of May, at Teneriffe, and on the 12th
 at Goree, proceeded to Bulama, and on the 25th of that month anchor-
 ed in a harbour, at the^ western extremity of the island, where the  go-
 vernor of the new colony, Mr. Dalrymplc, determined to wait for  the
 arrival of the Hankey, on board of which  was the investment for pur-
 chasing  the island, and trading with the natives.   But in  the mean
 time, he imprudently landed, with some others, to explore the island;
 while,  as Captain Beaver informs us, (at page 46 of his African Me-
 moranda,) several of the colonists erected small huts and tents on  the
 shore; parties wandered wherever  they pleased  in  the  day, and  re-
 turned to the ship, or not, as they thought proper, in the evening.   In
 short, nothing," adds he, " could be more irregular, or improper than
 their conduct.  In this disorderly state, they were on the 3rd of June
 surprised and attacked by a party of Bijugas, a warlike tribe of Afri-
 cans, inhabiting the neighbouring island of Canabac, (to whom Bulama
 then belonged) who killed five men and  one woman, wounded four
men, and carried off four women and three children.   This disaster,
which  had resulted  from a mistaken notion in  the natives, that  the
 colonists had come to dispossess them by force of their territory, caus-
 ed so much alarm  among those who had escaped,  that they re-em-
 barked  immediately, and  sailed on the 5th for Bissao, a Portuguese
settlement on the coast, at a small distance.  But on their way thither,
finding the Hankey was just arrived in the Bijuga channels, they joined
the latter ship, and on the 8th of June, both ships, with the sloop, pro-
 ceeded to the road of Bissao, where they anchored.  By this time,  as
Captain Beaver informs us, (p. 58.  " the  Calypso had many persons
on board ill oi fever, tliough none had yet died of it;" besides which,
he adds, " nothing was heard but mutual reproaches from the people
of the Calypso.  The colonists accused the members of the council in
that ship, of a want of attention to their comfort and accommodation:
 (those in the Hankey having fared better than themselves, by procuring
supplies  of  fresh provisions at  Teneriffe  and St. Jago.)  They were
tired out with the length of the voyage; irritated by the loss of their

  * At p.94 of his Letter to Dr Haygarth, Dr. Chisholm,  after mentioning Captain
Reaver's publication, describes it as  " a most complete and circumstantial narrat've ol
the whole of their proceedings;" (those of the  Hankey and the itiilama colonists,) and
as executed " with a candour and naivete, which stamps it with the seal of truth." 
448T
friends, in the recent attack of the natives, and the disappointment 6$
their hopes.   On  the junction of the  ships, these discontents were
speedily communicated to the colonists on board the Hankey : Captain
Beaver, who  had made his passage in that ship, says, that he had " left
her on the 5th of June, a quiet, clean, healthy, and orderly ship;" but
at his return, on the 7th, he found her « a noisy, dirty, disorderly ship;
the colonists dissatisfied and dispirited."
  During their stay at Bissao, Captain Beaver mentions the fever to
have appeared on board the Hankey; and that on the 21st of June it
"still continued in both  ships, but only one person had yet fallen a
victim to  it in the Calypso, and none in the Hankey."  '(Pa;.. 3 60.)
Soon after the arrival of the ships at that settlement, agents were sent
to the island of Canabac for the purpose of ransoming the women and
children taken prisoners at Bulama, which was  accomplished on the
19th of June;  and the willingness of the Bijugas to sell the latter island
having been ascertained, the ships quitted Bissao on the 21st of June,
and anchored on the 27th  in a fine harbour, in the  East Channel, be^<
tween Bulama and the Biafara shore, opposite to the spot on which the
settlement was subsequently fixed;  having previously dispatched Cap-
tain  Beaver with  Mr. Dobbin  to Canabac, where  they speedily con-
cluded a treaty, by which the island of Bulama was purchased for 473
bars, worth from 120 to 140 pounds sterling.  In the mean time, how-
ever, the discontents had increased among the colonists; " the major
part of whom," Captain Beaver describes (in a letter addressed to the
Trustees of the Bulama Association in London, dated from Bulama, the
22d of November, 1792,  and printed at page 300 of the second part o£
Wadstrom's Essay on Colonization,) as being " drunken, lazy, dishonest,
and impatient;" and the setting in of the rainy season, which began
on the 4th of June, with the prospect of great fatigues and privations
to be undergone during that season, had probably contributed not a
little thereto.  In  this  state  of mind, a very considerable number of
them resolved to abandon the  colony, notwithstanding the success of
the negotiation with the Bijugas.  Accordingly, sixteen of them sepa-
rated almost immediately; and others,  to the number of 147^ (among
whom were the governor, Mr. Dalrymple, and the lieutenant-governor,
Mr. Young,) sailed from the  Bulama in the Calypso, on the 19th of
July, for Sierra Leone, and thence  to  London,  where they arrived in
the middle of November, excepting about 40 who died  from sickness.
The state of both ships, in regard to health on the day of the Calypso's
departure from Bulama,  is thus  mentioned by Captain Beaver, at p.
80 of African Memoranda;—" 19th of July.  The fever had hitherto
continued in both ships; the  Calypso having buried  three who had
died of it since we had left Bissao, and sailed with many sick.  The
Hankey had  buried three also, and bad now two colonists, and three of
the ship's company labouring under that disorder."
   Upon the departure of  the Calypso,  with governor Dalrymple, &c.
the remaining colonists, consisting of 48 men, 13 women, and 25 chil--
dren, elected captain Beaver to be governor, and his conduct, amidst
the numerous difficulties and distresses by which he was continually
surrounded,  until  compelled to abandon the island on the 29th of No-
                                57 
450
vember, in the following year,  appears to have been  in all  respects-
highly commendable..  The first and principal undertaking of the new
colonists, was that of building a block-house for their protection and
accommodation, upon the summit of a hill near the harbour, which
was  then "covered with a thick forest."  See p. 93.  But, having no
sort  of accommodation  on shore, they were  constrained to live on
board  the  Hankey; and tlie better  to defend themselves*-  from the
rains,  &c.  they  erected a covering to the ship's deck.   Their only
shelter, on the  island, was " a little  tool-house,"  and as the hea\ y
rains made it impossible to dress their victuals on shore, the working
people were landed on the  island at day-light  every morning, and
brought on board to breakfast, at 8 o'clock; carried back to their work
at nine; brought on board to  dine at noon; again relanded at 2, P. M.   •»
to resume their labours; and, finally,  brought on board to sleep at sun-
set.   In this manner they continued to work through the rainy season,
(which ended about the 15th of October,) and afterwards until the be-
ginning of November; when the time being  expired for which the
Hankey had been chartered, it became necessary to land the colonists
with all their stores, to enable the ship to prepare for her departure,
although the  block-house could  not  be finished  until the month  of
February.
   On the 23d of November, the Hankey sailed from Bulama, having on
board sixteen of the colonists;  viz. 7 men, 4 women,  and 5  children,
besides her crew. At this time the colony had sustained a  loss, subse-
quently to the Calypso's departure, of 48 persons by death,  of whom
23 are stated to have died of fever ; one by " fever and flux," an 14 by
other specified diseases,hurts, and accidents.   On the  26th of Novem-
ber, the Hankey anchored at  Bissao, and sailed thence for  England on
the  3d of December, but in the night of the 4th she grounded  on a sand
bank near  the island of Warang, which made it necessary to send  a
part of her crew in the pinance (an  open boat) to  Bissao for assist-
ance; and these men,  after hard  rowing for two days  and nights, re-
turned with a schooner and  long boat; and with  their help the ship
was,, again  made to float : but on this day " all the people who came
from Bissao in the pinance were taken ill."  On the 13th  the Hankey
was brought back to Bissao,  to refit,  but finally  sailed thence on the
21st of December,  and anchored in  St. Francis's Bay, at St. Jago, on
the  26th of that month ; where  I shall leave her at present, that I may
 enter  upon an inquiry into the causes and nature of  the fever which
 had been so prevalent, while she remained at Bulama;—an inquiry
 which, as marsh fevers alone have hitherto been found  to prevail in
 that part of Africa, nothing but Dr. Chisholm's confident, though un-
warrantable statements, could have made necessary.
   It has been already mentioned that the Calypso had  arrived at Bula-
 ma  fourteen days before she rejoined the Hankey  in the Bijuga chan-
 nels in which interval, the colonists (tired of their confinement on ship-
 board, and believing they had now  reached the land  of promise, bad
 wandered  about that island in the most  unrestrained and imprudent
 manner, sometimes sleeping on shore, and otherwise exposing them- 
451
ftelvcs  most incautiously  to the action of  marsh miasmata,* until they
were  surprised, and partly  cut off, by the Bijugas.   Those who have
lived  between the tropics, or  who have read of the numerous instan-
ces of mortal  fevers  which have  been there produced by sleeping a
single  night  on shore, will not be surprized that after such conduct,  it
should have  been found, as is mentioned  by Capt. Beaver, that on the
8th of June " the Calypso had many persons ill of fever :" nor that this
fever should have been,  as will be  incontestably proved, the common
marsh, intermitting or remitting fever of the coast,  and that the same
fever should have appeared in the Hankey some time  after her arrival
at  Bissao ;  a place where this " coast  fever"  is known to prevail in
the rainy seasons, (which had then recently begun) and where  during


   • Dr. Chisholm, at p. 103 of his letter to D. Haygarth, says, " In every instance of great
mortality on the coast of Guinea, and in many other countries of the old and/iew continents
within the tropics, (and there are many dreadful  ones given by Dr.  Lind and otliers J
the cause has evidently been marsh miasmata, or an  " inland impure  atmosphere, loaded
with stinking sulphureous mists."  Yet, indirect opposition to  this assertion, he immedi-
ately after, endeavors to maintain that the  mortality on board the Calypso and Hankey
did not  result from this cause,  but from one which  certainly never did produce " great
 mortality" between the tropics ;  1 mean febrile contagion ; and for this purpose, he allfe-
ges that Bulama, " is every where surrounded by sea, is no where marshy, gradually ri-
ses to a moderate elevation  immediately from its shores, is blessed with abundance  of
 running water, and with a soil rich and prolific, affording ample pasturage to innumerable
wild  animals."   Had it however suited Dr.  Chisholm's purpose, I  am persuaded that,
even  supposing this description to be accurate, (whieh  I do not believe) he would, not-
withstanding, have readily discovered sufficient sources of marsh miasms at Bulama.  Its
 being surrounded by -sea is no  obstacle to their production ; witness the islands of St.
 Thomas,  Batavia, St Lucia, St. Domingo,  and scoies of others, which are extremely un-
 healthy ; and in  regard to its " rich and prolific " soil, Bulama, in this respect, only re-
sen, bles the country  along the banks of the Guadalquiver, in Andalusia, the Terra di
Lovoro, near Naples, and other places  already mentioned, as  being eminently prodiK-
 live of marsh fevers.  Governor Dalrymple, and the council,  in their joint letter  to the
trustees of the Bulama association, say,  "the island, we learn from the gentlemen who ,
have explored it, has extensive savannahs, of a deep black mould."  See Wadstrom's Es-
 say on  Colonization, 2d part, p.  144.  And governor  Dalrymple, in a separate letter,
quoted  in the preceding page, says,  " the north end of  the island, is one continued savan-
 nah, covered with long grass,  with a few  trees interspersed, but without any rocks or
stones."  He add9, " the soil of this plain is deep and rich "  Now, it is utterly impossible,
 that such a soil,  in such circumstances, should not be greatly  productive, of morbific ex-
halations, in that climate, whenever (by showers or otherwise) there is sufficient mois-
ture for their extrication,  and besides these savannahs, it is incredible that the shores of
 such an island, and especially its harbours, should not in a multitude of places be fitted to
 produce aud give out marsh effluvia copiously : there not being, so far asl can discover,
 one situation in that part of Africa where a ship  can anchor  near the shore  and remain
 even for a week, during the rainy  season, without some of her crew being soon after at-
 tacked bv marsh fever.  Such, however, was Dr. Chisholm's anxieU  to persuade others
 that in  this respect, Bulama differed from eveiy part of the coast, that (at p. 118 of vol.
 i. ofhis Essay) he has introduced a quotation from the " Voyage de Chevalier des Vlarchais
 fen Guinee and isles voisines)1' which, besides its  being otherwise of little importance,
 relates entirely to the islands in the river of Sierra Leone, and not in  tie smallest de:,ree
 to Bulama, which is in the Rio Grande, and distant more than 200  miles,  lie makes a
 similar mistake  bv quoting Dr. Lind, who  ha's not  once mentioned the islands in Rio
 Grande.  I may add that Dr. Chisholm's anxiety on this subject has also led  him to  ad-
 duce the testimony of  Mr Paiba, (which admitting it  to be correct  as far as his  know-
 ledge extended,  amounts to very little) though  in many other parts ofhis writings Dr.
 Chisholm earnestly endeavors to impeach Mr; Paiba's veracity, and  as 1 think, with very
 little re.ison ; for though  his communications to Dr. Smith,  were not all correct,  in re-
 pud to dates and numbers, (he relating them from  memory only, and after an interval of
 four years) his statements in oilier respect:, have been generally  confirmed by other evi-
 dence, and he  has no where made such groundless  misrepresentations, as. tliose of Dr.
 Chisholm, nor indeed any which manifest an intention  to mislead. 
452
her stay of 14 days, it may be presumed that the drunken,  dissipated,
and vicious characters mentioned  by Captain Beaver,  as being a ma-
jority of  the colonists, would have freely indulged their dissolute pro-
pensities,* in aid of the morbid influence of mash miasms ; but though
these vessels afterwards proceeded to the harbour, adjoining to  the
spot destined  for the settlement at  Bulama; yet by reason of the in-
tended departure of the adventurers, very little work was done on shore
during this interval;  and  the fever, being void of contagion, did not
spread in the ships ;  as only five persons were ill of  it on  board the
Hankey, when the Cp.lypso-quitted Bulama on the 19th July.  After
this time, however, all the remaining colonists, able to work, were con-
stantly employed in laborious occupations  on shore, for 9 hours daily,
and were often caught, as is mentioned by  Capt. Beaver, in very heavy
showers of ram, thrvn which few things can be more dangerous  in that
climate;  and  they must also have been greatly exposed to  the  marsh
miasmata constantly emitted in that rainy  and sickly  season.   These
causes, joined to their general despondency, and  various hardships, pro-
duced, as  might well be expected,  such an increase of sickness,  that,
as Captain Beaver mentions at p. 137, "every person employed about
the block-house was  ill and  unable  to work" on the 17th of Septem-
ber.
   Dr. .Chisholm ha:-, in  various places,  stated  his opinions  of the
causes of this fever, tliough  with some variety, and often with no  little
obscurity: that statement, however, which seems to have obtained Ms
last correction, may be found in his letter to  Dr. Haygarth, in which,
at p.  103,  after asking, "what were the causes of this fever and mor-
tality,"  he says, " all the  causes  which generate infectious or pesti-
lent: il fever, is the obvious answer."   Now, though this answer may
satisfy some of those who believe that there are such  causes, it is far
from satisfying mc, who  (for  many reasons already stated)  have no
such belief;  especially,  as though assuming' the presence of all these
supposed causes,  he has omitted to designate,  and establish the  exis-
tence of any one of them.  He has,  indeed, attempted to prove  that
the fever in question was  infectious,  and  for this purpose  (at p.  99  of
the letter just quoted) has availed himself of a passage in captain Bea-
ver's African  Memoranda,  (p. 54) where  the latter, describing the
transactions of "the Hankey and Calypso,  after their rejunction on the
7th of June, says, " the fever from which  the Hankey was still free,
had already made its appearance in the former ship;  and, instead  of
separating the infected from the well, and taking any  steps to prevent
the spreading of that dangerous disease, by prohibiting  any unneces-
sary intercourse between the two ships, the whole time, since the ar-
rival  of the Calypso,  had been taken up in the  constant interchange  of
visits : nay, the affected themselves, the very persons who had the fe-

   9 Wadstrom, page 311, gives the following  extract of a letter from Charles Drake,
Esq. " We left the remains of several of  our people at Balama ;  but I know of none
whose decease might not be accounted for, by tlieir being addicted to.  drink rum.''''
   Id page 113, Lieut, governor Young, in his" Return of the deaths of the Bulama Ad-
venturers," states that, " ot the nine persons who died at  Bulama, not one contracted  his
fever there, but all of them at Bissao, except  those who brought their disease from Eng-^
land.  Of the remaining number, many caught the fever at Sierra Leone, through  intem-
perance," &c. 
453
ver on  them at the time,  had been  actually  on board the  Hankey,*
and the consequence was, that many days did  not elapse before the
fever  made its appearance in mat ship also."   That  captain  Beaver,
when  he wrote this passage, (which probably was about the time when
the transactions happened,!) did suppose the fever in question to hare
been communicated from the Calypso to the Hankey, is evident.  He
seems, however, to have thought so, from an erroneous notion (which
has prevailed, in a great degree, even among medical men, and  which
captain Beaver might well have adopted)  that  all  fevers were  conta-
gious, and  that, as a matter of course, such a  communication of fe-
ver must have resulted  from the intercourse just described.  But there
is good reason to  believe,  that he did not long  retain this notion, but
was soon convinced,  by personal observation,  that contagion had no
influence  in spreading  the fever,  (especially  as, even on the 19th of
July,  only two of the Hankey's crew, and three  colonists, had any
fever,) or occasioning the mortality which resulted from it; for he does
not afterwards (according to my best recollection and belief,) even hint
at the operation or existence of any such cause; but wholly omits  it,
in  the various parts  of his journal  and  official letters,  in which he
endeavours to account  for the sickness and deaths, either of the co-
lonists or of the Hankey's crew ;| nor did he, when he afterwards be-

  * This  fact indicates, what will soon be proved, that the  fever in question must have
been a mild marsh fever, probably an intermittent, for under such contagious fevers as
Dr. Chisholm suppose^ the Hankey to have  drought to Granada, patients do not pass
their time in going from one ship to another, to make or return visits.
  ■j-Capt Beaver, at p.  v. of his pre<ace,  says, " most of the circumstances preceding
the 19«A of.Tuly were  written by myself, as the circumstances onBtirred;" and he profess-
es generally to have  published his journal just as he wrote it, in  order to exhibit the
impressions on his mind, at the moment when each part was written.
  * To establish the truth of this allegation,  the following  proofs will  suffice, viz. in a
letter from Capt. Beaver  to the  Bulama trustees, dated  November 22d, 1792, (sec
African Memoranda, p.  292) he writes, " the great mortality  must  certainly be attri-
buted to the great laboxir and fatigue attendant on those  who first attempted to settle
a colony, and to the necessity we were reduced to of working in  tlie ruins, in order to
have a fort to defend, and a house to cover us. With little strength,  we found it ne-
cessary to work from morn to night, except when the rains  poured like torrents, and by
these we  were often  caught when going in the boats either on board, or on  shore.""
Afterwards, he observes, ( African Memorada, p. 495,)  "had we carried out the frame
and materials necessary for the erection of a  large house,  jt might have been finished,
in at most one month; but "asaMthe timber,  which I built with, wi« growing at the
time of our arrival, it was February in the following year,  before 1 had a room to put
my head in.  The being exposed during the whole of that time to either the rains or
the^ sun must certainly have been a  great cause of our mortality."  He had before ob-
served, (African Memoranda, p- 367) that  the mortality  of the colonists at Bulama,
"though in,some measure certainly  to be attributed to the climate,  was much more
to the adventitious circumstances which have been already noticed; and I am inclin-
ed (adds he) to think that, independent of its  having really been tlie most unfiealthy
season of the year, independent of our hard labour, and great exposure during that
inclement season, much of our very  great mortality may be attributed to tlie  uncom-
mon depression of spirits which  our situation produced,  on the minds of most of our
colonists;  and I verily believe that I should have died too, if I had ever suffered  my
mind to be so subdued.  But how far this despondency may have contributed to our mor-
tality, must be left to the decision of physicians,"  Upon  this passage, Dr. Chisholm
(at p. 105 of'his letter) says, "WereI to hazard an opinion, I should be inclined to say
that it  contributed as a powerful predisposing  cause to  the action of infection, which
had already accumulated in their bodies, like the electric jhdd in the  Leyden phial,
and required  only this excitement to destrty at a single  discharge." But surely Dr.
Chisholm,  before he ventured upon this extravagant and  most inapplicable compari-
son, before he assumed this excessive accumulation of some undescribed lebrile contagion, 
454
tame governor of the colony,  (if it  may be so called)  adopu  in the
smallest degree, any of those measures,  for " separating the infected
from the  well," and  for " preventing* the  spreading" of the  fever,
which he had  at first  supposed to be of high importance; and which
he certainly would not have neglected, with so much  humanity and vi-
gilance as he has manifested on all occasions, had he still  retained hit*
former opinion.  Capt. Beaver was, in truth, so far from believing Dr:
Chisholm's allegations respecting the Hankey, that he has, on various
occasions, given those allegations  the  most decisive 'contradiction:
witness among others, the following passage, at p. 305 ofhis African
Memoranda, viz. "the mortality which took place in  tlie island of Bu-
lama, and on board the Hankey, after her departure from it, was in this
country called the  plague, or Bulama fever, by those who were inim-
ical to the success  of our enterprise;  and such serious representations
were made on the  subject, as produced an order from the  privy coun-
cil to sink that ship, though on further inquiry it was not  carried into

should at least have proved the existence of a few particles of it,  either in the Calypso
and  Hankey or upon  the island of Bulama.  In regard  to the  former,  Dr. Chisholm
has  admitted (what might otherwise be readily proved) that when these  ships sailed,
and during  the voyage out,  the crews and settlers were  all heal thy/' and that " no sus-
picion whatever can be entertained of the existence of latent infection among them."
See his Essay on the malignant pestilential fever, he. vol. 1. p. 103, et seq.  It follows,
therefore, that if the fever  in question  was produced by contagion, generated ineither
of these ships, it must have been after her arrival on the coast of  Africa, and that the
guilty ship  must have  been the Calypso, since, according to Dr. Chisholm's  last new
opinion  (adopted to take advantage of Captain  Beaver's error) the  infection was commu-
mcated from Iter to the Hankey.  But I have already, in different places, adduced so
many facts decisively proving that filth,  crowding, and all the other causes supposed to
be capable of generating febrile contagion, do not produce that  effect, when in cold or
temperate climates, and in circumstauces which  ought to render those causes highly
prolific, if they were capable of such generation, that I shall not be here  expected to
enter upon  a particular refutation of Dr. Chisholm's unsupported  and most improbable
suppositions, respecting the Calypso and  Hankey ; especially as  it has been  already
proved that the high temperature between the tropics, is so unfavourable, I need not
say to the generation,  hut to the existence, of febrile contagion,  that even when it hap-
pens to  be brought into that temperature it cannot subsist, much less propagate itself.
Dr  Chisholm's inconsistencies on this subject  arc truly ridiculous.  In his Essay, at p.
0.'j of vol. 1. he asserts,  that " the state of the atmosphere between  the  tropics does
not seem to admit  the generation of a high degree of infection," and at p. 189 of  his
letter to Dr. Haygarth  he says,  " one universally admitted fact,  I mean  in the West In-
dies,  incontestably proves that  heat and filth  do not render shipping " the most dan-
gerous of all human habitations." The fact (adds he) is this, that the shipping frequen-
ting the different ports of the  West India islands before 1793,  were almost uniformly
and  remarkably healthy "  Yet, in the very same letter, he twice  adopts ami  repeats
what he had previously declared in  his letter to Dr  E. H. Smith, tliat "a fever (on
board the Hankey) proceeding originally, perhaps, from the inclemency of the seasop,
and the  circumstances of the situation of the adventurers, had become, by confinement,
filth,  consequent impurity of air,  and depression of spirits, a true jail fever,  or fever
of infection heightened to almost  pestilential violence."./? jail fever  between tlie tro-
pics ! ! ! and a. jail fever heightened to almost  pestilential violence,'''' in an atmosphere
which he had before mentioned as not admitting " the generation of a lugh degree of
infection ! /"—And least these contradictions should  be thought  too few,  he tells us,
at p. 217 and 218 of the very same letter to Haygarth, that (instead of jail fever) the
disease imported by the Hankey to Grenada was a " nova pestis, a  peculiar, original fo-
reign pestilence, recently generated, andutterlyilnkno~.cn  before,''' &c. (see p. 201  of
this volume J Had he told us that the supposed causes of this new plague, had generated
Elephants at Bulama,  I should have thought  the  tale less  improbable, because  these
animals have  been frequently seen on that island, while neither plague  nor pestilential
fever ever was nor as I believe ever will he. 
455
 effect;  and the ship was restored to the owners, after their having sus-
 tained very considerable loss, by the industry with which certain inte-
 rested people kept, up the report of the malignity of the  distemper,
 which it was said that ship brought home, and for which there was
 not  the  shadow of a foundation"  Again, in a note to p. 192, after
 noticing the report of the pestilential fever or plague, supposed to have
 been carried by the Hankey " from Bulama to  Grenada," captain Bea-
 ver adds, "this report was for a considerable time believed; the Han-
 key was sent to Stangate Creek to perform quarantine, and orders were
 given for sinking the ship and cargo;  however, on examination,  tlie
falsehood and  malignity of this  report Jbeing proved,  this  order was
 oonfined to the Bulama baggage only."
   In addition to these facts I shall now adduce the most decisive evi-
 dence,  to prove  that  the  fever  which prevailed in the Calypso and
 Hankey, and  among the  adventurers  to Bulama,  was the common
 marsh fever of the western  coast of Africa;  and for this purpose I
 shall first quote the testimony of Lieutenant-Governor Young, who, in
 his " return" of the deaths  of  the Bulama adventurers,  and in allu-
 sion  to  the fever,  which produced  so many of them,  observes  con-.
 cerning it, that " the coast fever is o( the intermitting kind and not
 infectious."   [See Wadstrom,  page  3IS.]  This  gentleman's com-
 petency to form  a judgment on the subject will scarcely be doubted,
 after reading the following character of him by Capt. Beaver,  at p. 82
 of African Memoranda :  " Young, next to the governor in the  council,
 was  a man in mind and information inferior to none I have ever had
 the happiness to know.   I respected,  I loved him: and never was in
 bis company without  leaving it both wiser and better, from his know-
 ledge and  virtues :"  and he must have had very sufficient opportuni-
 ties of observing  the  intermitting nature of the fever, and its non-in-
 fectious quality, both at Bulama and on  his passage in the Calypso to
 England, during which about forty of the persons on  board are stated
 to have died, mostly of this disorder.  Mr. Paiba's testimony on this
 subject, as communicated to Dr. E. H. Smith, and published in the
 New-York Medical  Repository, vol.  1, p. 463, is in these words:
 "  Concerning the sickness which carried off the colonists, both at Bu-
 lama and  Sierre Leone, and on the home passage of the Calypso, it
 may be  remarked, once for all,  that it was by no means of one kind.,
 as the readers of Dr. Chisholm would be led to suppose.  Few, if any,
 escaped, altogether,  some had  regular intermittent fever, (which is
 the fever of the  coast,)  of various continuance, from a week to seve-
 ral months;  others had a  violent fever, which terminated favourably
 or fatally, in one,  two, three, four, five, or six days ;  or which linger-
 ed out  after its first violence as many weeks ;* some had diarrhoea,-


  * The " violent fever" here mentioned may, in many cases, have been a marsh fever,
 aggravated by some other of the well known causes of fever, such as bein-j: caught by
 Kftivy  rains, drunkenness, fatiguing exercise, or labour in the sun, &c. and in a  few it
 mav have been produced by these latter causes only, though it seems difficult to believe
that any person,  who had been even but a few weeks on the island, could have so hr es-
caped the influence of marsh miasms, as that a fever in him should not, in some decree
have resulted from their influence. 
ioG
a»d dysentery; and others fell martyrs to tlie indiscreet use of opium
and spirits, as preservatives."
   But to render superfluous all other evidence on this subject, I will
here adduce that of Dr. Winterbottom, who, by  appointment of the
Sierra Leone company, was physician to that colony,  when the Calyp-
so arrived there, with Governor Dalrymple, and the discontentd colo-
nists from Bulama; and consequently had abundant opportunity of be-
coming well  acquainted with the fever which prevailed  among them,
and which was supposed to have been communicated from thai  ship
to the  Hankey,^ and undoubtedly the testimony of a physician so im-
partial, and so respectable by his character, and his general as well as
professional knowledge will be deemed conclusive on this subject.  It
was  given at p. 16  of the 2d volume of his  account  of the native
Africans,  where he says, " the fever which carried off so many of the
settlers at Bulama, precisely resembled the endemial remittent fever of
Sierra Leone,  a  sketch of which, at some future opportunity,  may
perhaps be laid before the public ; but the fever described by Dr.
Chisholm" (meaning the malignant pestilential  fever,  so called  by
him,  and supposed to have been brought by the Hankey to Grenada)
" differs so essentially from that which occurred at Sierra Leone, that
it cannot  be recognized as the same disease."   Afterwards, in the
same page,  Dr. Winterbottom corrects one of Dr. Chisholm's errors'
in regard  to the Hankey, by stating that she " had no communication
whatever  with Sierra Leone;  adding, " the other vessel, the Calypso,
after leaving Bulama, called  for refreshment at Sierra Leone, where
she remained about six weeks, during which time upwards of forty
of the crew and passengers died of the remittent fever, though un-
attended with any appearance of peculiar  malignity."  Against such
testimony, the unsupported assertions and suppositions of Dr. Chis-
holm, who never was on the  coast of Africa, nor personally acquaint-
ed with any of the facts in question, must be of no value.
   I might here, therefore, dismiss this part of my discussion, did not
a regard  for truth compel me to notice Capt. Beaver's account of his
own fever, in order to expose and correct a very important, and seem-
ingly a very  culpable,  misrepresentation,  which  Dr. Chisholm has
made concerning it.  This  account may  be found  at p. 161 of his
African Memoranda in these words : " The letter which  I wrote to
the  trustees by tlie Hankey was, I think, dated Nov.  23,  1792.   It
was written during that and the two preceding days, in those intervals
when I had  the full possession of my senses, and was able to apply
myself for a short time to writing, for long I could not; and each of
the first two of those days, as well as for several before, I was delirious,
 generally from about 10 A. M.till 2 or 3 P. M. and this was the case in al-
most all the severe attacks of the fever which I afterwards had.  This
was owing to the excessive heat between those hours; for I  invariably
 got  better  as the sun declined, and never experieneed the violent
raging of the fever till the sun had again acquired power on the follow«


   ■J" Though the fever was not communicated  by one ship to the other, it was manifest-'
Jy. klie same in both, and derived from one common source—marsh effluvia. 
457
dc'sr in^n   T     ' AfnCan Memora»da.  See likewise  his  other
  rdisoXr    PagG  irr"4' md at PaSe 114~121 i* ^m  all which
fevers,!    PPCarS  l° h/Ve been °ne °f those wor*A» OT intermitting
at le,«t ?  ♦ Paroxysms of whl<* ^re often accompanied by delirium,
at least between  the  tropics; and it could  not, therefore, possess any
contagtous property, even in Dr. Chisholm's opinion, as delivered in
various parts of his writings; and particularly in the first volume ofhis
J^ssay, ccc. p. 299, in these words, viz. "The true uncombined yellow
i emitting fever, deriving its origin from the miasmata of marshes,
and the various exhalations from putrid vegetable substances, confined
humidity, and stagnant water, is not contagious; nor can it be proved
to be so  in any instance, of  Torrid Zone at  least."  But in direct op-
position  to this opinion, he makes the following unaccountable state-
ment,  at p. 102  of his letter to Dr. Haygarth, 'viz.  « The fever" (at
Bulama) "appears to have  been direfully contagious ; for in one in-
stance, particularly,  three persons who were near his" (captain Bea-
yer s)  " bed, during his  own illness, from  which he almost  miracu-
lously  recovered, received the infection from his person, and died soon
after."  And  for proofs in  support  of  this allegation,  Dr. Chisholm
refers  to pages 171 and 172 of the African Memoranda, where indeed,
mention is made of captain  Beaver's  illness, and of the deaths of three
persons  m two succeeding days, but without any fact, or circumstance,
indicative of the existence of any  thing  like contagion, or of any con-
nexion between captain Beaver's disorder and the deaths in question.
The only passages relating to this  allegation, which occur in the pages
referred to by Dr. Chisholm, are the following, viz.
  "Thursday,  December  13,  1792.  "Very ill;  delirious part of the
day.   In the evening, after  having somewhat recovered  my deranged
senses, sent for Messrs, Fielder "and Hood, the only subscribers able
to move; made my  will, and gave them  advice  how to act in case of
my death."
  " Friday,  14.  Died of a fever, and were buried, both Mr. and Mrs.
Freeman.  This couple I married on the  4th of last month.   They
were both taken ill, about  ten minutes after the ceremony was per-
formed, and have been so ever since.   They  both died this morning,
within ten minutes of each other,  and  were both buried in the same
grave.   Myself a great deal better in the morning, but delirious great
part of the afternoon."
  "Saturday,  15th.   Died  and was buried  this evening.  Mr. Fielder.
This is  the  man who, two days ago,  made my will,  and  whom I
thought likely to be my successor.   He was  young and brave—fit to

  * Capt, Heaver, at p.  354, states himself to have  " lind seven separate attacks of the
fever ;" a circumstance which even if most of them should be considered merely a-, re-
lapses,  must render it very unlike Dr. Chisholm's malignant pestitei.tial fever, which he
represents as der'.ved from the same source, or contagion, as that which hi. supposes to
have produced thr fever of Captain Reaver; for the doctor asserts, that,  "by a general
law of the peculiar contagion"  of his pestilential fever, " tliose once attacked and recov-
ered are exempted from being affected by it."  See letter to Dr.  Haygarth, p. 180.  My
readers will not, I hope, conclude from the mention which 1 sometimes make of this
supposed  " malignant pestilential fever," that 1 believe such a fever to have ever existed,
or that the fever so called was any thing else than a modification,  or variety, at most, of
Mie common non-contagious yellow fewr.
58 
458
 dravv^a lion's toolh."  These being the only deaths to which Dr. C bis-
 holm's reference can be applied,  or extended,  we must necessarily
 conclude that these were the three  persons in his contemplation, when,
 to prove that captain Beaver's fever was direfully contagious, he ven-
 tured to assert, that in one  particular instance, (leaving us to suppose
 many  others probable,) three  persons, who had been  near captain
 Beaver's bed, &c. received the infection from his  person,  and died
 soon  after."  Now, from  the  antecedent parts of captain  Beaver's
 journal, it appears that the fever, under which he laboured on the 13th
 of December, 1792, had only commenced  on the 9th of that month,
 34 days after Mr. and Mrs.  Freeman were attacked with that fever
 which occasioned, and lasted until their deaths.  It is true, indeed, that
 captain Beaver had been attacked by fever some weeks before, but this
 was not until five days after the illness of Mr. and Mrs. Freeman had
 commenced, i. e.  until the 9th  of November; and as previous to thai
 day,  captain Beaver had been well for about six weeks, Dr. Chisholm
 could not, with any degree of truth, pretend that they  had received
 febrile infection from his person,  and died soon after;  especially as
 their deaths only happened after forty days; a protraction of disease,
 which I am persuaded Dr.  Chisholm has never mentioned, as occur-
 ring in his malignant pestilential fever.
   In regard to Mr. Fielder,  no  mention is made in the pages referred
 to by Dr. Chisholm; nor, so far as I can recollect, in any  other, of the
 disorder which  caused his death;  nor are we entitled  from any thing
 within my knowledge, to conclude that he died of fever.   But if this
 did cause-his death, it could not have been produced by contagion
 from captain Beaver's persOn, at the time of making his will; because
 even if his Beaver's) fever had been contagious,  we have the strong-
 est reason  to believe, that no febrile'contagion has ever produced dis-
 ease and death within forty-eight hours from the time of  its being re-
 ceived.  There is, therefore, nothing which  I can discover to excuse,
 and much  less to  justify, Dr. Chisholm in the  serious liberty which
 he  appears to have taken with the truth, on  this  interesting subject; a
 liberty  which is the more  extraordinary, because as the facts which
 have  been  so strangely  misrepresented, were distinctly  and perma-
 nently stated in print, there appears to have been no room for any mis-
 take ;  and,  unfortunately for Dr. Chisholm, the impressions  resulting
 from this incident will  not be weakened by others, which  must hereaf-
 ter  fall under our notice.
  After this digression,  it will  be proper for us to  return  to those
 events which more immediately relate to the crew of the Hankey,  of
 whom it has been already mentioned that three were ill of fever, when
 the Calypso sailed on the 19th  of July.  But during the subsequent
 part of the rainy season, they remained comparatively  healthy; proba-
 bly  because they  were much less exposed than the settlers to the
 causes  ot fever on shore.   For if the fever had been contagious,  as
 Dr. Chisholm pretends, the seamen, by remaining constantly on board
 with the sick, would probably  have been infected  sooner, and  in
 greater numbers,  than the  colonists  who  were  labouring on shore.
But when the Hankey began to prepare for her return to Europe, and
her captain, (as is stated in  caption Beaver's Journal, p. 135,) "want- 
459
.ng ballast, and being unable to procure any of stone, determined to
ballast her with wood;"—" all the men he could spare" were sent " on
^hore to cut it;" which is  notoriously a most dangerous employment
between the tropics.  It is  also mentioned, in captain Beaver's  journal,
under the date of October  31, that " all this day, by permission of cap-
lain Cox, the Hankey's crew have been stowing away our goods in the
store-room" on shore.  And they are stated to have been employed in
this service on the three following days.  Again captain Beaver states,
" 4th of November.—Four of the sailors came on shore to cut  logs for
us;" i. e  the settlers,—see p. 159.  And besides these, they were
sent upon another dangerous employment, that of watering the ship;
by all which they must in that situation have  imbibed  marsh miasms,
sufficient to account for their subsequent sickness,  aided by other ma-
nifest causes.  After leaving Bulama on the 23d  of  November, the
Hankey went to the unwholesome settlement at Bissao, and remained
there for a week, during which, it may be presumed, that the sailors
run into their customary irregularities; and  with these, added to the
other causes of disease, it cannot be thought extraordinary,  that " three
of the crew were taken ill of fever,'/ on the 3d of December, when the
ship sailed from Bissao.   Her getting aground, and the other events
which followed until she reached St. Jago,  have been already men-
tioned.   On this  subject, captain Beaver  has made the following ob-
servations,  at p.  192 of African Memoranda, viz.—"When the Han-
key left Bulama,  not one of her crew  had  been buried, although so
many of the colonists had; however, a few days afterwards  she be-
came very sickly: and this was most likely increased  by the  extraor-
dinary labour, consequent on the ship's running a-ground on the 4th
of December, in the Bijuga channel; in which situation she  remain-
ed until the 9th ; and the boat having been sent about 90 miles to Bissao
for assistance,  I find noted in the Hankey's Log-Book, on the day of
her return,  which was the  8th, " all the people  which  came from Bis-
sao in the pinnace taken ill."   He adds, " this was, in all probability,
owing to their greatfatigue, and exposure to the sun  in the day, and
the dews in the night."   Here it will be observed, that tliough Dr.
Chisholm would have  us believe that  all the sickness and mortality
which occurred on board the Hankey  about this,  as  well  as at other
times,  were produced by that " direful" conti gion, which was  ima-
gined by him,  Captain  Beaver had  entirely  discarded all belief of it,
and has ascribed events  to  their usual and natural causes, upon this,
as well as former occasions.
  I have already mentioned the Hankey's arrival in  the  Bay of St,
Francis, at St. Jago, on the 26th of December, whence she removed",
and came to anchor at Port Praya,  in the same island, on the 4th of
January, 1793; having then  lost by deaths,  subsequently to her de-
parture from Bulama, eight of her  crew, with five men, three wo-
men,  and two children, colonists,  who  had been taken on board, I
believe, all in a sickly condition.*

  * Mr.  Paiba states, that all the colonists who  embarked  at Hulama, to return in the
ITankey,  excepting himself, Yin;  Vu\b:\, and another woman, v. ere unwell,- as ir.ight iu-
deed be  supposed from  preceding events.   That " before the Hankey put  to sea, all 
160
     When the Hankey had been a week at Port Praya, the Charon,
   ship of war, Commodore Dodd, arrived there from England, an event
   which was made the  foundation of a most extraordinary misrepresen-
   tation by Dr.  Chisholm, in  his  first publication, respecting what  be
   called the  "Malignant  Pestilential Fever,"   ufro?n Boullam," Sec.
   The  following is Dr. Chisholm's statement, (p. 87) viz.—
     " With much difficulty they (the Hankey's people,) arrived at  St.
   Jago, where they fortunately found the Charon and Scorpion,  ships of
   war.*  Captain Dodd, of the former, humanely rendered them every
   service in his power; and on leaving them,  put two men of each ship
   on board the  Hankey.   With this aid, they  proceeded to the West
   Indies;  a voyage  to England being impracticable in their wretched
,  state.   On the third  day after leaving St. Jago, the men they procur-
   ed frpni the ships  of  war, were seized with the fever,  which had ear-
   ned off three fourths of those on board the Hankey,  at Boullam; and
   having no assistance, two of the four died: the  remaining two were
   put on shore here, in the most wretched state possible.   Captain Dodd,
   on his arrival at Barbadoes,  from the coast of Africa,  was ordered by
   Admiral Gardner to  convoy  the homeward-bound  fleet of merchant-
   men.   In the execution of his  orders, he  came to  Grenada  on the
   27th  of May, and hearing  of the mischief which  the Hankey had
   been the cause of, mentioned that several  of  the Charon's and Scor-
   pion's people were sent on board  the  Hankey at St. Jago, to repair
   her rigging,  &c.;  that from this circumstance,  and the communica-
   tion which  his barge's crew had  with  that  ship, the pestilence was
   brought on  board both  ships:  and that of the  Charon's crew thirty
   died; and of the Scorpion's crew about fifteen.   The Hankey arriv-
   ed at the Port of St. George, on  the  19th of February, in  the most
   distressed situation ;  and for a few days lay in the bay, but was after-
   wards brought into the Carenage."
     By the publication of such apparently decisive, \ho\\g\\ fictitious, in-
   stances and proofs of a most powerful and destructive contagion, on
   board the Hankey, joined to others of equal value, which were stated
   by Dr. Chisholm to  have occurred  after her arrival  at Grenada,  we
   cannot wonder that many persons were  so far misled, as to believe in
   the generation and importation of a new and "  direfully" contagious
   fever by that ship; for at first the  Hankey, and not the Calypso,' was
   represented as the  parent  of  this monstrous and dreadful produc-
   tion.   Fortunately for the cause  of truth, the  falsehoods regarding  the
   Charon and Scorpion, were detected,  and laudably  exposed by  Dr.
   Trotter, who happened  to be then surgeon to the Vengeance, ship of
   the line, one of Admiral Gardner's squadron, under whose protection

   from stem to stern,  both above and below, m ith salt water, and then with vinegar and
   water, and the purification was completed,  by thoroughly fumigating her with tai\ pitch,
   and gun-powder ; and that this purification was repeated  at Bissao ; and he ascribes the
   eight deaths, which occurred subsequently to the ship's getting a-ground, principally to
   the terror,  confusion, great fatigue, &c occasioned by that event.  See New York Medi-
   cal Repository, vol 1, p. 466.

     •The Charon did not arrive until the 13th of January, a week after the Hankey's
   arrival : and Scorpion only entered Port Praya on the  24th, one  day after the Charon
   had left it. 
461
the homeward-bound West India summer fleet (of 1793)  was then
returning to England.   He- informs us, at p. 327 of the first vol. of his
Medicina Nautica, that on the  22d of August, a ship, one of the fleet,
" lost her fore-mast in a squall of wind,  and received  other damage,
when the Admiral made the signal for  the Vengeance  to take her in
tow.  The ship proved to be the  Hankey from Grenada and Bulama.
Captain Thompson sent carpenters on board, with the necessary stores
to assist in repairing her losses : they remained for three or four davs,
but no sickness followed, &c.  Dr. Trotter afterwards mentions, how
Irom this, and other circumstances, he was induced to make inquiries
concerning Dr. Chisholm's account of the consequences of the Hankey's
intercourse with the  Charon  and Scorpion, particularly from Captain
Dodd, who " had his  broad pendant"  in the former ship, and  of Mr.
Smithers, who was her surgeon: from them, says Dr. Trotter, I have
copied the following narrative of their transactions with the Hankey,
viz.—
   " When the squadron, under Commodore Dodd, came to St. Jago,
in  1793, the  Hankey lay there, in great distress  for want  of hands,
having buried above one hundred persons,* men, women, and children,
from the time she had been at Bulama.  The fever was now overcome;
Mr. Smithers saw two men who had lately recovered.  He prescribed
to the master, who was ill of  a venereal  complaint, and for  which he
left him some mercurials, with  directions how to use them; at the
same time be left a quantity of bark.  The Charon and Scorpion sent
two men each to  assist in navigating  her to the West Indies.  The
Hankey at this port was cleansed, washed  with vinegar, and fumigated.
No fever appeared in either of the men of war in consequence of this
communication; they arrived  at Grenada in perfect health" i~c.  Dr.
Trotter adds,  " It is probable from  these facts, that the Hankey did
not import the infection that produced  the Grenada fever."—It is also
doubtful, how the effects left in the  Hankey, could produce-the fever,
for the bedding was thrown away, and what clothing remained had been
aired, and probably had scarcely been in contact with the body after
being sick.   Mr. Smithers was  examined before the (lieutenant) go-
vernor of Grenada on the the subject, and gave his opinion decidedly,
that the Hankey did not communicate  this fever to the  colonists."
   From this statement, and other proofs, it has been unquestionably as-
certained, that every part of Dr. Chisholm's account, which asserts the
communication of any disease from the Hankey to the Charon and
Scorpion, was a mischievous falsehood, fabricated without the smallest
foundation, or particle of truth ; since  the latter ship did not lose a
single man during her whole voyage, and the  Charon lost only  four,
from causes described by Dr. Trotter, and wholly foreign to the Han-
key.   Indeed, two of these four did not belong to the Charon, and one
of them was a black prisoner, sent to England to be tried for murder.
But what is Dr. Chisholm's  apology,  what his atonement, for having
asserted and published these falsehoods ?  Why, truly, in  the  preface
i.o his second edition,  after noticing Dr. Trotter's publication  on this


   * This number is stated generally, and probably from imperfect  recollection. The
deaths amounted to sixty, and no more; of the:;e nine were seamen. 
462
subject, he says, p. xxli.  - On further inquiry, I find I have been in-
correct* in my statement of the circumstances of the  interview (an
interview between ships!) which the Charon had with the Hankey at
St. Jago;" and then, as if not willing to retract on the evidence of Com-
modore Dodd and Mr. Smitlu i>, or without seeming to do it spontane-
ously from other evidence, (which we are to suppose an anxious regard
for truth had induced him to procure)  he mentions his  having been
" politely favoured" " with the perusal of a Log-book, kept" by " a
lieutenant of the Charon, during the voyage in question;" in which he
says', '* I found that no  sickness took place on board that ship in  con-
sequence of the interview."   And then he adds, (perhaps as a compli-
ment to Commodore Dodd and Mr. Smithers,) that "  a Log-book h
unquestionable evidence, and, therefore, I have suppressed what I have
advanced on this affair,"  (a great favour truly!)  " on the authority
of the late  Mr. Home:"  adding, " but why Mr. Home  should men-
tion this as a fact communicated to him by Commodore Dodd, I can
assign no reason:" nor indeed can any other person, as I believe.  But
before wc employ our time in assigning reasons or motives for  sup-
posed events, it is always best to inquire whether they have really  hap-
pened.  The  question  seems to be,—Whether, in  truth, Mr. Home
did inform Dr. Chisholm that Commodore Dodd had told  him these
falsehoods ?  This being a question of no small importance; the affir-
mative is not to be assumed with  Dr. Chisholm's seeming levity and
unconcern.   For the assumption is nothing less than fixing upon the
character (as I believe unblemished)  of  a gentleman now dead, and
unable  to justify himself, the  stigma of having invented and propa-
gated the most groundness  (and in no  small degree injurious) false-
hoods ;t for no person  will believe that Commodore Dodd, without
any discoverable motive, should have invented and  reported what he
manifested so much readiness in contradicting, and in authorizing Dr.
Trotter to contradict, and what every man on board the Charon and
Scorpion, as well as himself, knew to be false.
  Had Dr. Chisholm in stating these untruths, named his authority,
as he ought to have done,  and had the person named admitted  him-
self to  have been the informer, Dr. Chisholm's veracity would not  have
been impeached, whatever  might have been thought of his discretion,
in publishing such reports.   But instead of this, he ventured to assert
as from, or, within his  own knowledge, that Commodore,  or  Captain
Dodd,  on coming to Grenada, and hearing of the mischief caused by
the Hankey, had " mentioned" the  falsehoods in question ; and by this
unqualified assertion, he had made himself responsible for its truth, and
liable to be considered as  its author.  I do not mean to  decide that
Mr. Home did not give Dr.  Chisholm such information, as he pre-

  * When the principal facts in a  statement are true, and the  lesser circumstances, oi
incidents only, are imperfectly or erroneously stated, the author of such a relation may
describe himself as having been "  incorrect;'" but when all the parts for which a stale
ment was made, are completely  unfounded, and without any  intermixture of  truth,
other and stronger terms can alone be proper. 1 should not have made this observation,
if Dr. Chisholm had not so often, and  wiih  very little reason, applied the harshest and
jno-t offensive language to others in his writings.
  f Mr. Home, I believe, lost his life by the liands of assassins;  and I will not co-opsFflt'-
in'stahbing his reputation, when he is no longer able to defend it. 
463
••ends ; but on a question of this nature,  I feel it to be my duty to con-
sider and weigh probabilities;  and,  in doing this, I recollect that Dr.
Chisholm is, at best,  an interested  witness,  and, therefore, cannot be
received  as  one, on this  subject;  that his own  character is in jeo-
pardy ;  that when making  his  groundless statement,  he, in a note to
the very page  which contains it,  has mentioned Mr. Home, as giving
him  information respecting Captain  Coxe's refusal to destroy the ef-
fects  of the  Bulama adventurers,  unless  indemnified; but  has not
even  hinted  at Mr. Home as  having mentioned the other supposed
facts, which had just before  employed his thoughts  and  his  pen ;
and which, therefore, it would have been most natural and proper for
him  to have done,  if they  really had been stated on that gentleman's
authority.  And  I  recollect also, that while I  have  no reason to  sus-
pect Mr. Home of having ever, either  wilfully or incautiously propa-
gated  untruths, Dr.  Chisholm appears to have done this in but too
many instances ;*  and,  therefore, the balance of probabilities, in  my

   *  Some of these instances have been already mentioned, and others will soon fall un-
der our notice.  But iu the mean time, there is one so analo. ..us to the matter in discus-
sion, that I cannot avoid noticing it here, especially as it proves, that instead of becoming
more cautious and attentive to facts, as an atonement for the untruths published respect-
ing the Charon and Scorpion ; Dr. Chisholm, subsequently to his retraction of them, did
not scruple to assert, and publish others equally void of truth, and for the same mischiev-
ous purpose of proving his Nova Pestis to be -direfully contagious.
   The following are his own words, at p. 320, of vol. ii. ot his Essay, viz :—" When
visited this island,  (St. Thomas's) in November, 1796,  an accident furnished me with aa
opportunity of informing myself  relative to the history of the malignant pestilential fever
as it appeared there in 1793.4,5, and at that time.  The history was indeed a melancholy,
but it wan also an instructive one   An eminent  merchant, M. C. G. Fleicker, with whom
I had been acquainted at St Croix, requested me to visit a valuable younj; German gentle-
 man of this house, of the name of Schnialer,  wlio had arrived from  Hamburgh only about
 ten days before, and at this time unhappily  laboured under a fatal attack of this  most,
dreadful malady.   In  Mr. Fleicker"s  how-e, the malignant pestilential fever had very
 frequently made its appearance during and since 179-5,  and except iu one instance, the
 captain of a Hamburg ship, always fatally. No means, at least, none sufficient for the era-
 dication  of the infection, had been employed on the death  of the unfortunate sick, conse-
 quently the chambers, which were successively occupied by strangers from Europe, be-
 came a never-failing seminium of the pestilential contagion.  A. very few days after his
 arrival, Mr Schmaler  felt its influence," &sc   This misrepresentation, to call it by the
 mildest name, being made known to I. F. Eckard, I'-sq. Danish vice-consul, at Philadel-
 phia, that gentleman w rote a letter to  Dr Mease  of that city,  in which after giving a co-
 py of it, he adds the following observations, viz.
   ' " I )r. Chisholm, no doubt alludes, in the above paragraph to Mr. C. G.  Fleicker, who
 resided at St. Thomas's, but who had not, at  the period of Dr. Chisholm's visit any regular
 establishment in the island, but acted as an assistant to my house, of which Mr. Schmaler
 was clerk.   There being a greatintimacy between Mr- Fleicker and myself,  he often in
 my absence, was authorised to superintend my  concerns, and this was the case at the time
 Mr. Schmaler died.  I was, however,  at home when he arrived from Europe, and return-
 ed soon after his death
   «• More young  men had died in my house, from 1793 to 17'.)6, and eyen later, than per-
 haps in any otherin town ; because more had come out to me from Europe than to oth-
 er merchants.   Their deaths, however, could  not have been occasioned by the contagion
 remaining in the chambers of the house, as Dr.Chisholm supposes;  for  the cases took
 pl-ice at  remote  periods,  in different houses  ; I  having changed my dwelling in  1795 -—
 aV either  could their deaths have been occasioned  bv tlie contagion  remaining iu the bed-
 din", for the beds and  bedding of those who died of a putrid fever in my house were never
 used attain. Further, according to the best  of my recollection, two persons were never ill
 of the tever at any time, in the same  chamber, in either of my houses; in  both of
  which L  had lour or  five rooms appropriated  for clerks: besides many persons slept
  in those  chambers witnout anv inconvenience.   If Dr.  Chisholm's account were cor-
  rect  mv house  must have been  a  lazaretto, for those sippnsed  pestiferous chanr- 
464
judgment,  is very unfavourable  to  him.   And in any event,  a writer
who  will adopt, and give his  utmost sanction to unfounded  reports,
when they  happen to suit his own purpose, must not expect that even
his facts, when he  happens to state  them, will be believed,  without
other authority than his own.
   It  will be recollected, that the testimony of Commodore Dodd and
Mr.  Smithers, did not  extend to any transactions  on board the Han-
key,  subsequently  to her leaving St. Jago, and, therefore, a  part of
Dr.  Chisholm's statement  was  left uncontradicted by  them,  though
since proved to have been false by the Hankey's Log-book. The part in
question is as follows,  viz :—That  "  on the third clay after leaving St.
Jago, the men procured from the ships of war  were seized  with the
fever, which  (as  he pretends) had carried off three-fourths  of those
on board the  Hankey, at Boullam, and  having no assistance, two of
the four died : the  remaining  two (he  adds)  were put  on shore here,
(at  Grenada)  in  the most wretched state  possible."   The object of
this part of Dr. Chisholm's mis-statement, like that of the  former, is
to prove the existence of this  " direful"  contagion on board the Han-
key : but it seems to be as  completely  destitute of truth as the other.
The Log-book,  indeed, mentions that Samuel Hodge, one of the
seamen sent from the Charon, on the 23d of  January,  died on the 4th
of February;  but Mr. Pabia, a passenger in the Hankey, says  this
man " was unwell when he came  on board,"—though " able at  that
time to do  duty ;"—" that he grew  more and more unwell as they pro-
ceeded."   That " Captain  Coxe, who  was still unwell  when  the Han-
key left SL Jago, recovered his health, before they reached the West

bers were almost always occupied ;  and I can assure him, that commonly a who'e
year, and sometimes a longer period, passed without any one of my family being
sick of  fever.  It is, moreover,  incorrect, that all  those persons died who had been
sick of the pestilential fever during, and since  1793, except the Hamburgh captain ;
and also, ' that  after the two first years of the introduction  of this fever,  the inhab-
 itants, without  exception,  whether Creoles or  foreigners,  equally  suffered.'  The
truth is, that many Europeans and Americans recovered, both before and after the time
of Dr. Chisholm's visit to St.. Thomas's, and the  fever never spread to the inhabitants  at
large, but was confined to persons recently arrived from Northern climates, and to tliose
on board the vessels in the harbour ;  nor was there  any apprehension of contagion, ex-
cept among the shipping.  I never heard of a single instance of  any person who had resi-
 ded for some years in the island being afflicted  with the malignant fever.  A residence of
 nearly twenty years in the island enables me to speak positively as to  this fact.
   "1 have not the honour of Dr. Chisholm's personal acquaintance,^but as he was  so
 polite as to visit Mr. Schmaler in my absence, I feel myself obliged to him* and I am sorry
 1 have been under the necessity of correcting his mistatements.  He  mentions Mr. Jen-
  nings and Dr. Tucker as his acquaintances  at St. Thomas's,  and to these gentlemen,  as
  well  as to Mr. Fleicker, I refer for corroboration of any part of my statement if re-
 quired.
                          Iam,&c.
                                                CSigned,) J. F. Eckardi
   Phtlaweli-hta, Feb.  1,1804.
    This letter has now been published seven years, (in the 1st  vol. of the  2nd Hexade of
  the New York Medical Repository, (p. 337) of  which work Dr. Chisholm appears to  be
  an attentive  reader,) but he has carefully avoided all notice of it, not pretending (so far a3
  I can discover,) to have been misled by even a dead person ; though his letter to Dr. Hay-
  garth must have afforded him a most inviting and suitable opportunity for giving, if it had
  been possible, some satisfactory explanation concerning these his gross misrepresentation's: 
<kG5
Indies, (though he afterwards had a return of his disorder,)*  and all
the others were perfectly well,  ■ notwithstanding  the hard duty they
had to perform,) and continued so."  See New York Medical Re-
pository,  vol. 1, p. 469.
  For these latter untruths,  Dr. Chisholm has never, so far as 1 can
discover, pretended to have had Mr. Home's, or any other person's
authority; and, though Dr.  Trotter's publication ought to have con-
vinced him that they  were,  at least,  very improbable,  he confidently
re-published them as matter of fact, in  his second edition; and has
not, in any subsequent publication, either retracted, or apologized for
them, though the truth had been forced  upon his notice by the Han-
key's Log-Book.
  After a passage of  19  days, the Hankey arrived at Barbadoes, and
there, Mr.  Paiba states  that, during a  great  part of two days, her
captain,  passengers,  and crew,  communicated freely with the inhabi-
tants,  without causing disease in any of them : they did the same af-
terwards at  St.  Vincent's; and  anchored at Grenada on  the  19th  of
February, according  to Log-book time, but in ordinary language, in
the afternoon of the 18th.   The next day, several paragraphs  appear-
ed in the St. George's Gazette, mentioning the Hankey's arrival "from
the  island of Bulama, on the coast of Africa;" and " that  she and
another vessel had carried out to that settlement upwards  of  300 ad-
venturers, of whom one-third had not survived her departure from the
settlement," &c.  In addition to these exaggerations, it was asserted, as
u from good authority, that  of  the  whole  number the two ships car-
ried out,  only  ten were living when she (the Hankey) took  her de-
parture."
  It is not wonderful  that such gross mis-statements should have creat-
ed apprehensions of danger from supposed contagion in the Hankey,
among the inhabitants of St. George's, and have also excited and given
a bias to Dr.  Chisholm's industry on this subject.  It happened,  also,
that a state of  weather then  existed, and had existed some weeks be-
fore, at Grenada, very unlike that of other years, and better suited for
a copious production of marsh  miasmata.  This fact appears from an
account  which  Dr. Chisholm has  himself published, in the introduc-

  * This appears to have been an intermittent, of which Captain Coxe is stated to have
had several returns, as commonly happens to those who  have been much exposed to
marsh  miasms  Mr. Paiba states distinctly, that while the Hankey was at  St. Jago,
there was no sickness on board of  her,  but "debility, and slight intermittents;" that
" her crew and  passengers mixed without suspicion, and with perfect freedom with the
inhabitants of Port  Praya,  and received them on board, where they had a number of en-
tertainments,  of which the governor of the island  and several of the principal  people
partook," without so much as a suspicion of any sickness " being excited by it." He adds
"Indeed no sickness prevailed at  St. Jago during the Hankey's stay, excepting the com-
mon ague and  fever of the place." That during  the ten days which the Charon re-
mained at  Port Prayra, it was the commodore's " custom to send his  barge every morn-
ing to the Hankey, for Mr. and Mrs. Paiba, who usually spent the day with him, and re-
turned  in  the  evening.—That  Captain  Coxe was  several times on beard the Charon ;
and both Mr. Smithers and his mate visited the Hankey, and two of the Charon's seamen
were employed great part of one day about the Hankey's rigging.  And finally, thatCom-
modore Dodd had so little  apprehension  that any person belonging to the Hankey would
be liable to infect others, that he gave Mr  and Mrs  Paiba a letter of recommendation to
a gentleman at Grenada ;  and in consequence of it, they were invited to reside, ard did
reside at this gentleman's plantation, while they remained on the island.  See New-York
 Medical Repository, vol.  p. 468-470.
                                  59 
466
 tion to his Essay, of " tlie changes which took place in each month of
 the years 1784, 1785, 1786, and 1793," and from his "table of the
 highest, lowest, and  medium height of the thermometer during that
 time;" "from all which it results that in  1793, the months of January
 and February  were generally rainy,  which he notices as  " an uncom-
 mon circumstance ; and that the heat in those months was uncommon-
 ly great ;  the thermometer,  at noon,  rising to 88, and 89",  and which
 is 3 and 4 degrees  higher than it was during the  same months in any
 of the preceding years; and seven degrees higher than in 1785.  And
 in the three following months there appears to have been such an in-
 termixture,  or alternation  of showers and of hot sunshine, as  com-
 monly renders  marsh fevers prevalent in places liable to them.
   Dr. James Clarke, also, in his treatise of the yellow fever, which
 prevailed in the same, and  following  years, in the neighbouring island
 of Dominica, says, p. 49,  " from the month of January to the 15th of
 June,  (1793) when this fever first broke out, the weather was extreme-
 ly calm, and much hotter than usual in this and the neighbouring is-
 lands.   There  was little rain (he adds)  till the 15th of October," at
 which time  " this fever became less violent here;  and about the be-
 ginning of November it ceased altogether."  In the next page he ob-
 serves, that in June, July, August, and September,  Fahrenheit's  ther-
 mometer  " generally rose to 88° or 90° and sometimes to 92 degrees,
 between the hours of two and four o'clock, P. M."  Again, at p. 51,
 he  says, " the  heat for some months before, and during the continu-
 ance of this  fever in the island, especially in the night time, was al-
 most insupportable."
  Whether  the very early  appearance of the yellow fever in most of
the West Indian islands, in  1793, resulted from this  unusual state of
the weather  alone,  or whether there was a co-operation of other causes
which were  either unknown, or unnoticed, I  leave for the considera-
tion of others and content  myself with  again  expressing my belief,
that we are not  yet acquainted with all the causes which assist either in
the production of marsh miasmata, or in rendering their morbid influ-
ence more powerful than usual.   But we know particularly from  what
happened at Charleston, in 1732, (see p.  245 and 319,)  and  at other
places to be  hereafter mentioned, that the occurrence of yellow fever,
as an epidemic, may be accelerated several months by particular con-
ditions of the atmosphere:  and as Grenada is situated  several degrees
southward of Dominica,  and must therefore  have  sooner felt the in-
fluence of the sun in  its  approaches  to  the northern  tropic, we  shall
not be  surprized that the fever became prevalent soonest at the former
of these islands.
  In regard to the supposed communication of febrile, or pestilential
contagion, from the Hankey, subsequently to her arrival  at Grenada,
Dr. Chisholm asserts, in the first volume of his Essay, (p. 121,)  that
" a Capt. Remington, an intimate  acquaintance of Capt. Coxe, was the
first person who visited the Hankey  after her arrival  in St. George's
Bay.   This  person (says Dr. Chisholm,)  went on board of her in the
evening after she anchored,  and  remained three days, at the  end of
which time he left St. Georges, and proceeded in a drogher, or coast-
ing vessel, to Grenville Bay, where his ship, the Adventure, lay.   He 
467
 was seized with malignant pestilential fever on the passage; and'the
 violence of the symptoms  increased so rapidly  as  on the third day to
 put an end to his existence."  In regard to this transaction, Mr. Paiba
 not only contradicts Dr. Chisholm concerning the time of Cant. Rem-
 ington's visit to the Hankey, (which it seems now difficult to ascertain)
 but he asserts that this Captain " had been all day and  night coming
 from Grenville Bay, and had been wet through."  " That he slept on
 board in his clothes, and went in an open boat* the next day,  back to
 his ship;  enough  (adds he,) to kill any one in that  climate." See Me-
 dical Repository, vol.  i.  p. 471.  On this point, Dr. Chisholm, in his
 2d edition, (p.  122,) says,  "That this person had fatigued himself,  and
 had even  slept in wet clothes, might have happened;  but does  this
 prove any thing further than a greater predisposition of his bodv to be
 acted on by infection?"  Yes,  if true, it  proves that Capt. Remington
 had been exposed to causes sufficient to  produce a mortal fever, with-
>out any infection, as  thousands have experienced; especially in that
 climate.   Dr. Chisholm, however,  objects to  Mr. Paiba's statement,
 because it was  made  after he  had seen  Dr. Chisholm's Essay.   But
 would the  Dr. have us believe that truth is not admissible,  if brought
 forward to correct particular  misrepresentations?   On this  subject,
 however,  Dr. Chisholm  has referred us to " Dr. John Stuart,  an emi-
 nent practitioner, who attended him !vRemingtonl at Grenville,  when
 he arrived there."   And as I have the pleasure of knowing Dr. Stuart
 (who, satisfied with the produce of his estate, has since relinquished
 bis profession and title) and entertain great respect for his character,
 as well as  the utmost reliance on his candour and veracity, I shall most
 readily admit every thing  stated as matter of fact  by that gentleman,
 only regretting that his statement on this subject is not more compre-
 hensive.
   It is contained in the New-York Evening Post, of Tuesday, Novem-
 ber 26,  1805, in a letter to Dr. Hosack,   to  which  Dr. Chisholm has
 referred in his  printed letter  to  Dr. Haygarth) and in  it Dr. Stuart
mentions his going, in the  month of March, 1793,f on board the ship
 Adventure, then lying in Grenville harbour, to visit the carpenter, who
 was under his care, and then adds, " While there, Captain Remington
arrived from St. George's  by sea: he had come round in a drogher,
and had had heavy squalls,- with rain in his passage to windward.   He
then complained of being  feverish,  and seemed low spirited;  he had
heat of skin, his pulse full,  and under 100 ;  head-ache, pain in his back

  + The droghers, at Grenada, are not properly open boats ; but the  space they afford,
as a protection from rain, under the deck or half deck, is so very close, hot,  and confined,
if my recollection be accurate, that most people rather than avail themselves of it for
any length of time,  would probably allow themselves to get wet.
  \ Unfortunately,  Dr. Stuart fus not mentioned the day of the month when this hap-
pened ;  but he has mentioned enough to prove, that Dr. Chisholm must have erred con-
siderably in regard to the time when Capt. Remington went on board the Hankey.  For
if it had been, as he asserts, upon the evening of her arrival at St. Geo rge's, this w6uhl
have been on the 18th of February, and supposing him to have remained on board 3 days,
and not one night only, as Mr. Paiba asserts,  he must,  notwithstanding, have set out on
his return to Grenville Bay,  upon the 21st of  February, and supposing him to have em-
ployed two other days in making the passage,"th:<u;»!i it  is commonly done in less than
one, still he  wonid have reached  his ship not in March,  as Dr. Stuart mentions him to
have done, but on the 23d of February, 
488
and limbs, and over his whole body.  These symptoms I imputed to
cold caught in his  passage  up,  and accordingly took eight ounces ol
blood from him, which unexpectedly neitner exhibited the buffy coats
nor the coagulum, any degree of contraction, nor consequent separa-
tion of serum.  He took an emetic of ipecacuanha in the evening, and
a dose of Glauber's salts the following morning.  During three  days
I. continued to visit him, his  pulse did not exceed 100, nor was the heat
of skin considerable;  he took occasionally  small doses  of antimonial
wine, with the addition of laudanum at bed lime, and made free use of
tepid drinks.   At the end of that time, I was  under the necessity of
putting him in charge of a  neighbouring  practitioner, having a call to
the other side of the island.   On leaving him, I certainly did not en-
tertain any idea ofhis being in danger ; I was, however, forcibly struck
with, and ■• o aid not well account for, an uncommon degree of despon-
dency of nund that was then present, and it was not possible to remove
the impression  that he was  to  die; nor was I the less  surprised? on
going to Grenville some  days after, to be told of his death,  and more
especially to hear of that event  having been preceded by haemorrhage
from his nose, stomach, mouth,  and urinary bladder.  On this occasion,
while in conversation with some gentlemen on the fate of this unfortu-
nate man, I could help noticing the malignancy of the case, and the dif-
ference in the train of symptoms, from what I had  ever witnessed to
take place in the worst case of our endemic fever.  But a few minutes
had elapsed when  a gentleman arrived from  St. George's;  I had no
sooner mentioned  Capt. R.'s death to him, and my surprise thereat,
when he  instantly replied, it was none to him, for that Capt. R. had eat
and  slept on board the Hankey, during several days that  he was in
town."
  If my readers will compare this account with that given by Dr. Chis-
holm, they will, I presume, be forcibly impressed by the  important de-
viations from the truth which occur in the latter, and by the evidence
which it affords of his inexcusable carelessness about facts which might
have been so easily ascertained, if  he  either did not know, and was at
all solicitous for the truth.  It appears from Dr. Stuart's statement of
Capt. Remington's case, that, instead of that " violence  of the symp-
toms," and that rapid increase of their violence, which, " on the  third
day, put an end to his existence," < as Dr. Chisholm  asserts) the symp-
toms were all so very moderate, that when Dr. Stuart left his  patient, at
the end of three days, he was not even suspected to be in any danger,
and, according to the best information which I have been able to pro-
cure, Capt. Remington did not die until the 8th day of his illness.*
  In regard to the cause of Capt. Remington's fever, Dr. Stuart's ac-
count of it accords, in my judgment, much better with that of Mr.
Paiba than of Dr. Chisholm.  Whether Capt. Remington got wet in
going to St.  George's, or  returning thence to Grenville harbour, or
both, Dr Stuart avowedly, and with reason, considered his disorder as
proceeding from cold.  And though he appears to have been surprised

    The editor remembers distinctly to have heard Dr.  Stuart mention, that it  was on
Sunday that he  first prescribed for  captain Remington,'that he took leave of him on
Wednesday;  that his death happened oil the following Sunday. 
469
 at its fatal termination, I cannot persuade  myself that it is so unusual
 in that climate for fevers  produced by such a cause, to end in death,
 and even with haemorrhage from  different parts,  as fairly to authorize
 a belief that some more malignant cause must have co-operated; and,
 perhaps, if Dr. Stuart had never heard of  the  groundless reports con-
 cerning the Hankey, he might not have  suspected any  such co-opera-
 tion:  though after all that appears to have been told him  of that ship,
 his doing so was, I think, very  natural.  But  as my readers will soon
 be convinced, if they are not so already, that no infection was, or could
 have been communicated from the Hankey, and as Capt. Remington's
 fever  manifested no contagious property,  even in the narrow space of
 a ship's' cabin,  and when as  there was  no suspicion of infection, no
 precaution would have been used to guard against it, we have, I think,
 the strongest presumptive,  as well as negative evidence, that it did  not
 proceed  from,  or possess  any contagious influence.  Indeed, if  the
 Hankey had abounded in contagion,  it must have been altogether in-
 credible  that it could  have produced disease  so  speedily;  and if  the
 getting wet, and sleeping in wet clothes should not be deemed a suffi-
 cient  cause for the disease and  death of Capt. Remington, another,
 and that infinitely more probable, in my opinion, than a new pestilence,
 naturally presents itself to those who recollect, that besides the  influ-
 ence of marsh miasmata in the bay and carenage at St. George's,  his
 own ship lay in Grenville bay or harbour, which Dr. Chisholm  (at p.
 290 of his letter to Dr. Haygarth) has particularly designated as  one
 of the  places  which, in an uncommon  degree, expose  ships  lying
 therein " to the malignant  influence of marsh miasmata."
    Dr. Chisholm  tells  us  (Essay, p.  122,)  that "the crew of the Defi-
 ance, of Blythe Port, near Newcastle, were the  next who suffered by
 visiting this ship; (the Hankey 1  the mate, boatswain, and four sailors,
 went  on board the day after her arrival ;*  the  mate remained either on

    * Dr. Chisholm apparently was anxious to lose no time.   He made captain Reming-
 ton go on board the Hankey the very evening of her arrival ; though Mr. Paiba says it
 was nearly a month after, which it might have been, consistently with Dr. Stuart's state-
 ment ; and  consistently with that statement,  he could not have gone on board in much
 less than a week :  and, therefore, if the people of the Defiance went on board the day
 after the Hankey's arrival, and were  immediately seized with the fever, they, and not
 captain Remington, must have been the  first " who suffered."  And, as they are said
 to have all died in three days, excepting the mate, whose disorder was slight, and, there-
 fore of no long duration ; and it is not pretended that any oilier of the crew took the fever
 fromtliem ; it ought, according to this account, to have ceased entirely on board the De-
 fiance, before the end of February.  But by another statement, at p-  202 of the same
 volume, we are told that "about the end of March, 1793, the Herberts, Captain Brown,
^iPsailed  from the Port of St. George, Grenada, for Glasgow.  In working the ship out of
 the harbour, (continues  Dr. Chisholm,) Captain Brown was  obliged to  send five of his
 "men on board  the Defiance,  of  Blythe Port, to fasten a warping line.  At this time,
  (the end of March) the malignant pestilential fever  raged on board the Defiance." It
  always rages in Dr. Chisholms accounts.  He  adds,  " The next day after the Herberts
 sailed, the  five men were seized with  the disease, and three of them died." Here the
  Doctor's favorite number, three, h applied to the men who died, and not the day or  days
  on which the termination happened. Now, what are we  to believe amidst these  contra-
  dictions ?  Did this fever rage on board the Defiance, about the 20th of February, ac-
  cording to the first statement, or, about the end of March, according to the second ? In
  regard to the latter story,  nothing less than  Dr. Chisholm's credulity could produce it
  belief.  If five men were sent in a boat along side the Defiance,  with a warping-line, the
  end of  that line might easily have been thrown on board  of the Defiance, and fastened
  by one of her crew, and is often, and as ought to have been done, where a pestilential 
470
 deck, or in the cabin, but the rest went below,  and staid all night there.
 All of them were immediately *e/z<?d>vvith the fever,  and died in three
 days."  Here Dr. Chisholm seems to have been either totally regard-
 less of truth, or completely infatuated, if he believed this account to be
 true.   What,^z»<? persons immediately seized  with a contagious fever !
 Did any species of contagion ever produce disease immediately ?  The
 plague itself does not  act with  such celerity.  Moreover, these  five
 persons  all died exactly " in three days."   Did ever contagion act with
 such  deadly  and exact uniformity ?  Differences of age,  constitution,
 susceptibility, &c. were, it seems, completely inefficient.  And here I
 cannot help noticing Dr. Chisholm's singular predilection for the  exact
 term of  three days.   The  four seamen obtained by the Hankey from
 the ships of war at St. Jago, are stated to  have been all seized "on the
 third  day" after she sailed, " with the fever,"  which probably  neither
 of them  ever bad; and Captain Remington is made to die of it on the
 third  day, though Dr. Stuart  did not then  believe him to  be in  any
 danger;  and  again,  the  five men from the  Defiance, are all repre-
 sented as having died in three days, and a sixth, (the mate) as  having
 only escaped with a lighter disease, because, by remaining on deck or
 in the cabin,  he was " less exposed to the virulence of the infection."
 All this,  however, rests upon Dr. Chisholm's unsupported authority,
 the value of  which, I must  leave  others  to estimate, having no means,
 except those furnished by  Dr. Chisholm, even  to ascertain whether
 the ship  Defiance ever existed.
   After  this,  Dr. Chisholm tells  us,  (p.  123) that " The crew of  the
 ship Baillies,  from the same imprudent  civility, or curiosity,  were the
 next who suffered."*  " These  (he  adds) communicated the infec-

 feverwas raging .- and, at most, if this was not done, it could only have been necessary
 for one mart to jump on board, for a single minute.  No stay could have been allowed, as
 the men must, at that time, have been wanted immediately  on board their own ship.  To
 suppose, in such circumstances, that they could all have been infected, and that this in-
 fection  should have operated so as to produce disease in them all the very next day, is
 completely inadmissible, because  no contagion  yet known, is capable of being transmit-
 ted so far, and in so short a space ;  and also of producing disease within 24 hours after
 being transmitted ; and, therefore, if five men belonging to the Herberts, were attacked
 by the  supposed malignant pestilential  fever, they must have previously been  exposed
 to the causes which had produced it in others, independently of any communication with
 the Defiance.
   * It is here remarkable, that Dr. Chisholm makes no mention of the nature, or extent
 of the suffering supposed to have been thus brought  upon the crew of the Baillies.  He
 might have told us, at least, how many had been attacked by the supposed new fever, on
 board that ship ; and I certainly regret that he did not. He gives us, indeed, four sup-
 posed cases of that fever, which fell under the management of his partner, Mr. Camp-
 bell, at a time when Dr. Chisholm himself was under salivation for hepatitis,  and proba-
 bly before  he had seen any^ase of this fever. One of these without date, but said to have
 been the first which oceurfed in Mr. Campbell's practice, was that of the carpenter of
 the ship Charlotte, of London, which is not mentioned by Dr. Chisholm as having  had
 any communication with the Hankey : and the second is the  case of "John," a sailor on
 board the Baillies.  And this was probably the first  case  of  fever  which  occurred on
 board that  ship; for,  as the partnership of Chisholm  and Campbell  appears to have had
 her sick, it is not likely that any other practitioner was employed.  Mr. Campbell first
 saw John on the 21st of March, 1793, on which day he  first resolved to make trial of
mercury, and this in John's fever ; being, as he says,  "fully satisfied that this disease  was
 the malignant fever, which preyailed at that time."   Now, if Dr. Chisholm's account of
 the commencement of this fever was correct,  how could the malignant fever be then
 prevalent ? Captain Remington had sickened some time in March, and for zay thing 
471
  tion to the ships  nearest to them,  and it gradually spread from those
  nearest the mouth of the Carenage, where the Hankey for some time
  lay, to those  at the bottom of it; not one escaping, in succession, what-
  ever means the captain took to prevent it."   An effect which,  if cor-
  rectly  stated, is much more like that of marsh miasms than of contagion.
     This statement, however,  is too general for a particular examina-
  tion,  and being,  like the former,  without any support, I can have no
  reliance on its accuracy.  That a violent marsh or yellow fever did at
  that time,  or soon after, prevail among the shipping at the  Carenage,
  at Grenada,  (as it had often done there, and in the like situations, long
  before the supposed generation of Dr. Chisholm's new pestilence,) I
  believe; and I also believe, that  this  fever (which, as usual,  began
  among the seamen) soon after  appeared  in some of the inhabitants on
  shore,  but not  as Dr. Chisholm supposes from contagion.   We have
  seen that the Calypso,  who is  supposed  by Dr. Chisholm, to have in-
  fected  the Hankey, and  whose  fever consequently must have been
  the same,  was not suspected at Sierra Leone  to have  communicated
  any disease there, nor to have had any  other than a  marsh fever on
  board.  And we  have seen that she returned thence to England, after
  suffering a mortality, greater in proportion to her stay in Africa, than
  that of the Hankey ; and it never was even suspected, that either her
  crew,  or her surviving passengers,, with all their bedding and effects,
  and those of the dead also, (though landed  and dispersed in  Great
  Britain) had introduced any  sort of contagion, there being fortunately
  no person here, to excite  groundless alarms, by inventing and propa-
  gating falsehoods as in  Grenada.   In regard to the Hankey, we have
  every reason to believe that no  other than marsh fevers, or fevers from
  cold, fatigue, intemperance,  and other similar causes, and had occur-
  red on board of her during the whole voyage.   It appears,  moreover,

  that appears to the contrary, subsequently to John ,- and also at a remote part of the
  island.   The Baillies is stated by Dr. Chisholm to have been the second ship which com-
  municated and suffered by communication with the Hankey ; and, from his second state-
  ment, quoted in the preceding note, she appears to have been the first. But supposing
  the Defiance to have been the first, the sickening of a part of her crew alone, could not
  justify Mr. Campbell in stating this to have been a prevalent fever, nor that it wp* one
  in which he was "well convinced the common mode of practice was  by no means success-
  ful."  To have acquired this conviction, he ought to have had a considerable number of
  cases,  or have known that  many cases of this new disease had occurred to others, and
  terminated unfavourably under "the common mode of practice  in fever."   But such
  cases could not have  happened, according to Dr Chisholm's statement, from a commu-
  nication with the Hankey ;  and it  therefore seems probable, that what Mr. Faiba has
  asserted in the New-York Medical Repository, vol. 1, p 47, may be true, viz  that this
  "sickness was universally known to  b6 in the town of St. George, when captain Hem-
A. pieton visited tlie ship,"  the Hackney.   And Mr.  Campbell's first case, tn*t ot the
  carpenter of Uie Charlotte,  before  mentioned, seems to prove that at least in this in-
  stance, the supposed new fever was not derived from the Hankey.  Mr. Campbell men-
  tions a second case on board the Charlotte, that  of Mr. Taylor, the mate but without
  any date ; and he also mentions a second case  on board the Baillies, that ot  i Stephen,
  which occurred on the 10th of April:  and these are the only ones mentioned %o have oc-
  curred on board that ship, either by Mr. Campbell or Dr. Chisholm.  It seems remark-
  able, also, that Mr Campbell does not even hint so much as a suspicion, that either ot his
  patients had communicated with, or  derived  his fever from the Hankey;  and to me it
  seems probable, that cases of this supposed new 'ever had appeared at St. George s  before
  the Hankey, though  not much noticed, as indeed they were not likely to b h while spaio
  die, and few in number. 
472
 that she was three limes cleansed and fumigated, viz. at Bulama,  Bis-
 sao,  and  St.  Jago;  and  at the latter of these places, (at  least) she
 must  have been free  from any contagion;  for  otherwise,  her un-
 restrained intercourse with the  inhabitants, would have excited disease
 in some of them ; which it did not, nor in any person  on  board the
 Charon or Scorpion, nor in the four sailors obtained from those ships
 by Captain Coxe; who,  during the subsequent part of the  voyage,
 could not have  escaped it, if  any had existed,  capable of  producing
 such wonderful effects as Dr.  Chisholm  has supposed, in Grenada.
   It appears certain, that  every body on board  the Hankey was well,
 when  she arrived at Grenada,  and continued so during her  stay there,
 and also  during the whole of her voyage to England, which is proba-
 bly more than could be said of  any other ship then at Grenada;  so that
 even if it were  ascertained that an importation of  febrile infection had
then taken place,  every other ship ought to have been suspected of it
 before the  Hankey,  coming, as she did, from a place where there is
 good  reason to believe no contagious  fever  had  ever existed.  Dr.
 Chisholm, indeed, does not pretend that  the infection  supposed to
 have been derived from the Hankey, had emanated from any person
 actually on board  when she arrived at Grenada, but from  the  baggage
 and effects of the deceased  colonists: to this, however,  there are  in-
superable objections, some of which will be stated in  the  subjoined
 note ;* besides others, arising  from the fact of its  having been found


  * It appears from Mr. Smither's account, that the baggage and effects in  question
 consisted of clothing, which " had been aired,"  and probably never in "  contact vitii the
 body of any person," after that person became " sick ;" tliough as there was no conta-
 gious sickness among the colonists, that circumstance  seems to be of but little impor-
 tance.
  In regard to the  bedding,  Mr. Smithers confirms Mr  Paiba's assertion, that it was
 thrown away at Bulama.  But whatever  the effects brought  from Bulama  may have
been, they were carefully preserved by Captain Coxe, and " deUvcred up" at Stungale
 Creek, on the 18th of October,   1793, as is proved by the Hankey's Log Book, (though
 Dr Chisholm has asserted, without any foundation, that they were thrown overboard at
 Grenville Bay ;) and therefore,  it will be easy for me to place Dr. Chisholm in a most
 embarrassing dilemma   Assuming, as he does, that the Bulama baggage  was the ve-
 hicle, receptacle,  orfomites, whence the Hankey's supposed contagion issued, he must.
 necessarily conclude, either that this contagion was most powerful at first, and that it dai-
 ly became weaker and weaker, by constant evaporation, and diffusion through the atmos-
 phere; or, he must conclude,  according to the common opinio- in regard  to  fomites, that,
 like vermin, it possessed the power of multiplying itself, and of becoming daily more pow-
 erful aud destructive.  Should he adopt the first of these conclusions, it  will  be necessa-
 ry, though impossible, for him to explain how this baggage could retain enough of conta-
 gion, to produce such wonderful  and unexampled effects at Grenada, though when in its
 stronger and more accumulated state, it was too weak to excite disease  in Mr Smithers
 or his mate, or any other person at St. Jago, or in any of (he seamen during the passage
 thence ; and if he should prefer the latter conclusion, it will be equally necessary,  and
 equally impossible for him to explain, why, if this supposed contagion had become so virulent
 and powerful, as is pretended, at Grenada, it should, with its power of farther multiplying
 and increasing itself, have been found perfectly inert, and harmless, during the passage to
 England from Grenada, not only to the six seamen receivedby Captain Coxe from the com-
 modore atthatisland, (onthel8th of July,)butalsoto the carpenters sent on board the Han-,
 key, from the Vengeance ship of war, (on the 22d of August J and whoreniained three or
 four days on boai-d ? The contagion, by this time, ought oertainly to have become "direful-
 hf" active; and the carpenters, as well as the six seamen lately mentioned, must have been
 much more exposed to it, and for a much longer lime,  than any of those, who according
 to Dr. Chisholm,  s<i suddenly became its victims at Grenada. And, on either supposition 
473
 that such effects are absolutely incapable of exciting  Dr. Chisholm's
 supposed malignant (or any other) fever, after having been used by
 hundreds ill, and dead of it.  He,  as is  well known,  and his adher-
 ents at Philadelphia,  insist most strongly, that the yellow fever which
 prevailed as an epidemic in  that city,  in  1793,  had  been  imported
 from the West  Indies,  and that  it was truly the malignant pestilential
fever, supposed  to have been  derived  from the  Hankey;  and it is
' solely upon this identity, that they found their assertions and belief of
 its being contagious.   It is also  known,  that during the prevalence of
 this fever in that year, an hospital was opened at Bush-Hill, near Phila-
 delphia, and appropriated exclusively to  the reception of patients ill of
 it;  who, in great numbers, were placed under the care of M. Deveze,
 as was mentioned by  me, at p,  258.   And it is also well known, that
 when the fever  had ceased, as usual,  at the approach of winter, all the
 bedding, blankets,  clothes,  and other effects, which  had been used
 by the  sick, were sold to the Agents of the French government,  and
 employed  for  their sick soldiers and seamen, without having  been
 washed,  fumigated,  or even aired,  and without its having been ever
 suspected that  any disease was  produced by these effects.   See Dr.
 Valentin's Traite de la Fievre Jaune, 8cc. p. 92 and 93*
    Those who are acquainted with the town and neighbourhood of St.
 George, in Grenada,  will readily believe, that it is much more likely


 it is incumbent on him to shew how,  with this amazing activity at Grenada, Mr. Paiba and
 his family were able to land there, with all their effects, including a quantitysof goods, which
 with the Bulama baggage, made the whole of the Hankey's lading, and which were stored
 at the house of Mr- Napier, in St George's, without even the suspicion of having infected
 any person ?
   To account for the wonderful escape  of Mr.  and Mrs. Paiba and their servant, from
 that supposed infection, Which is said to have rendered the slightest communication with
 the Hankey so deadly to others, Dr. Chisholm  asks, vol,  1, p. 131, " What connexion
 had Mr. Paiba and  his family with the packages of clothes and  bedding, from which em-
 anated the infectious aura, productive of almost" (he might have omitted the almost,)
 "unexampled mischief?" To this inapt question, I  answer, that  their connexion, during
 nearly three months, which they lived on board the Hankey,  after her departure from
 Bulama,  must undoubtedly have been much greater with the packages in question, than
 Captain  Remington's or any of the seamen, whom  curiosity or civility brought for a
 short time from other ships, and who mav be presumed never to have even seen them ;
 and, it is diflicult to conceive, how those packages, even if they had been infected, could
 have done the mischief supposed.  It is not  pretended that they were opened, or even
 removed by Captain Coxe ; who, faithful to his trust,  and convinced of their mnocency,
 had determined to carry them to Kngland, and could, therefore, have no motive to open
 or shew them to any  one.  In short, there never was, in my opinion, a more inconsistent,
 improbable, and incredible tale, imagined, than this,  which is, I believe, now smhcieutly
 refuted.

   * The following  are Dr. Valentin's words, via  :—" Le vetemens, les fournitures des
 lits   qui avaient servia des personnes  infectees, ou mortes de la fievre jaune, et qui ont
 passe a d'autres, sans avoir meme ete acres, laves, du parfumes, ne la leur ont pas trans-
 mise.  On en a eu  un exemple frappant, dans les fournitures qui ont ete veudus, -cle I hos-
 pital de  Bush-Hill, immediatementapres l'epideinie de-1793,  par le comite de -.ante de
 Philadelphia aux  Agens de la Republiqe Franchise, pour les m.htaires malades comme
 I'a rapport* mon am? Deveze auquel ils ont He  confies."  ndeeu  thousands ot proo s
 might be adduced of the innocency of clothing, &c alter having been used ,n North
 America, bv persons labouring under that very fever, which Dr  Chisholm supposes to
 have been imported to Grenada by the Hankey, and afterwards transported to difterent
 narts of the  Continent, Spain, &c.  And, therefore, all his assert™* of  he emanation
 of contagion from  the  Bulama baggage, must be unworthy of a moment s consider*-
tion.
                                     60 
474
16 produce violent marsh or yellow fevers, than Bulama, where the
greatest heat felt by the colonists, appears not to have exceeded 84 de-
grees ; and nothing but the aggravated and  fallacious reports spread
upon the  Hankey's arrival,  could ever have  suggested the idea  ot
looking to the latter of these  islands as the source of what Dr.  Chis-
holm mistook for a new pestilence.   Dr. Lind mentions, at p. 180 of
his work  on the Diseases of Hot Climates,  that a " malignant sick-
ness in the islands of Grenada and the Grenadines, proved very fatal
to the English, who, upon the peace, in  1763,  first went over to settle
there." In a work, printed at Paris, in 1805, under the title of Obser-
vations sur la  Fievre Jaune, ike. par J. B: Le Blond, Medic in Natn-
raliste, &c.  (who formerly practised physic in Grenada,) the author
mentions the yellow fever as having occurred frequently at that island,
and with great mortality to strangers;  adding,  that a its malignity was
shocking, in consequence of the unhealthy exhalations from the port
and  town of St. George. (See Medical Repository,  vol. 10, p. 73.)
And Dr. John Hunter, at p. 307  of his work  on the  Diseases of the
Army, says, " The town of St. George lies low, and  there is marshy
ground in the neighbourhood ; the troops, in such situations, have al-
ways been unhealthy," Sec.   These accounts are, however, too  gene-
ral ; and therefore, I will add, from my own recollection, that this town
is situated at the foot of a steep and lofty hill;  (Mount Cardigan) and
on both sides of a ridge descending from its  summit towards, and into
the sea, and forming what is called the  Carenage, or harbour,  at the
bottom of a capacious bay.   This Carenage is a long inlet or arm of
the sea, in which vessels are land-locked,  (except a small opening at
the south-west, whence the wind rarely, if ever blows,) and are moored
close to the wharfs; and here, both the atmosphere and water are com-
monly stagnant, in a considerable degree:  the shore on this side  of the
ridge or town, is remarkably low, and crowded with houses and other
buildings, reaching close to the wharfs; most of them small, built of
wood, and filled with low and profligate inhabitants.  And in addition
to all these circumstances, obviously  favourable to the production of
yellow fever,  there is a large  offensive  marsh at the east end  of  the
Carenage, over which  marsh, the wind  commonly  blew upon  this
inlet, and the  greatest part of the town, during the months in  which
the supposed  new fever became prevalent.   But I would not have it
understood, that those only  were attacked with the fever who lived
within the reach of marsh miasms.  Mankind exercise their locomo-
tive powers;  and when these miasms are  not  brought to their habita-
tions, they often go on business, or pleasure, to situations in which this
cause of disease abounds.  In  this way, persons  commonly residing
or stationed on Richmond Hill, and Mount Cardigan, were sometimes
attacked by the fever, though much less frequently, and with less vio-
lence, than others.   Dr. Chisholm considered these attacks as the ef-
fect and proof of contagion;  but the late Dr. J. Hunter had, nearly  ten
years before,  thought more justly  on this subject; for,  at the page
lately quoted, after mentioning the salubrity of these elevations, he  ad-
ded, " But in order that troops may enjoy the full benefit of such situa-
tions, care should be taken that they be not permitted to go down to
the low grounds, for if they are, they will infallibly carry fevers up 
475'
 with them.'*  Dr. Lind had, indeed,  previously convinced himself of
 this truth; for, at p. 217 ofhis work on the Diseases of Hot Climates,
 he observes, "that in  several places, mentioned as a secure refuge
 from sickness,"  (by marsh effluvia,)  "there are instances of persons
 being seized with the diseases of the adjacent country.   The yellow fe-
 ver has been known to seize persons in the garrison 6f Mo?ik's Hill,
 in Antigua! But inferences (he adds)  drawn from a few uncommon
 cases, have no force against observation and experience."—"unless
 the garrison of Monk's Hill had been apprised of the danger of sleep-
 ing in unwholesome places, and had cautiously avoided sleeping out ofi
 tlie garrison, the question cannot be fully determined, whether persons
 who never slept out of Monk's Hill,  were attacked with the diseases
 of the adjacent country ?  It is my opinion, they seldom or never would.
   "I mentioned the affair to a person  who had resided long at English
 Harbour, in Antigua,  and he informed me, that he had known some
 gf the garrison on  Monk's Hill to have had the yellow fever.   I  de-
 sired he would endeavour to recollect the circumstances of their being
 taken ill, and whether they had slept any nights preceding their illness
 in the low grounds, or in English  Harbour.  It immediately occurred
 to him, that when he was seized with the yellow fever, there were at
 the same time, two officers belonging to the garrison at Monk's Hill,
 labouring under it, who had both been seized with it early in a morning,
 after sleeping the two preceding  nights at  English Harbour.  Upon
 beginning to cons'derthe great danger of sleeping in unhealthy places,
 (with which he was before entirely unacquainted,) he recollected that
 most of the people in Monies Hill, who had been seized with this fe-
 ver, were taken ill after sleeping on the low grounds;  it being a com-
 mon custom among the officers of that garrison, to sleep in the house
 at English  Harbour  where they  had  dined  and  supped."  I need,
 hardly mention that English Harbour  notoriously  abounds in  marsh
 miasmata.   The  application of these facts will be obvious.
   Dr.  Chisholm  has laboured, as  the foundation of his Whole  super-
 structure, to create an essential difference between his supposed new
 fever or pestilence, and the yellow fever, which had previously exist-
 ed in the West Indies and  North America;  and for this purpose  has
 employed the most strained, though unavailing efforts to identify it
 with the true plague ; and he concludes a chapter on this subject by
 declaring, (vol.  1, p. 322,) that   "We must consider  the  fever of
 Grenada,  in the  years 1793, 1794,  and  1795,  as  truly pestilential,
 and differing from the plague, strictly so called, only in not always
 exhibiting those symptoms that are said to be peculiar to that malady."
 Surely, when  Dr. Chisholm committed himself so unfortunately, he
 could not have recollected that the plague had never  existed between
the tropics.  My readers, I presume, will not expect that I should em-
ploy their time, or my own, so unprofitably as I must do, if I were se-
riously to rcf.ite a conclusion so extravagant,  after the facts recently
 stated in my chapter on  the plague.   Indeed, Dr. Chisholm has not
appeared  to be  satisfied v.-ith his own opinion on this  subject,  for,
without disclaiming, he  has strangely  deviated  from it in several in-
 stances; sometimes representing  his supposed  new malignant fever,
 its resulting from " the united action  of pestrlentialn-ontaglon, and the 
476
 miasmata of marshes, and other direct causes of the yellow remitting
 fever," &c. See vol. 1, p. 208.  And at other times, after laying aside
 his pestilential contagion, he substitutes that of typhus or jail fever, and
 represents this as having  caused  not only his  supposed new fever  at
 Grenada, and  in other parts of America, but also that typhus which
 prevailed among the troops under General White, at  Cork,* and af-
 terwards, in the passage thence to  Barbadoes,  in  1796, as I  have men-
 tioned at p.  344; thus deriving from one cause,  two fevers, as diffe-
 rent from  each other  as  any within my knowledge.   Dr.  Chisholm
 seems, however, as little  disposed to adhere to his jail  infection, as to
 that of the true plague;  for, in his letter  to Dr. Haygarth, which is
 the most recent publication of his sentiments on this subject, we find
 these words, at pages  117,  118, viz :—
   " To  conclude,  let  the unbiassed reader now  become umpire, and
 decide whether, or  not, a ' nova pestis, a peculiar, original, foreign
 1 pestilence, recently generated, and utterly  unknown before, endued
 ' with a new and distinct  character, possessing new powers of devas-
 i tation, and capable of propagating  itself by contagion  throughout
 1 the world,' was introduced by the Hankey, on the 19th of February,
 1793,  into Grenada."  He adds,  " The  demonstration of  my senses,
 and the clearest perception of my mind, assure me it was a nova pes-
 tis,  to  which the observation of Thucydides  is  truly applicable;  for
 never before had so dreadful a pestilence occurred in the West Indies,
 nor such a destruction of  the human race been recorded."
   Here it is remarkable,  that though Dr. Chisholm declares the Gre-
 nada fever of 1793, to  have been a new, peculiar,  original pestilence,
 never known until  the 19th of February^  1693 ; yet in the very next
 page, he makes it a very old disease, by asserting, that if it be compar-
 ed with  the plague of Athens, as described by Thucydides, " we shall
 find that they bear a strict affinity to  each  other, in their  causes and
 symptoms ;" and  that "  they  seem, indeed, to have been the same
 disease,  the same destructive monster."   But though Dr.  Chisholm
 excites our astonishment,  and tries the extent of our credulity, by his
 accounts;—first of the miraculous creation of a new and terrible pes-
 tilence ; and then of the almost as miraculous revival of one, which
 had been for many  ages extinct,  or unknown, he has  kindly relieved
 us from these awful impressions,  by stating  in a letter to  Dr.  David-
 son, dated Demerary,  August 10, 1800,  that a fever then prevailed in
 that colony, whose " features were almost without exception, precisely
 those of the malignant pestilential fever  of Grenada, of 1793 and
 1794;"—"fully as fatal, as rapid, and as insidious ;" and that this
 direful fever originated in a ship,  which had " arrived about the be-
 ginning  of July, or end of June, from Liverpool, after touching at
 Surinam."—" The filth on board,  (he adds. occasioned by a cargo of
 horses,  and the extreme neglect of tlie officers and crew, beggars all
description."   (See Medical Repository, vol. 5, p. 229.)   Here  we
have Dr. Chisholm's new pestilence, stript by his  own hand of every
thing miraculous and wonderful, with which he  had previously cloth-
ed it, as proceeding from Africa  and*the  Hankey ; and we are told

     *  See Dr. Chisholm's Essay, &c. vol. 1, p. 'J0.3, et seq. 
477
rhat it was produced by  a common vessel, making a common passage
from Liverpool to the  West Indies, and with nothing more extraordi-
nary than a cargo of horses ; of which, thousands oi cargoes have at
different  times, been brought to  the West Indies, particularly from
New England,  as closely stowed at least, and probably with sailors as
neglectful, as those of  the Liverpool ship, and all,  as I believe, without
any suspicion of having ever generated a contagious fever.  Indeed, the
only peculiarities which  belong to a ship with horses,  are those which
occur in stables on shore, and which are not found or supposed to pro-
duce any morbid effect,  much less to have ever generated any species
of pestilence, or pestilential fever.   Dr. Chisholm mentions  in the
same letter, that at the  request of Drs. Dunkin and Lloyd, in  Sta-
broek,  and of Dr.  Ord,  on the Eastern Coast  of Demerary, he  had
visited a  few of the sick with this fever, and that he  had " no  hesita-
tion in pronouncing it a fever of infection"  No person will, I be-
lieve, suspect  Dr.  Chisholm of any great disposition to hesitate in
pronouncing; though I  have good reason to believe  that the  gentle-
men whom he mentions  as having called for his intervention, did hesi-
tate ;*  and that they were very far  from adopting the decision  pro-
nounced so readily;  having  been long acquainted with  the first of?
them,  and having had opportunities of conversing with him on  this to-
pic,  several  years after  the date of Dr. Chisholm's letter.  But I am
entering unnecessarily into a refutation of Dr. Chisholm's inconsistent,
extravagant, and incredible notions, which  only need to be stated, and
contrasted,  in order to their being properly estimated.
    Here, then, I might have desisted  from  any farther observations on
this subject, if Dr. Chisholm's supposition of novelty in the fever of
 1793, at Grenada, had not been countenanced, and in a great  degree
adopted, by Dr. Stuart,  whose opirlions I consider as justly intitled to
a respectful  attention.   This gentleman, in  his letter to Dr. Hosack,
 lately mentioned, has stated his reasons for believing,  that the fever in
 question  " was specifically distinct from every form of the indigenous
 bilious remittent," which he had ever before observed. These reasons
 are,—
    1st.—" Because it appeared at a season of the  year which I had al-
 ways found healthy, during 19 years I had resided in the colony."  But
 this, as I have already observed, can decide nothing.  The occurrence
 of yellow fever,  principally depends  upon the temperature, and other
 conditions of the atmosphere, and if these conditions take place before
 the usual time, (as was  the  case, according  to Dr. Chisholm's state-
 ment, in  1793,) the fever will be also precocious.   It has bees,  tfready
 mentioned,  particularly  at p.  245, that the yellow  fever, whioJ. rarely

   • In the month of  February, 1805,  the editor passed two nights as the guest of Dr.
 or Mr. Ord, (formerly suigeon to the 39th regiment,)  when going froni Demerary to
 Berbice, and returning thence ; and was, each time, distinctly told by him, that he had
 ivrver seen any fever in that colony, or on that coast, which he believed to have been
 contagious. The editor has also heard a similar opinion from  Mr.  Dunkin, lately Gar-
 rison Surgeon  at Demerary, and now Deputy-Inspector of Army Hospitals, when con-
 versing  with him on this subject. Indeed this gentleman's ve?-y accurate and judicious
 report,  concerning the prevailing fevers of Demerary, (see Chisholm's Essay, &c. yo.
 2nd, p. 203, &c.) shews, that bis ideas and reasonings were too well  founded for him
 to have ever adopted opinions like those of Dr. Chisholm, in regard to the existence of
contagious fever, in that part of America. 
478
prevails at Charleston before the month oi August, became very ge-
neral and mortal there, in the month  of May, 1732.   A like precocity
happened at La Vera Cruz,  in 1802, when, according to a statement
by the " Consulado" of that place, a mortal sickness, with a black vomit-
ing, began there in April, and raged with extraordinary violence until
October, causing the deaths  of fifteen hundred seamen, and strangers
from the interior  and  higher country.   See Medical Repository, vol.
10, p. 296.
  2ndly.—" Because it did not particularly appear in those situations,
where bilious remitting fever usually prevailed, during the  unhealthy
season of the year."  This being a general statement, I can only an-
swer it generally, by reminding my readers of what has been already
noticed, in different places, that the most violent forms of marsh fever,
accompanied with black vomit, &c.  commonly require for  their pro-
duction, the co-operation of all, or some of the circumstances or pecu-
liarities of a large sea port, or commercial town, accessible to ships or
vessels.   And, therefore, yellow fever, strictly so called, often does not
appear in some marshy situations, which are very bable  to  bilious re-
mittents.
   3rdly.—" Because there was an evident difference  in the character
and type of tlie two diseases;  there was a greater despondency of mind
in this fever; the eyes were more muddy and inflamed, there was com-
monly a deep-seated pain in the eye sockets, the motion of the eye balls
was attended  with uneasiness; the  pain  in the back and limbs  was
greater than in the bilious fever; the vomiting was not of  so violent
and straining a nature, nor was there such evacuations of bilious mat-
ter.*  The black vomit generally occurred at an early  period; the
yellowness was of a  dingy  hue, not of the real icteric tinge, accom-
panying cases Of bilious fever.  The delirium was, in many instances,
of a peculiar nature, and much resembling a state of intoxication;  hae-
morrhage was more frequent, particularly by urine, and from the sto-
mach and intestines."
  This  statement, in my apprehension, relates chiefly to the plus vel
minus of particular symptoms, and presents nothing new, or characte-
ristic of a new disease:  nothing, at least, of any importance, which had
not been noticed  and described by Towne, Warren, Lining, Moultrie,
Hume,  Hillary, Mosely, and others, as occurring in  the yellow fever,
long before the year 1793.   Indeed, the  differences  here alleged, as
distinguishing the supposed new fever, seem to depend solely upon an
increased violence,  or aggravation in the usual symptoms; and, there-
fore, never could, according to my conceptions, alter the nature or kind
of a disease, or create even a new species  of it.
  I have already, in various places, adduced numerous, as well as high
authorities, to prove that marsh fevers are  liable to  all the variations
noticed by Dr. Stuart, and therefore I cannot persuade myself that they
afford any ground for considering the fever of  1793 as a new disease.
Perhaps Dr. Stuart had not sufficiently attended to this fact.  He men-

  * Dr. Chisholm asserts, vol 1, p. 174, that " the vomiting w:is, for the most part, por-
raceous;  but towards the faial crisis, always black, aud resembling coffee badly boiled.''
It may be hoped, that he does not consider this a-s a new symptom, or as the mark of a
new disease. 
479
«*Jons, in  his letter to Dr. Hosack, that he had for nineteen years exer-
 cised his profession at a considerable distance from St. George's, and
 that his ordinary  residence during that time was four miles from even
 the small port of Grenville; consequently his patients must have been
 in a great degree  separated from those circumstances, or causes, which
 have been mentioned as modifying and aggravating marsh fevers, into
 that particular form which is called yellow fever;  and as this fever had
 not for many years prevailed with so much violence and exasperation,
 even in the  large sea-port towns of the  West Indies as it did in 1793,
 Dr. Stuart might well have been strongly impressed by this aggrava-
 tion of its symptoms, beyond any thing which he was accustomed to
 see; and believing as he did the extravagant reports which were cir-
 culated respecting the Hankey, he might naturally have been persuaded
 that the fever in  question was a new disease.
   This fever, at  Grenada, appears in most cases, and especially those
 of seamen,  (who  were the greatest  sufferers by it) to have resembled
 that variety  or modification of the disease, to which the French applied
 the name of Mal de Siam, more than a century ago; and in which
 from  a scorbutic  taint (as I have supposed,  at p. 237) or  some other
 cause, haemorrhages, black vomitings,  and petechiae, were predomi-
 nant symptoms;  occasioned,  undoubtedly, by what has been  called a
 dissolved state of the  blood; which seems  to occur (at least in some
 degree)  before death, in all the more  violent forms of yellow fever.
 And, by attending to this fact, we shall find no difficulty  in accounting
 for the early appearance of black vomiting, in  the fever  of 1793,  as
 mentioned by Dr. Stuart, nor for the dingy hue which, from extrava-
 sations of blood,  was given to the " icteric tinge" of the skin; nor for
 the more frequent occurrence of haemorrhage from the urinary blad-
 der, stomach, and intestines.  Nor can we be at any loss in explaining
 why the stomach, in that  gangrenous state, which frequently attends
 the worst cases of the disease, should be less irritable, and  less  capable
 of violent strainings to vomit, than it is when less injured, as in the or-
 dinary bilious fever; nor why  the least violent strainings  should  pro-
 duce the smallest ejections of bile; nor why exudations of blood into
 that viscus,  should change the colour of the matters ejected, as they had
 done a  century  before.   In regard to  the  4th,  5th, and  6th, reasons
 mentioned by Dr. Stuart, viz.  the fever's not having ever to his know-
 ledge terminated " within a few weeks in an intermittent;"  (as happens
 sometimes  to bilious remittents;) its producing a greater  degree of
 weakness;  and its not admitting, at least with benefit, of an early, bold,
 and free administration of the  bark, I must observe, that, to my under-
 standing, they do not oppose any obstacle to the  belief of this disease
 having been the  yellow fever; which seldom changes to  an intermit-
 tent ;  always'produces extreme debility; and, in its inflammatory stage,
 before the appearance of a remission, is, I believe, always aggravated
 by taking the bark.
   As Dr. Stuart's reasons, for thinking the fever in question  to have
 been a new disease, were stated with candour and precision; and as
 they have been quoted and adopted by Dr. Chisholm, (at p. 24 of his
 letter to  Dr. Haygarth,)  I have  chosen  to answer them in preference
 to those  which Dr. Chisholm has described with  greater prolixity, and 
480
 with a manifest effort to make  this  fever resemble the plague.   His
 descriptions appear, also, to have been adapted,  almost exclusively, to
 the worst  cases;  though he  admits,  that in  many  persons  the fever
 was mild, and thought to resemble the ordinary bilious remittent.  But
 the worst cases were best suited to his purpose of creating a distinction
 between these fevers ;*  he  has, however,  not only failed  to establish
 any such distinction, hut has even mentioned facts which prove  that
 the fever of 1793 could  only have been a marsh fever.   The following
 are some of these facts,  viz.  (like all other marsh fevers  it most  rea-
 dily and generally attacked strangers from  cold or temperate cli/natest
 and with the most fatal consequences;  sparing all  others in different
 degrees  according to their susceptibilities, as explained by  me,  be-
 tween pages 177 and  197.   At p.  140 of tlie first volume ofhis Essay,
 Dr. Chisholm has given,  in regard  to this  disease,  what he calls a
•" scale of its violence, or the  gradation it observed  with respect to the
 different classes of inhabitants;" which  accords entirely with what I
 have repeatedly  mentioned of the  effects of marsh fever,, upon similar
 descriptions of persons, in other situations.   The highest place in  this
 scale, is occupied by "  sailors,  more especially the robust and young;
 those least accustomed to the climate,  and those most given to drink-
 ing new  rum."   The  next, by  " soldiers, more  especially  recruits
 lately from Europe,  and the  most intemperate."   After these come
 " white males in general lately arrived, more especially  young men


  • Dr. Chisholm seems principally to rest the supposed novelty of the fever under  con-
 sideration, and its character, upon  a  sort of petechise, or efflorescense, resembling
patcfies of red or  livid spots,-" (vol.  1, p. 58) upon a " dinginess, or peculiar mixture of
 livid and a dirty  yellow," (mentioned  by Dr. Stuart)  which he (Chisholm)  whimsical-
 ly ascribes to (a nonenity) " the action of tlie matter of infectinn ,•" (vol. 1, p 76) and
 upon the frequency  and profusion of hcemorrhages ;  (p. 166) but all these  symptoms
 obviously result from a dissolved state of the blood, which as well as the symptoms them-
 selves, have been  long noticed  by almost  every writer on  the  yellow  fever.   Dr.
 Moseley  (p.  456) observes  of it,  that,  in  " the  last stage,"  " the interior  sur-
 faces of  the body  are all  oozing out  blood, into their cavities ;  every excretion is cor-
 rupted blood j" "and internal haemorrhage becomes-general"  Hillary says (p  151).
 ' in the latter stage of this fever, the blood is so attenuated, and dissolved, that we fre-
 quently see it flowing notonlv  out of  the nose and mouth, but from the eyes,,, and  even
 through the very pores of the  skin"  He mentions, also, " livid spots in many parts of
 the body," and that they are multiplied after death.  Dr. Moseley's description of
 Capt  Mawhood's case, which occurred before  the Hankey existed, affords all the worst
 symptoms of the worst cases  of the  supposed  new  fever of 1793-  It was not, indeed,
 accompanied by Dr. Chisholm's " dinginess, &c," which I have mentioned (at the bot-
 tom  of p.  47)  as someties occurring in the disease,  and which Dr. David  Grant', in
 describing the yellow fever of Jamaica, calls " a livid hue tinged yellow."  It is remark-
 able, however, that though so much  importance is now attached to this symptom, Dr.
 Chisholm,  in the first Edition of his Essay, did not mention or even allude  to it; but
 contented himself with stating, as " a principal distinction,"  between the supposed new
 fiver, and the bilious remittent, that in the former, " the yellow suffusion, seldom hap-
 pened ; in the latter always."  Seep. 128 of his first edition.  The " dinginess" seems
 only to have been noticed by Dr. Chisholm, after hisreturn to the West Indies in 1796,
 when, according to his representation, tlie malignant  pestilential fever had  ceased to
 prevail there, and the common yellow fever had taken its place.
  I may here observe, that the fever of 1793, at Grenada, did not differ half so much
 from the common yellow fever, as it did from the fever which occurred in the Hankey,
 and among the colonists at Bulama ; and  it must be very absurd to derive the former
 from the latter as its parent, and at the same time pretend that the  supposed new
 fever, with its  smaller variations from, the com non yellow fever, could not h^ave origi-
 nated from the causes by which it (the yellow fever) is produced. 
481
from Europe."  The  places of  other descriptions of persons, will
be  readily understood  by what I formerly  stated of their respective
susceptibilities,  in regard to  marsh miasms : always recollecting that
females are less susceptible than males, children less than adults, and
negroes least of all.   The greater liability, or predisposition to the dis-
ease in seamen, than in any other description of strange*, Dr. Chis-
holm ascribes  with  reason, to their "violent exercise  in the sun,  the
immoderate  use of  undiluted rum; bathing in a state  of intoxication,
and often when violently heated; and the sleeping on deck during the
night."   (Vol. i, p.  124.)  Indeed, these causes alone will often pro-
duce yellow fever.   Dr. Chisholm has,  however,  suggested another,
(p.  302,)  vs. perhaps rendering  "tue disease infinitely  more  fatal" to
them, than to " any other class of men," viz.—a scorbutic taint, which
I formerly mentioned,  as likely to have occasioned that variety of the
disease called by the French  mal de Siam.   In regard to the military,
at Grenada, he says, "that nearly one half of the 45th regiment" were
in the barrack near the carenage, and that  " all* the officers and men
were successively seized with the disease;  but it proved fatal  only to
the recruits  who had lately  joined."  Vol. i. p. 132.   The  case was
similar  in the  ordnance  department; of those  who had become sea-
soned, in some degree, to the climate, only five died out of 56; but of
recruits  just arrived,  21 died out of 26; and this with all the advan-
tage of Dr. Chisholm's skill, two months after he had discovered the
wonderful benefits of mercurial salivation, in  this  fever.   See vol. I.
p. 133.
  After  these instances of the frequency and violence with which per-
sons newly arrived from  northern climes were attacked by the disease,
(as always happens  with marsh fevers exclusively) he  proceeds to the
other extreme, and  mentions field negroes,  as being the most  exempt
from it;  though that mixed race called people of colour, seem  to have
enjoyed  this exemption in a very high degree;  for Dr. Chisholm tells
us, that  " the inhabitants of the  district of Montserrat," (and a part of
St. George's, adjoining the carenage) are almost allfree people of co-
lour ; and among them the disease never appeared, affecting their own
persons ; many of the  sick, (he adds) from the shipping, were  accom-
modated in  their  houses;  but a peculiarity of  temperament saved
them generally."   Vol.  i. p. 128.  This peculiarity  of temperament
might,  indeed,  well save them from the morbid effects of marsh mi-
asms, as it has always been found to do, when they had not lost it, by
long residence in a cold climate;  but negroes  and people of colour,

  * It is difficult to understand what quantity, or proportion, Dr.  Chisholm means by
 "all."  He says,  at p. 1,"14, vol  1,  of his Essay, that " about the middle of June, the
disease broke out  in the 67th regiment, and among the artifices and labourers on
 Richmond Hill." " all  were  successively seized with it; but it fell heavier ou the offi-
 cers than  the men; several of the former, being young men lately arrived  from Eu-
 rope. He adds, that " of about 300 men, at that time the strength of the  57th regi-
 ment, only about sixty were seized  with the symptoms of infection  and of that numbei?
 only three died."  Here we find that all signified only one-fifth part, and that the dis-
 ease proved fatal only to one in twenty  Did Dr. Chisholm form his description of the
 disease from its general appearance on Richmond Hill I  Or did  he conclude thf dis-
 ease to be direfully contagious, because only 60 out of 300 men took it, and doubtless, by
 going down the hill, and within die reach of marsh miasmata ?
61 
482
have rk> peculiarity which will protect them from the morbid effects of
pestilential and typhus  contagions;  on the  contrary, they are, as has
been proved, the first and greatest sufferers by these contagions, and
this single fact would alone orerthrow Dr. Chisholm's whole  sys-
tem.*
  In regard to the termination of this epidemic, Dr. Chisholm states,
(vol.  1, p. 136) that " from about the middle of September, till the
month of February, of the year  1794, the  disease seemed to have dis-
appeared every where in Grenada."  Why a contagion, with such ir-
resistible power, should have become extinct when there was no want
of persons susceptible of it, he  has not  explained; but,  in looking
over his account of the weather we find, hi vol.  1, p. 90, the follow-
ing statement,  viz.  " September, the greatest part of  this month re-
markably rainy, attended frequently with most  vivid lightning  and
tremendous thunder, and violent  squalls."   Of October, he  says
ump,ch rain fell in this month also," "but not in the violence of the
last."  He adds of November, " five days excepted, the whole of this
month was uncommonly rainy ;" " a great deal of thunder and light-
ning."   " December was also very rainy."   That these excessive and
long continued rains vassisted by the salutary effect of violent squalls,
thunder,  &c.)  should have  put a stop to  the fever, by diluting the
marsh miasms, and washing away the  materials necessary for their
production,  will, I am persuaded, be  thought highly  probable, by
those  who may  have attended to the facts  mentioned in the former
parts of this work.  Concerning its return, in February,  1794, as the
Hankey did not  then return, it might have been expected that Dr.
Chisholm would have found some difficulty in giving a  suitable expla-
nation, but having  before luckily  sent the contagion to  Philadelphia
by  some unknown vessel, and from some place, respecting which
there are very  contradictory accounts,  he contrives to have it brought
back to Grenada, by the way of Martinico,  where, after it had  been
deposited by one vessel, it was taken up by another and left at Gre-
nada.  But unluckily, though he was then at Grenada,  Dr. Chisholm
is unable even to hint at her  name, or the name of her captain ; a sort
of inability which (considering how much greater difficulties he had
previously surmounted) I should not have  expected; especially as he
says the  sick belonging to this vessel, and  by whom Grenada was the
second time infected, were placed  under his " charge ;" and that he
« had  no doubt  respecting  the identity of the  disease."  Really,  I
should have believed that the books of himself and his  partner, must
have contained the names at least of the vessels,  to which  patients of
that description belonged ; as they certainly did not bestow  medicines


  * At p. 302, ofhis first volume, is the following passage, " why, however it" (i  e.the
virus of  his supposed contagon) "should operate with  most violence on Europeans just
arrived, and who  had never entered the Torrid Zone before, is a singularity I do not
pr:-tend  to explain."  This abstinence from explanation, though unusual in Dr. Chisholm-
was, I think, discreet on the present occasion. Certainly, if his supposed contagion had
existed, and manifested this wonderful predilection for Europeans, at their  first entering
the  Torrd Zone, it wi-uld have been a singularity never observed in any other contagion f
jand therfore well calculated to discourage him from any attempt to explain.  The singtt-
Jarity, however, and the contagion, were but creatures  of his own imagination 
48S
 and attendance gratuitously.   I should have, moreover,  expected, a$
 Dr. Chisholm had no doubt of the  identity  of their disease, with that
 which had recently done so much mischief, that its  re-introduction
 would have been deemed by him  a matter of high importance, and
 that instead of such unexampled negligence, he would have spared no
 pains to collect and preserve all possible information on the subject.
   I have stated, in a note,  at p. 260, that Dr. Chisholm's adherents in
 Philadelphia, convinced that they  could not otherwise  establish any
 distinction between what they represented as his Grenada fever, and
 the marsh bilious fever of that country, had assumed  contagion as
forming its distinguising character ;  and Dr. Chisholm has followed
 their example,  doubtless'for the same reason.  At p. 200, vol. 1, he
 says, " the most remarkable distinction  between the malignant pesti-
 lential fever, and the yellow remitting,  is contagion;"  this assertion he
 repeats at the next page, and then very properly endeavours to prove
 the existence of this contagion; but here he unfortunately adduces fop
 his first and principal proofs of it, the absurd story concerning the ship
 Herberts,  lately noticed; and his equally absurd notion " that much
 of the melancholy fate of the army collected at the Cove  of Cork,  un-
 der major-general White,  about the end  of  the year  1795, for St.
 Domingo, is to be attributed to the infection of the malignant pesti-
 lential fever." Thus making yellow fever the parent oi typhus. These
 being  evidently, in his own  estimation,  his best proofs  and instances
 of the contagion,  which is supposed to distinguish the fever of 1793,
 I shall not be expected to notice the others,  after all that  I have before
 written on this subject.
   Dr. Stuart, in  his letter to Dr. Hosack, mentions  5f this fever,
 that "its contagious nature  appeared from  many instances of men in
 1793-1794, going to  St. George's  on business, and being attacked  a
 few  days  after their return to the  country,  with fever;  to several of
 whom it proved fatal."   This,  however, is  only what  commonly hap-
 pens to persons, exposing themselves to the influence of marsh mias-
 mata; and what has been often described, as happening to persons going
 into towns where the common yellow fever prevailed,  long before the
 Hankey  existed ;  which yellow fever,  Dr. Stuart  (as well as Dr.
 Chisholm) believes never to have been contagious.   Dr. Stuart, in-
 deed, with laudable candour, makes this addition to what has been just
 quoted from his letter,  viz. " but  I must observe  that  I met with no
 instance in the country,  of  the disease being communicated to others,
 either visitors or attendants.  It is true that  every attention was paid to
 keep the chamber of the sick well aired, their linen frequently shifted,
 and when a fatal issue took place, every article of wearing apparel and
 •bedding was commonly destroyed."  Tins  destruction, however, was
 probably of no use, as it only took place in fatal cases, and not invariably
 even in these, as  I conclude from  the expression  " commonly ;" and
 as the cases which were not fatal, would have equally  infected the un-
 destroyed clothes  and bedding, from^which no harm resulted.  The
 airing of  the  sick  apartments might,  indeed, have  been effectual,
 against typhus; but not  against any such virulent and  powerful conta-
 gion as the Hankey is supposed to have imported.  This part of Dr.
 Stuart's statement is confirmed by Dr. James Clark,  in  regard to the 
484
fever which began at Dominica, in June,  1/93, and which Drs. Stuart
anci  Chisholm  suppose to have been the  same with that of Grenada,
and  derived  from the  same source.   Dr. Clark's statement on this
point I have  already quoted at p.  296, and I may add that  as  no pre-
cautions were there employed to  hinder the operation of contagion, I
am persuaded that if none had been used at Grenada, the fever would
have proved  equally incommunicable.   Dr. Clark says, (p. 61)  "that
the common  remittent fever, dysentery, and other bilious complaints,
bad  begun to shew themselves previous to the appearance of the yel-
low  fever" in  1793; a plain indication of the prevalent influence of
marsh miasms.   The same author, at p.  22,  makes the following ob-
servations concerning the supposed new fever, viz.  " I have been  in-
formed that it has been considered, by some, as an imported and very-
infectious disease; but in this island it  did not appear to be either im-
ported or infectious.   The very  few instances which  seemed to indi-
cate contagion, I  think,  may be accounted for on other principles.
Some inhabitants, who had been  accustomed to breathe a cool healthy
air,  in high situations in the country,  were sometimes attacked after a
visit to town  in the  same manner as new comers from Europe and
America, who never had been in the West Indies before; the reason
of which will be enquired into hereafter.   Those who had resided long
in town,  or  near the sea side, were not attacked with it.  The physi-
cians and surgeons who visited the sick,  and the nurses who attended
them constantly, were not infected ; nor  did there occur  a single  in-
stance,  oi one of them being seized with this fever for these  three
years, that I  have remained in the island,  since it broke out: although
no prophylaetic, or  precaution of any sort whatever, was made use
of to counteract or avoid contagion.  I am, therefore,  of opinion, that
this  terrible disease  was not imported into this or any other of  these
islands, or into  America; but  that  it was  produced from  natural
causes."* Of Dr.  Clark, Dr. Chisholm has stated, at p.  258 ofhis
2d volume, that he was " a physician of great eminence, whose prac-
tice  for five and twenty years,  in the West  Indies,  furnished  a most
ample field for observation and experience ;" and it appears that he
was not singular in believing that the fever in question was not conta-
gious.  For  Dr. Chisholm states, (vol. 2, p.  254) that "Dr. Fillan,"
who " has been an eminent practitioner in Dominica, for near twenty
years," " imagined he could perceive nothing contagious or infectious
about it, i. e. the new fever:" this.negative exercise of the imagina-
tion, however, is at least unusual; persons having much oftener ima-
gined they could perceive what  does exist, than the reverse.  It ap*
pears, indeed, that it was not Dr. Fillan who thus exercised his ima-
gination,  but Dr.  Chisholm, who thought it most convenient to repre-
sent Dr. Fillan as having only imagined, when in fact he had asserted,
that, he could  perceive nothing  contagious,  &c. for he  immediately
subjoins the  following  sentence, viz.  " on  questioning the doctor close-

  * Dr Roberts, Physician to the forced,  who was at Grenada during the great mortality
there, in 1796, and who, probably, saw more than 1000 cases of the supposed malignant pes-
tilential tever. declares that he could discover no sufficient reapon  for considering it as a
disease different from the common yellow fever of the West ludies, with which he was
Well  acquainted ; having been born at Antigua. 
485
iy on this subject,  I perceived that no conclusive or well-founded rea-
soning  could be  adduced  in  support of this assertion."   That  Dr.
Chisholm should not tnink  any reasoning conclusive or well-founded^
which had induced another person to imagine  he could not perceive
that contagion, which has  so long occupied and  bewildered  his own
imagination, I can  readily believe; and  though I cannot applaud the
candour ofhis statement, I am glad that it contains less of misrepresen-
tation than many of those which I have found it necessary to controvert.
But though  Dr. Chistfolm could not, by " closely questioning," hin-
der Dr. Fillan from asserting his inability to discover any appearance
of  contagion in the supposed new fever, he  seems, from his  own ac-
count,  to have been a little  more  successful  with Dr.  Fillan's " assis-
tant."  For the latter, (who is styled, by Dr. Chisholm, an " eminent
practitioner")  after declaring that he had neglected to make any " in-
quiry so as  to establish the  source of the disease in any instances," is
said to  have readily "acknowledged,  that had an investigation been in-
stituted, with  the  care and attention  the subject merited, he had rea-
son" (where did he, get this reason)  " to think that contagion might
have been detected,  as the cause of  the disease,  in every instance."
If  Dr.  Chisholm has not misrepresented this (probably young) gen-
tleman's language, it may be well that his complaisance, or his imagi-
nation,  did not carry him farther*
   But  after  all this, Dr. Chisholm, who has repeatedly stated  his sup-
posed  new fever, or its contagion, to have been carried from  Grenada
to Dominica, (though without designating any mode,  or  vehicle,  or
person, by whom  this mischief was perpetrated,) tells us, at p. 256 of
his 2nd vol. that " the first appearance  of the  disease  (at  Dominica)
was in  a ship, called the Providence of London.  She arrived (he adds)
about the 8th or 9th of June, and the first case of fever appeared about
the 13th: many of the crew were attacked immediately after, and died.
The fever appeared in the neighbouring ships,  and spread so  rapidly,
that  about  the 20th, scarce  any were free from it."  And this, Dr.
Chisholm (whose  intellectual and perceptive faculties appear  inacessi-
ble to  all ideas, which do  not accord with  his supposed  contagion,)
considers as a proof,  that the disease was communicated from the sick
to  the well,  and from one ship to another, in succession ;  and all in the
space  of one week.  A monstrous supposition!  utterly incompatible
with every thing known  of the different kinds of contagion; among

  * As an illustration of the truth of this remark, I will here mention a statement made
by  Dr Chisholm (at p. 257, of vol. 2d.) on the information,  as he alleges, of Dr. Fillan's
assistant  It relates to a  Dr. Wilson at Dominiea, who  resided  about  12 miles from
town, and who three days after returning to the country from town, where  he had visited
persons  labouring under  the prevailing fever, was astonished to perceive a number of
carbuncles, spreading round his neck, and towards his face  and breast. The progress of
these was so great, as to threaten  a mortification.  In this distress, he sent an express for
Dr. Johnson.  Dr. Fillan's assistant "who  immediately visited him. By the time he
arrived a mortification had actually taken place, and Dr. Wilson died a few hours after,
whilst endeavouring to examine the state ofhis neck in a looking glass. The description
of the sores on this patient's neck, says Dr. Chisholm, left no room to doubt they were
pestilential carbuncles.'"  Thus  has  Dr. Chisholm's heated,  distempered imagination,
created  the true plague at Dominica; aud that it might not  be created in vain, he imme-
 diately adds that " an  immense number of the inhabitants were seized and many died."
Is it possible that  he can  have believed and wished to make others believe, that these
persons  died of the true plagne ? 
486
 which, there is scarcely one, that could have so soon produced disease.,
 even in two persons successively.   When ships are placed within the
 reach of those miasms, or local causes of disease, which, at certain
 times, commonly produce the yellow or other marsh fevers, in the har-
 bours of the West Indies, their crews being acted upon, nearly at the
 same time, by the morbid exhalations, many persons will naturally fall
 sick almost simultaneously: and nothing but such a cause, could have
 produced the effects just mentioned, as having occurred at Dominica.
 But how Dr. Chisholm expected to reconcile the first appearance of the
 disease, in a London ship, just arrived at Dominica, with his  assertion
 of its having been derived from Grenada, I am unable to conceive.
   Believing that it would be not only superfluous, but tiresome  to  my
 readers, as  well as to myself, if I were to carry this refutation any far-
 ther; and presuming, that I have sufficiently demonstrated the fallacy
 of all those  statements  and arguments, by which  Dr. Chisholm has la-
 boured to prove the fever in question to have  been derived from  the
 Hankey; and that there is no good reason for considering it as specifi-
 cally different from the common yellow, and otheiynarsh fevers, which
 have been proved to be void of contagion, I shall  here dismiss the sub-
 ject; adding only a few observations, to justify the uncourteous  and
 disobliging expressions which I have been sometimes forced to employ,
 in regard to Dr. Chisholm.  Had this  gentleman  contented himself
 with stating fairly and correctly, the facts and reasonings which occa-
 sioned,  and  were by him  thought capable of  supporting  his most
 extraordinary opinions, I  should  have left the public to judge of their
 sufficiency,  and have gladly avoided every appearance  of controversy
 with him.   But instead of doing that, which would have most benefited
 the cause of truth, and the interests of mankind, Dr. Chisholm, with
 great perseverance, and very little temperance or moderation, has la-
 boured to propagate and maintain these  opinions,  by assertions as
 positive  as  they  were unwarranted;  and by statements of pretended
 facts, which were destitute of any foundation in truth, and at the same
 time of such decisive import, that  a bebef of them, must necessarily
 produce an  adoption of the opinions  intended to be thus maintained;
 which opinions, I sincerely believe to be not only erroneous, but likely
 to obstruct the  progress of medical science; perplex and frustrate all
 endeavours to elucidate the important subject of contagion; and, more-
 over, to produce all those mischievons consequences which I have
 mentioned at p. 332—336.  Under this conviction,  I have thought it
 my duty, to  endeavour, at least,  to  rescue  and vindicate the truth,*
 from those fallacious arguments, and confident misrepresentations, with
 which it has been surrounded and obscured, by Dr. Chisholm; and for
 this  purpose, to contradict, and  confute the untruths advanced, (I  will
 not say fabricated,) by him; and demonstrate  the little reliance wThich
 (either from his extreme want of caution, or excessive anxiety to over-
 come his opponents,) ought to be placed on his supposed facts  and
 representations, in regard to the origin and nature of the fever  of 1793.

  * Dr Chisholm,  at p.  219 of his 1st  vol. has declared, that " the cause of truth is
paramount to all other considerations;" and has assigned this as his motive, and justifica-
 tion, for contradicting Dr Rush; professing, at the same time, to entertain the highest
 opinion of "the humanity, the genius, and the professional skill of that gentleman. 
487
£or such contradictions and confutations, I have found  it necessary to
employ adequate terms;  but I have done it reluctantly, and have in-
variably preferred the least offensive,  as far as  I could do so, with-
out weakening my conclusions,  or leaving  my ideas imperfectly  ex-
pressed.
  This explanation  I have  thought due to  my own character, rather
than to  Dr. Chisholm.   For, whilst endeavouring to  spare his feel-
ings,  1 have believed that very few writers were less entitled to in-
dulgence and tenderness in this respect: because, with a few excep-
tions, he seems to have  exercised neither towards those by whom  his
statements and opinions are controverted. His Letter to> Dr. Haygarth
abounds inoffensive, arrogant, and injurious language, particularly at
p. 75, where he designates the most respected and meritorious physi-
ci-ns of New-York and Philadelphia, as " pertinacious theorists."—
" Disturbers and destroyers of society:"—and  as deserving " to be
execrated  by their fellow citizens:" and this, only because they  had
controverted his opinions, respecting the fever of 1793.   And again,
at p.  159, he has generally accused all who deny the supposed conta-
gion of that fever, of" a predetermination to break down the barriers,
which alone can secure mankind against the calamities" arising from
" infection and  contagion," " universally diffused, and universally
destructive of the human race."  He had previously, in his preface to
the 2nd edition of his Essay, plainly intimated, that the " Medical Staff"
of the army, under Sir Ralph Abercrombie, in the West Indies, were
chargeable, in a great degree, with the deaths of  13,437 soldiers;  and,
at p. 243  of that volume, he has accused them of a species of " con-
duct, which led to the pernicious, indolent, and unscientific habit, of pre-
scribing for the name of a disease:"—" prevented the investigation of the
principles on which practice, in any  particular  distemper,  should be
founded;"—" which tended to the discredit of a mode Of treatment of
the  epidemic, from which alone,  success could be  expected:"  and
which  was, " in short, the paramount cause of tie  mortality which
has disgraced the annals of-the West India Medical Staff of the day."*
The  foundation of these outrageous accusations, and  the delinquency
to which they relate, is nothing  more than a belief or pretence, in Dr.
 Chisholm, that the  medical officers of the army in question, did not
 sufficiently adopt and persevere in the practice recommended by him,
 of giving or applying mercury to excite salivation, in the yellow fev r;
 a practice, of which I have delivered my opinion, at p. 73—78; and I
 will here observe, as one of the physicians  to that army, that there was
 nothing in Dr. Chisholm's situation, which could make it our duty, or
 even warrant us, to persevere unsuccessfully, in the trial of his strange
 and unpromising innovation.f   He had only been known as  a practi-

   * The mortality with which the medical officers of Sir Ralph Abercrombie's army are
 here reproached, was certainlv great,  and ever to be deplored ; but it did not, in any
 instance, extend to 21 out of 26  patients, as happened to persons under Dr.  Chisholm's'
 car< •.. after his pretended d iseov ry of an almost certain remedy.
   ■j- It is remarkable, that while Dr. Chisholm  brings such heavy accusations against the
 med'cal officers of the army, for rot having sufficientlv employed mercury to cure the-
 yellow fever. Dr Cillespie, who was then in charge of the naval hospital at Fort Royal,
 in M:-.rtinic(>, dec! .p--<--.  '-that many o('these rentlemen  fell victims to their m pi icit feith
 in mercurial medicines which  had been lately snpposed so efficacious in epidemics, of a 
488
taoner at Grenada; and when there, could not have pretended to  an
equality with several others, in public estimation.   Nor did 1 find that
bis boasted success at that island, from the use of mercury in the yel-
low fever, had been known there, until his printed accounts of it had
arrived from  Europe, nor that  it was  believed when  thus made
known.  I feel, however, no resentment against  Dr. Chisholm, for
the obloquy which he has thus attempted unjustly to throw upon me
among others, though I sincerely regret, that his acknowledged talents
and industry, were not more judiciously and beneficially employed.

similar nature to those which then reigned."  Meaning the Grenada fever, and Dr Chis-
holm's account of it.  See  Observations on the Diseases," &c. "ofhis majesty's Squad*
ron, on tlte Leeward Island station," &c.p. 19'.
APPENDIX.
NO. VIII.
  At pages 204 and 205,  I have explained the subject and motives
of this appendix; and the following is Dr. Blane's  statement, (therein
mentioned,  to the American and Prussian ministers, viz.
  "On the 16th of May, 1795,  the Thetis and Hussar frigates, cap-
tured two French armed ships from Guadaloupe, on the coast of Ame-
rica.  One of these had the yellow fever on board, and out of fourteen
men sent from  the  Hussar to take care of her, nine died of this fever
before she reached Halifax, on the 28th of the same month, and the five
others were sent to the hospital, sick of tbe same distemper.  Part of
the prisoners were removed on board of the Hussar, and  though care
was taken to select those seemingly in perfect health, the disease spread
rapidly in that  ship, so that near one third of the whole crew was more
or less affected by it.
  "This fact carries a conviction of the reality of infection, as irresisti-
ble as volumes of argument; and, it further affords  matter of important
and instructive information, by proving that the infection may  be con-
veyed by the person or clothes of men in health."
  Numerous facts and considerations, most of which have been already
mentioned,  having induced me to think it impossible,  that the yellow 
489
lever should have in this instance manifested  properties,  which it had
been found not to possess in a multitude of others, I was solicitous to
investigate the circumstances of this transaction, as minutely as possi-
ble, in order to ascertain the truth,  on a point which I have long con-
sidered as of high importance to  mankind; and I therefore applied to
the commissioners of the transport department, for permission to in-
spect the medical journals of the surgeons ofhis majesty's ships Thetis
and Hussar, for the year  1795, and the correspondence of the surgeons
of those ships with the sick and wounded board, for the same period,
and was very soon honoured by a letter from  Sir Rupert George,  Mr.
Serle, and Dr. Harness, dated 14th  October,  1807, and informing me
that " the journals were ready for my inspection, but that there did not
appear to  have been any letters received from  the surgeons of those
ships during that period."  I lost no time in availing myself of this  per-
mission ; but as  the journals in question did not afford all the desired
information, I  extended my researches to the  navy  office;  after which,
I thought it my duty, fairly to communicate the results of my inquiries
to Dr.  Blane;  and  having  done so, he thought it proper  to write the
following letter to Dr. Wilson, now physician  to the Plymouth hospital,
and formerly surgeon to the Hussar frigate, viz :
                                       "London, Arov.  17, 1807,

   "You may possibly  have seen, in some of my writings, that  I have
adduced as  a proof of the infectious nature of the  yellow fever, that it
spread from the Raison, French prize,  to the Hussar frigate, in May,
1795.  There is, in my opinion, sufficient proof of  this fact from other
quarters, but as  you were then surgeon of the Hussar, and as I find by
my notes, that it was partly on your testimouy  that I built, I take the
liberty of  putting some questions to you on this subject.   What leads
to this is, that Dr. Bancroft, a respectable medical gentleman  of this
place, who has paid much attention to the subject of infection, but who
is of a  different opinion from me on this point, means to controvert my
statements of that case, and founds his  proofs chiefly on your journal,
which  he has not only inspected, but has copied  it for the months of
May and June, 1795, and has very  candidly called on me, and shown
it me.  There is certainly nothing in that part of your journal which
can be construed into  a  proof, that the ship's company of the Hussar
had the same fever with the prisoners.  But the composition of it bears.
marks of very great haste;   and no description of the  symptoms is
given, except a reference to the case of Mr.  Backhouse, who was not
taken ill till a month after the battle, and  whose symptoms have nothing
characteristic of the yellow fever. I am sure, however, from my notes,
that either in some other parts of your journal, or in those accompany-
ing remarks,  enjoined by  the  form of the journal,  or in your letters
from the hospital, there must have been some further testimony  from
you on this  subject.  The purpose of this letter, th.crefore, is to request
you to consult your memory, and your papers, regarding it.   You will
certainly recollect, whether or not, the men of the  Hussar,  either on
board, or at the  hospit-d, were affected  with a fever  attended  with yel-
lowness of  the shin, and coffee-coloured vomiting, and in what num-
bers; also, whether only the prisoners apparently in health, or both the
                                 62 
490
  sick and healthy, were brought on board of your ship?  If you should
  be able to give any satisfactory information, either for, or against, these
  facts, I should hold myself extremely obliged to you, and I am sure so
  would Dr. Bancroft, in order that neither of us may be  led into error,
  in so material a point.  There is a reference in your journal, to some
  letter you wrote from the hospital, but as Dr. Bancroft could not  find it,
  it has,  no doubt, been mislaid at the office ; but it would  be a great sa-
  tisfaction to us,  if you should have kept a copy of it.  In short, if you
  will have the  kindness to send all tlie information on this affair,  which
  your memory, or written documents, can supply, and your time will af-
  ford, you will greatly oblige
                   Sir, your most  obedient,
                        and very humble servant,
                                                   GIL. BLANE.
      " Dr. Wilson, Plymouth Flospital.
    " P. S.   I ought to  have mentioned that Dr. Bancroft has also in-
  spected the muster-books of  the Hussar, at the navy office, and finds
  the prisoners in  sickness as well  as health were brought  on board the
  Hussar, contrary to what I have stated in my  letter to the American
  and  Prussian  ministers, which you may probably have seen in print."
    To this letter the following answer was returned,  viz:
               "Royal JVavy Hospital, Plymouth, Nov. 22,  1807.
      " Dear Sir,
   ■" I am much afraid I have lost the journal of the sick kept by me, at
 the time the yellow fever prevailed on board the Hussar; I have, how-
 ever, found a copy of the letter, which I transmitted to the sick and hurt
 board, on  that occasion.  I have, agreeably to your wishes, transcribed
 the greatest part of it, and herewith enclose it for your perusal; if
 plain matter of fact can have  any weight, you will there find sufficient
 to establish fully  your observations on the contagious nature of that dis-
 ease.   Should any other testimony be wanting, by a reference to capt.
 Beresford, who then commanded the Hussar, and now commands  the
 Theseus, further particulars may be obtained.
   " Mr. Backhouse was subject to frequent attacks of chronic rheuma-
 tism ; was, in  consequence, sent to the hospital  at Halifax;—first, on
 the 27th of June, 1794—and again  in  November  following.  Many
 were afterwards, at different periods, sent for the same complaint, and
 particularly two on the  28th of May;—one on the first, and another on
 the 17th cf June, 1795.*   Their treatment being nearly the same as
 that of Mr. B. a  reference, in order to avoid repetition, was in conse-
 quence always made  to his case.  This, I trust,  will explain, why no
 symptoms, in common with yellow  fever, could be found  in the  cases
 alluded to, or any thing that could  lead one.to believe, the  Hussar's
 ship's company to have the same fever with the prisoners.

  *  This accords with Dr. Wilson's Journal; but in his subsequent letter to Dr. Blane,
he admits, that the entry relating to the 17th of June, could not have been correct; "as
from the 6th of that month, to the 4th of July following, we  (the Husstjr) had no com-
munication whatever with the hospital."   It must consequently follow, that the entry in
his journal of another name,  as sent to the hospital, the  20th Jane, must also be incor-
rect. 
491
   " I  do not recollect the number of  prisoners  received on board the
Hussar: I only remember,  that the  sick were not removed from the
Raison ;  that  they remained  in the  prize  until her arrival in port,
and that  it  was  only  those in  health  that were permitted to  come
on board  of us; the names of the  sick, as well of. those in  health,
were, as is customary in such cases, indiscriminately entered  on the
books of the Hussar.*
   " The  number of  the Hussar's ship's  company affected with the
disease, appears to have  been 98.  The number of deaths on board
the Raison, between the 16th and 28th of May, were (was)  .   .   9
   The number of deaths at the hospital, between the 28th of May
and 6th of June................6f


                                                               "Total 15
   " The above will, I believe, be found a correct statement.
                                   " I am, dear Sir,  &c.
                                                            " J. Wilsox.
   " To Dr. Blane."

    The only way in which I can reconcile this with the opposite testimony, is' by suppo-
sing, what appears in other respects probable, that there were no sick on board La Rai-
son.  I found, by the books at the JVavy Office, that " head money" had been paid to the
captors for 116 prisoners,  as having been on board the liaison, at  the  commencement of
the action ; and it appears from the master-book of the Hussar, that she received the same
full numberof 116 men on board, from La Raison, on the 16 th of May, and that every one
of these men were delivered from the  Hussar to the Security, prison'ship, at Halifax, on
the 28th of May ; consequently none  had been killed in, or died subsequently to the en-
gagement of the 16th of that month.   Their  names  are all stated in the book at full
length ; and under them is a certificate, signed  by  John Beresford, captain, and Francis
Prior, declaring " to the Commissioners for Victualling his  majesty's Navy,"  " that the
before-mentioned prisoners, beginning with the name of A.  L. Le Sau, and ending with
thatot Anthony Pignon, were actually victualled at two-thirds allowance, the numberof
days as specified  by the several entries  and discharges."  These entries and  discharges
include all the days from the 10th  to the 28th of M:sy ;  and aginst the names is a column,
for them when  mustered,  and in this  column the  23d of  May  is written  against
each  name, or the letters Do. under that   date.  I inquired particularly of the gen-
tleman at  the  office, whether it might not be possible  that  these letters should
be affixed to the names of  some of the prisoners who had  remai- ed  on  board  the
Raison, and was answered in  the Negative ;  with an  assurance, that every man against
whose name those letters were written, must have been actually on board ; and that  if
any man had been sick, so as not to receive his allowance, or  absent from the Hussar for
a single day, it would have been noted in  the column,  or "checked," as they express it:
and in confirmation of this, I was shewn several instances of such checking, iu the books.
It is to be recollected, that the " two-tliirds" is the full allowance to prisoners in health ;
and it  would have been fraudulent to make a false entry in this respect : and,  moreover,
it is highly probable, that they must have been in health, because at Halifax they were all
sent, not to the hospital, but the prison ship ; and none were  sent thence to  the hospital
until three  days alter ;, and even at that time, it does not appear that any one sent was ill
offever. That they would have been sent earlier from the prison-ship to the  hospital,  if
they had been ill  sooner,  is manifest, because two of  the Prevoyante's crew  were sent
from the prison ship to the hospital, one the 29th  of May,  and another on the 30th, as
appears by the hospital books,  and being all prisoners made  at one time, and in the same
circumstances ; the men belonging  to the Raison, if any  had been ill on those days, would
have naturally been sent at the same time.
   -j" Dr. Wilson  has stated and admitted, several times, what the books of the hospi-
tal at Halifax prove, that the whole  number of men belonging to the Hussar, who
were  sent to this hospital,  in  May and June, 1795,  amounted only to 12;  and, iu his
Letter to Dr- Blane, of December 20th,  1807, he declares,  that six  of these were sent
back to him, on the 6th of June,  and  that they all  recovered.  He also states, mat
two of the remaining six, were cases of  rheumatism, in the persons of David Sullivan
and Nicholas Martial, who,  by Dr.  Wilson's Journal, are stated to  have been put on 
492
    The following is a copy of the transcript, mentioned in the preced-
 ing letter, oi   the greatest" part of Mr. Wilson's Letter " to tuc Sick
 and Hurt Board," viz.—
    " On the 16th of May,  1795, his Majesty's ships Thetis and Hus-
 sar, cruizing off the Cape  of Virginia,  fell in with five French armed
 ships, two of them,  after a severe action of  about an hour and a half,
 Struck; they had sailed some time before from Guadaloupe, where the
 yellow fever had prevailed, and had carried off numbers of the French ;
 unfortunately for us, La Raison, the ship  we took possession of,  had
 suffered greatly from this disease; several of her  crew having died on
 the passage, and at this time many were found confined to their beds,
 in a state of the greatest debility.*   Capt. Beresford, in order to pre-
 vent, if possible, the Hussar's ship's company being infected,  ordered
 all the prisoners who had the least appearance of disease, to remain
 where they were, and those only who appeared to be in a perfect state
 of  health were  allowed to come on board of us.   Frequent communi-
 cation was,  however, found unavoidable; and, notwithstanding  every
 precaution  was taken, I was extremely sorry to  find, that before we
 reached.Halifax, we began to experience the sad effects of the con-
 tagious nature  of this  disease.   And of fourteen fine, young, healthy
 seamen, with officers, Etc. ordered to conduct the prize into port, five
 only survived their arrival ;f and four of those in so debilitated a state,
 as to  render it  necessary to send them without loss of time to the hos-
 pital, together with six others, that had been affected with  the  same
 complaint on board  the  Hussar.  The  disease now began to  assume
 so serious an appearance, that it was deemed proper to send them on
 shore the moment they complained, where few survived  longer than
 three or four days.\

 the  sick list of the Hussar; one on the 1st, and the  other on the 4th, of May: and
 they continued sick, and  were sent to the hospital at Halifax, on the 28th of that month,
 and entered as cases of fever in the hospital books.  But  as neither of  them died, the
 deaths in the hospital could  only have  been  four, and  not six, as is here stated.  It is
 moreover to be remarked, that I hough these two men are stated to have been constantly
 on the sick list in May, Dr. Wilson, in contradiction to his own Journal, asserts,  in his
 Letter to Dr  Blane, of the 20th of December, 1807, " that for some time previous to the
 action of the 16th of May, 1795, tltere had not been  a man on the Hussar's sick list.''
   *  In the preceding note, 1 have stated documents aud  reasons, which make it impassi-
 ble for me, at least, to believe that this can be correct ; and this impossibility will be in-
 creased, by facts to  be adduced hereafter.
   ■)- Facts are here equivocally, or obscurely stated ;—nine only of the Hnssar'screw died
 on board the Raison-   We  are  no where  informed, how many officers were  put on
 board that ship, in addition to the 14 seamen.  But it appears that no person of that des-
 cription, either died, or sickened, by going on that service.
   t Dr. Wilson here admits what may be otherwise sufficiently proved, that ten of the
 Huzzar's crew  went to the naval hospital, at Halifax, ill of the supposed yellow fever ;
 none of them, however, as appears by his own Journal,  was sent  until after two days
 illness   Of these ten men, he states in his letter to Dr. Blane, of the 20th December,
 1807, that lie received hack six, on the 6th day of June,  and that they all recovered.  It
 appears also, by the books of the naval hospital, at Halifax, and  by  a letter to the com-
 missioners of Sick and hurt seamen, written by Mr. Haliburton, surgeon to that hospital,
 and dated the 25th of June, 1795, that at the date of this letter, only three persons had
 died there, of the supposed yellow fever ; and,  in fact, no more than  four did die, in the
 tyhole, o< that \'e\er, at Halifax ; and this fourth man appears, by the books of the hospital
to  have relapsed, and died on the 30th of June.  With a  knowledge of these facts, I have
fi.it no little astonishment, at finding that Dr. Wilson had permitted himself to assure 
493
   " The idea of  an infectious disease, which  had in so short a time
proved fatal to so many seamen, alarmed the inhabitants of Halifax and
its vicinity to such a degree, that they  made application  to  Captain
Roddam Home, commanding his majesty's ship Africa, and then senior
officer in port, to  order the  Hussar, officers, and ship's  company, to-
gether with those yet alive at the hospital, to be  removed to the oppo-
site uninhabited shore: the  request was immediately complied with.
Tents were erected for their accommodation;  and on the  morning of
the  6th  of June,  1795, at day-light, the  Hussar was  anchored  at the
place pointed out for that purpose.   The following is an extract from
the  Physical Journal kept by me, during the time the sick were under
my  care;  the symptoms, of those taken ill when on shore, were ob-
served to  be the same as in those first taken ill on board  the Hussar
and Raison.

   " On the commencement of the disease, the patients were, in general,
costive,  and  complained of  great lassitude, giddiness, sickness  at sto-
mach, frequent sighing, cold chills, succeeded by a burning heat all over
the body,  and affecting the whole of the prima via; a hot dry skin; pain
and oppression about the procordia;  pain in the  head, back, and loins;
pulse rather quick  and full,  with  a considerable throbbing of  the tem-
poral arteries; a constant vomiting of at first a yellow, and afterwards,
of a very dark-coloured bilious  matter; eyes  red,  full,  and heavy;
thirst  great;  tongue much  furred; teeth  incrusted with a  dark-co-
loured gummy substance; a yellow suffusion of the skin ;  great pros-
tration of  strength;  restlessness;  delirium,  8cc. Sec*  The above were

the Commissioners of Sick and Hurt Seamen, that from the very sei-ious nature of the
disorder, it had been deemed proper to send them, the sick, on shore the moment they
complained/" and that there (on shore) " few survived longer than three  or four days."
Nine of ihe  ten persons in question were sent on shore on the 28th of May ; and exactly
four weeks after, three only of the ten had died.  Few, is generally understood, at most,
to mean the smaller number;  but here,  more than two-thirds had  survived, not merely
three or four days, but as many weeks.  In making this comyiutation, I have  taken facts
most favourably for Dr.  Wilson—because, in addition to the ten persons here mentioned,
nine seamen belonging to the Thetis, who were sent on board the Raison, to supply the
place of the  Huzzar's men, when sick or dead, had also been sent to the naval hospital
with the same fever, where they all recovered; and these, I should suppose, ought also
to have been taken into  Dr. Wilson's consideration, when  he thought proper to state
that few had survived  longer than three or four days.
  * Many circumstances convince me, that it is proper to receive  this general account of
the symptoms of the  supposed yellow  fever with great caution.  Indeed, the imagina-
tions of some persons at Halifax, appear, on that occasipn,  as at Grenada, in regard to the
Hankey, to have acquired a morbid activitydnd biqs . Even Mr. Halliburton, the supe-
rior medical officer of the navy on that station, has, I think, clearly manifested this, in his
letter to  the  Commissioners of Sick and Hurt Seamen, though written on  the 25th of
June, when all apprehensions of danger had subsided, and sober common sense might
have been expected  to regain its proper ascendency. Among  other instances ot the
effect of his excessive alarm, he states the following, viz—" I went on board the lluzzar
with Captain Beresford, had all hands turned up,  spoke to the men of the absolute ne-
cessity of their not concealing their complaints, if they had any; that their safety depended
on an early  application.  Six of them came forward, with evident symptoms of the ap-
proaching malady, and although at work, I recommended it to Capt. Beresford to send
them instantly to the suspected tents ;  and in the evening when I visited them, I found
three of them very ill, with quick pulse, vomiting, &c."  How much of the illness in these
three men depended upon their imaginations,  or the imagination of Mr  Halliburton, I
know not ;  but if the symptoms of yellow fever had beei, so evident in  the six men, as
he states, we  might expect  that  he would have found more than  three of them very ill
that evening.  And, I will add, moreover, my belief, that if a distempered imagination, or 
■m
tlie symptoms, as they in general occurred hi succession.   But, Gen-
tlemen, previous to my submitting to your consideration  the mode ot
treatment adopted on this occasion, permit me to make a few observa-
tions.
  " On the first appearance of acute diseases, in general, the evacua-
tion  of the alimentary canal, becomes a primary object;  and in no
complaint, whatever, is this maxim to be attended to, more than in the
disease at present under consideration. In its early stages, I have often
experienced the good  effect  of emetics and cathartics; but when the
former were too often repeated, they were found to be productive ol
the most serious evils; that they not only increased the irritable state
of the stomach, but also, that of the  hepatic  system ; and that in con-
sequence, a train of such disagreeable symptoms obtained, as frequent-
ly baffled every effort of either medicine or art to get the better of.
  " On the first  attack of the disease, the patient, if of a full habit of
body, was bled, head shaved, a blister applied to the breast, and an eme-
tic, consisting of 2 or 3  grains of tartarized antimony, given; but in
order  to avoid the bad consequences  above alluded  to, the emctjc
was  seldom, if  ever,  repeated; nor was any  liquor  allowed to be
drank during its operation.  A considerable quantity of  bilious mat-
ter was, in general, thrown up; the spasm on the extreme  vessels, in
some measure, removed,  and a stool or two frequently procured.   In
cases where this last circumstance did not take  pla'ce, injections were
had recourse to, and often without effect;  calomel, however, from 10
to 20 grains, seldom  failed in  procuring some  free passages.   Could
the stomach have borne a sufficient quantity of the kali tartarizat, or
any other neutral salt, I am fully of opinion every purpose would have
been  equally well answered.   The pain and oppression about the prse-
cordia, and laborious respiration, were much relieved by the bleeding
and blister; and in cases where the vomiting was very severe and pain-
ful, saline medicines,  combined with camphor,  aether, and opium, af-
forded relief: saline draughts (with opium,) in a state of effervescence,
were also  of infinite service; and those  with whom the vomiting, to-
gether with the burning  heat of the prima via, continued, by taking
three or four grains of nitre, with a few drops  of laudanum, in a  wine
glass of cold water, or lemonade, every hour, although ejected almost
as soon as drank, yet, by persevering in its use for eight or ten hours,
found the irritation at the stomach, in some measure, removed,  and
the  febrile action  considerably abated.   Purgatives,  whenever  they
could, with any prospect  of effect be given, were  administered,  and
several passages, if possible, daily insured.  When, however, the vio-
lent heat,  and morbid action could  not, by these means, be subdued,
much  benefit was derived from  the cold affusion.   The manner in
which I used it was as follows : The patient was stripped perfectly na-
ked, and if violent, held,  whilst sea water from a bucket, was poured

something else,  had not overpowered Mr. Halliburton's sober judgment, he never
would  have thus mentioned evident  symptoms of an approaching yellow fever in men
 who were quietly at work, and seemingly had no suspicion of being unwell, until fright-
 ened into a belief of their bein^so.  Other physicians often find it difficult to ascertain
 whether a fever will prove to be a yellow fever, even sometime after its actual commence-
 ment. 
495
 on his head, and all o"*er his body, until, if delirious, he came a little
 rational, which was, in general, in the course of ten or fifteen minutes,
 (if not delirious, not so long ;) the affusion was then discontinued, the
 patient rubbed dry,  with coarse flannel cloths, and put to bed.  Sleep,
 and a gentle diaphoresis, usually followed, and the patient awoke in the
 course of a few hours, apparently much refreshed,  and free from ei-
 ther fever or delirium.  On a return of these complaints, the same  re-
 medy was again, or again, if necessary, had recourse  to, and invariably
 with the same  effect.  Tonics, consisting of bark, wine,  Sec. &c. with a
 proper nourishing diet, soon perfected the cure; and, I  have great sa-
 tisfaction in adding, that of  those who were under my care on shore,
 amounting hi number to 83,1 did not lose a single patient.
                                                        "J.  W."
   The preceding communications from Dr. Wilson, afforded me but
 little information, which was either new or satisfactory.  In the hope,
 however, of obtaining more, I stated, in a letter to Dr.  Blane, several
 new difficulties and  objections, which had occurred to my-mind on the
 subject, together with fourteen questions, which I thought it probable
 Dr. Wilson might be  able to answer from memory, (if no written evi-
 dence should be in his possession,) and which I conceived likely, and
 necessary, to  ascertain the  symptoms and nature of the disease, and
 supply the want of important facts, which had been  omitted in all the
 former accounts.  These  questions, together  with  my letter,  were
 transmitted by Dr. Blane to Dr. Wilson, who, in consequence thereof,
 wrote an answer, dated December 20, 1807, explaining some contra-
 dictions which I had mentioned, between his journal and the books of
 the naval hospital at Halifax, and recapitulating his former statements,
 but without answering any one of my questio?is, which his memory,
 as he declared, did not enable him to  do.  He moreover intimated, that
 he thought  it  " hard to be  thus called upon, at this  distant period  of
 time, for further proofs of accuracy and fidelity."   Having thus failed
 in my endeavour to procure full information on this subject, nothing re-
 mained for me, but to  employ, as well as I was able, the little which had
 been afforded:  and  as this did not, in any degree, weaken the reasons
 which had, from the first, made it difficult for me to believe the disease
 in question  to have  been the yellow fever, I  shall state those reasons,
 after  having premised the following additional facts  and explanations,
 viz:
   It appears, from official documents, as well as from the information
 which was  given to me verbally,  on the 26th of October, 1807,  by
 Mr. Sawers, who was surgeon  to the Thetis, in  1795,  that in conse-
 quence of the  sickness  and deaths  of most of the  men sent by the
 Hussar on board the  Raison,  a number of seamen  belonging to the
 Thetis* were also sent on board that ship, to assist in  navigating her  to
 Halifax.  And  in Mr.  Sawers' " Medical Journal of his majesty's ship
 Thetis,  from  the 13th  of  October,  1793, to the  14th of October,
 1795," the names and  ages of nine of these men are stated, and against
them,  the several days, from May 27th,  to June 11th, on which thev

  ♦ Mr. Sawers was not able to recollect the exact number, nor the times when sent  on
 bom-d La Raison.   He thought, howeveiythat they might amount to 15 or 16. 
496
were sent to the Naval  Hospital, at Halifax; and  to these names ami
dates, the following explanation is annexed,  viz:
   " These men were sent into  Halifax in a French prize vessel.   We
afterwards learned she had been employed a great part of the war as a
pnso?i ship, atGuadaloupe, and had been very sickly, and a numberof
men had died on board of her.*   When they began to move her stores,
upon her arrival in Halifax harbour,  the  men began to complain, at
different times,  of pains in their heads, attended with rigors and shi-
venngs, and  great lassitude,  loss of strength, with violent retchings;
the matter brought up from the stomach, 1 was told, had  the appear-
ance of contaminated  bile.-f   A  number  of men from his  majesty's
ship  Hussar, were also on board this  vessel, several of whom died;
and it was remarked, that they were either very yellow some time be-
fore death,  or turned yellow  soon  after it.  In  short, from what I
could learn from the prize-master,^ and other people on board, it must
have been the yellow fever.
   " I  had not an opportunity  of attending  those men myself,  as  they
were sent to the hospital,  agreeably to the dates, immediately upon
their complaining.   They were accommodated in the out  apartments
of the hospital, and  in  tents  erected in the fields.  I went frequently
and saw them.   The method of treatment  was as follows: strong ca-
lomel, or other active purgatives, were given in the beginning, and
repeated, whenever  an  inclination to vomit came  on, and  after the ir-
ritability of the stomach was  subdued; bark, serpentaria, decoctions
of chamomile,  and  other tonics,  were given freely,  with  plenty of
wine,  and nourishment; as also, ripe fruits.   In some  cases,  sluicing
with cold water, was administered, with good effects.   They all re-
covered, which I suppose was owing to  early assistance being given at
the hospital."
   In conversation, Mr. Sawers told me that the  disorder  of the nine
men belonging to the Thetis  was slight, that they were able to  walk
about, but looked sallow, and had been taken to the hospital rather as a
precaution, than from any urgency of sickness.   That the Prevoyante
bad  remained three  or four months  at Guadaloupe, after coming there
from France, and had lost some  men during that interval, by the yel-
low fever; but that she was in good condition, and her crew very healthy,
at tlie time of her capture; and that they gave no disorder to the  The-

  * This expression  loaves it uncertain,  whether the writer meant that these men had
(bed on  board the Raison,  during her passage from (iaudaloupe, or whilst she was em-
ployed as a prison ship ; but the latter teems to have been the fact.
  f This comparison does not give me any better idea of the " matter."
  * It appears, by this reference to the prize-master, that no medical  assistant could
have been senton board La Raison, notwithstanding the great number of her own sick that,
as is pretended, were left  on board, and the additional sickness  and deaths of the men be-
longing to the Hussar : and if it had not been for the little information here given by Mr.
Sawers, we should have had none whatever,  respecting th • sickness of thenine men be-
longing to the Hussar, who died before her arrival at Halifax.  And even at this time, af-
ter all my researches  and inquiries, I am utterly ignorant how soon any one of them was
attacked after being sent on board ; what other svmptoms, excepting turning yellow, ap-
peared in any of them ; how long the illness lasted, nor when any of them died. If it had
been  wished to compel a belief of their having all died of yellow fever, by  withholding
eveiy thing requisite to form any judgment whatever, this extraordinary  omission woutf!
have been very natural. 
497
lis ; which ship did not send one man to the hospital after her arrival
at Halifax, excepting the nine who were on board La Raison.   It ap-
pears, however, by official documents, that two  of the crew of tbe
Prevoyante, notwithstanding her good and healthy condition, died on
the passage to Halifax, viz:—one, a French seaman, on  the  25th  of
May,—and one black seaman, on the 26th; whilst none died of the
Raison's crew, though represented as being then in a most sickly and
deplorable condition.  And it is moreover in proof, that after their ar-
rival at Halifax,  the sickness and mortality were much greater among
the crew of the Prevoyante, than among that of La Raison.
   But as Dr. Wilson has  given  an account of his proceedings with
the 83 sick, of the Hussar's crew, it will be proper to give a like ac-
count, in regard to sur.h of the crews of the French ships Prevoyante
and Raison, as sickened before the  7th of July, after they had been,
transferred, on the 28th of May, to the prison ship,  Security, at Ha-
lifax.  It appears, from the books of the Naval Hospital there, that on.
the 31st of May, eight of the crew  of La Raison, were sent from the
prison ship to the hospital ; three of whom died before the  25th of.
June, and one on the 9th of July; and  these were all the deaths from
the  crew  of that  ship.   The other four  remained in hospital four
months ;  and it  seems probable, that the whole number of eight, had
either hectical,  or  chronic, affections;  because  Mr. Halliburton,  in
his letter of the 25th of June, to the Commissioners of Sick and Hurt,
giving an account of  the sick  French prisoners,  says,  " One or  two
hectic patients have died, but none with this fever:" meaning the sup-
posed yellow fever:—an  observation  which  applies equally to the
crews of the Prevoyante, and  makes a detail in regard to them unne-
cessary.  It  seems probable,  however, that after the  crews of these
ships had been transferred to the prison ship, they were exposed to the
contagion of typhus,  (which is, indeed, no uncommon event, in such
situations,) though Mr.  Halliburton, and Dr.  Wilson,  imagined it to
be the contagion of yellow fever.
   Mr. Halliburton, in  the letter  just mentioned, after giving an  ac-
count of his, and Dr. Wilson's  proceedings, in regard to  the Hus-
sar's men, supposed to be labouring under yellow fever, adds, " the
disease now began to make its appearance on board the  prison-ship,
and  as they were much crowded, I represented to Captain Home, now
senior officer, that the same precautionary  measures should  be adopt-
ed,  which were pursued respecting the Hussar; that the sick must be
separated from the sound and healthy,  and that all with suspicious
symptoms should likewise be  removed.  In consequence of which, a
place was hired about six miles from the town, by water, called Kava-
nagh's island, and all the sick, to the number of 31, were towed there,
in a boat by themselves, that they might have no communication with
the  ship's boats that towed them.  Ten or a dozen of them were very
 ill, and many* of them were  afterwards seized with it,  who  had  the

   » It appears,  by this expression that the disease did not actually occur in all who had
 the  first symptoms upon them ; and this circumstance ought, perhaps, to lessen the
 regret which we must otherwise have felt, at Mr. Halliburton's not baying made us $s
 wise as himself,-in regard to the nature of these « first symptoms-
                                 63 
498
first symptoms upon them, when removed, but we have not as yet lost
 one of them ;  and by pursuing Dr. Rush's mode of treating the Phi-
 ladelphia fever by bleeding, &c."  " has  proved very successful,  and
 highly pleasing and satisfactory."
   It appears by the books of the hospital, transmitted by Mr.  Halli-
 burton, to the sick and hurt office, that this removal of sick  prisoners
 took place on the  15th of June; and  that they  consisted of 17 men,
 who had belonged to the Prevoyante, and of 14 who had belonged to
 the Raison ; and certainly there never  was a  more harmless yellow fe-
ver, excepting that of the men under Dr. Wilson, nor one more ac-
commodating ;  for, except one man, who, besides the fever, seems to
have had some lingering chronical  disorder, they are all stated to have
been ill, exactly fifteen days;  so that as they  had been all towed to
the island in one boat, they might all be towed back in another.  There
is,- however,  one important fact connected with this transaction,  and
which seems to have been hitherto quite overlooked ; and this is, that,
among the 17 supposed yellow-fever patients from the Prevoyante, six
were blacks,  (negroes,) whose  names are distinctly entered;  and of
the 14 from La Raison, three were also blacks,  though there were on-
ly ten of that description  among her crew.  Now the idea of  nine
blacks,  coming directly from the West Indies, where they might have
bid defiance to the yellow fever,  even when most prevalent as an  epi-
demic,  and taking  that disease at  Nova  Scotia, a place  where,  like
Great Britain, from its moderate temperature,  tbe yellow fever never
did, nor ever will occur, (at least  without a great alteration  of  its cli-
mate,) must appear as ridiculous and absurd as any thing which can
be imagined ; at least to those who may have read the preceding parts
of this volume, or who shall have otherwise acquired competent infor-
mation on the subject.   This single fact,  in my judgment, would suf-
fice  to  prove, indisputably, that the disease in question, could not
have been the yellow fever ; because the notorious insusceptibility of
negroes, coming directly from  a hot climate to a cold one, would ne-
cessarily,  according to the principles formerly stated, and  the  uni-
form experience of more than a  century, have been encreased, not
diminished; but, on the other  hand, their susceptibility of disease,
from typhus contagion, by  such  a transition from heat to  cold,  would
have been  augmented, as has been repeatedly observed: and this may
explain why so great a proportion  of negroes took the  (typhus) fever
at Halifax.  Dr. Blane, in his letter to Baron Jac6bi, asserts, what he
has indeed repeatedly mentioned in his other writings, that the yellow
fever " has never been known to appear, except either in tropical cli-
mates,  or in those seasons in the more temperate  climates, in  which
the atmospheric heat has, for some length of time, been equal  to the
tropical heat, that is,  at,  or above 80° of Fahrenheit's  thermometer.
This (he adds) is  a fact incontrovertibly established by observation;
for there is no  instance either in North America, or Europe, of the
yellow fever appearing,  except  at these  degrees  of heat, nor of its
surviving after it had fallen to a lower  degree of temperature."  Now,
if Dr. Blane, before he allowed himself to  adopt  and give his sanc-
 tion to  this story, of a  communication  of the  yellow  fever, by  the
 crew of La Raison, to those of the  Hussar, &c.  had exercised his 
499
good sense, in reflecting upon the  usual and probable temperature of
the atmosphere on the coast of New England and Nova Scotia,  at that
early season of the year, he must  have been convinced that it never
could have there attained, and much less have been " for some length
of time," at, or above 80° of Fahrenheit's thermometer.  Mr. Sawers
told  me, on the 26th of  October, 1807, that on the passage to Hali-
fax,  after the capture of  the Frevoyante and Raison,  they had encoun-
tered a gale of wind from the north-west,  which rendered the air cool,
as it must have done  on that coast, where this is the coldest wind; and,
indeed, it appears by the length of the passage,  (12 days) notwith-
standing the aid  of  the  gulf stream,  that the winds must  have been
generally from the north, and the  temperate, probably,  was  during
that time much oftener be low than above 60°:  and it is well  known that
even in South Carolina,  except from  a rare  concurrence  of circum-
stances, the yellow fever does not prevail  before the month of  July or
August; who, then, will believe, that in the frigid climate of Nova
Scotia, it should have attacked so many persons, about the end  of May
and  beginning of June ?  and this  though it never did before, nor since,
appear there, even in the hottest  months of the summer.*
  Whatever the cause of the fever may have been, it certainly was not
derived from, nor first applied  to, the crew of the Raison;  for no one
of them appears to have  had it, until near the middle of June;  where-
as, it is stated in the abstract of Dr. Wilson's Medical Journal, authen-
ticated by his own signature, that three of the Hussar's men (viz. W.
Atterly, John Lopez, and Jonas Ireland were attacked with it, in that
ship, on the 25th May, and two others on the 26th; and, notwithstand-
ing all that  has been  strangely asserted to the contrary, the crew of La
Raison, if any faith can  be placed in official documents, were  less
sickly, and  had less  mortality among  them, than  those of either the
Hussar or the Prevoyante.
   It would be to me a very unpleasant undertaking, were I to enter
upon a critical examination of Dr. Wilson's general account of the ag-
gregate symptoms of  his supposed yellow fever patients;  an account
so indiscriminating and  deficient that  no  body can discover from  it,
whether the ordinary progress of the fever lasted  a week  or a  month;
or even whether it was continued, remittent, or intermittent; and though
some  of the 14 questions forwarded to Dr. Wilson  were especially, and
pointedly directed to  these important circumstances, I  obtained no
answer to  them.  Whether Dr. Wilson was unwilling or unable  to

  * Dr. Trotter, in the first volume ofhis Medicini Nautica, has introduced the following
  atement, at page 357, viz—
  " December 3d—most of the ships which have returned  this season, (the Autumn of
 1796,) from the West Indies, have been sufferers from the yellow fever; yet the diseases
 in all of tliem, uniformly dissappeared as they increased their latitude : at 32° North,
 no fresh attacks were known."  " The Dsedelus frigate, that  arrived at  Portsmouth in
 October, left the  islands with this fever on board; so large a number of men and officers
 were affected, that captain Countess thought it expedient to push for Halifax, to land his
 sick ; but before he reached that port, the disease had taken a  favourable turn, and was
 soon extirpated." If this  effect was produced on the coast of America, in the hottest
 part of the Summer, how can it seem credible,  that, in the month of May, and with cold
 northerly winds, the yellow fever should have made so many  " fresh attacks," as were
 supposed in the Huzzar,  so much beyond the 32d degree of North latitude, and even at
 Halifax itself. 
500
 reniember, is best known  to  himself; there  is, however, one of his
 symptoms, which I cannot overlook, as the description of it seems  to
 have been intended to obviate all doubt of the fever's having been the
 true yellow fever:  and this is " a constant vomiting of,  at first, a yel-
 low, and afterwards of a very dark-coloured bilious matter.*'   At that
 time, the black  vomit, so  called, was thought by  many persons, and
 probably by Dr. Wilson, to consist in a great degree  of condensed  or
 dark bile, and this description seemed to have been intended to induce
 a belief that  black  vomiting was a common symptom among  his pa-
 tients.   But that I might not fall into a mistake on  this particular, one
 of my questions was directed immediately to it: as another was to the
 number  or proportion of  the  sick who  became  yellow ;*  but  these
 questions, like all the others, were left completely unanswered, and, as
 I must think uncandidly; because it is incredible that Dr. Wilson should
 not, at least, have known his own meaning in regard to the " very  dark-
 coloured bilious matter" vomited by his patients;  and it was, I think,
 bis duty to remove all doubt concerning it.  Certainly, if what is  com-
 monly understood by black vomiting had occurred, in even one of his
 83  patients, there is the strongest reason to believe that no more than
 82  of them would  have recovered.   And his  unexampled success, if
 there were no other reasons to disbelieve the existence of yellow  fever
 am mg his patients, would  render it absolutely incredible.  Some gen-
 tlemen, indeed,  from whom I should have expected more discernment,
 have strangely  imagined that  the  recovery of every individual of 83
 patients,  under  Dr. Wilson, might be ascribed to  a superiority in his
 treatment of them,  without suspecting that the disease was not the true
 yellow fever; and Dr. Wilson seems to have derived credit and  promo-
 tion from this mistake; which,  however, is not likely to subsist;  experi-
 ence having,  I  believe sufficiently proved, that in cases of the  true
 yellow fever, recoveries  have not oftener resulted from this, than  from
 other modes of treating that disease: and it will,  I  think, have been
 fortunate, if no  mischief has  been done, by an imitation of that part of
 his practice, which consisted in the giving of antimonial emetics.*

  *  1 have  already several times remarked, that yellowness of skin  is not a characteristic
 symptom of the yellow fever, nor a rare occurrence in typhus ; but, on the contrary, that
 in some circumstances and situations,  (particularly one mentioned by Dr. Lind) it has so
 frequently accompanied the latter fever, as to have procured for it the name  of yellow
 fever. Dr. Blane has, also, mentioned a  similar occurrence on board the Royal Oak,
 where a ship-fever,  introduced by six men  who came from England in the Anson, and
 which extended to thirty others, was attended with yellowness of " the eyes and skin," in
 all that were affected by it, though the disease was very mild in most of the cases.  See
 his work on the diseases of seamen, p  148 and p. 352«
  »  I have mentioned the danger of giving emetics in yellow fever, at p. 67, kc. and this
 danger is multiplied in a ten-fold degree, by preferring antimonials.  The following is Dr.
 Moseley's observation, respecting the effects of emetic tartar, or tartarised Jlntimony, em-
ployed by Dr. Wilson, to the extent of three grains, viz. " How often have I seen  and la-
mented the effects of emetic tartar, given to remove the supposed cause of the treache-
 rous symptom of vomiting !   Even in slight degrees of fever, in the West Indies, in young
plethoric subjects, newly arrived, the stomach has been some times destroyed by it. In-
 stead of removing the irritating sickness in this (yellow) fever, or exciting a diaphoresis, a
 spasm has been produced in the stomach ; incessant vomiting ; inflammation ; the  vessels
 of the thorax and head have been sljfled with blood, and the patient has vomited away fus
 , ife " See his valuable work on topical diseases, &c p. ,435 of the Third Edition*
 Mi'
4 
501
B>
    That the fever which spread among the crew of the Hussar, and in
  the Security, prison ship, could have been no other than a typhus, I am
  convinced.  It was, indeed, so unusually mild, and devoid of mortality,
  that we can only account for so many recoveries, even under that fever,
  by the known effects of a warm temperature (which would have taken
  place at Halifax in June) in first moderating, and soon  after producing
  a cessation of it.
    Whence the infection  of this fever was derived I cannot be expected
  to explain, destitute as I  am of all information respecting the coramur
  nications  which  the Hussar may have had with infected persons, or
  things.  Mr.  Sawers told  me, what indeed  must be otherwise highly
  credible,  that  ships of war on the Halifax station, were sometimes
  known to get the contagion of typhus, by pressing seamen, and emi-
  grants, out of merchant vessels  going from Great Britain  and Ireland
  to the United  States, &c.  many of the latter being often  taken from
  the lower classes of society,  among whom that fever is but  too  com-
  mon.
    In  regard to the fever which produced so much mortality among
  the men sent by the Hussar,  on board the Raison, and of which we
  know nothing, except that some of them became yellow, either before
  or after death, it would be presumptuous in me, without more informa-
  tion, to offer any thing but (a  very probable) conjecture, that it was oc-
  casioned by the foul air or morbid effluvia, contained in her hold, or
  in some other part which these men had rummaged, in search of rum,
  or wine, or other things which their appetites, or cupidity, might dis-
  pose  them to  plunder, and which, in a prize, they might expect to
  find, perhaps, concealed.  In numerous instances,  fevers  resembling
  the yellow fever, and even  more  generally and speedily mortal, have
  been  manifestly produced by exhalations  from the  foul  ballast, and
  other decomposing matters, retained in the ships ;*  and the fact  stated
  in Mr. Sawers's Medical  Journal,  as lately noticed, in regard to the
  men belonging to the Thetis, who were sent on board  the  Raison, viz.
  that " when they began to  move her stores, upon her arrival in Halifax
^ harbour, the men began to complain, at different times, of pains in their
  heads, attended with rigors and shiverings, and great lassitude, loss of

    * For decisive instances of such fevers, produced by these causes, see the New-York
  Medical Repository, voh i. p. 394, vol. ii- p. 327, vol. iv. pages 2, S, 243, 245, and 353 ; vol.
  vi. p 159 ; vol. vii. pages 86, 87, and 88; and vol. viii p. 71.  The  first  instance in the
  4th vol of this Repository relates to a yellow fever produced by  the foul atmosphere of
  the hold of  the  America frigate, General Green, which was fatal  to twenty persons,
  and decidedly not contagious; though some of the crew fell sick on board, several weeks
  after she had been cleansed and freed from the noxious matters producing  the noxious
  atmosphere ; a circumstance, for which  it then seemed difficult to  account, but which,
  from what I have mentioned in a  former part of this work, concerning the time that mi-
  asmata often remain inactive,  may  now be  readily  explained.  See also, for similar in-
  stances, Trotter's Medicina Nautica, vol. ii. p 97, &c. Dr  Gillispie's volume, page 19
  20, 21, and 61; and Valentin's work on yellow fever, from p. 121 to 129.   I could easily
  multiply these quotations, but I will finish with one from. Or Blane, on the diseases of sea-
  men, p 609, viz.  " With regard to the effect of putrid exhalations, I need only mention
  that at the time of (the battle of the 12th of April 1782, there was not  a sickly ship in our
  fleet, but many of the officers and men who were sent  to take care of the  French prizes,
  were seized with the yellow fever ; and it was observed, that when at any time the holds
  of these ships, which were full of putrid matter were ttirred, there was an evident in-
  crease of these fevers soon softer."                  n                * 
502
strength, with violent retchings, Sec. seems to prove the existence of a
noxious atmosphere, or rather of matters capable of emitting noxious
effluvia when disturbed;  and this might well be expected  in a ship
which had been long employed as a prison ship, and afterwards sent,
probably without being cleaned, to obtain a cargo in the United States,
for France.   That this fever, or that which afterwards occurred at
Halifax, could not have resulted  from contagion in the Raison,  must
be evident; because if that had been the case, as it  must have been
applied to her own crew several  weeks before, and for a much longer
time than it was to those of the  Hussar and Prevoyante, the former
would not have been  among the last and least sufferers by it.  Here I
will close this appendix, and, with it, this volume. 
            BY




JOHN B. DAVIDGE, A.M. M.D.
«fc. $c.
0   .
I* 
 
NOTES.
                             Page 40.
The matter of black Vomit is, notwithstanding the reports of tbe  ex^
aminations of bodies dead of the yellow fever, sometimes met with in
the gall-bladder, common duct leading to  the duodenum,  and in  the
duodenum, in considerable quantities, as well as in  the stomach.  I
have had occasion to observe this fact, and have also been informed by
respectable authority, in which  the utmost confidence may be placed,
both as to dignity of character, and acuteness to observe, that such is
the fact.  To Dr. Wm. Donaldson, a  physician  of great circumspec-
tion in  observation, and  extensive professional knowledge,  I am in-
debted on this head.
  That the matter of black vomit is the result of morbid secretkm,
appears to be the opinion of  some of the best informed in  this city,
Baltimore.  The hemorrhage  occasionally met with is, perhaps, inci-
dental.  That the liver is the organ chiefly concerned in the  secretion
of this matter, I am strongly inclined to believe, from its presence in
the gall-bladder, and its existence  in  cases where there has been no
effusion of blood, at least, observable.

                             Page 93.
I have taught, from my Chair  as Professor, for several years past, tbe
doctrine, which I am much gratified to find advocated by the able  pen
of Bancroft, that putrid animal matter, simply as  such, is never pro-
ductive of fever.  And although in certain habits, sickness at stomach
and faintness may Occur from the effluvia  of putrid animal bodies, yet
in regard to the production of regular fever, of whatever type or genus,
they are wholly innocuous.
  The genius of our learned author has shed much important light on
the subject of Typhus, arising from  collections of healthy persons in
ships, hospitals, or jails.   He properly and judiciously rejects all such
speculations, and places the affair in its proper attitude.  There is no fever
that can with propriety be attributed  to any such collections of healthy
persons. If disease, fchrile disease, take place among persons crowded
                                64 
together in ships, or jails, or hospitals, we must look for its cause to
some other source, than the recrementitious materials thrown off from
the bodies; the cause is from without.  When persons  die under the
circumstances above suggested, it is somewhat as when they die from
carbonic acid gas; they are  killed negatively.  In other words, they
die for want of pure, repirable air; not from  any poisonous operation
of the  ffluvia.  These effluvia, I hold to be, equally with those from
putrid dead animal bodies, unproductive of a febrile disease.

                            Page 122.
In the Introduction, I have taken the liberty to prefix to  this volume,
the reader will have perceived that I have called the attention of the
medical philosopher to the important, yet simple fact, that no feverous
disease arises from, or with propriety can be referred to, more than some
one simple cause, however aided that cause may be by circumstances
incidentally disposing the body to be acted on.  And that if the yellow
fever be derived from marsh miasmata, as  is proved by  the ingenious
and learned author of the present work, and is well known to be a fact,
by every man conversant with the subject,  it is altogether unphiloso-
phick, if not absurd, to ascribe it to a poison generated in the body.
All communicable diseases, so far as our  researches extend, have their
origin universally from poisons generated in the Uving body. How. con-
tagious diseases came first into operation,  whether from climate and
conditions of life, or original  poisons created by Deity, as the various
principles of animal and vegetable lives are, I am not prepared to an-
swer.  Much learning and talent have been  displayed  on  both sides.
  No disease, that has its origin from a poison or cause not formed by
the morbid action of living  vessels, is communicable or contagious.
And if the yellow fever be, a thing occurring daily, imported from one
country to ..nother, it must be in the original materials, and not by dis-
eased bodies, or infected clothes.  I  touched on this subject in my
Sketches, published in 1798.

                            Page 312.
In the year 1797 I was, by a particular combination of circumstances,
led into a discussion on the nature and origin of the yellow fever. Mat-
ters took such a course, that I  deemed it proper, in  the beginning of
1798, to collect and arrange into form  the scattered and fugitive  re-
marks, that, during the discussion, I had occasionally given  to the 
507
public, and to publish them  in a more serious and formal manner, as
the result of my mpst mature deliberations and judgment.
  In this small Treatise, I assumed it, as an ascertained medical axiom,
that no marsh disease is a communicable disease; that the yellow fever
is a marsh disease; that as  such it cannot  be communicated by any
intercourse of persons; that its diffusion is  co-extensive with, and at.
tributable to the  marsh effluvium; and that no disease whatever is de-
rivable from more sources  than  one: every simple effect being the
production of a simple cause.
   Sir Gilbert Blane, although  he has altogether failed in establishing
his favourite hypothesis, furnishes an important argument for us to be-
lieve that the yellow fever is not found beyond the influence and opera-
tion of the marsh effluvia.   So well assured is he of this valuable and
pertinent fact, that he delivers it as his serious and professional opinion,
" the few cases that occurred in the Hussar, after her arrival at Hali-
fax, are  to be ascribed to the inhalation of poison in the warmer lati-
tudes," (not to the contagion emitted from the diseased bodies on board
of ships);  " and ventured to assure the Ministers of Russia and Prussia,
that their countries had nothing, to fear from the importation  of this
pestilential epidemic."
   No point in medical history is better ascertained, or more strongly
established, than that all diseases known to be contagious, are certainly
more communicable in the colder than  in the warmer latitudes.  Nor
can a stronger or more conclusive  argument against the contagious
nature of the yellow fever  be brought forward  than the well-settled
fact; it does not communicate in the more cold and  humid  regions.
 It is well known, and wholly beyond controversy, that all poisons, ani-
 mal secretions, are more condensed, and,  in proportion to their state
of concentration, more active, in the colder  than  in the warmer lati-
 tudes.   This holds true in  regard to the small-pox, measles, chicken-
 pox, mumps, &c. &c. and  every other contagious disease which acts
 through the medium of the atmosphere.   Contagions  that act by im-
 mediate contact, as canine madness, siphilis, and perhaps the plague,
 act equally in the colder or warmer regions.  I am writing at present
 on diseases that communicate  at smaller or greater distances, without
 contact.  But to return to the facts of Sir Gilbert.
   " It has never," says Sir Gilbert Blane,  " shewn itself, in the fisrt
 instance, but in a sea-port  town, and never in the interior of the coun-
 try, whether island or continent."  4? 
508
   In scientific disquisition there is nothing less  entitled to considera-
 tion, or  more unphilosophic, than dogmatical  gratuitous  assertion.
 That the yellow fever has never, in the first instance, shewn itself but
 in a sea-port town, is wholly gratuitous, and in direct opposition to facts
 from the  most respectable authorities.   From  authorities, which, as
 they are  not professional, and had no particular prepossession to sus-
 tain, must be viewed as the more valuable and disinterested.
   To aver that to be an uniform, or even a general fact, which has been
 the object of our personal observation only, is to proceed very far on the
 principle of the begged question.  For although  personal observation
 affords  respectable ground on which our author is to repose his opi-
 nions, it is proper to take into account the consideration that our indivi-
 dual experience does not embrace in its range the whole field of facts, and
 may not be laid under those circumstances, as to country and climate,
 demanded by the subject in discussion.   That the first  appearance in
 the interior of the  country, in any one instance, of the yellow fever, was
 not the experience of Sir Gilbert, is a thing very probable.  But from
 Such personal  negative observation there can be no positive induction
 that the fever never shews itself, in the  first instance, but in a sea-port
 town.   The conclusion is far more than commensurate with the pre-
 mise, and  such as to furnish ample reason to  question  the  ground
 upon which it is made.
   That the yellow fever does not shew  itself, except  in a  sea-port
 town, involves a full consideration of all the circumstances of its origin.
 We are led by the position to an examination of all those sources from
 which it may possibly derive its  existence: and also of the various tes-
 timonies as to facts.   It must be shewn, that the original cause, what-
 ever it may be, cannot have place but in a sea-port town.   The disease
 must have derived  its origin  from some definite cause, and  under
 given circumstances.   What can this cause be, and what are those cir-
 cumstances ?
   If the cause be human effluvia, it is difficult to conceive the circum-
 stances, in a sea-port town, under which such  effluvia  can  efficiently
 act, that could not have place in a town in the interior of  the country,
 whether island or continent.  I am apprized of the operation of no
cause or  causes productive of disease, contagious or not contagious,
exclusively the production of a sea-port town. Whether human efflu-
via, or  marsh effluvia, or any vegetable poison, be the  subject pre- 
509
scnted to mind, I am still at a loss to conceive why, occasionally, such
effluvia or poison might not be furnished, under given circumstances,
in an inland as well as a sea-port town.
   That the yellow fever does  not shew itself, in the first instance, ex-
cept in a sea-port town, is, a priori, indefensible, and, I am convinced,
in contravention of well-established facts.
   Dr.  Miller, of New York, in his excellent Essay on the  Yellow
Fever, repeats a communication,  highly important and valuable, by
Mr. Andrew  Ellicott, a gentleman of character, both as regards ability
to observe, and integrity to communicate such matter, as his enlight-
ened mind might deem worthy of communication and public notice.
   " The village of Galliopolis," says this judicious  observer, " is a
few miles below the great Kanhaway, oft the west side of the Ohio
river, and situated on a high bank.  It is inhabited  by a number of
miserable French families.  Many  of the inhabitants, this season, fell
victims to the yellow fever.  The mortal cases were generally attended
with the black  vomiting.   This disorder  certainly originated  in the
town, and in all probability from the filthiness of the inhabitants, added
to an unusual quantity of animal and vegetable putrefaction in a num-
ber of small ponds and marshes within the village."
   " The fever could not  have been taken there  from the Atlantic
States, as my boat was the first that descended the river after the fall
of the waters in the spring.  Neither could it have been  taken from
New Orleans, as there is no communication at that season of the year,
up the river, from the latter to tlie former of those places.   Moreover,
the distance is so great, that a boat  would not have time to  ascend the
river after the disorder appeared that year in New Orleans  before the
winter could  set in."
   " General St. Clair," continues Miller, " who had the advantage of
a medical education, and is, moreover, a gentleman of a discriminat-
ing mind and distinguished talents, has assured me, that he is well
convinced the yellow fever is  an  endemic complaint, in a large por-
tion of our south-western  country, where he  resided as governor a
number of years."
   Here are two interesting facts; one communicated, "in a public do-
cument, by a gentleman who cannot be supposed  to be at all involved
in the professional  question of contagion; the other by a gentleman
who was educated under the old  doctrine of .contagion.  Until 1797, 
5W
when a fugitive  communication or  two appeared hi the  Baltimore
newspapers,  from my pen, I  find nothing but the idea of contagion
in any American writer, and it must be presumed that the preposses-
sion and habits of thought with general St. Clair, were  in favour of
contagion.  The  circumstances of his observations must have been
very decisive in character,  for him to embrace new  sentiments, and
abandon altogether the doctrines he had  received in his early years.
   With the former of these gentlemen, Mr. Ellicott, there could have
been no conceivable reason, or interest, for him to misrepresent a plain
fact.  He could have had no professional prejudice to overcome; no
affair of party to support.   In short, there could be nothing to give to
his narrative  a false or disingenuous colouring, or to  his mind a dis
honest obliquity.   He is no^only positive as to the fact, but, by a plain
and conclusive course of reasoning,  shows that the disease must have
derived its origin from the circumstances of the village.
   In addition to the above,  we  are furnished with a fact or two by Dr.
Watkins, a man of distinguished talents and  acute observation; and
whose decision is the more  valuable,  inasmuch as he was educated in
Edinburgh, under the doctrine of contagion,  and is to be presumed
not to be wholly free from prejudices in favour of the system of con-
tagion.
   " There  is  a village," says the Doctor, " called New-Design, about
fifteen miles  from the Mississippi,  and twenty from   St.  Louis, con-
taining about forty  houses,  and  two hundred souls.  It is on high
ground, but surrounded by  ponds.   In 1797,  the yellow fever carried
off fifty-seven of  the inhabitants, or more than a  fourth.   No person
had arrived at that village from any part of  the country where this fe-
ver had prevailed, for more than twelve months preceding.   Our in-
formant resided in the village at tlie time, and, having seen the disease
in Philadelphia, he declares it to be the same that prevailed at New-
Design.  He also mentions an  Indian village depopulated by the same
disease, two or three years before."—Med. Rep. vol. iv. p. 74.
   In corroboration of the above communication, Dr. Watkins, during
a stay of a few days in Baltimore, visited several cases of yellow fever
with me, and gave  the assurances  that he had seen, in  the  western
country, perhaps allud'ng to the instances  already quoted, a disease
accompanied  by  all the circumstances and phenomena that were pre-
sent in the  yellow fever we were then visiting. 
511
  2dly.  <{ No part of the population of the towns where it has broke
out has been affected,  but such as had  some communication with the
shipping, directly or indirectly."
  What  sir Gilbert Intends to convey by the term indirectly, it is diffi-
cult to conceive,  since no one  fact on the page of faithful medical re*
cord is more uniformly true,  than  that no persons  residing remote
from the sources of marsh effluvia,  have ever received the disease by
way of contagion from other persons, who have  contracted the fever
by being in the more  immediate vicinity of such sources.
  Why  those who  may be in the neighbourhood of the shipping, will
have the disease, is obvious.  The shipping is along the wharves, and
the wharves are,  for the most part, constructed  in, and sometimes of
the alluvious soil, the very materials  to which the origin of the fever is
justly  referred.   That certain  persons, of highly susceptible  habits,
residing  at sites remote from the shipping, may be affected, is not only"
possible, but probable.  It may be readil/ conceived, and there is re-
spectable record to support the opinion, that by certain currents of
air, the poison evolved by the  wharves or ponds, or alluvion, may be
carried to great distances,  and  applied to those highly sensitive habits,
and produce the  disease, while the general  population would remain
healthy.   What  given quantity of the  poison is  adequate to the pro-
duction of the disease, is not  ascertained;  and were it, the great varie-
ties of susceptibility remains to lie settled.   Before a medical philoso-
pher permits himself to admit the existence of contagion, he should be
well satisfied that no marsh effluvia are  present;  since few, or no men
are so sceptical at the present,  as not to concede that this fever does,
jxi the general, have its origin  in poison thrown off by alluvious earth.
   Sir Gilbert Blane constantly speaks of this fever,  as being present
with the shipping.   He does not surely mean that it arises  from the
ships, or the sea-air,  or the  sea-water.  It must be ascribed to some-
thing contained in  the ships.  What can this something be ? If it be
animal matter—animal matter is  found remote  from ships, in all its
possible conditions. If it be vegetable matter—vegetable matter, under
all its  changes  and  revolutions, is met with in places distant from ship-
ping or wharves. If animal  and vegetable matter, mixed  and' com-
bined, the  same mixture  and combination are  discovered  in ponds
and lakes, and alluvious soils  in the interior of the country, whether
island or continent.   If the reference be to multitudes collected toge- 
512
 ther, and living filthily, the same conditions of life are to be met with
 on land, in places to which ships can have no  access, and under the
 same latitudes.
   '* In the year 1798," says sir Gilbert, " I wrote a letter to Mr. Rufus
 King, minister from the United States of America to the British court;
 and in the year  1801, another to  Baron Jacobs,  minister from Russia,
 for the information of their respective governments.   In these letters I
 laid particular stress on what occurred regarding a French ship, taken
 in battle on the coast of America,  in May, 1795,  on board of which,
 this fever, or its infection, was found, and was communicated  to the
 seamen of the British ship Hussar, by the men in health, who were
 shifted into her from the prize.  It is evident, that if it could be proved
 that this fever is communicable from one ship to another at sea, such a
 proof of the reality of contagion would be of the nature  of an experi-
 mentum crucis, there being no possibility of land exhalations to ac-
 count for  it;  such I  then cc -sidered, and still consider the facts of this
 case to be; they were,  however, so strongly and  so speciously  con-
 tested  by Dr. Bancroft, as greatly to  frustrate the  impressive  effect
 which my statement was calculated to produce.  The reader will be
 able to judge  of the validity of his objections from an annotation at
 the end of this  work.  I feel to myself that  I was so far from making
 too much advantage of  these  facts, that I might and ought to have
 availed myself  of them still more.   I^might have adduced them  as  a
 very striking illustration of the incompatibility of  the disease with  a
 certain temperate degree of atmospheric  heat, for the range into cool
 and pure air, in proceeding to Halifax, did in a very short time, first
 deprive it of its malignity, and then of its infectious nature, so as en-
tirely to extinguish it.   The few that were seized after arriving at Ha-
lifax, might have imbibed the poison, in the warm latitudes  through
which they passed.   It was on the strength of such tacts as these, that
in my conferences with  the members of the British parliament, and in
my correspondence  with  those of  Russia and  Prussia, I  ventured to
assure them that in none of those countries was there any thing to fear
from the importation of this pestilential epidemic, which in the end of
the last century, and in the beginning of this had so afflicted the West
Indies, North  America,  and  Spain,  as  to excite  a general  alarm
throughout Europe." 
513
   " There is another useful remark which I did wrong in omitting in
my statement of fourteen men sent from the Hussar to navigate the
prize; nine died before reaching Halifax,  a passage of twelve days; the
other five were sent to the Hospital,  where some of them probably
died."
   In the two paragraphs, just quoted, Sir Gilbert Blane has given what
he terms the experimentum crucis.   From them  I  expect to derive
such proof as will be satisfactory to all, in any degree acquainted with
the nature of the subject, that there is not in the circumstances detail-
ed, the slightest evidence in favour of the hypothesis of contagion.
   " It is evident," says Sir Gilbert, " that if it could be proved that this
fever is incommunicable from one ship to another at sea, such a proof
of the reality of contagion, would be  of  the nature of an experimen-
tum crucis, there being no possibility of land exhalations to account
for it."
   It has never before been suggested by any writer, that the  yellow
fever, as to its origin or  cause, is attributable to land exhalations.   I
was not aware that land, as land, evolved any exhalations to which any
fever could be legitimately traced.  It is only contended that the yellow
fever is properly ascribable to a certain condition of vegetables, whether
on land or on board of ship.  And, notwithstanding the authority of Sir
Gilbert, I am still disposed confidently to believe, that putrid coffee, or
cabbages, or potatoes, or flax-seed, Sec. &c.  would be the same, in na-
ture and effect on board of ship,  as on the  land.  The profession,  no
doubt, will be amused, if not instructed, to hear from such high and
respectable  authority, that the yellow fever is derived from land  exha-
lations ; or that it is necessary for  putrid vegetable matter or foul water
to be on land, to emit the noxious poison from which this fever draws-
its origin.
   Hitherto it has been  presumed, and  really I thought the opinion
rational and modest, that vegetable or animal  substances, in a given state
of putrefaction and quantity, would, other circumstances being equal,
produce the same effects at sea as in harbour.  But it appears that the
common sense  of the world, acting upon the experience  of all  ages,
has been wrong;  place and vehicle are every thing !
   Perhaps, however, Sir Gilbert, or those who conceive his facts and
arguments to be decisive, can furnish the rationale, why a foul ship, as 
514
the French prize is  acknowledged to be, lying along-side of a clean
ship, at sea, could not, as readily and certainly, by poisonous exhalations
evolved from her foul materials, produce disease in the seamen of the
healthy ship as in harbour.
  To my understanding the proximity and relative position of the ships,
the exhalations and  presence of healthy excitable bodies, the inter-
course between the ships, would result in the same on the ocean as at the
wharf.
  Sir Gilbert says nothing of the relative position of the ships while en-
gaged in battle, or after the French struck her colours to the English
ship; not whether they fought in contact, in  grappled relation; nothing
as to the course of the wind, whether from the  foul French ship to the
healthy British seamen, nor whether the French ship was boarded after
the fight, by way of taking  possession of her,  by the  British seamen;
nor whether the very seamen who took possession, in part, at least, were
not those, who after the ships set sail for Halifax, became diseased.
  An inquiry into the above is of primary importance to me : but to
Sir Gilbert and  his admirers it may not be so necessary.  They are
satisfied that no land exhalations were present.
  As the facts now stand stated, there is no more evidence or probability
of contagion, than if I were, with a company  of armed men, to approach
a wharf, or any other source of foul alluvious ground,  engage in battle
prove victorious, take  possession of the unhealthy district, and, after
the delay  of  some hours, necessarily consumed  in making arrange-
ments, within the range of the miasmata, again continue on to my des-
tined position, taking with me a few healthy prisoners, there would be,
that my company would be diseased by the healthy men taken, and not
by the poisonous exhalations which had been  inhaled during the con-
test, and the delay in the neighbourhood of the alluvious ground.   And
were I to give publicity to the opinion, that the company attacking, most
certainly took the disease from the healthy men, and not from the foul
district, my ignorance, I believe, would meet with  little else, from men
of science, than pity or contempt.
  The cases  are parallel as far as  regards every thing that can be con-
ceived to be efficient in the production of the disease.
  To knOw how very foul the French ship was, we have only to admit
the evidence  of Sir Gilbert, " that of the fourteen men  that were put
on board the  prize to navigate her into Halifax, in the course of twelve 
515
days nine died, and the remaining five were sent diseased to the Hos-
pital, where probably some died."
  Certainly no ship could be more foul;  but yet, not a word is said of
the medical men, nurses, or patients in the hospital.  Was the disease
communicated to them? No.   Did the purity of the air of the  Hos-
pital check the contagion ?  A  contagion can a,ct at sea, in the purest
air, but cannot be propagated in a Hospital!  Had a few of the citizens
of Halifax paid a visit to the foul prize, they, in all probability,  would
not have found the air of such purity, as to have kept them in safety.
  Can credulity itself adrnit that a contagion which, on board of ship,
is so virulent, as not to permit  a  solitary man, out  of fourteen, to es-
cape, and yet to become weak and innocuous the instant it is placed
within the walls of an Hospital!                           *
  In regard to the British ship, the Hussar, we are told that the sea-
men were infected by the healthy taken from the prize ship.  Sir Gil-
bert does not enter into particulars;  he does not say all her seamen.
Yet the phrase, the " healthy men from on board the prize communi-
cated to the seaman of the Hussar," does, by liberal interpretation, mean
the whole.   Or Sir Gilbert may mean that the healthy men from  the
prize, communicated the fever to  the men of the Hussar who had been
on board the prize.
  That he does not mean the whole of the  men of the Hussar is cer-
tain, from what follows.  " The few that were seized after arriving at
Halifax, might have imbibed the poison in the warmer latitudes through
which they passed."  And if the  few who were seized after arriving at
Halifax,  imbibed the poison while passing through the warmer lati-
tudes, what certainty is there that the few or many that were  seized
before her arrival at Halifax, did not derive the poison from the  same
source—the warmer latitudes.  Or from a source far more probable,
the exhalations of the prize while  engaged in battle with her, and sub-
sequently during the stay in her neighbourhood.   The marsh effiuvia
will evolve its effects in morbid plienomena, after the lapse of eighteen
or twenty days, or indeed several months.   I write from personal obr
servation and knowledge.  See Bancroft, p. 81,
  " There have occurred, since  the  period alluded to,  facts equally
conclusive, regarding the communication of the disease from one ship
to another.   It will be enough to specify one or two.  ' A French ship
of vvar^ the  Palinurus,  lying at Martinique, severely affected vwith the 
516
 yellow fever, was ordered on a  cruise, to try the effect of sea-air on
 the disorder.  She fell in with and captured the Carnation, a merchant
 ship, on her passage from England, part of the crew of which were
 seized with the fever while at sea.  Another French ship of war, in
 which this fever prevailed, both  at St. Domingo, and on her passage
 to Brest, made prize  of a merchant ship from the Mediterranean, off
 Cape Finisterre, and having, without shifting  the persons, sent a party
 of their own seamen to navigate her, the crew of the prize caught the
 fever,  and almost all  died of it.  The  men having been seized on
 board of their own  ship, makes it a stronger  case than the other, in
 which this circumstance is not mentioned; had they been taken ill on
 board the capturing  ship, it might have been said, that it was from the
 exhalations of the hold or stores."
  In the affair of the Palinurus, the narrative,  as far as it goes, amounts
 to but little.  It is not stated, whether the men were changed from
 the merchant to  the foul ship.  It is only affirmed, that the Palinurus
 captured a merchant ship from England, and that a part of the crew
 were seized with the fever while at  sea.  It may fairly be presumed
 that the healthy men were  translated to  the  French ship, for Sir Gil-
 bert appeal's at this stage  of his argument, to be quite sensible of the
 possibility, perhaps certainty, of the disease  being communicated by
 the " exhalations of the  hold and stores."   And had the capturing
 ship sent  her men on board the merchant ship, he  would have been
 careful to  take advantage of the fact.  The case  of the  Palinurus,
 therefore, might, with no loss to  the argument, have been omitted  in
 this catalogue of imaginary facts.  It is altogether without bearing on
 the subject.
  The second case carries with it,  at first view, some speciousness
 and plausibility.  It however, conveys us to  the old ground, and we
 have again to inquire, at  what distance did the merchant ship remain,
 after capture, and while she kept with the ship of war, affording facili-
 ties for the removal of the men from  the ship  of war, together with the
 body and  bed-clothes to  her  own  cabin? With the men, provision
 for their support until they could arrive  at Brest, was, doubtless, con-
 veyed from one ship to the other.  This  provision, possibly, might be
vegetable, and this vegetable matter not  in the sweetest and  soutidest
 condition.  Might I propound the question,—Was this disease  at first
produced, and afterwards kept up, by this provision ? On land, nothing 
517
more usually gives  origin  to  fever, than  putrid cabbages,  pota-,
toes, &c.
  Without the least  violence to probability, or even  fact,  it may be
admitted, that the two ships lay in convenient relation to each other,
side by side, or at a short distance.   The two ships, under  such cir-
cumstances, would of necessity be  involved in the same exhalations,
which, Sir Gilbert acknowledged, in the  other  ship, to pour out from
the hold and stores very copiously.   Twenty minutes may be, equally
with twenty  days, sufficient time for the poison to make its impression.
From the great  mortality the poison must have been active and con-
centrated.
  All that is said derives probability and strength from the fact  that
the capturing was the  foul ship.  Hence there could be no possible
reason why the two ships should keep at a distance.
   It is not said that, on the arrival  of the ship carrying those, almost
all of whom died on their way to Brest, the disease was communicated
to any persons of the town or hospital.
   Neither Sir Gilbert, nor any  of his admirers, will tell us that the air
of a city or hospital,  is better suited to put a stop to a contagious dis-
ease than the pure air of the ocean.   While on board of ship, as in the
affair at Halifax,  the disease operated; but when the men were  re-
moved to the hospital, it ceased. Nothing can be  more clear and con-
clusive, than that the poison was in the ship, and not in the persons.
   Such are the facts which have afforded cause of great triumph to  a
writer, in a late number of the Medical Recorder; a book deservedly
of extensive circulation, in favour of the opinion,  that the yellow fever
is a contagious disease.   Facts, from which my mind, were they insu-
lated, and the only known facts in relation to the  fever, would deduce
the opposite  conclusion,  or  surrender  its privilege  of thinking  and
 reasoning.   The assertions of sir Gilbert Blane, and the pretty and im-
 passioned declamations of his friends, being laid aside,  there is nothing,
 as  I hope, the reader perceives, in his facts, to induce even a careless
 inquirer to believe otherwise, than that the yellow  fever is of the marsh
 progeny, and incommunicable. Dr. "Bancroft had great reason, in-
 deed, to contest the subject,  and weaken the confidence of any Board,
 in the opinions and conclusions of sir Gilbert. 
010
                            Page 337.
 It is gratifying, to the cultivators of science, and highly beneficial
 in the promotion of patient and successful research, to sec such abili-
 ties and professional knowledge, as possessed by Armstrong and Ban-
 croft, blending their  powers and influence in recommending the im-
 portant, and I apprehend defensible doctrine, that the typhus fever is
 a contagious disease,  and referrible to a generick poison alone, in the
 same manner as small-pox, canine madness,  Sec. &c.
   While I refer  the  reader to the work  of Armstrong, for the facts
 and the arguments, he will excuse me,  if I quote a sentence or two
 from his valuable pages.  His opinions are so  pertinent, and so natu-
 rally constitute a part  of my present subject, I cannot avoid doing my-
 self the pleasure  of recording them.
   At page 7, says Armstrong, " It strikes me, that to call any species
 of fever typhus,  which has not the contagious essence, capable of pro-
 ducing an unequivocal typhus, is equally incorrect in logic as in lan-
 guage.  In this  essay, therefore, the word typhus  shall  be limited to
 the peculiar disease,  which is allowed to originate from a specific con-
 tagion, and  which, doubtless, has  the power of producing an affec-
 tion of its own nature, in individuals exposed  to its influence."
   The typhus is not,  so far as my observations have  extended, a dis-
 ease of Maryland, perhaps  not of America; at any rate, not south of
 the New-England states.  And since, as Armstrong and Bancroft,
 and most other enlightened physicians, admit contagion as  essential to
 typhus, (I here refer  to the typhus of Britain and Ireland)  it must be
 highly absurd to speak of tbe typhoid condition of diseases, in regard
 to those  diseases  that are not admitted to be contagious in any stage.
 For surely, no disease can be said to be like  another, that  is deficient
 in an essential quality.  Hence it appears, how unphilosophic  the lan-
 guage is, that states the  low and collapsed condition of the body, in
 remittent bilious  fever, synocha of the whiter,  or  pneumonia, to be
 typhoid.   Those  diseases are wholly distinct  from typhus,  in all their;
.Stages, cause, and sensible phenomena. 
519
                            Page 369.

In my  nosology, I  have considered the  plague as  a species  of
typhus.   More extensive reading, and  the consultation of the more
modern and enlightened authorities,  have, however,  satisfied me that
I was not correct.   The plague, upon the authority of those who ap-
pear to  have had the best opportunity to observe it, is an exanthema-
tous or eruptive disease, and as distinct in nature and character from
typhus,  as from small-pox, or measles j it is a disease sui generis.
THE EXB. 
if 
INDEX.
                               A.

AbeYinethy, Mr. quoted for a case of black vomiting without yellow
   fever, p. 26, n.
Adams, Dr. quoted in regard to variolous and vaccine infections, 91, n.
   His opinion that febrile contagion  may be generated by crowding,
   contested, 338. His mistake respecting the Old Bailey session, 1750,
   445, n.
Agathias, quoted respecting the plague in Justinian's reign, 392, n.
Aine, J. J. Job, his deputation to Cayenne, 104.
Akenside, Dr. his opinion of Dysentery, 354.
Appendix, No I. On the nature of the black vomit, and the condition
   of the stomach, Sec. in yellow fever, 415.
--------, No. II. Proving that putrid animal effluvia do not cause
   fever, 420.
■c-------, No. III.  Proving that the crowding in the black hole  &
   Calcutta, did not produce fever, 425.
         , No. IV. Facts respecting the black  assize at Oxford, and
   the spring sessions at the Old Bailey, 1750, 430.
--------, No. V. Hotel Dieu, at Paris, 446.
--------, No. VI.  Salubrity of Peat bogs, 447.
________, No. VII.  Confutation of Dr. Chisholm's account of a " Ma-
  lignant pestilential  fever" supposed to be brought to Grenada by tlie
  ship Hankey, 447.
________? No. VIII. Controverts the alleged communication of yellow
  fever from the French prize, La Raison, to the crew of his majesty's
  ship, Hussar ,488.
Anjula, Dr. his account of the yellow fever in Andalusia, 307.
Armesto,  Dr.  Rodriquez, his account of the yellow fever at Cadiz, 303;.
                                66
                                                             %
                                                             I 
522
                              B.

Bacov, Lord Chancellor, his opinion concerning human putrefaction
  and jail infection, 93.
Baglivi, quoted respecting the effects of marsh miasmata at and near
  Rome, 165.
Balfour, Dr. his designation of Dysentery, 353.
Bartholina, Thomas, his account of a marsh fever at Copenhagen, 209.
Batavia, accounts of, 127.
Baussard, Mr. his dissection of a putrid whale, 423.
Baynard, Dr. Edward, quoted respecting the weather during the plague
  of London,  1665, 404, n*
Beaver, Captain Philip, quoted in Appendix, No. VII. passim.
Berthe, Professor, sent  by the French government to enquire concern-
  ing the yellow fever,  44. n.
Black Assizes at Oxford, 110.
      ■        at Exeter, 111.
     ,  '  ■     at Taunton, ibid.
Black hole, at Calcutta, 108/
—— skin diminishes the sun's rays, 193.
—— vomit,  not  peculiar to  the  yellow fever, nor a constant symp-
  tom, 39.
Blane, Dr. his opinion of the Black vomiting, 45.
Boghurst, Mr. William, quoted respecting the plague, 410.
Bourgeois, M. mentions a remarkable difference between Creole  and
  African Negroes, 155.
Brocklesby, Dr. mentions the yellow suffusion of the skin  in marsh
 •  fever, at the Isle of Wight, 211.
Buce, Mr. William, his account of marsh fever and dysentery, at
   Sheffield, in New England, 355.

                                (5.

 Caldwell, Dr. asserts the temperature at Philadelphia to be from four
   to six degrees above that of the surrounding country, 191.
 Chalmers, Dr. his account of the effects of heat and moist, in South *
   Carohna, 1 87.
 Chirac, M. hi6 acceunt ©f die yellow fever at Rochefort, 297. 
523
©hisholm's, Dr. observations on his practice of exciting salivation, 74.
  in Appendix, VII.
Clarke, Dr. James, of the influence of the weather in producing yellow
  fever," 149.                          0
------, Dr. John, his account of the violent effects of marsh effluvia at
  North Island, 79.
Clay in soils, favours the generation of marsh miasms, 85.
Coxe,  the Rev. William asserts that jail fever does not exist in Russia,
   116.
Cullen, Dr. his definition of yellow fever, 25, of typhus, 337,  of dysen-
  tery, 353, of the plague, 376.

                                D.

Dancer, Dr. his account of the expedition against St. Juan, 195, »
Davidge, Dr. his account of the yellow fever at Baltimore, 252.
Deidier, Dr. rejects the use of mercury in the plague, 411.
De Roset, Dr. of the yellow fever in North Carolina, 249.
Desgenettes, Dr. quoted respecting the plague, 398, &c.
Devize,  M. of the yellow fever at Philadelphia, 257.
Deimerbroeck, of the plague, 377.
 Du Tertore  Pere, of the yellow fever at St. Christopher's, &c.  224.
 Dysentery, when epidemic is connected with marsh r iasmata,  353.
Eckard, Mr. Danish Vice-Consul at the Philadelphia, corrects some
  of Dr. Chisholm's gross misrepresentations, 463.
Epidemic, definition of, See.  29.
Evagrius, Scholasticus, his account of the plague in the reign of JuSt
  tinian, 372, n.
Exhumations at Dunkirk, Sec. Sec. 95.

                               F.

Fellows, Sir James, his letter to the author, 330, n.
Ffirth, Dr. bis experiments with the matter of black vomit, 291.
Fontana, L'Abbe', his opinion of the yellow suffusion produced by the
  poison of vipers, 51. 
                              524
ronta»a, Nicholas, his account of the morbid effects of marsh miasms,
   122.
Fordyce, Dr. George, that pure  aqueous vapours produce fever,  12?,
   Sec. Sec.
forestus, his account of a fever caused by a putrid whale dissected*

                               G.
 Gilbert, Medecin au Chef, Sec. 234,
 Gilchrist, Dr. Ebenezer, 342.
 Gillespie, Dr. of the production of marsh fevers, 125.
 Gonzales, Dr. his account of the yellow fever at Cadiz, 312,
 Grainger, Dr. quoted concerning; dysentery, 368.
 Grant, Dr. (Jamaica) denies the supposed  contagion of yellow fever,
   244.
 Guthrie, Dr, his account of the  Russian peasants, 101.

                               H.

 Hamilton, Dr. Robert, his account of marsh  fevers near Lynn Regis,
   209.
"Haygarth, Dr. 81.
 Heberdeen, Dr. quoted, 3L
 Herring, Dr. qu^ ed, 405.
 Hodges, Dr. qurced, 403.
 Holwell, Mr. thack hole of Calcutta, 425^
 Hosack, Dr. of the yellow fever, 273.
 Hunter, Dr. John,black vomit, 48.

                               J.
 Jeeferson's, Mr. official declaration, 295..

                               K.
Kennedy, Dr. Gilbert, 298.

                               L.

Lawrence, Mr. his letter  on the innocency of exhalations fi'om putrid
   hum an bodies, 420. 
525
Lind, Dr. James, 26.-
Lining, Dr. yellow fever, 260.

                              M.
Morton, Dr. remittent fever formerly prevalent in London, 40J.

                              N.

Smooth, Dr. judges rightly that the yellow fever at Gibraltar  was not
   contagious, 327.

                              P,

Poupee Desportes, M. on the yellow fever of St. Domingo, 150.
Plague, definition, Sec. Sec. 369.

                              R.

Ramsay, Dr. David, 245,

                               S.

^elden and Whitehead, Drs. yellow fever in Virginia, 250.
Stomach, its high importance, 40..

                              T.

*TYPHys, jail, a contagious fever, 337.,

                              U.

TJlloa, Don Antonio,  his account of Peru, 134;

                              V.

Vapour, pure aqueous, not a cause of fever, 132.,

                              Y.

Yellow Fever, different appellations:  of,  25—observations  on its
   generic and  specific names, 25 to 29'—distinction between sporadic
   and epidemic, 29, 3Q—symptoms of, 30—parts most affected, S.5 - 
526
dissections of bodies dead of it, 36—black vomit, 39—affections of
the skin, 46—diagnosis of, as distinguishing from the plague  and
typhus, 56—treatment, 58—causes of,  122--proved not to  be coh-
ftigious, 332.
1 HE ENB.