9i£ mm, ^H ■ici i fkM ■ M UNITED STATES OF AMERICA WASHINGTON, D. C. GPO 16—67244-1 A COLLECTION OF FACTS INTERSPERSED WITH OBSERVATIONS ON THE NATURE, CAUSES, AND CURE OF THE YELLOW FEVER: IN A SERIES OF LETTERS, ADDRESSED TO THE INHABITANTS OF" THE UNITED STATES. PART I. all wfr- BY THOMAS RUSTON, M. D. OF THE UNIVERSITY OF EDINBURGH, AND OF THE ROYAL INCORPO- RATED MEDICAL SOCIETY; A. B. OF THE COLLEGE OF NASSAU HALL, AT PRINCETON, IN THE STATE OF NEW JERSRY ; MEM- BER OF THE AMERICAN PHILOSOPHICAL SOCIETY AT PHI- LADELPHIA ; AND HONORARY MEMBER OF THE ROYAL SOCIETY OF FRIENDS OF THEIR COUNTRY, AT VALENCIA, IN SPAIN. " Omne tulit punctum qui miscuit utile dulci." •• PHILADELPHIA: PRINTED BY BARTHOLOMEW GRAVES, MO. 40, NORTH FOURTH-STREET. 1804. \ LIBRARY a r.-*- i.'J. « i * DEDICATION. TO MRS. ELI£A POWEL, OF POWELTOWN. MADAM, THE high estimation in which you are held, not only by your acquaintances, but also by all who nave the pleasure of knowing you, in which I most heartily concur, is a sufficient inducement for me to wish to lay the following publication at your feet. But, besides this, there is a singular propriety in doing it; because, as it respects the health of your native city, in which, not only your affec- tions, but your most essential interests, are con- centrated, it cannot be doubted, but, that you have its happiness and prosperity much at heart. I, too, have an interest in making this dedi- cation ; because, whatever may have received the sanction of your approbation, cannot fail to be- speak a favourable reception from the public. It also affords me an opportunity of expressing the unspeakable satisfaction with which I subscribe myself, Your most obedient, Most devoted, And very obliged humble servant, THOMAS RUSTON. INTRODUCTION. MUCH has been said on the subject of the Yellow Fever; from which some may be led to infer that the subject is exhausted. Amidst such a variety of publications, it would be strange, indeed, if some light had not been thrown upon it; but at the same time it must be admitted, that a great deal has been said, which instead of illuminating, has only tended to raise a mist, to obscure and darken the horizon ; and, what is worst of all, has . led to false theories, which have been the foundation of very perni- cious practices. It is not my intention to bestow censure on the well meant endeavours of those who have even failed in their attempts ; but whatever suc- cess they may have had in discovering the occa- sional or remote causes of this disease, I think it will not be contended that they have been very successful in explaining the nature of it, or in finding out the immediate or proximate cause, 4 much less have the most sanguine of them pre- tended to have found out a sure and infallible cure. In the following sheets, which only constitute a Eirst Part, I have collected a number of well authenticated facts, which, I expect, will lay the foundation for a rational theory, from which will be deduced a most safe and successful practice. At the same time I have endeavoured to point but the insufficiency of most, or all of the methods. of practice that have been hitherto in use. LETTER I. THE accounts we have from New York, of the Yellow Fever, are truly distressing. In the Mayor's account of the 6th of August, 1803, he says " that since the 20th of July, to the 5th of August, inclusive, thirty- three cases of bilious malignant fever have occurred, sixteen of which terminated in death, eight in recovery, and nine remain still doubtful." Since then, the re- ports of new cases have generally been from about six- teen to twenty of a day, of which, about half have gene- rally died. May we not then with propriety ask what is become of that boasted remedy, alkaline salts, from which we were taught to expect such great things ? In the coure of last year, Dr. Priestly, in a letter to one of his scientific friends, dated August- 7th, 1802, at Northumberland in Pennsylvania, writes thus...." I have lately received the last number of the Medical Re- pository, and am much pleased with many of the articles, especially those which contain the use of alkalies in me- dicine, in the purification of ships, ckc. I have no doubt of Dr. Mitchell's being fundamentally right, with respect to this business ; and on this account he will be ranked among the great benefactors of mankind. Thus, adds the account, this great authority concurs in opinion with the measures which have originated in New York, and are rapidly carrying into operation. If this was the case last year, what are they about now ? Is Dr. Mitchell lying dormant, or have the alkalies failed of their ef- 6 feet ? For my own part I have not, nor have I ever had any faith in this medicine as an antidote to putrefac- tion.* But there is another writer of last year, who dates his letter at Dover, August J.5th, 1802, signed J. Rodney, who comes forward with a very serious charge against the faculty. He begins with observing, that " That destructive contagious fever, which has so often depo- pulated the fairest city in America, having returned again, and the physicians not having yet acquired the fowwledge of any certain remedy," &c. he goes on to give a statement of his own case for publication. That the disease did return last year in Philadel- phia is certain, but it is also certain that it soon received such a check, that it was generally thought to be extir- pated, in so much that many families who had fled to the country returned to town, and though it broke out again, and made some progress for want of applying to the proper sources for assistance, yet it is very certain that the disease did not commit any thing like such ra- vages as it had committed in former years. This writer, however, seems to be a humane and be- nevolent man ; and, I make no doubt, made his commu- * In Relf's Philadelphia Gazette of August 25th, 1803, is inserted the following paragraph: Accounts from New York represent the situation of that city in the most distressing terms. The fever is fatal in nearly all the cases of its attack; and nothing has prevented the mortality from swelling to an enormous amount, but the timely and almost universal flight of the ci- tizens. We sincerely hope that this circumstance, added to the present salubrious air, will, ere long, stay the pestilence." It would seem, there- fore, that all hope from medical assistance was vanished. 7 nication to the public with the very best intentions; but as he does not appear to be a medical man, he should have been very cautious how he brought general charges against medical men ; and as some of his ideas appear to be incorrect, and therefore may have a tendency to mislead, I shall take the liberty of making a fewj ani- madversions upon them. The writer begins with giving some slight hints about the recovery of his son, who had been ill of the Yellow Fever at Wilmington, in the year 1798 ; but before he got there to see him, " he was mending, though the fe- ver was still high, and his skin yellow;" and he goes on to give us a history of his own case, which he considers as " the extreme degree of the disorder, which may properly be deemed the plague :" But it is Aery plain that he seems little acquainted with the true nature of the plague ; for, with what propriety can it be considered as the plague, since it does not appear to be attended with buboes or eruptions of any kind, which generally break out and give a vent to the malignaty of that disease ? With much less propriety can his case be called the Yel- low Fever, since he says that " during my illness I had no fever ; my pulse indeed was far below the state of health, and that my skin was not the least coloured or tinged with yellow." This case indeed seems to have been a pretty severe one of the kind of which it was; for he says, that "■ on the fourteenth day," that is I suppose after his return from Wilmington, " at dry light in the morning I awoke with the mortal symptoms ol the Yel- low Fever on me, a dreadful head-ache, a violent sick stomach, and a degree of lassitude which rendered me 8 unable to raise my head, or move round, a violent vo- miting succeeded immediately, and continued with hardly a moment's intermission for about four hours, and all the bile that came off my stomach was as black as ink. I had directed some beef tea to be prepared and made very salt, and as soon as the vomiting ceased, I drank plentifully of it all day. In the afternoon I sat up two hours and drank one dish of green tea, and eat a little toast, but still felt so bad I was obliged to go to bed again. I rested very little the following night; my sleep was only troublesome and broken slumbers. At day light the next morning vomiting returned, and con- tinued near three hours, discharging the same kind of black bile that had been discharged the previous morn- ing. As soon as the vomiting ceased, I drank plentiful- ly of the beef tea again ; by ten o'clock my stomach seemed settled, and my head-ache greatly abated, so that I got up and sat all the remainder of the day. At din- ner I eat plentifully of turkey.soup, very salt; in the evening I drank tea and eat some toast. The following night I rested well, and slept remarkably sweet and sound ; next day being the third day after I was taken sick, I rose at day light, as is my custom in health. My head ache and sick stomach were gone, I felt feeble indeed all day, but eat breakfast, dinner and supper as usual when in health; I rested well the following night and next day, being the fourth day after I was taken ; I felt as if I had never had the complaint." But with what propriety can this be called the Yellow Fever ? Mr. Rodney seems indeed to have' been thoroughly frightened; but was this any thing more than a violent 9 vomiting of black bile, and does not the disorder seem to have been almost entirely lodged in the stomach, for, upon the repeated discharges of bile from that organ, is not only that, but all the other syptoms relieved ? What rea- son is there to think, that the disease liad got hold of the system, much less is there any reason to think that it was infectious ? The violent head ache, and the great lassitude, are easily accounted for, from the violent sick- ness occasioned by the great foulness of stomach, but there was no fever. As to the remedy he made use of, it required no physician to inform him of that; for every old nurse knows, that after a violent fit of vomiting, a little weak soup or beef tea, well seasoned with salt, is as good a thing to settle dia stomach as any thing that can be thought of. Sprinkling rooms with water or vinegar, and fumigating them with binning sulphur or brim- stone, in order, to purify them from foul air, which he recommends, have long been practised. But a much better method has been invented, by fumigating with the vapour of nitric acid.* . * In the years 1795 or lTOCi, Dr. J:v.ncs Carmichacl Smyth, phvsic'sn ex- traordinary to his Britannic Majesty, suggested a process for determining the effect of the fumes of nitric acid in destroying contagion. The utensils and materials provided for the purpose were the following: A quantity of fine sand, about two dozen of gusot earthen pippins, as many common red cups, some long slips of glass to be used as spatulas, or-a quantity of concentrated vitri- olic acid, and a quantity of pure nitre (nitrat of potash). The proccs3 was conducted in the following manner : 1st. AH the ports and scuttles of the Union Hospital ship, on board of which the experiment was made, were shut tip ; the sand, which had been previously heated in iron pots, was then scooped out into the pipkins, by means of an iron ladle, and in this heated sand in each pipkin, a small tea-cup was immersed, con- taining about half an ounce of the sulphuric acid; to which, after it had B 10 And though Mr. Rodney says, he sent for no physi- cian, nor took any other medicine, of any kind, but the beef tea, well seasoned with salt, yet he confessed, " he was induced to rely on this simple remedy, by the in- formation of an eminent physician, who visited Grand Cairo, in Egypt, when the plague happened to be there, acquired a proper degree of heat, an equal quantity of nitrat of potash, in powder, was gradually added, and the mixture stirred with a glass spatula till the vapour arose from it in considerable quantity. The pipkins were then carried through the wards by the nurses and convalescents, who kept walking about with them in their hands, occasionally putting them under the cradles of the sick, an& in every crevice in which foul air was suspected to be lodged. In this manner they continued fumigating, until the whole space between decks, fore and aft, was filled with the vapours, which appeared like athfckhaze. The vapour at first excited a good deal of coughing among the patients, which gradually ceased as it became more generally diffused through the WfU'd^. The advantage of the fumigation was not felt by the ship's company and attendants aionc, whom it preserved from the baneful effects of the fever j the sick and convalescents derived almost an equal benefit from it, the symp- toms of the disease were meliorated, and lost much of its malignant appear- ance. It is necessary to observe, for the sake of those who may not be versant in chemical pursuits, that the ingredients ought to be pure, and that metal vessels or rods must not be employed. Any kind of metal getting among the ingredients would cause the vapours to be very noxious, instead of salutary. The fumes that rise should be white ; if they are of a red colour, there is reason to suspect the purity of the ingredients. If there are any circumstances in which its utility may be called ia ques- tion, it can only be in case of inflammatory diseases ; for in sucli cases su- peroxygenation has been thought hurtful. That the fumes of the mineral acids possessed th? property of stopping contagion, was proved by Morveau, as far back as the \ear 1773; who, by means of the fumes of muriatic acid, extricated from the muriate of soda (sea salt) by the sulphuric acid, purified the air of the cathedral of Dijon, which had been so much infected by exhalations, that they were obliged to abandon the building. 11 and who said that he attended patients, and found com- mon salt, dissolved in water, or beef tea, the best, and in- deed, the only remedy for the plague, and never failing when taken in time". Salt, as an antidote to putrefaction, has long been known : the practice of using it for preserving animal food, from putrefaction, has long been customary ; and the use we make of it every day, at our meals, is a far- ther proof of the utility of it; the whole animal crea- tion, but more especiall quadrupeds, cannot do without it. The hollow ways or gullies, that are worn by wild beasts, in steep banks or steep declevities, in their pur- suit of salt springs, or salt licks, and their resigning even their lives, as it appears by their skeletons, which are found in those morasses, is a further proof of the eagerness with which they arc sought after. Not only all animals, but the sea itself, and the fishes therein, would run into putrefaction, if it was not for the salt that it contains ; there can be, therefore, no doubt of the utility of salt in all cases, where there is a tendency to putrefaction, as well as in common life; but they will be miserably disappointed who depend upon this alone : There are antidotes still more effectual than this for the disorders in question; and I cannot help thinking it rather ungenerous in Mr. Rodney, to throw a re- proach upon the profession in general, by saying that " the physicians have not yet acquired the knowledge of any certain remedy for that destructive, contagious fever, which has so often depopulated the fairest city in America." 12 That this remedy is not generally known, I readily admit; but that such a remedy is found out, is, I believe, pretty generally known to the faculty, and Mr. Rod- ney's not being a professional man, is the only excuse that I know of, for his net knowing it also. That he may not, however, be able any longer to plead this excuse, I beg leave to refer him to a publi- cation of mine, in the Philadelphia Gazette of the 11th of September, 1799, wherein, in a tender of my ser- vices to the Board of Health, in a letter to Edward Garri- gues, esq. president of that board I make use of these expressions : " Sir, " Upon the occasion of the fever, which creates so ge- neral an alarm, 1 think it my duty to inform, and I con- ceive it v. ill not: be unacceptable to your very respecta- ble board to know, that, from a long course of study and experience in Europe, in infectious diseases, I con- ceive I am possessed of means, more immediate and ef- fectual in removing those complaints, than are generally known or practised in this country. If the board, there- fore, will point out in what way I can be useful, in this line, their commands shall be cheerfully complied with. " From your obedient friend and servant, " THOMAS RUSTON." IS LETTER II. OF PERICLES. HOW many great men have fallen a sacrifice to this disease ? Among others that died of the plague at Athens was Pericles. In him were united most of those qualities which constitute the great man. Such as those of the admiral, by his great skill in naval affairs, of the general by his conquests and victories, of the finan- cier by the excellent order in which he put the finances, of the great politician and statesmen, by the extent and justness of his views, by his eloquence in public delibe- ration, and by the dexterity and address with which he transacted the business, of a minister of state, by the methods he employed to increase trade and promote arts; in fine, of father of his country, by the happiness he procured to every individual, and which he always had in view, as the true scope and end of his adminis- tration. Another characteristic, which was peculiar to him- self was, that he acted with so much wisdom, modera- tion, disinterestedness and zeal for the public good, he discovered in all things so great a superiority of talents, and gave so exalted an idea of his experience, capacity and integrity, that he acquired the confidence of all the Athenians, and fixed in his own favour, that natural fickleness and inconstancy for which they were famous during forty years that he governed them. He sup- pressed that jealousy, which an extreme fondness for 14 liberty had made them entertain of allcitizensdistinguish- ed for their merit. But the most surprising circumstance is, that he gained this ascendency merely by persuasion, without force, or without employing any mean artifices or any of those arts bv which a paltry politician excuses himself upon the specious pretence, that the public af- fairs, and reasons of state, make them necessary. Pericles being extremely ill and ready to breathe his last, the principal citizens, and such of his friends as had not forsaken him, discoursing together in his bed cham- ber, about his rare merits, they run over his victories ; for, while he was generalissimo, he had erected nine trophies, in memory of so many battles he had gained for the glory of his country. Many did not imagine that Pericles heard them, because he seemed to have lost his senses, but they were mistaken, for not a single word of what they said escaped him; and breaking sud- denly from his silence, " I am surprised, said he, that you should treasure up so well in your memories, and extol so highly a series of actions in which fortune had so great a share, and which are common to me, with so many ether generals, while at the same time you seem to forget that which I esteem the most glorious circum- stance of my life, which is, that during forty years that I have governed Athens, I have never caused a single Athenian citizen to put on mourning." How different this from some modern govenors we have heard of. THOMAS RUSTON. 15 LETTER III. OF HIPPOCRATES. IN the second year of the Peloponnesian war, the plague made a greater devastation at Athens than had ever before been heard of. It is related that it began in Ethiopia, whence it descended into Egypt, and from thence spread into Libia to the west, and a greater part of Persia, to the east, and at last broke in at once, like a flood on Athens. Thucydides, who was himself seized with that deadly disease, has described, very minutely, the several symptoms and circumstances of it; in order, says he, that a faithful and exact relation* of this calamity may serve as an instruction to posterity, in case the like should happen again at any future period. Hippocrates, who was employed to visit the sick has also given a medical description of it; Lucretius has a poetical one. This pestilence, notwithstanding the skill of Hip- pocrates, baffled the utmost effcits of his art. The most robust constitutions were unable to withstand its attacks, and were most liable to fall victims to it, and the great- est care and skill of the physicians were a feeble help to those that were infected with it. The instant a person was seized he was struck with despair, which quite disabled him from attempting any cure. The assistance that was given them was totally ineffectual; and the disease proved mortal to all such of their relations as had courage to approach them. The 16 prodigious quantity of baggage which had been remov- ed out of the country into the city, proved very noxious. Most of the inhabitants, for want of lodging, lived in little cottages in which they could scarce breathe, dur- ing the raging heat of the summer, so that they were seen either piled, one upon the other, (the dead, as well as those that were dying) or else crawling through the streets, or lying along by the side of fountains, to which they had dragged themselves, to quench the raging thirst that consumed them. The very temples were filled with dead bodies, and every part of the city exhi- bited a dreadful picture of death, plurima mortis imago, without the least remedy, for the present, or the least hopes from a future prospect. This plague, before it spread into Attica, had made wild havoc in Persia, and king Artaxerxes, who had heard of the mighty reputation of Hippocrates of Cos, and who was the greatest physician of that, or any former age, caused his governors of provinces to write to him, and to invite him into his dominions, in order that he might prescribe to the unfortuuate subjects that were infected with it. The king made him the most advantageous offers, setting no bounds to his generosity, en the score of in- terest ; and, with regard to honours, he promised to make him equal with the first persons in his court. But Hippocrates sent him no other answer, than that he was free from eiiher wants, or desires, and that he owed all his cares to his countrymen and fellow citizens. 17 Kings are not used to such answers : Artaxerxes, therefore, in the highest transport of rage, sent to the city of Cos, the native place of Hippocrates, and where he was at that time, commanding those to deliver him up, for his supposed insolence, in order that he might be brought to condign punishment, and threatening to lay waste, in case they refused, both their city and coun- try, in such a manner, that not the least vestige of it should remain. However the inhabitants of Cos were not under the least apprehension, and made answer, that the menaces of Darius and Xerxes, had not been able to prevail with them, to give them earth and water, (a phrase made use of to denote subjection) and that Ar- taxerxes's threats would be equally impotent, and that, whateter might be the consequence, they never would give up their fellow citizen. Hippocrates said in one of his letters, that he owed himself entirely to his country. Accordingly, the in- stant he was sent for, he went to Athens, and did not stir out of the city till the plague had ceased. He devot- ed himself entirely to the service of the si;!:; and to mul- ply himself as much as possible, he sent his disciples into all parts of the country, having instructed them in the manner in which he treated his patients. Feeble however, as his art was, as we may see from the descrip- tion that has been given of the ravages that were com- mitted by the disease ; yet the Athenians were so much struck with a sense of gratitude for his generous care, that they ordered, by a public decree, that he should be initiated into the most exalted mysteries, in the same manner as Hercules the son of Jupiter ; that a crown of c 18 gold should be presented to him, worth a thousand sta- teras, amounting to five hundred pistoles ; and that the decree should be read aloud, by a' herald, at one of the public games, on the solemn festival of Panathencea; that the freedom of the city should be given him, and that himself should be maintained at the public charge in the Prytaneum, all his life time, if he thought proper; in fine, that the children of all the people of Cos, whose city had given birth to so great a man, might be main- tained, and brought up in Athens, in the same manner as if they were natives. LETTER IV. OF THE PLAGUE OF LONDON." ABOUT the beginning of May, 1665, one of the most terrible plagues that ever infested any city or kingdom, broke out in the city of London, by whose dreadful ravages 68,596 persons were swept away. This , contagion happening just forty years after the horrid pestilence of 1625, occasioned some to impute a fatality to that number, as if the land was to have rest only forty years *. But in truth the city had not been quite free * In J625, (the accession'of Charles I.) the plague carried off 35,417, besides those which died of o#.er distempers, which in the whole amount- ed to 44,265, which by a genuine account appears to have been the greatest year of mortality that bad happened in that city, till that tnne, above one- third of the inhabitants being swept away. 19 from the plague for twenty-five years before, and it had been free from contagion for only three years,, in about seventy : And it is no wonder, when we consider the narrow, crooked, and incommodious streets (fitter for a wheelbarrow than for larger carriages) the dark, irregu- lar, and ill contrived wooden houses, Avith their several stories jutting out or hanging over each other^ whereby the circulation of the air was obstructed, noisome va- pours were harboured, and venomous pestilential atoms nourished. The week wherein the hideous distemper was first discovered, it carried off nine persons, by which the citizens were so much alarmed, that a universal panic diffused itself among the people of all ranks ; but the week after, that number, according to the bill of morta- lity, being reduced to three, their fears were greatly al- leviated. The next week, however, the number in- creasing to fourteen, and so progressively to forty-three ; the people were struck with great consternation, and it made many think of leaving the city. But, in the month of June, the number having gradually increased to four hundred and seventy per week, it put the nobi- lity, gentry, and principal citizens upon the wing, all being instantly in a hurry, the city emptying itself into the country, the streets and roads thronged with passen- gers. In the month of July, the bill increasing to 2010, all houses were shut up, the streets deserted, and scarce any thing was to be seen there, but grass growing in the streets, innumerable fires for purifying the infected air, coffins, pest carts, red crosses upon doors, with the in- scription of, Lord have mercy upon us, and poor women I 20 in tears, with dismal aspects, and with woful lamenta- tions, carrying their infants to the grave. Scarce any other sounds were to be heard than those of, pray for us, incessantly emitted from the windows, and the dreadful call of, bring out your dead, together with the piteous groans of departing souls, and the melancholy knells for bodies ready for the grave ! Under these deplorable circumstances, the citizens, in the great want of spiritual guides, were forsaken by their stated ministers ; but the people crowding into eternity, and bewailing the want of spiritual assist- ance, the non-conformist ministers were induced, though contrary to law, to repair to the deserted pulpits. Hither the people, without distinction of church and dissenter, joyfully resorted. The concourse on those occasions was so exceeding great, that the mi- nisters were frequently obliged to clamber over the pews to get at the pulpits. If ever preaching had a better effect than ordinarjr, it was at this time ; for the people caught, at every word, as eargely, as a drowning man would at a twig, and with as much greediness as if their eternal happiness depended upon it. In the month of September death rode triumphant, having borrowed time's fatal scythe, (if I may be allow- ed the expression) he mowed down the people like grass, for the burials then amounted to 6,588, but the week after the bill falling to 6,544, gave glimmering hopes that the distemper was past its crisis. But the great increase the week following to 7,165, plunged the people again into an abyss of horror and despair. They 21 were now struck with the dreadful apprehensions that in a few days the living would not suffice to bun- the dead. They were, however, happily mistaken ; for after this the contagion gradually decreased, till at length it pleas- ed the Almighty to restore that miserable city to its pristine state of health. As to the natural causes of this plague, physicians were of different opinions. Some ascribed the origin of it to an inveterate and most envenomed pox ; others to infected goods imported from Holland, where the plague had committed great ravages the preceding year. During the dreadful havoc that was made by this pes- tilence, it was observed by Dr. Baynard, an ingenious and learned physician of that time, that there was such a general calm and serenity of weather, it seemed as if both wind and rain had been expelled the kingdom, and that he could not discover the least breath of wind, not even so much as to move a vane, for several weeks to- gether ; it was with the greatest difficulty that the fires in the streets were made to burn, as they imagined, through the great scarcity of nitre in the air. The birds panted for breath, through the extreme rarefaction of it, especially such as were of the larger sort, who were likewise observed to fly more heavily than usual. The means that were made use of, at this time, to put a stop to it, were surely the worst that could be de- vised ; for, by shutting up the houses wherein the con- tagion happened, the healthy were offered a sacrifice to the unmerciful devourer. Had the distempered persons, 22 \ or those in health been removed out of each house, as soon as infected ; the former to a Lazaretto, and the latter to a place for the performance of quarantine, it may reasonably be supposed that one-tenth of the above mentioned number would not have died. And as heat is a great promoter of putrefaction, it was highly im- proper to make fires, in every street, with a view to pu- rify the air and to destroy the pkgue. LETTER V. MEDICAL philosophy, says a late writer, in its late wide ranges, has effected a revolution in the habits of men, and in the nature and treatment of their dis- eases, which has eminently contributed to the lessening of human misery. The plague, pestilential fevers, pu- trid scurvies, and dysenteries, have much abated in the 18th century. This is true in the great scale of en- lightened nations, though the general prevalence of the yellow fever in the sea port towns of the United States, for the last seven years, seems to form a local excep- tion. Platerus, a physician at Basil, who lived in the 17th century, gives an account of seven different pestilential fevers, or plagues which afflicted that city within seven- 23 ty years. Bartholine mentions five that raged in Den- mark, in the same period. There were in the city of London, in the 11th century, five; in the 15th two; in the 16th seven; and in the 17th there were four. The first of these began in 1603, and continued more or less every year till 1611; the second in 1625 ; the third in 1636, and continued for. 13 years; and the fourth in 1665. In these four visitations of the plague, in the 17th century, the city of London lost 133,985 persons. In York 11,000 died of an epidemic fever in 1691. In the 18th century nothing of this kind has taken place in any part of England, and only one (and that 80 years ago) in Marseilles, which in former centu- ries used to be the general rendezvous of the plague. That this abatement of the plague has, at least in part, been effected by the smiles of Providence, on the modern improvements in medicine, may be inferred from this circumstance, that Constantinople, Aleppo, Grand Cairo, and other places in the Levant, on which the sun of medical philosophy has never shone, do now, and throughout the 18th century, have suffered as much from the ravages of the disease, as they had ever done before. In the medical history-of South Carolina, the yel- low fever, and the small pox, have been the most injurious epidemics. My information relative to these two diseases, prior to the year 1763 has been chiefly furnished by Mr. Prioleau, as collected from the manuscripts of his accurate and observing grand-father, 24 the venerable Samuel Prioleau, esq. who died in the year 1792, at the age of 74. From this it appears, that in the year 1699 a disease prevailed in Amsterdam which swept off a great part of the inhabitants, and some whole families. 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 of a day, besides people of colour. The ringing of bells was forbidden, and little or no business was done. In the year 1739, the yellow fever raged nearly as bad as in the year 1732. It was observed to fall most severely on Europeans. In the year 1745 and 1749, it returned, with less violence; however, many young persons mostly Europeans, died of it. It appeared again in a few cases in 1753, and 1755, but did not spread. In all these visitations, it was generally supposed that the yellow fever was im- ported, and it was remarked 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 epide- mical attack of this disease, though there were occa- sionally, in different summers, a few sporadic cases of it. In the year 1792, a new era of the yellow fever commenced. It raged in Charleston in that year, and 25 also in 1794, 95, 96, 97, 99, and 1800. In these last seven visitations of this disease, it extended from July to November, but was most rife in August and Septem- ber. With a very few exceptions (chiefly children) it exclusively fell on strangers, to the air of Charleston, and was in no instance contagious. In the year 1796 and 1797, it raged with its greatest violence. In the two last years it was •onsiderably abated.. In the year 1799, the whole number of deaths from it was 232, and in 1800 no more the 131; but this decreased mortality was partly owing to the decreased number of strangers, for such were cautious of visiting Charleston in the warm months. In Philadelphia it began with great violence in the year 1793, and from that time till the present it has been more or less epidemic almost every year, in near- ly all the sea ports of the United States, except Phila- delphia, which escaped it entirely in the year 1800. D 26 LETTER VI. OF THE FEVER IN SPAIN. Madrid, Nov. 4, 1800. SOME particulars are at present reported here respecting the sickness which has depopulated Andalu- sia. At Cadiz, it blew a strong easertly wind, which pass- ing over a burning part of the country, augmented the excessive heat of the summer, whereby the atmo- sphere was well predisposed to receive the sickness, but by no means was the cause of it. The physicians in Cadiz were wrongfully impressed with this opinion, and therefore applied the wrong remedies, which aug- mented the mortality. On the 8th of August, an American vessel entered the harbour of Cadiz: the log book of the captain men- tions, that during the passage three men on board died of the yellow fever. The crew coming on shore, went into the neighbouring streets and taverns; the sailors soon spread more and more through the whole city; all died of the sickness except the mate, which soon after shewed itself among the inhabitants of the city; and there was not a house into which the infec- tion did not penetrate. The terror spread on all sides. Many of the inhabitants, not knowing that they had the yellow fever in their bodies, fled to Real Isle de Leon, 27 Chielera, Port Royal, and Port Santa Maria, from whence they dispersed farther to Xeris, St. Lucar, and Sevilla ; not only those emigrants got the disorder, but the same manifested itself pretty soon in the afore- said places. Since the 14th of August, until the 1st of Nov. have died of this sickness, to wit. At Cadiz, which contains 68,000 souls, 16,000 died, Isle Real de Leon 32,000 8,000 Port Royal and Chielera"> 2q qoo each 10,000 J ' 6,000 Port Santa Maria 2,000 6,000 St. Lucar 18,000 4,000 Rote, 6,000 1,500 Serilla 80,000 30,003 So that those nine cities, containing 279,000, have lost 79,500 souls. It is here published by authority, that the sickness has not extended to the borders of Estra* madura." TO THOMAS RUSTON. If I understand you aright in your first number, it would seem as if you were possessed of the secret of cur- ing the malignant fever which has for several years af- flicted one or other of the great towns on this continent; and I accordingly expected to see it openly promulged in your second letter, especially as you seemed to scoff at the theories advanced by your cotemporaries, men of considerable literary acquirements ; instead of which the public have been tantalized with extracts from ancient history concerning pestilences and plagues, which per- 28 haps had no affinity to the disease commonly called yel- low fever. When our cities are afflicted with so dread- ful a calamity, it is too severe a trial of our patience to force us to listen to the history of a disease which men of moderate reading are as well acquainted with as your- self, when all we want is the remedy. When we shall be relieved from this scourge, we shall then have leisure to bend our attention to narratives of past events ; and, if you are really acquainted with the cure, possessed of any philanthropy, you will scorn to keep the secret within your breast, or even to confine it to t! * faculty, unless a cure is to be performed in the last stace of the disorder. o But the probability is, that if there be an agent in na- ture that could neutralize or expel the subtile poison, it must be resorted to on the first attack. But who is there except a few hypochondriacs, that apply to the faculty until the second day of the disorder : After the enemy, by the violence and rapidity of his movements, has made such havock on the constitution, that the most power- ful agent, perhaps in nature would fail, or be defeated. The cure, then, to be effectual, must be put into the hands of every rational being, in as public a manner as possible; and if you are possessed of the secret, what satisfaction can you feel in your mind, when you see your ieiiow-citizen, falling around you on all sides, and at the same time conscious that you have the power to prevent it, even if it were only in part? The stale ex- 29 cuse urged so often by the faculty, of the danger of trusting powerful agents into unskilful hands, ought to lose its force in this country, where common mechanics arc as well acquainted with the operations of nature as the gentlemen of the learned professions. Quit then your histories of its former depredations, and your me- taphysical inquiries, into the origin of an invisible agent, known only by its effects, and come to the point at once, namely, the cure. It is a folly, in my opinion, to waste our time in un- profitable inquiries; such as, why the Almighty hath suffered us to be pestered with bugs and musquetoes, while we neglect to improve the faculties and power which he has given to us to subdue them ; and that man is a more useful member of society, who could exter- minate the Hessian fly, than the metaphysician who explains the design of nature in permitting those de- predators to exist, or the natural philosopher who re- counts his generation and subsequent transformation, or the historian who gives an account of the voyages and travels of that insect, from the land of his nativity till his arrival on the shore of America. Not that these in- quiries are altogether to be despised, or useless : by no means ; yet in point of utility, rational beings will de- termine which ought to have the preference. At this moment, when I see my friends hurried to another world without having time to settle their ac- counts, I care not whether the unwelcome messenger comes from the east or the west; the north or the south ; ] 30 whether he rises out of the bowels of the earth, or de- scends from the clouds; I only wish to know how his arm may be arrested before the fatal blow is given ; and if you can inform us on that head, your lucubrations will be read with avidity by yours, C. TO THE EDITOR OF THE AURORA. I HAVE seen in your paper of Sept. 14, some stric- tures on my observations respecting the yellow fever. The author, like a high spirited steed, impatient of the rein, is for plunging forward, or by a short cut is for reaching the goal before he has half performed his cir- cuit or course. I can account for, if not excuse his im- patience ; the subject is interesting, and as it is interest- ing it is to be treated with caution, not only as it is preg- nant with the greatest consequences, but as I am aware that in the prosecution of my subject, I shall have oc- casion to differ in opinion with some of my brethren, men for whom, in other respects, I have the highest res- pect ; yet I mean to do it with candour and circumspec- tion : I do not mean to attack any man personally, but only opinions and doctrines as far as I have occasion to differ from them ; but in doing this I am aware that I shall draw upon myself some censure, and perhaps abuse ; for in all controversies there is a spirit of party : 31 I do not mean with respect to politics, but with respect to dogmas or doctrines, and in nothing does this spirit of party shew itself more than in physic ; for instance, one party may be for a system, of repletion, another for that of depletion. I do not mean to range myself under either of these parties. On the other hand, there are some who range themselves under the authority of par- ticular names, and if I should happen to differ from these, I have a right to expect abuse from them or their disciples ; if I do experience it, I cannot help it, because truth and sound practice is my object, and from these I do not mean to swerve on account of any abuse*. With regard to my friend (who has honoured me with his strictures in your paper) as I have put my name to my publications, it does not exactly quadrate with my notions of propriety of conduct to enter into a correspondence with an anonymous writer in a public newspaper; but if he will please to call upon me, I shall be glad to speak with him. * " Est modus in rebus, Sunt cerae denique fines Quos ultra citraque Nequit consistere rectum." 32 LETTER VIII. THE deplorable state of the disease, and the in- competence of the practice then in use to relieve it, may be learnt from the following extracts from the " histo- ry of the pestilence, commonly called yellow fever, which almost desolated Philadelphia, in the months of August, September, and October, 1798 : Published by Thomas Condie and Richard Folwell." The board of health, impressed with a sense of the consequences of delaying to apply for medical aid, on the 13th of August, published the following recommen- dation. " Health-Office. " The board of managers of the marine and city hos- pitals have observed with deep regret, the fatal conse- quences of delay in the application for medical aid to persons afflicted with the prevailing malignant fever, and that the removal of patients to the city hospital, in many cases, is procrastinated until they are literally sent there to die. " They recommend, in the most earnest manner the removal of patients to the city hospital, where the public may be assured, that every possible comfort and accommodation will be afforded, &cc. " The board consider this recommendation as of the highest importance, and intreat the attention of their fellow citizens, &c." 33 Notwithstanding this recommendation, the fatal effects of delay in calling in the aid of medicine daily became more numerous: in consequence, the board on the 18th of August, repeated their admonition in the fol- lowing publication. " The malignity of the prevailing fever and its insidi- ous approaches, are such as to resist the power of medi- cine, unless application is made in the first instance of complaint. The board lament that their recommenda- tion has not been attended to; as in most instances the patients have been ill three or four days previous to ap- plication for medical aid, to which, in a great degree, is to be attributed the deaths of so many valuable mem- bers of society. The board reiterate their call to their fellow citizens, and earnestly request that not a moment may be delayed in obtaining medical assistance." The unparalleled mortality which occurred in the city hospital the five first days after it was opened, alarmed the resident physicians. Thirty-one patients had been admitted, of which ten died, and none had as yet recovered; in consequence of which they addressed the following letter to a physician in this city : City-Hospital, August 12tt, 1798. DEAR DOCTOR, Our want of success in treating the prevailing dis- ease, makes us anxious to hear from you, in hopes you may'have added some new and useful remedy to those heretofore in use. It is true, all our patients have been E 34 at least two, and some of them nine days ill previously to their admission. Is there any mode of relieving these unfortunate people which you can suppose we are unacquainted with ? We recollect your observing, that an emetic had been useful, after the disease appear- ed to be mitigated by bleeding. If you can spare a few minutes to write to us on these subjects, you will much oblige your sincere friends, &c." THE ANSWER. My dear and worthy friends, I am sorry to discover by your letter, your want of success in the treatment of our malignant fever, at the city hospital. I do not wonder at it; you seldom see the disease in its first stage ; and when you do, you meet it in an aggravated state, by the motion your pa- tients undergo in being conveyed to the hospital. In answer to your request, I have sat down to inform you of the practice which I have adopted in our present epidemic. In the treatment of the yellow fever of the last year, I have occasionally lamented the loss of pa- tients after reducing the pulse by bleeding, and by the liberal use of purging medicines. I have suspected that death occurred in those cases, from the stagnation of acrid bile in the gall bladder, or its close adherance to the upper bowels, in the manner described by Dr. Mitchell, in his account of the yellow fever in Virginia, in the year 1741. The slow pulse which occurs about 35 the fourth day, I suspect further to be the effect of this bile. Its effect in a much less morbid state in the jaun- dice, in reducing the pulse is well known. Mr. John Hunter says, he once met with an instance in which it fell to thirty-two strokes in a minute in that disease. Revolving these facts in my mind, I resolved to try to remove this bile, by exciting an artificial cholera mor- bus about the fourth day of the fever. I was the more disposed to attempt this method of cure, from believing as I have done for several, years, that a cholera morbus is nothing but the first grade of a bilious fever, thrown in upon the bowels, just as the dysentery and diarrhaea are the internal form of a common bilious or inter- mitting fever. I began this mode of treating the fever eight days ago. My solicitude for the issue of it was very great. Thank God it has succeeded to my wishes, and thereby lessened, in a great degree, the anxiety and distress which accompany our attendance up