UNITED STATES OF AMERICA
*  MB
* *   •
FOUNDED 1836
WASHINGTON, D. C.
GPO  16—67244-1 
 
 
COLLECTION  OF  PAPERS
•OK THE SUBJECT OF
PREVALENT IN THE UNITED STATES Fn»  *•
            FEW YEARS PAST.
      COMPILED BY NOAH WEBSTER, ?J/JV.

MEMBER OF THE SOCIETY FOR PROMOTING AGRICULTURE,
   ARTS AND MANUFACTURES IN THE STATE OF NEW-
      yORK, AND HONORARY MEMBER OF THE
           HISTORICAL SOCIETY IN
                BOSTON.
             N E w-r 0 R K:     s *.y +fi <u V

?RINTED BY HOPKINS, WEBB AND CO. NO. 40, PlNE-STR££r

                 I796.

      [PUSLISHK© ACCORDING TO ACT OF CONGRESS.] 
 
         CONTENTS.


J.  Account of the Yellow Fever in New-York in  1795
 ' .__By Dr. Valentine Seaman.

II.  Account of the fame, by  Dr. Elihi H. Smith:  to
  which is prefixed,

III. An account of the Fevers that prevailed in Sheffield,
  State of  Mafachufetts, in 1794 and  1795—^' Dr.
   Buel.
IV. An account of the  Fever at Norfolk,  Virginia,  in
   17nr__by Dottors Taylor and Hansford.

 V.  Letter from Dr. Ramfay on the fame fubjeft.

 VI. An account of the Fever at New-Haven, in 1794—
   By  Dr.  Eneas Munfon, and his Son.

 VII.  Dr.  Mitchill,  on Contagion.

 VIII. Letter from  Dr.  Reynolds,  on the  Fever  in
    Montgomery County.

 IX.  Remarks on Cleanlinefs  and Ventilation,  by  tin
    Compiler.

 X.  Concluding Remarks, by the fame. 
ADVERTISEMENT.
        id AD the following collection of papers been
    more complete,  it would have afforded double fatis-
    facticn to the Compiler.  The fiiccefs of this attempt
    has  however convinced me of the great  utility of
    undertaking.

      As fafls  are the bafis of human knowledge, it is of
-'   great importance to collect them.   There are proba-
    bly in every profeflion, facts enough which occur every
   year, in an  extenfive country, to conftitute a mafs of
    information, if collected, equal to what a long life of
    experience would be neceffary to acqviire for any one
    maiz.  If not collected, thefe  ufeful facts are loft to
    all the profeflion, except to a  few individuals; if col-.
    Iccted, they condenfe  the knowledge of a whole  life
    into the compafs of a few hours reading.  This might
    be done every year j and what could be more ufeful ?       -

      Though not a Phyfician, I  have been accuftomed
    to Philosophical  inquiries, and feel a deep  intereft in
    the profperity of my country and the happinefs of my
    fellow-citizens.   I am perfuaded that the Americans
    may be convinced by fads, that even in our climate,     t
    Epidemic and Peftilential Maladies may be generated
    by local caufes.   If they can  be  convinced of this,
    that fources of  difeafe  and  death may  be  found
    among themfelves created by their own negligence,
    it is a great point gained ;  for until they learn this,
    they will never  attend to the means of preferving
    life and health.  They will ftill wallow in filth, croud
    their cities with  low dirty houfes and narrow ftreets;
    neglect the ufe  of bathing and  warning; and live
    like favages, devouring, in hot feafons, undue quan-
    tities of animal food at their tables, and reeling home
    after midnight debauches.
i 
C  v  )
  If they can fettle this point  with  tbemfelves, that
danger may'exift at home, fome perfons may profit
by the conviction.  Our police at any rate may  be
wholly changed, and the mode of building our cities,
undergo a thorough alteration.

  I have to make  my acknowledgments to the  Gen-
tlemen, who have favored me with their communica-
tions.  Thofe who have neglected my applications,
doubtlefs have good reafons for it; thofe who have
treated this undertaking with contempt, have my moft
hearty forgivnefs.

  I have been folicited to advertife for fimiiar com-
munications, the next year* and am afiiired, that more
numerous papers may be expected.   But I have nei-
ther inclination nor leifure to  devote much time to
this object; nor am I  convinced that the object itfelf
will reward a continuance of my labors.

                        N.  WEBSTER, Jun.

   Nnv-Tork, jfufy i, 1796. 
(CIRCULAR.).
To the Phyficians of Philadelphia, New-Tork, Baltimore*
             Norfolk and Newhaven.

Gentlemen,

     As a malignant fever has, for three fummers
pad  raged in different parts  of the United States,
and proved fatal to great numbers of our fellow-citi-
zens, and extremely  prejudicial to the Commerce of
the Country, it becomes highly important  to take
fuch efficacious fteps  as human wifdom  can devife to
prevent the introduction,  arreft the progrefs, or miti-
gate the feverity of fuch  a ferious  calamity.   It is z
caufe equally interefting to every part of the United
States, and one that  deeply  affects the happinefs of
families,  and the general  profperity of the country.

   The firft meafure to be faken in this bufmefs feems
to be, to afcertain the following points—Whether the
bilious remitting fever, commonly called the Yellow
Fever, is of foreign or domeftic origin ; whether it is
always imported or may be generated in our own coun-
try; whether it is an epidemic, or depends for propaga-
tion on fpecific contagion ; or whether  it partakes of
the nature both of an epidemic and a contagious dif-
eafe.

   Thefe points,  however clear to  many of the fa-
culty, are fubjects of warm controverfy among others;
and while profeffional men differ in opinion, other ci-
tizens will differ alfo; and while a difference of opi-
nion exifts as to the origin and  nature of the difeafe,
no legiflative remedies, no effectual police-regulations
can be expected for  the prevention of  this calamity. 
(  vii   )
  To decide on the origin and nature of the Yellow
Fever, we want the evidence of fads ; thefe have oc-
curred in the United States, i'ufficient in number and
clearnefs, to furnifh evidence that fhall produce uni-
vorfal conviction, if all thofe facts were brought toge-
ther and offered to the Public in a mafs.

  If the gentlemen of the faculty will take the trouble
to furnifh me, feverally, or by committees, with fuch
facts as have fallen under their notice, relative to the
foregoing points, I will be  at the pains  to  arrange
them, and will riik the publication and circulation of
the work throughout the United States.

  In an undertaking of this kind, private intereffc
ought not to be wholly abandoned ; but my princi-
pal motive, is to promote the beft interefts of my fel-
low citizens, by doing what few men will undertake:
that is, collecting the fragments of knowledge which
lie  fcattered  in "various places, and arranging and
publifhing  them for the  common benefit  of my
country.

   The particular points on which  I wifh to obtain
information, are the following :

   The origin of the yellow fever  in  the refpective
places to which you  belong—the time of its appear-
ance and difappearance—its fyrnptoms and,'the molfc
fuccefsful  mode of treatment—what proportion of
perfons feized with decided fyrnptoms of this  fever
have died—how far the fever has been attended with
fpecific contagion, and the  proofs of this—in  what
fituations as to free air, water, ftreets and buildings,
this difeafe has been  moft fatal—what defcriptions of
people have fuffered moft,. and their mode of living—
what malignant complaints  have, for two or  three
feafons, preceded the yellow fever—how it differs in
* 
I
(  viii  )
fyrnptoms from the ordinary bilious fever of the coun-
try—whether or not you have known a fever, with
the fame or  fimilar fyrnptoms, to occur in fcattered
inftances, in other feafons than that in which the yel-
low fever has prevailed—and whether fuch cafes can
be traced to any known caufe—and in fhort, pleafe to
communicate any other information  which, in your
opinions, may throw any light on the origin,  nature
and cure of the difeafe.

  The Health Committees of the Cities above men-
tioned,  are  particularly requefted  to furnifh fuch
facts,  on any of thefe points, as may have come to
their knowledge.
             o

  The Phyficians  of Newbern, Edenton,  Wilming-
ton and other towns in North-Carolina; of Charlefton
and Beaufort in South-Carolina ; of Savanna or other
targe  towns in  Georgia ; and the Phyficians  on  the
eaftern fhore in Virginia,  Maryland and  Delaware,
together  with thofe of  Alexandria, Richmond, Pe-
terfburgh, or other large towns in the fouthern ftates
where bilious fevers prevail,  are requefted to com-
municate fuch facts and obfervations relative to thofe
fevers, as may enable the public to judge how far the*
ordinary remitting  bilious fever  of our country
correfponds  in origin and fyrnptoms, with the fatal
epidemic which has raged in Philadelphia, New-
York, &c.

   A  fimilar requeft is made to Phyficians in every
part of the United States, efpecially in the neighbor-
hood  of the drowned land, and at Shawangunk in the
ftate of New-York, and thofe who have had the care
of thofe perfons who were taken  with  a malignant 
(  «  )
   fever at the treaty with the Indians near lake Cayuga,
   the fummer paft.

     The Phyficians  about Coxfackie, the  drowned
*  lands in  Salifbury  in  Connecticut, and Sheffield in
   MaiTachufetts, and who attended the fick in the neigh-
   borhood of the marfhy ground on the borders of thofe
   towns—in fhort, all Phyficians who have had expe-
   rience in  bilious fevers of a malignant kind, are re-
   quefted to communicate whatever facts can throw
   light on the origin,  nature, or cure of fuch fevers.—
   They are requefted to inform, in what feafons the fe-
   vers prevail moft, whether wet or dry—at what time
   in fummer they  appear and difappear—at what dif-
   tance from a marfh they prevail, to determine the ex-
   tent  of the contagious influence  arifing  from  low
   grounds—whether  the water is running or ftagnant—
   whether  fuch  fevers ever prevail near frefh  water
   ponds, whofe banks are high and rocky, and the mar-
   gins of which do not abound  with grafs and weeds-—
   whether  the  putrid  fevers arifing  evidently  from
   marfh-exhalations in the country are ever attended
   with fpecific contagion—in fhort,  every  fpecies of
   facts that can ferve to explain the caufe, the progrefs,
   and the fyrnptoms, of bilious fevers.

     It is requefted that your anfwers to thefe inquiries
   may  be forwarded to me  at New-York as fbon as
   convenient, and by private conveyance, if poffible.  I
   am perfuaded that a full inveftigation  of  the caufes
   of the difeafe,  will enable the government of our
   ftates and cities, to make fuch regulations as to guard
   our  commercial towns from a repetition of the  cala-
   mities they have once fuffered.  If  the dife?fe  has
   been imported, more effectual  mcafures mult be taken
   to prevent its introduction—if generated in our own 
                     c   *  y

country, it is  abfolutely neceffary for our populous
towns to fufter moft decifive amendments, in their*
docks, houfes, ftreets, £:c.

   Our  latitudes are the fame as many countries in
Alia, where the plague  rages; and perhaps, our  cli- ;■
mate, which formerly refifted the progrefs of fatal |
epidemics,  is  aflimilating  itfelf annually to that of
Smyrna and Conftantinople.                       »

   I cannot but hope, gentlemen, that you will be of J
opinion that this fubje.ct is of great and ur.iverfal con- P
cem to the United States; and that you will confent |
to aid a plan which  has  the health of our fellow-citi- f;
zens, and the happinefs and profperity of our coun- 1
uy for  its object.

         i am, gentlemen, your fellow-citizen,      |

                    NOAH WEBSTER, Jun.   |

New-Tork9 Od. 31,  1795.                         I
I 
                       A N

            ACCOUNT
                    OF THE

 EPIDEMIC  YELLOW  FEVER,

           AS  IT APPEARED
                    IN THE

CITY OF NEW-YORK IN  THE YEAR 1795.
                 CONTAINING,
             BESIDES ITS HISTORY, fc?V.
  THE MOST PROBABLE MEANS OF PREVENTING ITS
      RETURN, AND  OF AVOIDING IT, IN CASE IT
         SHOULD AGAIN BECOME EPIDEMIC.
      By VALENTINE SEAMAN, M. D.
ONE OF THE PHYSICIANS OF THE HEALTH C0MM17T77 •
              OF NEW-YORK IN I795«
-------------" And tho' the putrid South
Be fhut; tho' no convulfive agony
Shake, from the deep foundations of the world,
Th' imprifoned plagues; a fecret venom oft
Corrupts the air, the water, and the land."
" Even Albion, girt with lefs malignant Ikies,
Albion the poifon of the Gods has drunk,
And felt the Iking of monfters all her own."
                                Armstrong.
                   NEW-YORK:
PRINTED EY  HOPKINS, WEBB fc>* CO. N°. 40, PINE-STREET.
                     _I?96._
             [CNTERED ACCORDING TO LAW.]
• 
 
          To BENJAMIN  RUSH, M. D,
PROFESSOR OF THE INSTITUTES, AND OF CLINICAL MEDfc
      CINE, IN THE UNIVERSITY OF PENNSYLVANIA.

    ■ I, HY  general liberality of fentiment, together with tftk
unparalleled  manner in  which thou durfl, in the  noble caufe
of humanity,  to introduce innovations in the  treatment of the
Epidemic Fever of Philadelphia in 1793, amidfl the perftcuting
fliafts of thy opponents, point thee out as a mofl proper patron
for the free thoughts advanced in the following pages.
     Befides this, Ifliould confider myf'elfgreatly deficient, was
 I to neglect this opportunity of acknowledging the  high fenfie.
 of gratitude I entertain for the benefit  received, not only from
 thy valuable public inflrutlions,  but alfo from thy ever ufeful
private converfations.
     Wifhmg thy long continued  and increafing u/efulnefs,.
 in thy profeffwn and in the diffufion of Medical knowledge,

               I remain,

                 With refpetl and efleem,

                   Thy Friend,                ^
c/al&ntlnc  zfeaman* 
t
 
                       T O
     John Broome,       Robert Bowne,
     Gabriel Furman,    Nicholas Carmer,
     Andrew Van Tuyl,  Isaac Stoutenburgh,
     John Campbell,     Samuel Bard,
     Robert Lenox,       George Janeway, and
     Theoph. Beekman,   Nath.  Hazard,
Surviving Members of the Committee of Health of New-York
                    for 1795—
     Whofe undaunted attention to the objecls of their appoint-
ment, and whofe perfevering care for the relief of their affliclea
Fellow-Citizens, miifi,  no doubt,  have been followed  by the
gratifyingfienfe ofwett done, in their own bofoms :—Biffed
be their reward.
     As the following obfervations were drawn up partly at
their folicitations, and as the ideas and opinions advanced in
them, are confidered as meriting  their ferious attention, they
are mofl refpetlfullyJubmitted by

                 Their Friend and Fellow-Citizen,
THE AUTHOR. 
 
preface.
        1 HE utility of accurate Hiftories of Epidemic's
  to the improvement  of medicine,  has  never  been
  doubted from the time of the early and valuable pub-
  lications of Hypocrates, to the late and no lefs  judi-
  cious obfervations of Dr. RuOi: but as  the Yellow
  Fever has  been fo accurately and fully defcribed and
  treated of by feveral phyficians in  the Weft-Indies,
  in Philadelphia, &c. it may be thought entirely fuper.
  fluous to give any account of it as it appeared in this
  city.   Fully fcnfible  of the force of  this remark, I
  long declined attempting any thing  of the kind; but
  as feveral facts have occurred to me, a general know-
  ledge of which I confider as highly interefting to hu-
  manity and of importance to the community at large,
 and efpecially to the inhabitants of this city, I am
 finally induced to fubmit  them to the confideration
 of the  public, particularly as the Medical  Society,
 which had made fome progrefs in the bufinefs, have
 declined the profecution of it.

   The many accounts and complete defcriptions al-
ready given of this difeafe, feem to  render it unne-
ceffary  to  enter into a minute detail  of  its  feveral
fyrnptoms in this place; I have therefore  been very
fhort upon that part of the fubject, referring the more 
                   [  viii   ]
nice inquirer to the beforementioned authors, particu-
larly to Dr. Ruth's account of it, as it appeared  in
Philadelphia,  in  1793, where he will find its various
appearances  very particularly and  accurately  deli-
neated.
  As the following obferva'dons have originated al-
moft entirely from facts and circumftances  of the dif-
eaie, as it appeared in this city;  the reader will find
himfelf much deceived, if he looks for references to
long catalogues of  eminent authors, or for an elabo-
rate account of the difeafes of the  Weft-Indies, pes-
tilences of Europe, or  plagues  of Afia:  and as my
conclufions are drawn chiefly from cafes and occur-
ances, that have come within my own perfonal know-
ledge,  (which favored by my local fituation  in the
center of the  Epidemic, and my providential preser-
vation from its influence, till it was nearly extinguifh-
ed,  were confiderably numerous) he will  alfo  find
that my remarks have not  been  much  either influ-
enced or fupported by the uncertain communication
of my brother practitioners or other citizens; hence,
if decided and undoubted facts, fliall hereafter appear
which fhall disprove them, my error fhould be affig-n-
ed only to my general fcepticifm reflecting current
medical reports,  and  the limited nature that I have
Impofed upon my fources of information.
  As fome thoughts  which I have advanced, are de-
>■•'"! :dly nppofed to  the comn:cn ftiif-: of th? faculty ir 
 general, I wifh it to be confidei    that they are not
 the offspring of any favorite tL ^ry, or influential
 hypothefis;  for I had heretofore been taught and be-
 lieved very  differently, till the ftubborn obtrufion  of
 facts  upon my mind,  forced me to change my opi-
 nion.
   I am well aware of the lofs of reputation that I
 may  fuftain, from attempting, in the courfe of this
 effay,  to fupport opinions which are very unpopular
 with the inhabitants of this city; however, the im-
 portance of the fubject, has fwallowed up all perfo-
 nal confiderations, and determined me freely to com-
 municate what I confider as highly effential  to their
 welfare; and I fhall  be richly  paid, if my temerity
 fhall in the leaft degree, tend to  the prevention of a
 difeafe, which in its partial* operation, in lefs than
 three months,  fwept off upwards of {even hundred
 of our fellow-citizens; which  fhould be  fufficiently
 alarming  to put us upon our  guard in future, for
 fhould it again  arife,  in a feafon more favorable  to
its fpreading, perhaps its more  univerfal devaluation
will not be checked till it has numbered  thoufands
in its  mortal lift.
                       B
  * It being chiefly coqfined to a particular part of the city. 
 
A n
         ACCOUNT

                 OF THE

EPIDEMIC  YELLOW  FEVER,  &c.
Of the State of the Air, and Difeafes preceding and
  accompanying the Epidemic, and a Hifhry of the
  Difeafe.


     Jl ROM the tables of Meteorological observa-
tions, inferted immediately before the confiderationt
on the caufe, of the difeafe, it appears, that in the be-
ginning of the  fixth  month (June) the weather was
pretty warm, but became more moderate on the
feventh and eighth days, and that its temperature was
Suddenly increafed on the 9th of  the month, railing
the Mercury 12- degrees in Fahrenheit's thermome.
ter in the fpace of twenty-four hours; it was warm on
the tenth, then became  cooler for four or five days,
after  which time it continued very warm and  fultry
for feveral days; on the  19th the thermometer flood
at 87 °, and varied  between that and 69°  the  re-
mainder of this  month—we  had  rains  on the 2d,
1 ith, 20th, 24th, 25th, and 30th.  The mean tem-
perature of this month  was  73°**

  * Thefe were the ftates of the thermometer at one o'clock,
f\ M. 
                  ■■•"•/
2            AN ACCOUNT OF THE

  It gradually became cooler for the firft five days in
the feventh month (July); on the  6th the mercury
rofe to 8 30, which was 130 higher  than it flood the
day before; the next day it fell to72°; after which,
in the courfe of fix days,  it rofe to 890 without any
material fudden change; the weather then moderated
in fome degree, fo that in the laft nine days  of this
month it did  not rife  above the 8o° and in one of
them it flood at 68°—the mean temperature of this
month was 81 °: it rained  on the 3d, 1 oth, 18th, 23d,
24th, 27th, 30th, and  31ft.

  The thermometer flood near 900 moft of the time
during the firft ten days  of the eighth month  (Au-
guft)3onone  day it was  upwards of 930; in  the re-
mainder of the month it varied between the 60th and
88th°—great part of this time it was above 8o°, and
there were but a few days wherein  it was below 7 20;
the medium temperature  of this month was 830; we
had rains on  the 3d, 9th, 10th, nth, 12th, 13th,
20th, 21 ft, 23d,  and 31ft days, and feveral  of them
were very great.

  The firft week in the ninth month  (September)
the mercury remained between 70 and 750; in the
Second and third week it varied but little, one way or
the other, from 8b °; but  we had fome cool days in
the latter part of the month, the mercury being as
low as 580 on the 22d and on the 30th; mean tem-
perature about 730; we had five rainy days, viz. the
2d, 7th, 13th, 19th, and  20th.

  In the tenth month (October) the temperature of
the air was at no time above yf, but varied between
that and 490 irregularly;  the mean temperature was
620; the latter part of this month we frequently had
white frofts at night;  it  rained on the 10th, 20th,
arid 31ft.
• 
           EPIDEMIC YELLOW FEVER.          3

  Mufquetoes were never before known, by the old-
eft inhabitants, to  have been So mimerous as at this
SeaSon, eSpecially in the  South-eaftern part of the
city ; they were particularly troublefome to foreign-
ers, many of whom, had thofe parts of their bodies
that  were expofed to them,  covered with  bliflers
from their venomous operations.

  Our fummer fruits in general were no ways extra-
ordinary ;  water-melons particularly, from the wet-
nefs of the feafon,  were very flafhy and infipid.

  It was remarked that  many laborers  employed
at the different  buildings, gave out at their  work,
from the exceffive heat of  the weather.

   An  unufual  number of  perfons  fufFered in the
warm part of the feventh  and eighth months,  from
drinking cold water; and  feveral fell down and died
in the  ftreets, whofe deaths were  afligned  to that
caufe, when it more probably was  induced by an apo-
plexy, brought  on by the exceffive heat of the fun;
one cafe came under my particular obfervation which
was certainly of that kind, although currently report-
ed otherwife.

   The  cholera infantum,  was very  common  in the
early part of the  fixth month, and increased as the
weather  became warmer.    Bilious cholics and  ch'[ea-
teries became very prevalent in xhe feventh and  eighth
months.   At this time alfo the cholera morbus carried
off a number of grown perfons.

   In the beginning of the  ninth  n:o;:th, the meases
made their appearance, but they Suddenly vanifhed
with  the above mentioned dileaiej,  as Soon  :u the
yellow fever  had  Spread  itfelf among  us: I did not 
AN  ACCOUNT OF Til!
 obferve but a fingle cafe of it during the dominion of
 this powerful epidemic.

   The  common   remitting  bilious  fever,  was  no
 ways  uncommon  in  the  fummer months,  but this
 alio gave way, or  rather perhaps, run into the yelloiv
fever, as that gained ground in the city.

   As early as the fixth of the feventh ?nonth, I was
 called  upon  in conjunction with  Dr. Treat,  then
 health-officer to  our port, to vifit  Thomas Fofler,
 a patient  brought into  the alms-houfe,  whom  we
 found affected with all the full marked and decided
 fyrnptoms of an highly malignant yellow fever; the
 adnata of his eyes and his fkin were of a bright yel-
 low, the latter covered with purple fpots, his mind
 deranged, his tongue covered with  a dry  black  for-
 des, with hemorrhages from his gums and nofe, and
 a difcharge of black and very offenfive  matter from
 his Stomach  and bowels;  he died on the ninth.

   Dr. Treat was taken on the  2 2d of the J"eventk
 month, and died on  the  30th.   Several  other  un-
 doubted cafes occurred, about this time, in the neigh-
 borhood of  Dover-ftreet, but the firft one that came
 under my particular obfervation, was that of James
 Daiton on the 12th of the eighth month, then in the
 fitth day of his  illnefs, of which he died the  day fol-
 lowing as yellow  as gold.   From this time  the dif*
 eafe became more and more frequent; yet as we find
 by  the accurate accounts of the  Health Committee*.
 not above two a day upon an average died of it, till
 the 24th of the month.

   The increafing prevalence of the epidemic at the
 upper part ofWater-ftreet and in Cherry-ftreet, and
 in ail the neighboring low ground between them
 ; in! Chatham and the lower part of George-ftreets, in 
            EPIDEMIC YELLOW  FEVER*           5

 the forepart of the ninth month,  became fo alarming
 as to drive many of the moft opulent of their inhabit-
 ants to the country, while the lefs prudent and the
 more indigent remained expofed to a difeafe, which,
 from this limited fpot, in lefs than three months, car-
 ried as many as fivehundred to their graves.

    The difeafe was not,  however, confined entirely to
 this part oS the city ;  for in every other fituation,
 favoring the accumulation of filth and ftagnation of
 putrefactive materials,  there it  was no Stranger : it
 raged with peculiar  violence in the vicinity of a moft
 intolerable pent up  fink, to the  weft of Peck-flip,
 which is the receptacle for all the refufe kitchen arti-
 cles, and yard wafli of a number of  lots fronting  Pearl
 and  Water-ftreets,  that back upon it; it was like-
 wife very prevalent  in the neighborhood  of the Fly-
 market, alfo in and about  Skinner-ftreet,  as well as in
 fome of the unregulated grounds on the north fide of
 the town.

    If an account of the epidemic,  as it pervaded  the
 different parts of the town, could be  accurately as-
 certained, and depicted in colors, heightened in pro-
 portion to the combined early time of attack, and the
 numbers affected, blazoned by its comparative ma-
 lignity, there  can be no manner of doubt,  but that
 the low ground in the foutheaft of the city as above
 mentioned, would appear as the grand center of the
.. calamity, diffufing its effects, like diverging rays, to
 the adjacent parts ; aiding by its moft powerful influ-
 ence,  different  fecondary  centers, already fmoking
 hot, to flame out its peftiferous operations.   The ma-
 ny folitary cafes of the  difeafe that have occurred in
 diftant healthy  Situations, appear to have been kin-
 dled up by imprudent individual expofures too near
 thefe fources of infection. 
6
AN ACCOUNT OF  T.i'
   The black people appeared to be  as fuhject to the
dieafe as the -whites, but it was not fo fatal to them ;  I
of eight that I prefcribed for, only one died, and with  1
her, the complaint having ftclen in under the deceit-  J
ful form of a common cynanche, was permitted  to run
on for fome days, before medical aid was called for.
By report of Dr. S. L. Mitchell, in behalf of a com- •.
mittee of the Manumitting Society of this city, it ap-
pears that not a fingle fcholar of the free black School,
under their patronage, died with it.

   Sever?! circumiiances tended to render the difeafe
particularly fatal to the more  indigent part of the
community:  ift. The higher prices  of houfe-rent in
the other parts of the city, having concentered a great
proportion of them in the epidemic  neighborhood,
and  crouded them  in very fmall  confined  apart- i
ments;  a number of houfes contained as many fa-1
milies as it  had rooms in it.  2d. Their poverty not v|
permitting  them to quit their place of refidence when fl
the dileaie came around them.   3d. T he great difficul- ^
ty cf getting nurfes, and their exorbitant prices pre- M
venting them from getting proper attendance before m
their Situation became known to the Committee of M
Health, often-times a whole family being taken down fl
about  the  fame  time,' their  panic  ftruck fur-day jfl
friends cuitting them in their diftrefs, from the fear J
cf infection.   41b. The neglect cf  obtaining  early!
medical afliftancc, from a hope that their difeafe was««
not the prevailing ere : and 5th. The refufal of ma-1
ny, after  they were taken ill, thus miferably Situated,-M
to go to Belle Vue, " left (to ufe their own expreflion) |
they fhould catch the Yellow-Fever and die."  :   ,.

   Forcirne'.' who came from a more temperate cli- "
mate, as  the Engl ift!, Irifh, Scotch,  &c. and  people
from the  country, who had not long  refided in town, :
were particularly obnoxious to this complaint. 
           cPlD.^MIC  YELLOW  FEVER.           7

  The French from the  Weft-Indies, feemed proof
a i-ainft the influence of this  epidemic, a numerous
family of them continued in the midft of it, and view-
ed  without danger the death of a great many, and
the difeafe of nearly all their neighbors who remain-
ed in town;  not one of them fuffered the leaft in-
difpofition : In another boarding houfe of them, con-
taining at leaft thirty or forty perfons, not far from
Peck-flip, not any of thern took  the complaint, al-
though numbers of the other inhabitants were drop-
ing away with it, on every fids of them.

  The difeafe Spared no age or  Sex, although it was
mod  fatal to  the young and thofe in the prime  of
life.

Symptoms  of  the difeafe,  as  exhibited in the different
           parts andfundions of the body.

   ift. The vital fund ions Suffered  extremely in the
tirfl attack of the difeafe, it generally coming  on with
chillnefs, an anxious and interrupted refpiration, with
a total abfence of perfpiraiion ; this however, in fome
inftances, came  on very  copiouflv, after the great
heat  that generally  followed the  chill, had exifted
for a rime, but  in moft cafes the fl^in continued dry
and parched, except a fweat was induced by artificial
means.

  The pulfe  was as variable as  the hues of the ca-
meleon; in moft cafes  it  was frequent, and after the
chill  had fubfided, it became Somewhat hard: vet in-
ftances occurred of a preternatural flownefs. 1 me-.
with one cafe in  a black man, where it beat only for-
ty-two ftrokes in  a  minute; and  in another perfon
there was  a  complete intermiflion  of k in every
twelfth or fifteenth puliation : and in other  patient.?,
f 
 t>            AN ACCOUNT OF THE

 particularly in the 3d or 4th  day of their complain!.;-.,
 were phyficians  to judge from the pulfe alone, the,
 would declare them in a  convalefcent  ftate, at the
 very time they wrere in the moft imminent danger and
 Sometimes  within a  few hours of their end.  Al-
 though I firmly believe with  my moft eminent teach-
 er Dr. Rufh, that the pulfe is our bcft guide in the
 knowledge of difeafes,  yet in no complaint that has
 ever occurred to my observation, have I found this
 moft fure index of the ftate of the fyftem, fo  little  to
 be depended on.  Hemorrhages from the nofe, gums,
 flomach, uterus, &c. were very common at the com-
 mencement, as well as in  the'more advanced peri-
 ods of this difeafe.

   2d.  In the animal functions this  difeafe in  its
 firft attack, produced laffitude, and  an averfion to  all
 kind of bodily exertion with  a fenfe of general debil-
 ity, attended  with violent pains in the head  and
 back, femetimes Shooting down the le^s : thefe fre-
 quently preceded the chills,  and in moft cafes  ac-
 companied it  and continued afterwards, as a very
diftrefiing Symptom of the diSeaSe.   The mind was
 oftentimes  very  much dejeded,  with imperfed vifion
 and memory, "followed by delirium,] ubfultus, tendinum,
 he. before death.
                      *
   There was  in many cafes an evident, though flight,
 remiflion in the violence of thefe Symptoms Some-
 times in the courSe of twenty-four hours'from the time
 of the attack, as alfo at fome other periods ; but in
 the hurry of the raging epidemic, I  was  unavoidably
 prevented from  gaining an  accurate knowledge of
 them.

   3d.  No part of the body  appeared to Suffer more
 than the natural functions, which includes the
 alimentary canal and fecretions.  The flomach, as in 
           EPIDEMIC YELLOW FEVER.           9

all fevers, was affected with a degree.of naufea, and
Sometimes vomiting at the firft acceffion of this ail-
eafe, which frequently fubfided for a while, but is
fucceeded about the third day, if propev means eye not
ufed to prevent it, by an almoft unconquerable irrita-
bility and retrograde movement of this organ, throw-
ing up large quantities of green or yellow bile, and re-
jecting immediately every particle of medicine, feed or
dr'nkt that was taken into it—afterwards discharging
an aquccus fluid containing a number of light dun co-
lored fpecks in it ; this,  if not checked, was followed
by a puking of  a fluid exactly refembling coffee,
with  its grounds  floating  in it, which by (landing,
would fettle  to the bottom..

   The vomiting which occurs about the  third day*
 frequently, is the only diftrefling fymptom that the
 patient  labors  under,  his pulfe  becoming natural,
 fkin  cool  and moid,  with an entire  freedom from
 pain,  and a perfect clearnefs in the mental  opera-
 tions, that infuperable  circumftance Handing alone,
 as it were, to humble the pride of phyfic, and to warn,
 in cool blood,  the unhappy fufferer of his precarious
 existence.

    A hiccoughing often was very troublefome in the dif-
 ferent ftages of this complaint.  The bowels were very
 uniformly and obstinately cofiive: there were fome ca,
 fes it is true, that were  attended with frequent evacu-
 ations, but thefe generally feemed rather of a partial
 dyfentery nature,  and not free difcharges  from the
 whole courfe of the inteftines.

    The fecretion of bile was greatly  increafed, as ap-
 peared t>y its copious difcharge from  the ftomach in
 vomiting, as well as from the bowels when  excited
 by proper purgatives.   The flow of faliva and excre-
  tions from the mouth  and fauces were not much i:n- 
 iO            AN  ACCOUNT OF THE

 peded ; in the beginning the icngue appearing meifr
 and a little while, after a few days it  became  more
 thickly  furred  and  affumed  a  deeper hue, but fre-
 quently in the latter Stages it became quite dry and
 coveied with a black crufL

   The  appearances on the [upcrfalcs were  various,
 the fr.'ni oftentimes  retained its natural appearance,,
 but frequently, though not uniformly, as the difeafe
 advanced, it affumed a yellow tinge. Mufquetce 1 hc-3,
 which before had entirely disappeared, fhewed them-
 Sclves in all the parts that had been expofed to them,
in fmail purpleifli red fpots ; thefe were  often taken
for petechia, which  Sometimes, but more  rarely ap-
peared.

   Unfeemly fcabs,  oftentimes in the latter ftages,
 formed  about the mouth,  which,  on being Scratched-
off, Srequently were Sollowed by  troubleSome   little.
hemorrhages.   Thefe eruptions did not in this fever
as it docs  in others, indicate any favorable event  of
the complaint.

   The adnata of the eyes, in the beginning where the
attack was fevere, generally were tinged and fuffuSed
with a reddilh color,changing with, the Skin to  a yel-
 low, as the difeafe advanced : there were many, how-
 ever, even among thofe who died, whofe  fkin nor
 eyes fhewed the leaft appearance of tins color.

              DIAGNOSIS.

   If it fhould be eftablifhed, that this fever is as highly
 contagious as is„ perhaps, too generally  believed,  its
 diagnosis or peculiar fyrnptoms diftinguifhing it from
 others, would  become  a matter of the  greatefl im-
 portance,  both to individual Safety and to the wek
 fare of the community at  large. 
          EPIDEMIC YELLOW FEVER.           II

  This  part of the Study of medicine has,  of late,
been confidered of lefs confequence than formerly,
fmce the fallacy and imprudence of prefcribing  for
the name of a difeafe, has been fo fully expofed and
juftly condemned by the generality of phyficians ;—
however, in this particular  complaint, as the hopes
of a cure depend, almoft  entirely,  upon the means
ufed in the firft two or three days  of its attack, it
certairdy muft be cf prime neceflity  to know it in its
early ftage.   We cannot be too  careful in detecting
the existence of this difeafe, for in its  commence-
ment, its evident Symptoms are  oftentimes no way
in proportion to the danger.  Hence, as Dr. Jackfon
obferves, (in  hitreatife on  the fevers  of Jamaica)
" perfons unacquainted with the nature of the difeafe,
" would be difpofed to believe  that the patient  ex-
" preffed Sufferings that were not real."   And hence
phyficians are Sometimes led to neglect them till  it is
too late to Save their patient:.

   In the firft ftage cS this  Sever it is oftentimes with
difficulty diftinguifhed from the  common bilious re-
mittent, its fyrnptoms in general being exactly fimi-
iar, only aggravated in degree ;  the pain in the head
and back are more fevere and conftant, and the re-
rnimons, whenever they  are obServable, are more
obScure : ThoSe who are well acquainted  with  the
difeafe, may oSten recognize it  by a certain undef-
cribeable appearance in the countenance oS the Sick,
the eye is often more red, and the face more  flufhed
than the heat of the body  and the  general action of
the fanguiferous fyftem, would lead us to expect.

   The remarkable irritability of the Stomach,  that
generally comes on (when the  difeafe is  permitted
to  run an uninterrupted courfe) about  the third or
jkh rth day, whereby a conftant naufea and retchings 
  12            AN'  ACCOUNT  OF  THE

  to vomit, immediately brings up every thing#as Soon
  as Swallowed, Seems to be a  pretty  diflinguifliing
  mark of this difeafe at this Stacc of it.
                            o

    The yeiJow fkin, and coffee ground or bhcb vomit-
  ings, as they Sometimes occur  in the more r.cvanced
  Stage, maybe looked upon as derided art unequivo-
  cal evidences of this complaint;  but  they cannot be-
  confidered as pathognomic fyrnptoms, for although they
  are to  be found in this fever only, yet in the great-
  eft proportion of cafes they do  not  attend it.

    The prevailing epidemic fhould always have a great
  influence in fixing our judgment with refpect to this,
  as well as other difeaSes. Whenever it  is found, from
  decided caSes, that  it really exifts  in any particular
  Situation, I fhould confider every fever, in that neigh-
  borhood, attended with  aggravated fyrnptoms  of  a
  common bilious remittent, to  be of this kind ; for I
  mould fuppofe the powerful operation of its caufer
  would certainly predominate over  the milder eaufes*
  of more moderate maladies.

               PROGNOSIS.

    The prognofis is  to be drawn from the diSpofitioi;
  and  conftitution of the  perfons affected, as well as
  from the particular fyrnptoms.   Thofe who had been
  much debilitated by previous difeafe,  great  anxiety
  of inind,  drunkennefs, &c. moSt generally admitted
  of but an unfavorable profpect as to the event of this
  ciifeafe,  as likewife  did the refolute and hardy, who
  would not early fubmit to  their complaints, but en-
v  deavored to Shake them off as  they would a common
  rr.tarrh.  I ufed to warn fuch ones at  my firft vifits,
  that I feared from their difpofitions, that they would
  undertake to  wreftle with their difeafe, and that  if
  they did they would furely fall under it, and unfor* 
          EPIDEMIC YELLOW FEVER.          13

tunr.'.ely their conduct  too often verified  my  frars
and justified my prognostic.

   In the early Stages of the complaint, ii it came on
very moderately, without much affection  of the head,
if the eyes and countenance were not much affected,
and the bowels were eafily moved by the  medicines
hereafter to be mentioned, Ave, in general, were war-
ranted in pronouncing a favorable termination.   But
when the face and eyes were fuSiufed  wi<h a reddifh
tinge,  or  great  diftrefs and  anxiety were expreffed
in the countenance., with fevere pain in the head and
back, we had great caufe to fear the confequences,
particularly if the bowels were obftinately  conftipat-
ed ; this  laft  cifcumftance, in every  inftance, por-
tended the greateft danger; indeed, it feemed to  me
that the  degree of danger  was, very generally, in
proportion to the ftubbornnefs of the conflriction of
thefe vifcera and their infenfibility  to the impreflion
of purgative medicines.

   In  the  latter  Stages of the complaint,  when  the
conftant vomiting  came on,  there was always great
danger to be apprehended; yet fome have  recovered
after discharging the coffee ground like matter before-
mentioned, but thefe  cafes  were  confeffedly  very
rare.

  The other Symptoms of putrefcency, as a black
tongue, petichise,  &c.  were generally unfavorable,
although I did  not find hemorrhages Such terrible
occurences as they are,, by the generality of authors,
Stated to be. In the ninth month (September) 24th,
in a communication to the  Committee of Health,
among other things, I obferved, that  " in taking a
" retrofpective  view of my  different  patients  with
'* the prevailing complaint, I found among them five
" who had had hemorrhages, cither from  the nofe. 
 14            AN ACCOUNT  OF TttE

 " gums,  ftomach or uterus,  and one who had :uit
 " fome blood from an accidental wound in his head;
 " thefe were all  the patients  that I had  attended.
 " who had been affected with any hemorrhage v.hat-
 " ever, neither of them had died, three had recover-
 " ed, and the other three were much better than they
 " had been."—Thefe three alio afterwards recovered,
 neverthelefs, fome patients afterwards died, whofe
 complaints  were  attended with hemorrhages :  ftill
 thefe facts prove that they do not indicate fo  much
 danger as is commonly believed.

   Slaving given a curfory account of the  feafon  im-
 mediately preceding and during the continuance of
 the difeafe, and alio a hiftory.of it's moft  materia'
 fyrnptoms, together with  the  inoft  effential circum-
 stances refpecting its diagnofis  and prognofis, I pro-
 ceed to State Some  facts and free thoughts relative to
 a quefticn, in my  opinion highly interesting to  the
cauSe oS humanity, and  greatly  important to  the
community, Sor on it depends the welSare oS the  af-
flicted individual, as well as the method cf prevent-
ing or eradicating  the difeafe in general, viz.

   Is the ycILw fever ccmmunicaled by  cyr^cgion*  or
net?

   Unfhackled  from -A\ prejudice, I Shall venture to
mention feveral facts that oppofe the idea of the con-
tagious  nature  of  this difeafe, which,  if  they have
not determined  me to quit the beaten path of that
old eftablifhed  opinion, in which 1  have been edu-
cated, they certainly have Staggered  me very much,

  * By contagion I mean a matter or " e;5u\ia arifing diredtly
 " or originally from the body of a man under a particular difeafe,
 " and exciting the fair.,: kind of difeafe in the body of the perfon
 " to whom they are r.*-; 'J.-.!."  CulL-i.'-i firft liner. 
          EPIDEMIC YELLOW FIVER.          15

I therefore fubmit  them  to  public  consideration,
conceiving that they merit the moft ferious and can-
did attention.

   ift. In Several inftances, perSons have been  taken
with this diSeaSe, who had avoided, with the utmoft
care,  any communication  with the fick,  and Some
that came to my knowledge, who had not been out
oS their houSes for Several weeks, nor had any  affect-
ed perSon been within eighty  Seet of  them, were at-
tacked and Severely handled by  it;  hence iS it was
induced  by  contagion,  this complaint muft be the
moft highly contagious of any other; the contagion
of the plague itfelf, as appears by the report of phy-
ficians moft  converfant  with it,  does not extend at
fartheft above  ten paces from  the   infected  body.
(Howard on Lacerettos.)

   2d. Although many of the nurfes  and  attendants
on  the fick, in the part oS the city where it raged,
took the  complaint,  yet  others, who lived in the
Same neighborhood and cautioufly avoided Such em-
ployments, did not more generally eScape it.   And
notwithstanding many from  New-York died with
this diSeaSe in different parts oS the country, on Long-
Ifland, in JerSey, Albany,  &c. yet I have not  heard
of a fingle well authenticated cafe of any nurfe  or
attendant of the fick, or any other perfons taking it
except they  had lately been in the city.   It is true,
popular  reports have oftentimes fpread  the difeafe
about the country, yet upon clofe inquiry  that I have
made in  feveral inftances, to afcertain their validity,
I have found them to have originated  from difeafes of
an entire different nature, and fometimes from deaths
that occurred about the fame time, and which would
have happened^had the yellow fever never existed:
even  fhould it appear that fome  perfons were taken
                       D 
 i6            AN  ACCOUNT  OF THE

 with a fever  in confequence of the  anxious fatigue
 of nurfing, and the diftreSs from the loSs of near and
 dear relatives, which  finally proved  fatal to them,
 we are no way juftified in fuppofing that it was this
 complaint; Sor had like attention been paid to perSons
 with a  pleuriSy or rheumatiSm, like conSequences
 might have followed:  further,  fhould an inftance  be
 produced wherein a perSon who had had an inter-
 course with one in the country affected by this dif-
 eafe, fhould  afterwards  be taken with  a like com-
 plaint, it would  not  be a  conclufive  proof of  its
 contagious nature, Since Sporadic cafes have occurred
 at many  places where there  was not the leaft SuSpi-
 cion, or  poffibility of  its having been produced  by
 effluvia  arifing from a perfon under a like difeafe; *
 the communication with the fick, might in fuch  an
 inftance, be  merely an accidental and no ways  an
effential concurrence.

  Dr. Lining in a letter to Dr. Whytt, (Effays  and
 Observations Phyfical and Literary, vol.  2d) mentions
 that, when this difeafe raged in Charlefton (South-
 Carolina) " If any from the country received it  in
 " town and Sickened in  their  return home, the in-
 " Section fpread no further, not even to one in the
 " fame houfe."

   In the year 1793, during the prevalence of this
 difeafe in Philadelphia, feveral perfons  who  had
 lately come  from  that place,  Sickened with it  and
 died in this city, yet in no inftance did they commu-
 nicate it to others, although, they were carefully and
 constantly attended.

  *■■ « Few years pafs, fays Dr. Ruth (account of the bilious re-
 " mittent yellow fever, as it appeared in Philadelphia, in  1793,
 " page 159) without producing them in Philadelphia." Dr.
 " Lird, (diieafei incident  to Europeans in  hot climates) ky»
 ;i fporadic cafes of yellow fever have even occur?.d in England. 
          EPIDEMIC YELLOW FEVER.          17

   3d.  At Bell-vue, the hofpital appropriated for the
reception of the poor, fick with this complaint, there
was  not a fingle attendant who took the complaint
excepting fuch as  had been but a few days  from
town.;  notwithstanding they  were conftantly involv-
ed in the midft of the effluvia arifing from the nu-
merous fick and dead Surrounding them.

   There was not a fingle inftance oS the complaint
being communicated to any  oS the phyficians at the
hoSpital at Bufh-hill at the time it raged in Philadel-
phia in 1793,  and " among the nurSes for the fick
" two  only died, and they (as  is obferved by the
" chief phyfician  of that institution) probably had
" the Seeds of the diSeaSe, previous to their going to
" the hoSpital"; and which appeared the more like-
ly, as many of the other nurfes were not at all indif-
pofed,  although  they eat and flept in  the chambers
of the  fick.  (" Deveze  Inquirie's on the  epidemic
" difeafe of Philadelphia in 1793.")

   At our city alms-houfe, two perfons died of this
difeafe, which  they  muft have taken from going into
that part of the town where it prevailed, as they both
frequented that  neighborhood, yet in neither cafe
did they  communicate the complaint to a fingle one
either of their attendants, or  of their numerous com-
panions that were crouded in the fame room.

   4th. There  were . many patients Sent to Bufh-hill
laboring  under other complaints, and were put in
the  fame  apartments with the  patients  afflicted
with this fever, and where they Saw perSons  dying
with it on all fides of them, and were furrounded by
an atmofphere, as highly impregnated as it was poffi-
ble to be, with every infectious difcharge that could
be emitted from the bodies of thofe under that com-
plaint, and breathing the fame air, ftill warm, from 
i8
AN
ACCOUNT OF  THE
 the lungs of their dying room mates : and " what is
 " verv remarkable, there was not feen one example
 " of thefe patients having the epidemic, and  never
 " notwithstanding thefe circumftances fo favorable to
 " contagion, did their difeafe change its character,
 " fince  they were ail reftored."   (Deveze's Inquir-
 ies, &c.)  How different was this from what happen-
 ed in the city ; there it obliged all difeafes to partake
 of its  nature,  and to pay  obeifance to  the ruling
 power : (Rufh's account of the yellow fever) it feems
 as if thofe patients had been  protected for a time, by
 their difeafes, from the influence of the caufe of the
 deftructive epidemic, till they had gained a happy re-
 treat  from   the  contaminated  boundaries of the
 town.

   5th. Some contagions are communicated by con-
 tact only, as  Syphilis, itch, Sec. others  may operate
 at a certain distance through the medium oS the air,
 as the Small-pox,  mcaSels, &c. yet all, that we have
accurate knowledge oS, are the. moft certainly effect-
ive ceteris paribus in an inverSe proportion  to the dis-
 tance of the body Srom whence  they ariSe, and vice
verfa. . From, this consideration,  we cannot conceive
any thing more  certain  of producing the  difeafe
in queftion, than  the handling the bodies oS thoSe
who have died with it; that is, if we fuppofe it to be
caufed by effluvia arifing from perfons  already affect-
ed; yet  we  find diffections  of fuch  ones have been
performed, by  Dr. Mitchel in  Virginia,  Dr. Mac-
krittrickin the Weft-Indies, Drs. Fleming  and Jack-
Son in Jamaica, Dr.  Lining in Charlefton, &c. and
they all have lived afterwards to piiblifh an account
oS them : in Philadelphia,  Drs. Phyfick  and Ca-
 thrall did the  Same,  and Dr. Annan attended the
diffection cf others, and although it is very probable,
 that they, from living in the  atmofphere oS that city. 
           EPIDEMIC  YELLOW FEVER.           19

may have  had the difeafe, yet we  do not find that
their hardy expofures have  augmented  its violence
fo much in them, as to enroll their  names in the  re-
gifter of deaths.  Dr. Baily diffected a  perfon dead
with this difeafe in this city, and fuffered no inconve-
nience from it: but what  would feem Still more ex-
traordinary, Dr. Deveze and all his Surgical afliftants
entirely  eScaped the  diSeaSe, notwithstanding  he
opened a great number oS bodies, and consequently
was under  the ncceflity of dipping his hands in their
black and corrupted blood,  and of breathing the in-
fected vapor that exhaled from them.   Who could
fuppofe it poffible for any one who never had had the
Small-pox,  to have Such  cloSe connection with per-
fons in every flage oS that  complaint,  and even to
handle their bodies after death, and efcape being af-
fected with it ?

   6th. Specific  and  acknowledged contagions,  all
feem to ariSe from themSelves only: hence it  would
be almoft as hard Sor me to believe that the Syphilis,
Small-pox,  or meafles, could be produced from any
other cauSe, than Srom  their proper virus, obtained
from perSons affected with the like diSeaSe, as it would
be for me to conceive of the  formation  of a  plant,
without having received its feed or  radical from.one
of the fame nature.  Contagions feem to fix in the foil
of our bodies, and there feed, and from thence fpread
themfelves  as naturally and regularly as vegetables do
on the earth.   But the yellow fever has been pro-
duced from ether caufes  than contagion.*  Does it
not then admit of a doubt  whether it can poffefs a
powrer of propagating itfelf?  I confefs I am almoft

  * Lind's effay on difeafes incident to Europeans in  hot  cli-
mates, has many fafts in proof of this difeafe being produced by
ether caufes,  and without the aid of contagion. Alfo note p. 16. 
20
AN  ACCOUNT OF THE
ready to believe, that it either is always produced by
contagion, or never.  It is very difficult to conceive,
that two Such different cauSes, fhould produce exact-
ly Similar  effects.

   7th.  It is an acknowledged  fact with reSpect to
contagions in general, that they are no refpectors of
perfons, but  that all oS every clime and color,  un-
der like  circumftances,  are equally  fufceptible of
their operations.  But this is not  the caSe with  the
cauSe  oS the diSeaSe under our preSent consideration:
I have already obServed, in the  hiftory  of the com-
plaint, that the French people from the Weft-Indies,
although involved in the midft  of the epidemic,  uni-
verSally eScaped it.  The Same remark was made with
reSpect to  them in Philadelphia  in 1793, (RuSh's ac-
count of the  yellow fever).  Dr.  Jackfon (TreatiSe
on the Severs  of Jamaica) obServes, " that this diSeaSe
" Seldom  discovers  itSelf among  thoSe  people  who
" have lived any length oS time in a  tropical coun-
" try," and  that " it has never been obServed,  that
" a negro immediately from the coaft oS Affrica, has
" been attacked with  this diSeaSe;  neither have  cre-
" oles who have lived conftantly in their native coun-
" try, ever been  known to Suffer from it."  TheSc
circumftances certainly Should tend to make us hefi-
tate in pronouncing this Sever contagious.

   8th.  It  is generally obServed  of contagious  dif-
eafes, that they have a determinate period of invafion
Lifter  an expofure to their caufe: thus, if a thoufand
perfons under fimilar circumftances,  fhould  be  ex-
po fed to and receive the infection of  the  Small-pox
or  the meafles, at the Same time, they would gene-
rally be taken with the complaint within a Sew hours
one of another;  but in this difeafe, this  would be
pinning the matter too clofe; the fupporters of its  con- 
EPIDEMIC YELLOW FEVER*
21
   tagious nature,  find their doctrine requires that it
-  muft be permitted to act at any time, between that
   of the expoSure  and the Sixteenth  day,  otherwiSe it
   would not embrace caSes enough to give it a curren-
   cy.   This Seems to be  allowing themSelves great la-
   titude, as there  are but Sew perSons during the pre-
   valence of an epidemic in their neighborhood, that
 '  avoid every kind oS connection or near approach to
   the difeafed Sor as much as Sixteen  days together.
   Might not intermittents, when they occur generally
   in the vicinity of mill-ponds and marfhes,  as well be
   confidered contagious, Since Sew, I apprehend, could
   be Sound among Such patients, but  that had Some
-  time or  other,  and generally within two or three
   weeks, been near them that had that complaint, or
   to Something that might have imbibed  Some effluvia
   from them ? It  may be Said, that although there are
   but few caSes, Still there zxefome who have agues
   and fevers that  never have been within the reach oS
   febrile effluvia  from an affected perfon : I anfwer,
   So are there of the preSent complaint; Sew  phyfi-
   cians who have had an extenfive practice in this city,
   can be ftrangers to the occurrence of fingle inftances
   of it without any other cafes exifting, that could be
   fufpected oS having communicated it to them.   (See
   page 19, note 16.)

     9th. Contagions act more or lefs at all places and
   feafons, Simply of themfelves without  the  aid of any
   particular circumftance of air or climate ; but the iup-
   porters of the yellow fever being contagious, are oblig-
•  ed by the force of the  foregoing observations  to ac-
   knowledge their imaginarv fond ting; at beft,|but a half
   formed monfter, and perfectly inactive without being
   aflifted bv " the concurrence of a predifpofing confti-
   " tution  of the air."  (Rufli on yellow  fever)   This
   fever exifts onlvin warm weather; hence its canfe in 
22            AN ACCOUNT  OF THE

this  city was perfectly extinguiflied  by the frofty
nights in the i oth month.   It is confined moftly to
low Situations, in thick Settled places;  otherwiSe our
alms-houSe and the Surrounding country would have
Sadly experienced its deleterious effects.

  Let us examine a few cafes which are fuppofed
decidedly to  have been caufed by contagion.  Dr.
Malachi Treat, is Said to have  taken the Sever from
a perSon in a veflel  that he was on board of the day
before his indifpofition; his complaints might as well
have been affigned to having vifited a patient in the
Alms-houfe feventeen-days before.  But I cannot con-
ceive why he fhould be Singled out as a fatal victim
of the effluvia of this man's  body, merely from a mo-
ment's vifit, while all his room-mates and continued
attendants, univerfally  efcaped any inconvenience :
nor do I know any reafon why Dr. Treat might not
have taken his complaints  from the fame  caufe as
this patient did; and he was  fick and died Several days
before the  arrival of any of the veffels,  fuppofed to
have brought the feeds of the diforder  to this city.
Daniel Phoenix,  the city treafurer, is fuppofed with-
out doubt, to have taken his complaints from conta-
gion : the  corporation,  feme time paft, having iffued
into circulation, for the accommodation of the in-
habitants,  a great number of paper penny bills, it has
been concluded that he  mult have received contagion,
through the medium of fome bundles of thefe bills,
which he opened, that had been brought to him, af-
ter having been foiled and nearly worn cut, to be ex-
changed, and which he opened and examined to af-
certain their amount fome days after he had received
them : the probability of thofe having conveyed con-
tagion,  - cannot be very Striking, when we reflect,

  * Although  it io  very poffible, that  he might have taken his
cornob.:ut from t!.^  cfHi^ia, that arofe from tbcfe bills, hiVhJv 
EPIDEMIC  YELLOW FEVER.
23
that he was  one among the firft of thofe that  were
taken.   Whence then could the bills have gathered
the infection to give to him ? we cannot fuppofe them
to have come from the Weft-India iflands; but even
if his indifpofition and like circumftances fhould have
occured at a more advanced period of the epidemic,
it would not to me, appear to be a very likely method
of communicating  contagion; for perfons in  that
ftage of the difeafe, which is believed to be the moft
infectious, feldom  have much to do with handling
money,  or even of wearing  fuch clothes  as have
packets  in them, that might poffibly  have contained
Some.    It may be obServed,  he lived  in a part of
the town that foon after fuffered much  by this com-
plaint.

  Dr. William M. Johnfon's  cafe, is  published in
proof of the fever being  communicated  by conta-
gion; (Daily Advertifer, Vol. 2, No.  3343) but I
cannot  conceive whence the author derives his au-
thority for afferting that his complaints  " have actu-
ally happened in confequence of intercourfe with the
fick."  It is true, he had previoufly been  in compa-
ny with perSons that had the diSeaSe, but he alSo re-
fided in New-York before he was ftationed at Belle-
Vue, he confequently muft have been expofed  to the
fame general caufe of the  epidemic, as  his Suffering
neighbours  were;  and Srom  inquiry, I find he had
                         E

loaded with putrefactive materials that  they had collected from
the hands through which they had circulated, rendered adtive by
their  being packed up together in great numbers and confined
for a time in a  clofe cheft before they were opened, ftill it puts
them  only upon a par wi'h (and in my opinion corroborates the
idea of the difeafes being caufed by)  putrefactive effluvia in ge-
neral, and is far from proving them to have conveyed contagious
particles from perfons laboring under fuch a particular difeafe.—
(See definition of contagion, p.  28.) 
24
AN  ACCOUNT Of  THE
not left town but a few days previous to his bdng
taken ill.

   Frederick  Steymets,  one of the  Committee of
Health, fuppofed his complaint to be the effects of
contagion, received by examining fome  papers  that
had  belonged to a patient that died at Belle-Vue  hof-
pital.  Is  it probable,  that thefe papers,  which  per-
haps had not been within ten feet of the patient after
his difeafe had put on fuch a ferious afpect, fhould
imbibe and convey the caufe of his complaint three
or four miles,   while  the effluvia  arifing  directly
from his body, had  no effect upon thofe who were
conftantly about him, and performing the moft  me-
nial and loathfome fervices for him? This  valuable
citizen's activity  and perfeverance  in the  noble caufe
of humanity, often led him in the moft  Sickly parts
oS the  city; whence, more probably, his complaints
muft have originated.

   The " pofitive fads" infilled  on  by  Dr. Lind,
(Difeafes incident tp Europeans in  hot climates, page
195) I confider as  very exceptionable proofs of the
contagious nature of this fever, for  although an in-
fected perfon came on board one of the floops of war
which lay  in the river Gambia, two or three  days be-
fore  the ficknefs began in them, yet it is very likely
they w-ould have been fick at the  fame time had he
not come on board, as they had not been but eight or
ten days in that river, for the fame author  obferves
that Symptoms of indifpofition in fome inftances, do
not occur till twelve days after having received a taint
from the land air.   Robertfon's cafe (p. 195) is by
no means  conclufive; the little fpafmodic fhock  that
he futtained,  being, no doubt, an accidental cccur-
ance ; which, had it happened at any other time,  per-
haps never would have been noticed;  his being taken 
EPIDEMIC YELLOW FEVER.          25
 with a fever fc$fr aSter, proves nothing but that the
 feeling the pulSe oS a perSon dying, did not prevent
 him from getting a like complaint from the operation
 of caufes  that had been previously applied.  Nor is
 what occurcd on board the Merlin floop (page 196)
 more Satisfactory: all the conclusion that I can draw
 from them, is, that different claffes of the men, were
 rtaken earlier or later with their  complaints, accord-
 ing as they had been  more  or  lefs expofed to  the
 noxious land air.

   To thefe remarks may be  added the obfervation
 of the experienced Dr. Hunter, (Difeafes of the ar-
 my in Jamaica) when fpeaking of the yellow fever,
 that " It is a matter of fome confolation in  the histo-
 ry of fo grievous a difeafe, to be able to fay with cer-
 tainty, that it is not contagious."

   It has been faid, and I SuSpect with too much truth,
 that were all the phyficians in this city to affert, that
 our late autumnal epidemic was not contagious, they
 would not be able to make the people in general be-
 lieve them, Since 10 njany  think they are  well ac-
 quainted with decided proofs  of its being fo.  This,
 however, will not carry  a full conviction to the minds
 of the more confiderate and reafonable  part of the
 community, Since the moft popular opinions are  not
 always the moft juft.  I SuppoSe were all the faculty
 in America to unite, and declare their difbelief in the
 power of the imagination to mark the foetus in utero,
 that they could not perSuade the generality oS women,
 but  that, croffed appetites, unSatisfied cravings,  and
frightful fights, will patch their offspring with roaft
pig,  plumb cakes,  Strawberries,  &c.  or give them
hare lips, Stain them with bloody Spots or Something
of the kind; Sor moft oS them Sancy they have facts
enough  within their own knowledge,  fully to fup- 
26
AN  ACCOUNT OF  THE
 port the opinion of that moft influential operation of
 the mind.

   Should it be afked, whence could the general idea
 of this difeafe being contagious, have originated?  I
 anfwer, perhaps from no better foundation than the
 popular belief in  witchcraSt  aroSe,  in a part of
 MaffachuSetts about one hundred years  ago, as well
 as in different parts oS Europe Sometime before, i. e.
 from the credulous fears of the people,  worked  up-
 on by the erroneous opinions and publications of in-
 fluential perSonages*.  Nineteen  perSons  were exe-
 cuted in and about Salem in 1692 from this demoni-
 acal delufion, and no doubt, but ten times that num-
 ber have been fhamefully permitted to die of the yel-
 low fever in Philadelphia! and New-York, in confe-
 quence  of neglect  from the fear of contagion, when
perhaps the unhappy Sufferers, were as Sree from the
 power of afflicting  their friends, as the New England
 witches  were.

  * Hutchenfon's Effay concerning Witchcraft.
  t See Carey's Account of the Malignant Fever in Philadel-
 phia, 1793. 
         EPIDEMIC  YELLOW FEVER.           27

  METEOROLOGICAL OBSERVATIONS,

MADE BY GARDINER BAKER, AT THE EXCHANGE IN
THE CITY OF  NEW-YORK, IN  I795.

        Sixth  Month (June)
 Days
 of the
Month.
 Thermometer oblerved at
8 a. m.  1 p.  m.  6 P. M.
deg. hun. deg. hun. deg. hun
 Prevailing
  winds.
8.   1.  6.
Obfervations on
  the weather.
 
28
AN ACCOUNT OF  THE
METEOROLOGICAL  OBSERVATIONS,
MADE IN THE  CITY OF NEW-YORK, IN 1/9J*
Seventh Month (July)
 Days i   Thermometer observed at   !  Prevailing
cf the   8 a. m.  r p. m.  6 p. m.
M uth.  deg. hun. deg. hun. deg.  hun
I	" 1 50
2	6S
3	66
4	6>
5	67
6	68
7	
S	68 50
9	71 50
IO	
11	75
12	77 5°
*s	70 50
»4	71
'5	72 50
j6	73 5°
17	74
18	74
»9	79
7.0	/ /
2 [	77
22	76
23	74 5°
*+	73
25	7^
26	7 1
27	70 50
28	<>9 75
29	73
30	<y50
3l	72 50
75
70
71 50
69
69 50
33
71
79
8a
69
82 50
89
85
82
77
77
78 50
82
84
*7 5-
8c
8?
73
75 5°
So
76 50
73 5°
79 50
78
67 50
73
72
66 50
68
67 50
68
5°
77
80
73
75
87
5°
81 50
73
72
76
76 50
87
82
7f>
88
74
( T
74
73
6) 50
78 50

66
73
S S E
S E
 E
N E
S E
 S
NE
 N
 N
S E
s \v
s \v
sw
u
* F.
 s
 i
:." e
S E
 N
 NE
 K
 E
Si r
 s
s \v
S  E

W
 s
s \v
w
Obfervations on
 the weather.
 A. M.  P.  M.
 louch
  do.'
 rain
cloud)
 clear
  do.
ihund.
 ;lear
  do.
  i>ht.
  i-ar
  do.
  do.
  do.
  do.
 do.
 do.
cloudv
 clear
 do.
 do.
cloudy
  Co.
 rain
 •loudy
  do.
 do.
 clear
 do.
 do.
It. wind
  do.
It. wind

&liglit.
hi. wind

and rain
It. wind
wind
ram
vhid
th.&lig.
cloudy
It. wind
  ck*ar
  rain
It. wind 
      EPIDEMIC YELLOW FEVER.         29




METEOROLOGICAL OBSERVATIONS,
MADE IN THE CITY OF NEW-YORK, IN 1795.




        Eighth Month (Auguil)
Days j	Thermo	ncvr obd;	rved at 1 Prevailing				Obferv'.tions on	
of the 1	8 A. M.	I P. M.	6 P. M.	winds.			the weather.	
Month.'	deg. him.	deg. hun.	deg. hun.	8. 1. 6.			8. r-	
1	73 25	80	77 5°	w	S £ S W		cloudy	
2	79 5o	86	78	s w	1		clear	
3	73	71 50	74	E	SE 1		ftorm	& rain
4	77	82	80	w	NWJ		cloudy	It. wind
5	80	88 50	83-	w		s v.r	cleat-	
6	80	89 50	86	V.'			do.	
7	82	93 5°	84	w			do.	
8	82 75	87	78	w	SE	w	do.	
9	79	87	82 50	s	s w| 1		p-t.rain. 1 t	
10	80 50	87	78	w	; \v:		clear rain	
11	IS	79	76	N E	sE	s	cloudy	It. wind
12	74	80	75	NW		SE	rain	
•3	69	75 5°	75	N			CO.	
[4	69	7i 75	72 50	N £	s w		cloudy	
'5	71	73 5°	73	n 1?	s w		clear	
16	69	73	77	S VJ		w	do.	
17	75	85 50	76	N W		s w	do.	
18	79 50	M 50	82 50	s w	N W	w	do.	It. \n«d
l9	77	86	82	w			do.	
20	79 5o	88	63	w		N	do.	rain
21	57 50	60 50	59	N	N E		raia	it. wind
22	61 50	66	67 50	N E	i		cloud v	do.
23	66 50	68 50	68	N E	1 i K	E	d".'	rain
24	69	71	70	E	-> k		do.	
^5	73	8v	77	SE		S V»	clear	It. wind
26	76	84	77	N	S	SE	do.	calm
27	75	81	74	SE	s	SE	do.	
23	72	79	76	S			do.	
29	73 75	82	80 50	S			cloudy	
30	76	85	79	i			do.	clear
31	73 75	74	72	S			clear	rain
 
3©         AN  ACCOUNT OF THE




  METEOROLOGICAL OBSERVATIONS,





  MADE IN THE CITY OF NEW-YORK, IN 1795.
Ninth Month (September)
Days	Thcrmcmcter obfcrved at			Prevailing			Obfervaticns en	
of the	g A. M. I P. M.		6 P. M.	winds			the weather.	
Month	deg. hun. deg. hun.		deg. hun.	8. 1. 6.			A. M. P. M.	
I	73	75	1 77	w	N	1	cloudy It. wind	
2	66	70	70	NE			rain	high do.
3	65	71	71	W			clear	
4	64	75	73	N W			do.	
5	67	74 5°	72	N W			cloud)	
6	70	75	73	N W			clear	
7	68 50	74		N		N E	rain	
8	71 50	78	77	S	S W		1 cloudy	It. wind
9	75	83 50	77	s w			clear	'
10	75	82	76	s w			do.	
11	74	84 50	79	s w	w	N' \V	do.	
12	63	70	67	N	N E	E	do.	
'3	68	66	70	sr.	S		cloudy	rain
H	72 50	81	80	s			do.	
15	75 50	85 50	82 50	s w	S		do.	clear
16	76	87	8.3	s w			do.	do.
'7	68 50	79 75	78 50	N E			do.	do.
18	^7	78	-6	S			clear	It. wind
'9	60	65 50	64	N	N W		rain	
20	60	68 50	68	W	s*		clear	rain
21	53 5o	61	57	N\V			do.	hi. wind
22 '	48	58	57	N	N V		do.	do.
23	53	68	66	W			do.	light do.
24.	57	66 50	64	W	S W	S	do.	high dc.
25	53	73	"2	s w			do.	
i6	62 50	72	*5	? V.	S E	SE	cloudy	
27	66	68 75	(>1	E		SE	do.	
28	66	73 2S	68 50	s			clear	It. wind
29	63 50	64 25	60	NW			cloudy	
3°	5°	58 75	r,0	N	!		clear	It. wind
 
      EPIDEMIC YELLOW FEVER.




METEOROLOGICAL OBSERVATIONS,
MADE IN THE CITY OF NEW-YORK, IN 1795*




        Tenth Month (October)
Days	Thermometer obferved at			Prevailing			Obfervations on	
of the	8 A. M. I P M. 6 P M.			winds			the weather	
Month	deg. hun. deg hun. deg. hun			8. 1 6.			A. M. P. M.	
I	56	70	66	i W N E		s	clear	ic. wind
2	57	61 50	60	N E j E			cloud /	
3	55 5°	63 50	62	E	SE		clear	
4	65 5°	72 50	67 75	S		sE	do.	
5	65	75	69	s		SE	cloudy	
6	6z	67 50	66	w	■S \\		clear	
7	57 50	67	65	w		s w	cloudy	rain
8	54	54	55	NW			do.	
9	5i	62 50	61	NW	w		clear	
10	48 50	63	61	W		s	cloudy	rain
11	60	69	65	NW.' W			do.	
12	55 5°	66	66	W j			do.	It. wind
*3	60	7i	66	s sw			do.	do.
*4	61	68	68	s w			do.	
15	65	66	7i	s			do.	dif.thu.
16	52 50	. 62	60	w			clear	It. wind
17	58 ,	49	52	s w	w		cloudy	high do
18	42	54	5°	w	s w	w	clear	
*9	38 50	49 5°	49 5°	w		s	do.	
20	55	62 50	55 50	s		NW	rain	
21	46	52 50	53 25	N		NE	clear	
22	44 5o	53 5o	55	NT E	s	E	cloudy	c. wind
23	55	61	59 5°	N	E		rain	
24	52 5°	63\5°	58 50	NW		W	clear	
25	47	57	57	W			do.	
26	47	54 5°	55	w	N		do.	It. wind
27	43	58 5o	54	N	s w		do.	do.
28	49	60 50	60	s w		W	do.	
29	52	70	66	w			dp.	
3° j 55		69	61	w		s	do.	
3'i	52 50	55	54 5°	s	w		f°ggy	rain
F 
32            AN ACCOUNT OF  THE
The Caufe of the Fever, and the mofl probable method   I
  of preventing its return: likewife, the Precautions to
  be nfed to avoid an Attack, if it fhould again become   j
  Epidemic.

  On the fixth  of Auguft,  1795, I received a note
from John Broome, Chairman of the Committee of
Health, " earneftly foliciting me to give them every
" aid in my power, by my prudent advice, &c. for
" the  accomplishment of the important end  of  their
" inftitution."    In confequence of  which, a few   (
days after,  I made him the following communica-
tion.

  ' That a  malignant fever exifts among us, is a me-
' lancholy certainty,  well-known  to  the Committee
' of Health; that this fever,  in itfelf, is of a danger-
' ous nature, there can be no doubt; but whether it
' is contagious or not, is a queftion yet undetermin-
£ ed.  I  have  not known or heard of a fingle well
c attefted proof,  of any perlon taking  the complaint
' from another that was affected with it.                \

  i My advice is, that the Committee, while  they
* continue their unremitted and benevolent exertions,   ■
1 in preventing the introduction of infectious difeafes
' from abroad, fettle  not in afalfe fecurity, and neg-
' lect the caufes  of difeafes that may, exift in the ci-   j
' ty.  It is from the unguarded  operations of thefe   \
' inwalled enemies, that. I conceive we have to appre-   j
4 hend the greateft danger.

   \ If I have been rightly informed, a great propor-   J
< tion of the perfons,  that have  at this  feafon  been   |
' affected with fevers of a fufpicious nature, has been 
EPIDEMIC YELLOW  FEVER.         33
' confined  to  thofe  whofe  refidence or occupation
' has obliged them to pafs a confiderable part of their
' time between Peck-flip and the New-flip.   If fo,  it
c certainly is a  matter of confequence, to know, whe-
c ther in this part of the city, there is not fome local
' caufe that may induce fo fatal a malady.

  ' That putr'fying  fubftances, after a  continuation
6 of very warm weather, will give  rife  to fuch com-
c plaints; the  fatal operation of the dock mud de-
6 pofited at  Peck-flip in  1791, the putrid coffee in
c Philadelphia  in 1793, and  the noxious exhalations
' from the  creek in New-Haven in 1794, fufficiently
' prove, without the aid of  many other equally cer-
4 tain, though more  remote facts,  that  might be ad-
' duced in  its  fupport if neceffary.

  ' On thefe principles I have been led to fearch into
4 this  part  of  the town, for the caufe of the  prefent
6 complaint, and J believe my inquiries have not been
1 in vain: I fufpect that I have difcovered a fruitful
' matrix generating the feeds of this  complaint,  and
1 which if not  properly cared for, may poffibly fpr^ad
' mortality  in  its vicinity.

  ' A few  years ago the Corporation have had Wa-
c ter-ftreet,  between the two beforementioned  flips,
i filled up,  without obliging the proprietors of the
c property  on  the north  fide of the itreet  and in
e Cherry-ftreet, to fill up their yards even to a  level
' with  it.  Hence, the refufe water and offal  fub-
' fiances, from the families  occupying  thefe places,
6 are left to flagnate and putrify; and  what renders
6 it particularly diftreffing, is, that the healthful fhow-
4 ers, that in general wafh away all fuch  matters from
' other places, here only tend to render them more
' active 5 for by the water not runing off, it diffolves 
34
AN ACCOUNT OF  THE
' and prepares them, thus pent up, for entering into
' their peftilential  fermentation.   Our regular and
6 heavy rains, perhaps have  been one  great remote
6 caufe of the frequency of thefe  diftrefling difeafes,
1 in this neighborhood at this feafon.

  6 It may be worthy of remark, that many of thefe
e tenements contain feveral families; hence an addi-
< tional  caufe for putrefactive materials.

  * I make no apology for giving thefe hints to the
' Committee; the impreffion of their importance on
6 my mind, rendering it a duty: the hurry of an ear-
6 ly communication, amidfl  frequent profeflional in-
* teruptions, muft anfwer for their incorrectnefs."

     6 With a fenfe of refpect and efteem,

        * I remain thy friend and fellow-citizen,

                  'VALENTINE  SEAMAN-'

  New-York, 8th month 7
  tAuguft) 17th, 1795. J


  The caufe of the difeafe as above fuggefted, not be-
ing removed, its effects, in full fupport of myappre-
henfions,  truly " fpread  great mortality in the \ici-
" nity,'"' as is feenby its hiftory  in the foregoing ob-
fervations.

   This early idea of the origin of the epidemic, con-
 ftantly  gained  confirmation from  the manner  in
 which it increafed: it appeared to be almoft entirely
 confined  to the level fouth-eaftern part of the town,
 and there it was  the moft general and fatal, in the
 particular fituations that moftly abounded with thefe 
          EPIDEMIC YELLOW FEVER.          $$

pools of putrefactive exhalations.  Thus it firft be-
came the moft general  in and about the lower end
of Dover-ftreet:  this is  what might  reafonably be
looked for when we confider that befides all the lots
fronting this ftreet being funk beneath the  common
level of it, there are alfo on the docks at its lower end
feveral flore-houfes and granaries, built partly over
the water on piles, without having the  fpace under
them filled up; the foundation of fome of  them, on
the fides fronting the water are partitioned up fo as to
prevent the free circulation of the tide from warning
away any thing from under  them; however, theie
partitions  were not fo tight but that they let in water
fufficient to favor the fermentation of the putrefactive
materials  that fuch a common receptacle will always
collect, not  only from exterior  fources,  but alio
from the mowers of  grain that frequently  would
pour down through holes  that the rats fometimes
would gnaw in the floor.  Hence  there can be  no
wonder, that the feeds of this  difeafe  mould ripen
in fuch a hot bed of putrefaction,  aided  by the
effluvia emited  from  the great flats of mud in the
feveral furrounding impaired docks, left bare during
the ree'efs of every tide.  It is remarkable that feveral
perfons employed in a large  grain ftore-houfe, thus
fituated over fuch afource of noxious miafmata, were
among the firft victims of this difeafe.

   The difeafe foon  increafed; numbers were taken
 in every part of that quarter of  the town,  lying be-
 tween the upper part of Water, Pearl and Chatham-
 ftreets, and acrofs to the lower part of George-ftreet.
 From an attention to the fubjec"t not only during the
 hurry  of the epidemic, but alfo fince  its extinction,
 I  am  led to  believe  according  to my beft judg-
 ment,  that four  fifths  of  all  the lots  in  this af-
 fected  part of the city, were fituated below the level 
3.5            AN  ACCOUNT OF  THE

of the ftreets they fronted, whence from our regular
rains, thev very generally became ftagnant,  putrid
mud puddles.   I can hardly think it poffible, was it  ■
not for the obftruction of the houfes preventing^
free  obfervation of thefe  grounds, that  any candid  I
perfon  acquainted with the common caufes of fevers,  .1
could harbor the leaft doubt after walking through  1
this part of the town, but that the epidemic originated
from  this  fource,  rendered active  by  the  con-
tinued  exceffive heat of the fun during the laft fum-
t:er.   It raged with peculiar violence  in  the  parts
that were near  the  docks; this  is  what might  m
be  expected  from  the  additional  vapor  of the  I
dock mud as above-mentioned.   It alfo was very fa-
tal in a part of George-ftreet, " not lefs than fixty
" cerfons were buried out of it within the fmall com-
" pafs-of twenty houfes."  This was probably owing  j
to the  poiionous fleams difcharged from large quan-
tities of ftreet dirt and manure, collected during the
fummer and depofitcd near the head of it, fubjoined
to the common caufes above-mentioned.  Its fatality
to the  Weft of Peck-Hip was induced, no doubt, by  j
the noxious vapors from the putrid fink there.   The
reafon of its  prevalence about the Fly-market, can
feem no v/ays iiraiige  to any one acquainted with the  [
fituation of that place, the market being built  over
an ofiennve fewer, whofe exhalations were confined  ,
only by an imperfect  hoard floor, to which  may  be
added, the effluvia conftantly arifing from the putre-
fying animal and vegetable matter all around, as well
as from the flip that puts in  at it. Skinner-ftreet is  .
I >\vly  fituated, unpaved  and very imperfectly drain-
ed.

  That putrefactive tfiluvia will give rife to,and are the
 cc.mnv.n caufe cf fuch difeafes, is clearly proved by
 the accurate obflmuions of the moft judicious wri- 
         EPIDEMIC  YELLOW  FEVER.          37

ters on the difeafes of hot climates.   Lind's valuable
book of interefting  facts (Effay on the Difeafes of
hot climates) abounds with proofs of this difeafe be-
ing caufed by the air from the low lands in the Well
Indies; he particularly mentions, that it often raged
in the Greenwich Hofpital at Jamaica; which, as he
obferves, was unfortunately built near a marfh,  and
that it could not proceed from any fource of infec-
tion in  the hofpital.  Dr. Hunter  fays (Difeafes of"
the army in Jamaica) fhips  lying at  Port Royal in
Jamaica, on moving and taking their ftation higher
up the harbor, have  in a few days become fickly.
" The men, fays he,  have been  feized  with  fever;;
" owing to the low fwampy lands  along fhore,  and
" at the head of the harbor, from which laft the er.-
" halations are carried every morning  towards the
" fhips, when the  regular fea breeze fets in, as is
" perceived by the bad fmell which accompanies it."
He fays that there are examples, where cut cf fixtv
or feventy men, employed in filling the water cafes,
not one has efcaped a fever, from the watering place
being wet and fwampy.  The fame author obferves,
that Fort Augufta, which was at other times a falubri-
ous  fituation, became fickly in 1783, the fea  that
year  having  rifen  higher  than  ufual,  fo  that it
" overflowed the whole of the ground on which the
" fort ftands, near a foot  above the furface in fome
" places, and on ebbing left much flime  and ouze.
" A few days after this, many of the men were taken
" with fevers."   Dr. Jackfon  (Treatife on the Dif-
eafes of Jamaica) as well as a hoft  of other author.?,
might be brought if neceffary, to prove that putrid
exhalations  are  the common  caufes of epidemics.
The above facts, together with the many others ad-
duced by Dr. Rufh (Account of the Yellow Fever
&c.) in their fupport, appear to me to be fufficient 
38             AN ACCOUNT OF  THE

to eftablifh that opinion with every unprejudiced per-
fon—which if allowed, no one acquainted with the
iituation of the part of this city where the  yellow
fever raged as above ftated, can have the leaft doubt
but that it was owing to like caufes, without  the ne-
ceflity of ranfacking Weft India veffels  or innocent
bags of cotton, for that  which  is within ourfelves,
and whofe veiy. effence perhaps,  is fuch as proves  it
not to be of a tranfportabte nature*.

  Many  of the  ftrenuous fupporters  of the conta-
gious  nature  of  this difeafe, compelled by the force
of the  foregoing circumftances, acknowledge, that
the .difeafe may be caufed by other means, however
they  cannot  entirely, give  up this favorite opinion,
but perfift in aflferting that contagion  often does in-
duce  the difeafe, v.hen the foregoing  ftate  of the
tur favors its  operations; and they defy any one to
prove that it does not.   To prove a negative is al-
ways  difficult, fuch a one, perhaps impoftible.   But
fince the only proof we can have of the exiftence of
a caufe, is the neceflity of it for  producing known
effects, and lince we  are  to admit,  (according to
Newton's firft philofophic  precept) no more caufes
than are fufficient to explain the appearances, and, as
h:>s Ken  obferved, (IVmberton's  view of Newton's
piiilofophy) " When one caufe  is fufficient,  if there
'■'■ really  fhould in nature, be two, which is  in the
cc Jail  degree  improbable,  we can have no  poffible
': means of knowiug it, and confequently ought not
" to take the liberty  of imaginine.  that there are

  '* It has been obferved by Dr. Ruth, in Vol. I. of his Med. Ob-
frrv.uions, as well as by Dr. Li-id, that mufquetoes  generally
attend a iic'.f'y feafon—the fame was obferved here during the lait
fu:n::!.'.: the c~i:!e is very cl-.a--, for circumftances favoring the
ni; of putrid -..uf.ruta, tnuully favor the generation of thefe in- 
EPIDEMIC YELLOW FEVLR.
39
" more than one."   Now, therefore, as the above
fuggefted caufe of our epidemic feems fully fufficient
of itfelf to produce it, nothing can be more unphilo-
fophic or imprudent than  to fuppofr, that contagion
ever jiad any thing to do with it.

   The moft probable means of preventing a like ca-
lamity in future will be—ift, To have all the lots,
particularly in the low parts of the town, filled up, fo
as to afford a fufficient defcent to carry off the water
into the ftreets, and not permit any of it to ftagnate
in them.  2d, To have the dirt  and filth in the ftreets
and yards  more  carefully and frequently cleared
away.   3d, To have the docks  repaired  and  regu-
lated in fuch a manner, as not to permit the mud to
o-ather and be expofed to the fun at the ebb of the tide.
4th, To have the fpaces under the granaries and ftore-
houfes on the docks,  properly filled  up or walled in.
5th, To prevent great quantities of ftreet-dirt and ma-
nure from being collected in heaps, and left for any
time on the vacant lots, in and about the city.   6th,
To have the ftreets properly paved with a fufficient de-
fcent to prevent any  water from Handing in them;
and 7th,  To have the common fewers, in good or-
der and well  covered.   An attention  to  thefe cir-
cumftances, no doubt, will prevent the return of a
like epidemic in this  city; for,  as  I  fuggefted   fome
time fince to the  corporation, " whether the difeafe
"  is contagious.,  or  whether  it  was  imported  or
"  not; this one fact feems to be pretty firmly eftab-
"  lifhed, that it never has fpread, but by the influence
"  of putrefactive  effluvia."

   If,  either from  a neglect of the foregoing precau-
tions  or from any other  caufes, the  yellow  fever
mould again become prevalent in any part of this
                        G' 
40            AN ACCOUNT  OF THE

city, it certainly  would be  moft prudent  for fuch    I
as have it in their power, to remove from it; or if
unavoidable circumftances, or the calls of humanity   \
fhould  render it neceffary for fome to continue there
for a part of the time,  let them if poffible,  fhun the
night air, as the harbinger of death, and efpecially to
avoid  fleeping in that  neighborhood, as they value
their lives; for perhaps in the relaxed hours of reft,
the epidemic miafmata may act with redoubled force,   jj
Dr. Lind's- inftances clearly fhews the particular dan-
ger  of fleeping within the limits of the contaminated   -
air ; many perfons having been taken with the com-
plaint,  after having flept a night on fhore in the low   j]
ground, while others, who had paffed a confiderable
time there during the  day, and always  returned to
the  veffels at night, generally efcaped it.

  Befides, keeping from the night air of the epide-   !
mic neighborhood, and the fleeping in a healthy part
of the town: all perfons who are forced to pafs fome   ^
of their time in the contaminated atmofphere, fhould    1
avoid with the moft fcrupulous attention, exceffes of  J
every kind;  not only  of eating and drinking, but   1
alio of heat, exercife and  watching.   But I wifh  to   a
be underftood, not to mean a rigid abftinence from,   1
or a reflriction with refpect to thefe things ; but only
to advife moderation  and regularity in the ufe of  ■
them, becaufe it is likely that a very low diet and the' ;fl
entire neglect of wine, with them who have been ac-
cuilomed to it, as well as  cold, inactivity, too much   J
Jieop, fear, &c. may as effectually predifpofe to this   ,'i
complaint, as their oppofite extremes :  I believe the    1
more regularly we fupport the natural healthy tone    J
of out bodies, the more powerful they will refift the  m
crudes  of difeafes applied to them.                    1 
EPIDEMIC YELLOW FEVE-           41
  The obfervation of Dr. Lining muft be a great fa-
tisfaction to  thofe who have once fuffered with this
difeafe.   He fays (Effays and Obfervations, Phyncr.l
and Literary, vol. 2.)  " It is a great happinefs that
" our conftitutions undergo fuch alterations in it, as
" forever afterwards  fecures us from  a fecond at-
" tack."   He  certainly  had a good opportunity  of
knowing whether it did or not, as it raged four times
in Charleftown, South-Carolina (the place  of his re-
fidence) within fixteen years.  In the Weft-India in-
lands an attack of this  difeafe, which  feems almoft
entirely confined to perfons from more.northern cli-
mates,  is called Tifeafoning, and  after  which, if the
patient recovers, he  is fuppofed to be  pretty fecure.
 1 never have known of any perfon having had it twice
 decidedly ; perhaps fome inftances fuppofed to have
 been that fever, were only  common remittents.  Dr.
 Rufh  fays,  (Medical Obfervations, Vol.  2.) that
 " during the prevalence of the meazles,  he as well
 " as Dr. Quier, obferved feveral perfons (who had
 " had  that difeafe, and who were clofely confined to
 " the rooms of perfons ill with it) to be affected witli
 " a flight  cough, fore throat, and even fores  in  the
 " mouth."   And what are called nurfe pocks,  are
 no rare things with perfons (who have previoufly
 had the fmall pox) that  have much to do with pati-
 ents in that difeafe : fo  alfo is it poffible that fome
 people may fufter a flight indifpofition from the caufe
 of this difeafe, after having had it once, which per-
 haps ought not to be confidered as a full attack of it.
 It may be  that the  great debility, remaining after a
 complete  removal of this difeafe, may predifpofe to
 an attack of fome other, perhaps of a fever of a dif-
 ferent nature, that might even prove fatal, fo like con-
 fequences might  follow a  fevere attack of the fmall
 pox and no one would confider this as a return of the
 difeafe.   Notwithftanding thefe remarks are not en- 
42
AN  ACCOUNT OF  THE
 tirdy conclusive with me, yet they have fo much in-
 fluenced me, in the opinion of  the  impoffibility  of
 taking  this difeafe more than once,  that fhould  it
 again become epidemic here, although I could not
 again venture among it with lefs hefitation than here-
 tofore, I certainly fhould with much lefs apprehenfion.

             METHOD  of CURE.

   In the treatment of this, as  of ail other difeafes,
 the firft object fhould  be to remove their caufe ; for
 although in fome inftanees, the human body by habit
 may be enabled to refill the effects of injurious im-
 preffions, and even by proper means to recover itfelf
 after morbid effects are inducled, while the caufe ftill
 continues; yet that phyfician would be  confidered
 very deficient, who would undertake to cure an oph-
 thalmia  caufed by refiding in a fmoky  apartment, or
 t]:e cholera infantum,  originating from  the impurity
 and heat of the city air, without firft advifing his pa-
 tients to remove from fuch an obnoxious fituation,
 fa- although  he  might fometimes fucceed in his at-
tempts,  yet it certainly would be attended  with more
difficulty and uncertainty ;  fo alfo is it in the yellow
fever ; hence in this difeafe it is of the higheft impor-
tance to  have the patient removed, as foon  as poffible,
out  cf the reach cf the original caufe of his com-
 ehhits,  lata a more falubrious atmofphere ; a neglect
of this pi rhaps was one main reafon  of the great
frt.tlity of this epidemic ; therefor*, fhould it again
prevail,  it would be of the  utmoft con'equence, for
thofe whofe circumftances would  admit of it, to fe-
care a proper afyhim  in cafe of an attack, and the
poor ought to be induftrioufly fought  after and ear-
nciily advifed, early in their complaints,  to remove
lo fuch places as  the police may prepare for their re-
ccpti--11.   V  may be remarked, that but a finall pro* 
          EPIDEMIC YELLOW FEVER.          43

 portion died at Belle-vue who went there in the early
 ftages of their difeafes.

   Whether*the original caufe be removed or not, the
 next indications are,

   1. To obviate the reftricted ftate of the bowels,
 and clear the alimentary canal of the fuper abundant
 bile that feems to attend the difeafe.

   1. To ufe all means in our power to obtain a re-
 miffion  of the fever; and

   3. During the remiffion, to reftore the tone of the
 fyflem fo as to prevent a return.

   Whether the feat and throne  of this  difeafe is in
 the ftomach and bowels, according to Dr. Warren,
 or not,  it muft be  acknowledged that it is in a great
 degree upon a particular attention to them, that the
 hopes of a  cure depend,  as it is upon a particular
 morbid  affection of them that the greateft danger is
 to be apprehended.  To fulfil the  firft indication, a
 fufficient dole, viz. ten or twelve grains of calomel,
with as much jalap or rheubarb,  fhould be exhibited
 immediately  and repeated every fix  or eight hours,
till  it purges freely ; its opeiatious fhould be favored
 by the plentiful drinking of warm chicken or barlev
water or gruel, and  keeping warm in bed; by theie
means oftentimes a  free perforation is brought on,
and the  fecond indication is accomplifhed at the fame
time ; an almofl complete remiffion being the con-
fiquencc.

  Let no one fear  the largenefs of the dofe of the
purgative, or its  early  repetit'en as  above recom-
mended, for in no  difeafe perhaps is it of more con-
iequence to obtain  the fpeedy operation of medicine 
44            AN ACCOUNT OF  THE

than in this; it is probable many Kves  have been,.
loft from the cautious timidity of Phyficians^in giv-
ing but , fmall and repeated dofes of cathartics,  till
the difeafe ftole on to that ftage wherein the  great
irritability of the ftomach utterly refufed  to retain
any more of it, before they have  given a fufficiency
effectually to evacuate the inteftines.

  If a remiffion does not fucceed to the operation of
this medicine,  but fyrnptoms  of  great  excitement,'
with violent pain in the head, &c.  particularly in
perfons of a  full  habit of body, with a plenitude in
the vafcular fyftem, bleeding undoubtedly  promifed
and proved of the moft effential fervice, and ought
by no means to be neglected; but I do  not wifh to
be underftood to  recommend the indifcriminate ufe
of the lancet by any means, for there are innumera-
ble circumftances, both as they relate to the previous
ftate of the patient, as well as to the exifting fyrnp-
toms,  that fhould always govern  the judicious  phy-
fician in the ufe »of this moft powerful remedy.

   After the operation of the purgative, if the degree
of excitement or tone in the vafcular fyftem, fhould]
not juftify the loofing of blood,  or  if as much has
been  drawn as the  ftate of the patient  may render
advifeable, and ftill there remain a degree of tenfion;
in the pulfe, a drynefs on the furface, &c. a fudorifici
draught of half an ounce of fpt. minderer with twen-
ty drops  of  find, thebaic has often been  exhibited
with the happiell effects;  a fweat generally fucceed-
ing with a confidcrable remiffion of all the fyrnptoms;
in conjunction with the fudorific portion, the patient;
fliould have his feet and legs fomented with flannels1
wrung out of warm water, for as long as half an hour
at leaft; he fhould alfo favor its operation by a plen-
tiful dilution with the beforsmentioned  drinks. 
           EPIDEMIC YELLOW FEVER.          45

   The ufe of antimonial medicines, have been greatly
 recommended in this ftate of the difeafe, to bring on a
 remiffion; but  I confefs, in  the few inftances where-
 in 1 made trial of them, they did  not anfwer mv ex-
 pectations,  the ftate of the  ilomach generally beino-
 fuch as  would not  bear  even the fmalJeft  dofes or*
 them.

   For the violent pain in the head attending this firft
 ftage, nothing feemed more effectual than  the con-
 ftant application of linen cloths, wetted with cold
 vinegar and water to the forehead and temples, and
 changed as foon as they became warm.

   I  know  not whether  Dr. Jackfon's  method  of
' ufing the warm and cold bath alternately, has been
 practifed by any phyficians of this city; but the dafh-
 ing of cold water over the body, and afterwards drink-
 ing plentifully  of a ftrong infufion of rad.ferpentar.
 has been much cried up by fome; I ufed it in but  a
 fingle cafe, and although the patient was particularly
 attended to, yet the looked for fweat and remiffion
 did not fucceed; this was neverthelefs, accomplifhed
 afterwards by the partial application of cold vinegar
 and water to his forehead.

   After the bowels were properly  evacuated and  a
 remiffion obtained, I loft  not  a moment's time, but
 immediately applied to  the ufe of the  bark, in dofes
 apportioned to the ftate of the ftomach,half a drachm,
 if it  would retain fo much,  was given every two
 hours,  otherwife half that quantity was given and
 increafed as the ftomach would bear it;  it was exhi-
 bited in milk and water  or fome of the drinks before-
 mentioned,  which ever was moft agreeable; a few-
 drops of the acid elix. vitriol  with each dofe of the
 bark, fometimes would  make it more agreeable to 
 46            AN  ACCOUNT OF  THE

 the ftomach;  it feems  hardly neceffary to mention
 that in this cafe it muft  not be given  in  milk*
 When the bark in fubftance  could not be retained,  '
 the cold infufion was fubftitutcd in dofes  from half
 an ounce  to an ounce, according to  circumftances,  J
 and  repeated  every two hours  or oftener if it fat
 well on the ftomach.   At the exacerbations  of the
 fever, the ufe of thefe remedies was often fufpended,
 and the means beforementioned were applied  to, till  \
 a degree of remiffion was again obtained,  when the  j
 ufe of the bark, &c. was again refumed.  When the  |
 patient was coftive, he had a few grains of rheubarb
 imited with each dofe of his bark, till that  ftate was
 obviated.
                                                  i
   The acid elix. vitr.  was  ufed  with  advantage  :
 during the remiffion of this  difeafe, particularly  if
 hemorrhages attended it.   I have already mentioned
 it, as ufeful in making  the bark  fit eafy on the fto-  1
 mach ; but in  cafe the bark fhould be retained well
 without it, it then would perhaps be better to admi-
 nifter it between the times of taking that  medicine;
 it may be  that this  acid,  while it  covers the  bitter
 tafte, may  likewife tend to leffen the tonic  effects of
 the bark.

   Generallv, if the abovementioned means were not
 ufed, and  frequently notwithftanding our greateft at-
 tention, about the third or fourth day, the  fecond
flage of the difeafe would be ufhered in  with pain
 and conftant ficknefs at ftomach, particularly upon
fwallowing any  thing; an  epifpaftic was  often ap-
plied to the fcrobiculis cordis in this fituation, and
fometimes with advantage; fome others received be-
nefit  from ufir.g warm fomentations tQ  the  part.
Laudanum was  rejected; but la fome  inftances I
 thought a grain  of folid opiar.i was administered 
EPIDEMIC YELLOW FEVER.
51
with good effects, and fmall bleedings feemed fome-
times  ufeful;  this, however, as well as all other
means, often failed, the ftomach throwing up every
thing that was  taken into it.  In this defperate ftate,
our laft refuge was to the bowels, and our only  de-
pendence appeared to be upon the plentiful  exhibi-
tion of our remedies per anum, half an ounce of pow-
dered  bark, with  a gill of milk,  chicken  foup or
beef tea, and  twenty-five or thirty drops of  lauda-
num,  make a  proper injection for  this purpofe; it
fhould be repeated at leaft twice a day.  This means
no doubt has preferved the lives of many; fhould the
bark be retained in the  bowels till the period of ad-
miniftering the third dofe,  it would be advifeable to
bring it away by a common injection of warm water,
before that is given.

  From obferving that none died who were affected
with a falivation, I attempted in feveral inftances to
induce that affection, by rubbing the gums with calo-
mel and  ufing  mercurial frictions;  but as thefe at-
tempts were made only in the latter flages of def-
perate cafes, I  never fucceeded.  May not mercurial
frictions be advantageoufly ufed from the commence-
ment of the difeafe to produce this affection ?

  The diet of the patient in this difeafe, fhould be of
the mildeft nature; panado, chicken foup, beef tea,
roaft  apples and milk, tapioca,  &c.  appeared to
agree bell with the delicate fituation of the ftomach,
and perhaps were  the moft proper  food that could
be taken.

  In the convalefc'ence, a continuance of the bark
and elixir of vitriol,  a more nourifhing diet of roaft-
ed oyfters, beef-fteakes,  porter,  &c.  together with
                       If 
52
EPIDEMIC YELLOW FEVER, &C
moderate exercife in the country air, were the mofl:
effectual  means of reftoring the loft tone to the de-   j
bilitated fyftems of thofe who happily furvived the
effects of this moft dreadful difeafe.
FINIS. 
       LETTERS










                        XO










 WILLIAM   BUEL,  Physician,










                      ON THE









FEVER WHICH  PREVAILED IN  NEW-





                YORK, IN 1795.









              BY  E.  H. SMITH.









                TO WHICH IS PREFIXED,"






AN ACCOUNT OF THE TEBRILE  DISEASES 0>F  SHEFFIEL3,




 (MASSACHUSETTS) IN THE YEARS I793, I794ANB I795.









                B T  W.  BUEL.
"^'~'   '.VfiTr 
 
/
                      A N


ACCOUNT OF THE FEBRILE  DISORDERS

WHICH PREVAILED IN  SHEFFIELD, IN THE STATE

      OF MASSACHUSETTS,  IN THE YEARS

             x793>  1794 and  1795.

  EXTRACTED TROM A LETTER OF WILLIAM  BUEL,

     PHYSICIAN AT SHEFFIELD, TO E. H. SMITH,

             PHYSICIAN, OF NEW-YORK.
J3EFORE entering directly  on the  fubject of the
difordcrs, which prevailed here in 1793,  1794 and
1795,  1 fhall mention fome circumftances relative to
the face of the country in the  Town of Sheffield.

  The river Houfatonak runs in a ferpentine courfe
through  this town,  from North to South.  Upon
the banks of the river, on each fide, is an extent of
intervale, or meadow land, averaging on both fides
at about a mile in breadth.  The greateft part of this
intervale is overflowed at the time of  the thawing
away of the fnow, in the fpring ;  and fometimes, by
large and hidden frefhets, at other feafons.  The na-
ture of the foil, in general,  is fuch, that,  veryJbon
after the water is off, the land  is dry  and fit for
tillage.  It is, however, much interfperfed with coves
and inarfhes ; in the former of which the water re-
mains  ftagnant a confiderable part of the  fummer,
and in many of them perpetually  ; of the latter there
are  not  many  upon  this  river, but there  are fome
which remain fuch through the feafon. 
LETTER  FROM  DR. W. BUEL,
   Befide the Houfatonak, there are two other conn-
derable ftreams, running through part of this town,
which unite and empty into that river.   Upon each
of thefe ftreams are large tracts of low, marfhy lands;
great part of which is overflowed by frefhets, and is
never  perfectly dry.—There is (which is very mate-
rial) a mill-dam, on each of thefe ftreams ;  and the*'
two dams occafion the overflowing of feveral hund-
red acres of the low lands.  As fummer advances,
and the ponds fall, confiderable parts of thefe lands
are left uncovered by the water; more or lefs, ac-
cording to the drought of the fummer.  In  both of
thefe ponds are large quantities of timber and other
vegetable  matters, which,  in  hot weather,  are  al-
ways in a ftate of putrefaction.  This ftate exifts in
an increafed  degree as the  fubftances become more
expofed to the action of the fun.  The fcetor occa-
fioned by this putrifying mafs is fuch, in hot weather
and when the water is low, as to be extremely offen-
five to the fmell, at the diftance of many rods.

  The inhabitants of this town, who live in the vi-
cinity of thefe marfhy and drowned lands, have,  as
would naturally be expected, been always fubject  to
remittent and intermittent fevers, from its firft fet-
tlement.   It is, however,  generally remarked by the
old people, that thefe diforders have of  late  years—
until the three laft—decreafed : owing, probably,  to
the clearing, or partial draining, of the lands.

  Although the diforders  which  have  prevailed  in
this town, for two or three years paft, are owing un-
doubtedly, principally to thefe  local  caufes; yet
it is not improbable that fome predifpofition to them dj
was occafioned by a general conftitution of the air;
To afcertain this point, with any degree of precifion,
we ought to have before us an accurate hiftory of the 
TO DR. E. H. SMITH.
55
xveather, for feveral years paft.   Even then it would,
perhaps, be impoffible;  as it has ever been found a
difficult matter to trace any connection between the
manifeft qualities of the air, and the effects of a ge-
neral conftitution of  it,  favorable to difeafe. m  As I
am unable, either from minutes, or memory, to give
any account of  the weather, I fhall leave the  mat-
ter unattempted.

   In the  year   1793, during  the feafon in which
fuch  complaints ufually appear,  intermittents   and
their concomitants were  more frequent than they had
been for  many years before.   In  September  and
October,  there  were a few fcattering inftances of
bilious fevers.

   Early in the  fpring of 1794,  inflammatory com-
plaints, chiefly of the pneumonic kind, were unufu-
ally prevalent.   They were foon fucceeded by inter-
mittents ;  which were more frequent than they had
been the  year  before.  Nothing peculiar attended
them ;  and they continued to occur  pretty often
through the fummer.

   Towards the laft of July, the bilious, or, as it is
called here, the pond-fever, began to make its ap-
pearance ;  principally about the South Pond, one of
the mill-ponds beforementioned, and near the Canaan
line.  There were fome  fcattered inftances about the
North Pond : and a few, which were at  fuch a dif-
tance from both, that they were, probably, occafioned
by the flagnant  water  about the  great river, the
Houfatonak.'  But the diforder was chiefly confined
to the vicinity of the  South Pond.   The influence of
this pond appeared to extend about one mile and a
half from its borders.  Within this place there are   ^
about 150 inhabitants j and about 80 of this number 
$t>        LETTER FROM DR. W. BUEL,

were affected  wkh the fever :  part of them inhabit-
ants  of Sheffield, and a part of Canaan.  Among"
thofe who were fick, there were five or fix milance^  ;
of mortality.   There were not  more  than ten or
twelve perfons who had the diforder in other parts of
this town.  From thefe there was but  one death ;
and that in a cafe complicated with pregnancy, and'
eventually with  phthifis pulmonalis.  People con-
tinued  to be attacked with this  fever  through  the'  \
months of Auguft, September and a part of October.

  The diforder was, probably, in all refpects, what  |
is termed a bilious remitting  fever.   It  began with
an ague fit; intenfe pains in the  back,  head and,'
limbs,  foon fucceeded by thirft, drynefs of the fkin,
&c. continuing without much  variation  18  or  20  =1
hours: a  flight  moifture then broke out upon  the   d
fkin—feldom a profufe fweat; a degree of remiffion  1
of the fever, and abatement of the pains, then enfued,   \
and continued till about the time of day of the firft
attack, when  another exacerbation of fever com-
menced, with fyrnptoms fimilar to the firft.  If  the
difeafe  was left to itfelf, the remiffions would fome-
times become fhorter and more imperfect, as the pa-
roxyfms were repeated, until it grew to be nearly or
quite a continued fever.   A diarrhea, and fometimes
dyfentei ic fyrnptoms were added to the reft.  Moft of
thofe who died were attended with a preternaturally
lax ftate of the bowels ; which,  in  feveral inftances,
might properly be called dyfenteric. The tongue was,
from the  firft, covered  with  a  white fur.   After
three or four days, a black ftripe began  to appear ;
extending from the root, towards the extremity ;  and
gradually fpreading, as the diforder  advanced, till the
whole tongue affumed a black appearance. Even the
teeth and gums were fometimes  covered by  this
black' fur ; and in fome patients who afterwards re-
covered. 
TO DR. E. H. SMITH*
55
  In  the treatment of this  diforder,  evacuation of
fome kind, is undoubtedly neceffary in the early ftage
of it.   Venefection generally produced a temporary
relief from the violence of the pain, and was, proba-
bly, when the conftitution was firm and robuft,  and
the habit plethoric, frequently ufeful; but it did not
appear to me to be important as a curative  remedy.
Emetics fometimes did well;  and where there was a
great degree of naufea> I  thought them ufeful.   But
purging, with  calomel and  jalap, was the  mode of
evacuation I preferred, and generally practifed;  and
the remedy which of all others appeared to me mofl
advantageous in the early ftage of the difeafe. ]

   It is unneceffary for me to fay any thing  more, in
 this place, than that affiduous purging, in the begin-
 ning, and a plentiful ufe of the Bark, after the remif-
 fions had become fuch as to make it admiffible, were
 the effential parts of the management of this  diforder.

   So ftrong was  the tendency to diforders of this
 kind, that people  continued in fome inftances to be
 affected with intermittents, or fever and ague, thro*
 the winter.   Thefe were very frequent in the fpring,
 but with no peculiarities,  and yielding to the  common
 remedy with the ufual facility.

   During the month of  Auguft 1795,  I was in the
 county  of Ontario,  in the weftern part of  the  ftate
 of New-York.   There, was,  at that time, a diforder
 prevalent there, of the fame nature with that which
 I found rife in Sheffield,  on my return, and which I
 am about to defcribe.  It was chiefly exiftent in the
 neighborhood of  ftagnant waters, and in fituations
 fimilar to thofe places, in this town, to which the dif-
 eafe was moftly confined.   The treatment  required
 was, of courfe, the fame.
                        I 
 5$       LETTER FROM  DR. W. BUEL,

   On my return  to Sheffield, which  was the 5th of
 September,  I found a number of the inhabitants,
 about the North Pond, afflicted with a fever, which  -,
 began to appear  about three weeks before.   The
 people firft attacked were thofe who lived neareft to
die pond; whole families of whom were  down at
once.  Numbers continued to be taken, daily, chiefly  \
 within the vicinity of this Pond, or within three quar-
ters of a mile of its borders, till about the middle of ^
 October ; after which time there were few inftances
of new attacks.   In this time, i. e. from the 1 oth of
Auguft  to the 2 oth of October, of about 200 (which
is not far from the number of perfons living within
three  quarters of a mile of fome  of  the borders of
this pond) not lefs than 150 were affected with more
or lefs of this difeafe ; out of which number, but one
perfon died, and that an aged man, previoufly debili-
tated  and  difordered.—The  number affected with1 f
this fever, in all other  parts of this town, did not, I
believe, exceed thirty.  Of thefe, three  died : one,
an aged woman :  the other two, pregnant women ;
of whom, one died  in the fever,  the other fuffered
an abortion, and died fome months after, dropfical. .

  The  difeafe,  this year, put on a different form to
what it did  the laft.   It might, with more propriety
be called an  intermittent, than a remittent fever ;
though  it was very  different from a common  fever  '
and ague.  It began, like other fevers, with an ague
fit, attended vith  pains in the head, back and limbs.
The duration of this part of the paroxyfm was uncer- j
 tain.  It was fucceedcd by a hot fit, whofe duration !
was,  in  different perfons,  from fix  to  forty-eight  \
hours. A remiffion, and, fometimes, nearly or quite*
a perfect intermiffion, then came on ;  but whofe du-
 ration was as irregular and uncertain as was that of
 the paroxyfm before.  After the firft, the paroxyfms 
TO DR.' E. H. SMITH.
57
were not generally  ufhered in by a regular ague fit;
only fome flight chills were ft It; and thefe were ir-
regular, both in degree and continuance.  The length
of the next fucceeding paroxyfms and intervals could,
by no means, be calculated for, from the preceding:
fo completely irregular was this diforder.  The fever
evidently  tended to an  intermittent form ;  but it
could neither be called  quotidian, tertian, quartan,
nor by any other name ufed by authors to diftinguifli
the different fpecies of intermitting fevers. The pains
in the head, limbs and back, were very fevere,* parti-
cularly in the latter, which were  fo univerfally  in-
tenfe, that the  fymptom might almoft be confidered
as charactereftic of the diforder.   In the primse viae,
flatulency was nearly a conflantly-attendant and very
troublefome fymptom.  Evidences of an  increafed
fecretion and excretion  of bile, were generally pre-
fent through the difeafe,  but were  particularly ob-
fcrvable in the  convalefcence.  Some degree of ye'-
Iownefs of the fkin, which was almoft univerfal, indi-
cated a-reabforption of this fluid, and a depofition of
it upon the  fkin.  This  yellownefs was in two in-
ftances, which I faw, very intenfe.   A flight degree
 of delirium was very common, during the height of
the fever.  The appearance of the tongue was much
the fame that it was laft year.

   My method of treating  the fever of this year,  was
fimilar to that  which I employed the  laft year.—
Purging, in the beginning, and afterwards a plentiful
ufe of the Bark, appeared to me  to be the  moft fuc-
cefsful way of managing it.  In extreme cafes, parti-
cularly, a free and full exhibition of bark,  wine and
laudanum, feemed the only means of falvation.   It
was abfolutely neceffary  that the patient fhould be
thoroughly purged, previous to the ufe of ftimulants,
other wife the bark, wine  01 laudanum,  would have 
$S        LETTER FROM DR.  W. BUEL,

very pernicious effeas.   I faw  feveral inftances, at
the weflward, where, by too early a ufe of thefe me-
dicines, the fever was changed into a continued form*
attended with a conftantly dry and yellow fkin, com-
atofe fyrnptoms, &c. One of the inftances of extreme
yellownefs, which I have mentioned, was of this kind,  ,
and at the weflward.   I removed this fymptom, and
recovered the  patient, by giving repeated dofes of
calomel and jalap, fome perforative medicines, and
afterwards the bark, wine, &c.   Each purge, in this
cafe, leffened  the degree  of yellownefs, very appa-
rently.  The other  inftance of intenfe yellownefs, ~"*
which I faw,  was in  this town, in the cafe of the
pregnant woman, whom I  have mentioned to have
died in the fever.  This woman's fever never  had
diftinct intermiffions.  Several flight  attempts  were  ,
made to adminifter the bark;  but it  would not do.
Perhaps my timidity in the  ufe of evacuants, on ac-
count of her fituation, was injurious to her.

  The Bark did not fufpend the paroxyfms, in this
diforder, in as fhort a time as it does in common in-
termittents ; but, if the patient was properly pre-  <
pared, and the ufe of it was perfevered in, it never  j
failed to have the effect.

  Purging  was probably ufeful in a twofold  way :  ■
Firft, by carrying off the  fuperliuous  bile ; which
was, evidently, fecreted and excreted in a preternatu-  j
ral  quantity : Secondly, by reducing the fthenic dia-
thefis, which was, perhaps, always prefent, in the  j
early ftage of the diforder.                          1

  It is true, that thofe whofe fever was fufpended by
the bark, were fubjeft to frequent relapfes, and to  a  a
long and lingering ftate of couvalefcence.  This drew  \
an  odium  upon  that medicine;  and  many  were 
TO DR. E. H. SMITH.
59
induced to believe that it was owing to the ufe of it
that people were fo long in  recovering, and, of
courfe, that  it was improper.   I am convinced, how-
ever, from, very attentive obfervation, that thofe who
did not take the bark, but fuffered the fever gradually
to wear away, as it fometimes would,  were equally
fubject to thofe inconveniences.  Indeed, this feems
to be the nature of the difeafe.  The old people in
this town, who recollect the times when diforders of
this kind have prevailed here before, and when  the
bark was not at all ufed, inform me that thofe who
were afflicted with them, were a long time in recover-
ing.

   It feems that, in all cafes,  when patients have got
rid of the fever, either by means of the bark, or
otherwife, there remains an increafed  difpofition to
the formation and  excretion  of bile, and that this
humor  accumulates in the  primas vise, till it firft de-
ftroys the appetite and occafions naufea, and then
excites a fpontancous djfeharge by ftool or vomiting,
or a relapfe of fever, or both.  A continuance in the
ufe of fome laxative medicine, after a recovery, has a
tendency to prevent thefe effects ;  and, if ftrictly at-
tended to, would probably prevent them, and per-
haps obviate the difpofition to relapfe entirely.

   In reflecting on phenomena  of this kind, the  hu-
man mind is anxious to fix on fomething fatisfactory
as their caufes.  Specific contagion, I am convinced,
was in no inftance,  which came u nder my  obferva-
tion, either here or at  the weflward, the caufe of the
propagation of the diforder.  That marfh effluvia, to
whofe action the  inhabitants of fome parts of this
town are fubject, is the exciting caufe, and is necef-
 fary to the production of the df|r<lers in queftion,  is
 beyond any manner of doubt.  This is evident from 
60       "LETTER  FROM DR. W. BUEL.

their exifting only where this influence extends. But
fomething more  is  wanting ; otherwife  we  cannot
account  for  their prevailing in fome years, and not
in others. Every circumftance relative to» the ponds*  '
and marfhes in this town  has,  apparently, been the
fame, for many years paft ; and yet very little of this
form of difeafe has appeared, for ten or twelve years
back, until the two laft.   We muft either fuppofe a  .
peculiar conftitution of the atmofphere, occafioning a  '
predifpofition to thefe diforders, and coinciding with
the local caufe, or marfh effluvia ; or that the marfh .<
effluvia itfelf  is, by fome peculiarity of  the  atmof-  :
phere, wrought up to .a higher pitch of virulence, and
thus produces a higher degree of difeafe.  I am  in-
clined to admit the latter fuppofition,  as I am con-
vinced that the fevers which have prevailed here,  for
two or three years paft, and the common intermittent  ]
fever, are the fame, only differing in degree.   I have
feen all degrees, from  the mildeft form  of intermit-
tents, to the moft extreme of bilious remitting fever.
It is impoffible to fay where the line of divifion fhall
be drawn. The difeafe this year feems to have formed  :
a  connecting link between intermittent  and  bilious
fever ; and, were I to name it, I  would call it a bil-
ious intermittent.  Should the intermittent fever, in  .
its ufual form, prevail next year, the diforder may  be
faid, in the three years, to have been in regular gra-  *■
dations run through.
     SHEFFIELD, NOV. 30, 1 795.

  * i have endeavored to difcover the caufe why the ficknefs in
179.;, \v:.s ccr.f.'.vcl alrr.nl]; entirely to the South,'and in 1795, to  <I
the North-Pond ; but I  can find no local circumftances to have  J
exiftcd which fhould prcduce iicknefs about one, and not about  1
the other, in tiiher of thefe rears. 
      LETTERS

                     TO

 WILLIAM  BUEL,   Physician,
         SHEFFIELD, MASSACHUSETTS,

                    ON THE

FEVER WHICH PREVAILED  IN  NEW-
              YORK, IN 1795.

              BY E. H.  SMITH. 
t 
astoertifemcnt.
 I  HE following letters were written at the requeft,
and for the information, of a medical friend, with
whom  the writer has long been accuftomed to cor-
refpond,  both on  profeffional and general  topics.
Being  compofed originally without  any view to the
prefs,  and nearly finifhed before the idea of publica-
tion was fuggefted, they will need much indulgence
for  many defects of expreffion and method, which
the writer  has not leifure to correct.  Much, too,
muft be pardoned to that pruriency  of ftylc, and po-
fitivenefs of decifion, into which perfons in habits of
fraternal intimacy are apt to fall, and which the laws
of epiftolary intejcourfe do not forbid.    A careful
revifion, would, doubtlefs, have  rendered thefe let-
ters  more acceptable,  in  thefe  refpects,  and  have
chaftifed them of thofe repetitions  of fentiment and
expreffion, which,  though partially avoided in tranf-
cnbing for the prefs, ftill occur too frequently.  But
this was impoffible.  A further,  and more fatisfacto-
ry, apology  may be expected, for the opinions which
they contain;—confidering  the youth, and fuppofed
inexperience,  of the writer.   It is not improbable
that hafty and  unfounded  opinions have crept into
the following pages;  opinions unfupported by fact,
arid which informed reafon would difclaim.  If fuch
there  are, no perfon can be more defirous, than he
who has delivered, to difcover them, or more ready
to  relinquifh  them.  But a conclufion  againfl an
opinion fhould reft on fome better foundation than
the age of him  who  maintains  it.   To  thofe who
think  otherwife,  the  words  of the learned Van
Swieten may not impertinently be addreffed.
                        K 
   ce Honor and refpect are due to phyficians, emi-   ]
€i nent from t,heir long and extenfive practice of this
£i falutary art; but they, on their fide, ought  not to
" be fupercilious, nor defpife the advice of younger  I
" profeffors.   If even a  gardener  may  fometimes  1
" fpeak to the purpofe, how much more may not  j
" this be expected  from phyficians, though young,  J
*' when regularly educated  and diligent  in their
u profeffion : they have an opportunity of  obferv-
" ing the  whole courfe of  a  difeafe and its  fuc-
" ceffive changes,  while  the others,  overwhelmed
" with bufinefs,  view in hafle fome of thofe circum-
" fiances only which  happen  in the time of the
" difeafe, and are obliged to collect the reft from
" ignorant nurfes, who do not always tell the truth.
" The public good will be moft.promoted, if the fire ;
" of the young phyfician be moderated by the ma-
" ture difcretion and experience  of the old  practi-
" tioner ;  nor  let thefe,  while  they inftruct, be
** nfham^d  to  learn.*'*

   * Comment: on the 1413 aphorifm of Boerhaave.
NEW-YORK, MAY, 1796. 
LETTERS ON THE FEVER  OF 1795.
                LETTER FIRST-


              INTRODUCTORT.

     J-N compliance with your wifhes, and in return
for the communication with which you lately favored
me,  relative  to the difeafes which prevailed  in the
neighborhood where you refide,  for  the laft three
years, I have put together all the fcanty information
I poffefs, reflecting the fever which was the occafion
of fo much diftrefs to this City, in the laft fummer
and autumn.—I regret my inability to  communicate
a  more minute and fpecific flatement of facts ; and
the more, as there feems  little probability, at ptefent,
that any perfon, qualified for the talk, will undertake
it.   Various  circumftances confpired to  narrow the
fphere of my  obfervation ; and this may have led me
into  erroneous conclufions, which more extenfive
practice and wider obfervation would have corrected
in  me, and may have corrected in others.   But, how
faulty foever my reafonings may be thought, I muft
demand abfolute and entire credit for my facts.  In
thefe, 1 cannot well have been deceived: for the
very circumftances which rendered them few,  made
me more attentive, and gave me leifure to  be  accu-
rate.  There  is but one poffible way in which any
falfity can be  chargeable on them ; and this might
be, were I to pretend to decide that the courfe of
the difeafe was always fuch, as when it came beneath
my notice.   But you will underftand me ftrictly.   I 
66       LETTERS FROM DR. H. H. SMITH,

defcribe what I faw ;  and mean only then to  make a
remark  general, when I fo  exprefs it,  and when i  i
find a concurrent opinion on the pait of many. In my
reafonings on facts, you will not blame me for taking
a range fomewhat wider ;  for, fliould I,  in my way,
light on fome truth, interefting and important, it will
well repay you for the fatigue of accompanying me ;
and, fliould  I not, your friendfhip will  excufe me, in
this inftance, as it has often  done before.   Of one  ,
thing further you ought to be forwarned : That, con-  j
cerning every thing  connected  with  the fever of  j
i/oc, where opinion may be exercifed,  there is va-  1
riety -of opinion.  And as, in this conteft of jarring and '-I
hoftile opinions,  but one can have juftice on its fide,  J
I would have you follow mine, with diffidence,  into  j
the field of controverfy.  Victory does not  always
incline the balance on the fide of  right;  but even  ;
fhould mine dcferve defeat, it will fuffer  in the com-  J
pany of myriads.
               .LETTER SECOND.

An account of the fit nation and peculiarities of that part of  (

  the City in which the Fever mofl prevailed, /Vz 1795.   *.

   Though the fever continued  to  extend itfelf,  to
the laft, yet it never became general over  the  city ;
and, for a long time, it was moftly confined to a par-  '
ticular diftrict.   As the feafon advanced,  the  pecu-
liarities of this diftrict may  be fuppofed to have be- j
come common to  a larger portion of the  city  ; and
their extenfion  to  the whole oruy prevented by the
letting in  of winter.   To the diflricl alluded to, the
Eaftr:v-LT,  hem Long-Ifland ferry to  Mr.  Rutgers'?, 
TO DR. W. BUEL.              67
forms the eaftern  boundary ;  the northern  reaches
from thence to Divifion -ftreet; thence wefterly, down
Divi/ion-ftreet,   Chatham-ftreet,  the extremity  of
Pear 1-flreel, into William-ftreet, to Franckfort-ftreet,
down this laft to Gold-ftreet, through that to Beek-
man-flreet,  along  which the line proceeds to Pearl-
ftreet, as far as the Market, down which it fhould be
continued to the river.—The fpace included in thefe
bounds,  is all over vvhich the fever, according to the
beft of my remembran.ee, exerted any power, till after
it  had reached  its height;  when it extended down
Water-ftreet, a little below Wall-flreet,  and proved
very mortal.  It is  true that there were a few perfons
affected  in  various other parts of  the town ;  but,
during the greater pirt of the prevalence of the fever,
it  was  principally active  in the north-eaftern  and
middle parts of the diftrict comprehended as above :
and, as a thorough knowledge of the peculiarities of
this portion of our city is,  in my opinion, indifpenfa-
ble to the hiftory of the difeafe which afflicted it, I
cannot  doubt your patience with the minute descrip-
tion I think  it neceffary to give.

   The firft and moft obvious remark, on the greater
pait of the diftrict, juft pointed out, is,  that it is the
loweft, flattefl,  and moft  funken part of  the whd!e
city.   Some places are much  more  funken  than
others ; but the whole fpace is evidently fo, compared
with the adjacent ground ; and appears to have an in-
clination, more or lefs obfervable,in different ftreets,
to  the Eaft river.   This inclination is very confider-
able in Dover-ftreet;  a ftreet which is find always to
hav-a fuffered from fevers of this kind, during the hot
feafon.   From   the  divifion of Pearl  and Cherry-
ftreei:^, down the latter, the defcent is rapid, to fome
where near James's-ilreet; about which is the loweft
part of the ftreet, and from whence it is nearly  level 
 68      LETTERS FROM DR. E. H.  SMITH,

to the northern boundary.   Beyond this bound,  the
ground rifes again ;  and the made ground,  by the
rrrer fide, is alio fomeAvhat elevated : fo likewife, is
the whole of the ground over which  the wefterly line
paffes—through Divifion, Chatham, &c. ftreets.  Thus
you will perceive, that the part of the city where the
fever was moft active, for the longeft period,  forms,
as it were, a bafin, having its fide, neareft the water,
a little inclined..  Within this bafin, there are feveral
fmaller cavities ; one of which, in particular, will re-
quire a further defcription. Thofe ftreets, alfo, which '
are not included in this  hollow, but which lie along, j
the river, will require  fome attention ; which fhall be
given theim

   The extreme irregularity  in the difpofition of  the
ftreets, and the narrov/nefs of the greater number of
them, are great obftacles to a free ventilation of thL>
city.   This  misfortune, common to every part of it,
falls with peculiar heavinefs on that diftrict  which
has juft been fpoken  of.  The comparatively high
and neighboring lands ofMorriffania andLong-Ifland,
receive almoft folely the benefit of breezes from  the
north-eaft and eaft : The Sound, which divides them
from the city, being too narrow  to add much force
and frefhnefs to a  breeze  nearly  fpent  on their
heights.  North, the  ifland rifes into little hills, from
which  the wind paffes on to the  high  parts  of  the -
city ; rarely > ifiting the low and intervening fpace;
unlefs it  may be the  topmoft rooms of the houfes :  i
and, as the houfes are generally low, the effects of a
wind from  this quarter muft  be inconfiderable.—-  ,
North-wefterly, there is fomewhat more of an open-  <
ing ; but even  this is fmall.  Weft, fouth weft,  and
ibuth,  the other parts  of the town, which are higher,
and thickly fettled, break the force of the gales from
thefe points.   So that, thus fituated, this quarter of 
TO  DR. W. BUEL.             69
the city, though it were perfectly well laid out, would
have but little chance for a free ventilation : irregu-
larly difpofed and narrow as the ftreets are, we muft
be  convinced of the impoffibility of its receiving the
neceffary fupply of frefh air.   You will underftand
me as fpeaking of a thorough ventilation, and in the
fultry feafon,  when it is moft  neceffary : a partial
fupply of air,  equal to the fupport of a feverifh exis-
tence, it  undoubtedly obtains.

   Much of the ground, in the  northern part  of this
diftrict, is fwampy, and abounds with little pools and
puddles of flagnant water.   This was efpecially true
laft fummer  and autumn ; there being great rains,
and no adequate means for conducting off the water.
Indeed,  fo flat are  fome of the paved ftreets, in this
quarter,  that the rains did not run down the gutters,
but continued in little puddles, and were evaporated
from the places whereon they fell. In the new ftreets,
which are unpaved, and without any gutters, numer-
ous imperfect ditches affifted the difpofition of  the
water to ftagnate.   Thefe places were  often mud-
dy, when the fouthern part of the  town was dry;
and the fleams from them very offenfive, when the
.dry ftreets, towards the North river, were perfectly
 fweet.

   Several of the paved ftreets, and indeed the greater
number, in the diftrict of which  I am fpeaking,  are
 narrow and crooked ; fome  with neither fide walks
 nor gutters, and by far the largeft portion of them,
 miferably built.  Moft of thofe which are unpaved,
 are, in all refpects, ftill worfe ; the buildings chiefly
 wooden, and placed on the ground; the old ones
 falling to  decay; the new, but imperfectly finifhed.
 Of them all, it may be remarked, that they are much
 expofed, fome of them more than others, to the full 
 yo      LETTERS FROM DR. E. H.  SMITH.

 influence of the docks, whatever that may be, and ft
 cannot be falutary ; or to that of a broiling fun, from  ,
 early in the morning, till the middle'of the afternoon j  1
 and fome of them, to both.                         1

   So much for the ftreets, generally : a few particu-
 lars, concerning fome of them, are neceffary to the
•formation of a perfect idea of this diftrict.

   A line, drawn from the corner of Ferry and Pearl-
 ftreets, up the latter, to where William ftreet enters  1
 it; then down William to Franckfort, and through J
 that, a part of Gold and Ferry-ftreets, to Pearl-ftreet jfl
 again, will form  the ridge of a new cavity (included  |
 in the principal boundaries above mentioned) which
 feems contrived,  by art,  for the dwelling place of
 fever.  This court-yard of the palace of death, is di-
 vided by feveral  difmal lanes, courteoufly denomi-
nated ftreets; fuch as Vandewater, Rofe and Jacob-
ftreets, &c. which form the borders to innumerable? 1
tan-vats.   The whole is one vaft tan-yard, the firm
parts of which feem to have been conftructed by art
in  the midft of an extenfive quagmire.  To this placcv
as  far as I can difcover, there i-; no  outlet.  Think
what muft be the condition of it, in the  months of
Auguft  and September!—Yet  human beings  live  ,
here ; and  habit  renders its noxious exhalations, in
fome fort,  harmlefs to them.  It is  remarkable  that
few perfons, regularly inhabiting this hollow, died otM
the fever laft year.  To thofe, whofe evil deftiny led  1
them to feek a new dwelling place there,  it proved  I
 highly peftilential.                                 1

   Dover-ftreet is a fhort, narrow  ftreet,  running* m
from the beginning of Cherry-ftreet, down to the. 1
Eaft river; and  contains near  twenty buildings.—  ;
The defcent, from Cherry into Water-ftreet, is very 
TO DR. W. BUEL.
71
rapid.   As the expofure is nearly to the eaft, it  re-
ceives the whole effect of the fun, from 6 a.  m. to 3
p. m. in the fummer.   The defcent makes it  eafy to
keep the furface of the ftreet clean ;  though it pre-
vents a free ventilation.  But it has been raifed, fe-
veial feet,  fince  the  buildings, which are  moftly
low, were erected ;  fo that the road is, in many in-
ftances, up to the middle of the lower ftory windows;
leaving the cellars to the houfes, and cellar kitchens,
without a  communication with  the  ftreet.   The
yards remaining as before, are, of confequence, much
lower than the ftreet;  without vent;  and, of necef-
fity, all the  water, and filth of  every kind, which
gathers in them, muft there ftagnate, ferment and
putrify.   Add to this, fome pf thefe yards are capa-
cious,  and  contain little,  decayed, wooden huts;
fometimes built directly on the ground ; and contain-
ing, oftentimes, feveral families.

   Water-ftreet, above Dover-ftreet, is chiefly com-
pofed of low,  decayed and dirty wooden buildings.
This  ftreet  being either  made-ground entirely,  or
raifed like Dover-ftreet, the fame is true of  the fitu-
ation of the  houfes and yards.   And, left any of the
filth, or water, fhould drain off, from any of the
yards, the weflern fide of Water-ftreet has  been
kindly  converted, by the enlightened  zeal of the
directors of thefe affairs, into a perfect dyke  ; which
anfwers its defign, moft completely,  by preventing
even the flighteft leakage.   Befide, as this ftreet lies
directly on the water, it has the benefit of the whole
force of the fun, the greater part of the day  ; and of
the exhalations from the docks ; which are  here in
great number, and in the higheft ftate of their per-
fection.  There is, however, abetter opportunity for
frefh air,  in this, than in fome other ftreets.  Yet *VJ.{
even this  is  an advantage which the rage for  im-
                       L 
  7^      LETTERS FROM DR. E. H. SMITH,

  provement threatens to transfer to a new ftreet, ftill
  further out in the river ;  which, if completed, may
  form another dyke, to the increafed pleafantnefs and
  health of this quarter of the town.

    Of  Roofevelt, Catharine,  James,  Oliver,  &c.
  ftreets, nearly the fame remarks are true as of Dover
  and the upper part of Water-ftreet: for though they
 are fomewhat wider, ftraighter, and have more good
 and new buildings in them, yet they are raifed in the
 fame manner, have funken yards, and under-ground
 apartments ; and Roofetelt ftreet has  an open  fink,
 where  the drippings of  the  tea-water pump,  after
 having gently collected all the filth in their way, are,;
 received ;  and being juft enough to keep up a con-
  ftant dropping, and not enough to wafh the gutter, or
 the fewer, the ftench is moft intolerable, during the
 fultvy months.

   To many other of thefe ftreets the fame remarks  ,
 will apply ; and to fome with aggravated force : but
 what has been faid, will, perhaps, be fufficient to aid  .
 your imagination in the conception of a  juft idea of
 their condition :  I mean of their neceffary and  una-
 voidable condition.

   Of the Docks, it may be enough to mention, gc- j
 nerally, that they are badly contrived in every part
 o: the  town ; and worft of all, in this part ;  being '
 broken up into numerous little wharves, thus form- .
 ing narrow flips, where the ground is left bare at ebb ;
 dde ;  and where vegetable, animal, and excremen-
 ritious matters, being thrown in, at all times, inftead '
-of being caft into the ftream, ferment, putrify, and
 render the ftench truly peftiferous.   Indeed, this is
 fo much the cafe, with all  of them, in the fummer,
 that, except to perfons  habituated to  their exhala- 
TO DR. W. BUEL.             73
 tions, they are  abfolutely  intolerable;  exciting,  in
 perfons of a delicate make,  immediate vomiting ; and
 in others naufea, indigeftion, head-ach, or fome tem-
 porary illnefs, when expofed to  them but a fhort
 time.

  In addition to the above-related facts, concerning tho
 condition of the ftreets, in that part of the city where
 care  was moft needed, it may be remarked that, at
 no time, was there ever fo great an apparent inat-
 tention to preferving them clean.  Befides the impe-
 diments which the level nature of the ftreets, in manv
 parts of the town, prefented to the draining oft" of the
 filth which is conftantly accumulating in large towns
 like this, artificial impediments were permitted ; as if
 death were not fufficiently active, and needed the aid
 of the magiftrate.  In  all the ftreets where buildings
 were going  forward, the workmen were allowed to
 reftrain the  couffe of the water, in the gutters, by
 forming little dams, for their convenience in making
 their morter.  The effect of this ftoppage of water
 was  fo great,  that  even in Broadway, one of the
 ftreets the beft calculated of  any in the city  for
 free  ventilation,  in that part of it  where  the new
 Tontine Tavern was building, the ftench was exceed-
 ingly offenfive.  And in this condition was it allowed
 to remain for near two months ; though it  was  al-
 moft  under  the windows of the principal magiftrate
 of the  city.  If this were true of  the wideft, and one
 of the beft aired and cleaneft ftreets, of  New-York,
 what think you wras the ftate of thofe narrow, crook-
 ed, flat, unpaved, muddy alley?,  mentioned above ?
No one  can form  even a  faint.idea  who has. not
walked through them,  in the middle of fome one of
thofe deadly, fuiibcative days, which we experienced
in September laft. 
74      LETTERS FROM DR. E. H. SMITH,

   But this is not  all: befide thofe maffes of  femi-
putrid vegetable and animal matters—cabbage, tur-
nips, the heads and entrails of fifh, &c. which,  at all
times of the year, out of compaffion to  men who
might be ufefully employed as fcavengers to the city,
are allowed to complete the putrefactive  procefs, un-   -
difturbed, in the middle of the ftreets,-—the fight and
the fmell were fhocked, at every turn, by dead rats,
fowls, cats, dogs and pigs.   So remarkably was this
the cafe, that I queftion whether there  could have   ;
been found a fingle ftreet, alley, or even  bye-lane, of   j
any tolerable length, which did not  lend  its  aid to
render this exhibition full and frequent.

   The preceding ftatement, melancholy as it may   I
appear, will convey  a very inadequate  idea of our
misfortune,  in  refpect to fituation, without fpecial-   ■
information concerning  the feafon,  as  it  appeared
here, during the reign of the fever ; and a knowledge   [
of the people who moftly inhabited thefe  parts of the^   <
city,  and on whom  the feverity of the diforder was
moftly  inflicted.   With this knowledge  I fhall en-
deavor to furnifh you; but the length  which this
letter has already acquired will excufe me, to you,  %
for poftponing the attempt, to a future opportunity. •  \
                                                  4
                                                  t
                LETTER THIRD.

       Some Account of the Seafon  of 1795.

  Physicians, from the earlieft  ages of medical re-
cord, have remarked that great peculiarities and irre-
gularities of feafon, have exercifed an unfriendly influ-
nce on human health: And Hippocrates, himfelf, takes  I 
TO DR.  W. BUEL.
75
notice of the difficulty, which hence arifes, of forming
a proper judgment, and adopting a fuitable method
of cure, in thofe difeafes which occur under fuch cir-
cumftances.   The importance of this divifion of my
fubject, makes mc regret that it is in my power to fur-
nifh you with no other than general information.
You will be the more ready to overlook this defect,
when you recollect that I do not pretend to-deliver a
hiftory  of the fever, and are informed that  there is
fome  probability  that  this particular  delect will be
fuppiied by another hand.

   Generally, then—every one knows that the fum-
mer and autumn  of 1795 were cxceffively fultry and
exceffively wet.   Every article  of  houfehold furni-
ture,  or in ufe about a houfe, fufceptible  of mould,
was fpeedily and  deeply covered with  it.   It feemed
to penetrate  places where we fliould have  deemed
its appearance impoffible.   A friend of mine  found a
pocket-book of  Morocco  leather  quite mouldy ;
though it was in the drawer of a private defk, inclofed
within  a  large defk—both of which were  ufually
locked—and covered  by papers.   Boots and fhoes
hung  up by a wall,  near a fire-place, heated every
 day, contracted mould within twenty-four hours.

   Meats  fpoiled  in the  market-place uncommonly
 quick ; and thofe which were  brought home, appa-
 rently  frefh and good, in the morning,  were  often
 found  unfit to be eaten, when cooked and brought
 upon table.

    Efculent  vegetables, in  general,  and efpecially
 fruits, were unufually poor, tough and taftelefs.  The
 peach, particularly that called the cling-ftone, was
 fcarcely digeftible; and often occafioned temporary 
 J6      LETTERS FROM DR. E. H. SMITH,

 illneffes, quite fevere, while it doubtlefs aided in the
 production, or aggravation, of the fever."

    Flies were  very numerous and  troublefome, in
 every part of the city, in the beginning of fummer;
 but they fuddenly  difappeared, about the middle of
 July, from the more airy parts of the town, collecting i
 in fwarms, in the lefs healthy parts,  and fucceedea£;
 every where,  by clouds  of mufketoes,  incredibly
 large and diftrefling: and thefe continued to affli&
 us, long after the time when they commonly depart. ]
 Almoft  every perfon fuffered exceedingly from the
 bites of thefe infects ; and foreigners efpecially.   In
 fome they occafioned univerfal fwellings,  and erup- i
 tions, fomewhat  like Pemphigus ; and in others nu-
 merous little ulcers.   Thefe laft, a phyfician of my
 acquaintance, faw even in a native American.   The
 irritation,  reftleffnefs,  and  confequent watchfulnefs
 and fatigue, occafioned by thefe animals,  no doubt ;
 predifpofed the well  to  be affected  by the  fever;
 while they extremely harraffed the fick, and retarded
 their recovery.

   During the  whole of this feafon, I remember butj
 one thunder-ftorm ; and this was very gentle.  There ,
 was but a fingle hard clap of thunder, for more than
 four months, that I remember ; and very little thun- !
 der and lightning, at any time.                     I

  * Vegetable grow th was uncommonly rapid and abundant, in
 the fummer of 1795.  I mention this that no miftake may arife
 from the above remark concerning efculent vegetables.  The
 more rank they grow, beyond a certain degree, the more taftelefs
they are ; and the influence of a wet feafon, in rendering  roots
and fruits tough, as well as imipiJ, is well know.).
  It is worthy of rcmcrk, thai rr.sr.y fruit-trees, plumb-trees in
particular, bloffbmtd a iecond time,).?.% year, and  produced an  .
imperfect and fecoiK5. crop of fruit. 
                TO DR. W. BUEL.              J J

  Our rains, exceffive in quantity and frequency as
they were, feemed to have loft their wonted power of
cooling the air.  In thofe ftreets, moft  unhealthy,
and  leaft ventilated, this effect was, in a degree, ob-
fervable ;  but, in the airy  and healthy parts of the
town, on the contrary, they never failed to render
the  heat more intolerable ;  and the fteams from the
hot pavement were like thofe of a vapor bath.   The
clouds, too, feemed to fhut out every kind of breeze.
—One of thefe heavy rains, which continued two or
three days,  feemed to poffefs  all the  qualities  of
fleam.   It  pervaded every recefs of the houfes, and
diffolved  the beft glue—fo  that furniture, in many
inftances,  which  had been long Handing, fell  in
pieces.

  Fogs, which Dr. Lind enumerates among the figns
of an unhealthy climate, and caufes of difeafes—page
134 of his Effay on hot climates, he.-.—prevailed in
the city, and fpread over all the moft unhealthy parts,
in particular, in  a remarkable manner,—in the even-
ings—for a confiderable part of September and Oc-
tober.  The  oppreffion,  thicknefs, ftench, and un-
comfortablenefs in every refpect,  of thefe fogs, was
very uncommon.  In a phyfician, who, in the per-
formance of his profeffional  duty,  was expofed  to
their  influence  feveral hours, one night, they pro-
duced bleeding  from the gums and fauces, and black
and  fetid ftools.—On the city watchmen, however,
they had no fuch effects.   About the firft of Octo-
ber but one perfon  had died out of their number ;
and  he was a man who returned to the city, a little
before,  and refumed  this occupation, after having
been  fome time abfent in  the country.—Whether
this fecurity of the watchmen is to be attributed—as
it is by Dr. Rufh, to the influence of the cool night- 
7&      XT.TTERS rilOM  DR. F.  H. SMITH,
air*, or to that cf habit, I leave others to decide.  It
is not impofi.bie  but that  both  may concur  in pro-
ducing this infenfibility to  the caufe  of difeafe in
others.

  To thir imperfect account of the feafon, which, de-
fective as it is, appeared to me too  important to be
omitted, 1 have one fact to add, on the authority of
a gentleman diilinguiihed  for his attention to meteo-
rological phenomena. He informs me, that no Aurora
Borealis has been feen, of any magnitude,  in  our
country, north of Pennfylvania (as far as he  can
learn) for near four years, till  the latter end of Sep-
tember 1795 ;  and adds, that his father, a refpectable
clergyman, now  about 70 Years of age, who noticed
the fame abfence of thefe appearances, remarks, that,
according  to his uniform  cbiervation,  fome uncom-
mon ficknefs has never failed to follow a long conti-
nued difappearance of  thefe phenomena.   How far
the experience of other obfervers will tend  to con-
firm this  ftatement, I have had neither time nor op-.
portunity to inquire.   And. if it be admitted as in-
difputable, it may ftill be queltionable, whether this is
to be regarded as a caufe  of difeafe, or whether this
difappearance  and difeafe, Le  not co-ordhjate effects
of a common caufe.

  *  Page 35 of his account of tho Fever of Philadelphia: "  I
" aiciibe it to .he bclltual imprison of the cool night air upon
" the bodies of the city  wutehtv.en," i. :.   By habit, as ufed'
above, is mea':t that condition of the body'which is produced by
euflomary ex] 1'iuic  to any particular imprcfiion ; audi dclign
only to fuggtit a  piobahillty that the watchmen eiev.^.'d the fever,
as much from l\.Jw bavin-  been rendered b) bv.bk i; 'uibble to the
influence of the c.^e.-ia, ic. of the in.healthy p;-: t a of ti:.- city>
as from the iiukicnee cf cokh 
TO DR. W. BUEL.             79
                LETTER FOURTH.

Some circwn/lances relative to the principalfofferers by
                the Fever of  1795.

  It is a fact, generally admitted, I believe, that, of
thofe who were fick and who died  of the Fever of
1795, the greater number were foreigners : perfons,
either juft arrived from other States, from the Weft-
Indies, and from Europe ; or who had not been many
months, or years, fettled in this city.   It is probable
that the proportion of citizens, who died, to ftrangers,
did not exceed one to feven.   Of thefe ftrangers, it
is thought, a large number were Irifli;  and there are
fome reafons why this fliould be true ;  but I cannot
pretend to know it to be fo, from my own obferva-
tion.   The  caufes  productive of difeafe in foreign-
ers, in thofe of this nation in particular, are  numer-
ous, and fome of them deferve particular attention.
This I defign to bellow upon them, after remarking,
that, both among natives and foreigners, the feverity
of the difeafe was experienced by the poor.

   I. Dr. Blane, in his obfervations on the difeafes of
feamen, remarks, " that it fometimes happens, that a
" fhip, with, a long eftablifhed crew, fhall be  very
" healthy ;  yet, if  ftrangers  are introduced  among
" them, who are alfo healthy, ficknefs will be mu-
" tually produced;" and Dr. Rufli,  in the firft vo-
lume of his  "Medical  Obfervations and Inquiries"
takes notice of this remark of Dr. Blane's, and con-
firms it, by a reference to the  experience of: our coun-
try, during the late war.  Thefe  are his words—
" The hiftory of difeafes furnifhes many proofs  of
 " the truth of this affertion.—It was very remarkable,
<c that, while the American  army at Cambridge,  in 
?CV     LETTERS FROM DR. E. H. SMITH,

"the year  1775, confifted only of New-England
" men (whofe' habits and manners were the  fame)
" there was fcarcely  any ficknefs among them.  It
" was not till the troops of  the eaftern, middle and
" fouthern flates, met at New-York and Ticonderoga,
" in the year 1776, that the  Typhus became univer-
" fa!, and fpread with fuch peculiar mortality in the
" armies of the United States."

  It is  unncceffary to  enlarge, in this place, on the
oppreilions and diltreffes of what are called the lower
order of the people in Europe.  War, which doubles
the  burthens upon every rank in fociety, exercifes an
aggravated violence upon the poor.  This violence,
Severely felt by all, in England, chiefly falls upon the
manufacturing poor ; who are, at the fame time, the
moft ignorant:, abjeft and depraved:  in Ireland, its
effects  are more general, including  in  its circle of
'.vretchednefs, the cultivator,  as well as the mechanic.
The prefent war in Europe,  unparalelled as it is for
the  number of men involved in it, has given birth to
oppreilions and calamities equally new and deftruct-
ive.  Under thefe circumftances, and when men of
fortune and refpectability, difgufted and difheartened
at the enormous mafsof mifery which every day and
every hour  prefented  to their view,  turned  their
thoughts towards another hemifphere, it is not to be
wondered at, that the wretched  and depreffed poor
fhould  pant for a fettlement  in a country, wfiere li-
berty is the portion of every  man, and independence
the fure crown of all his honeft labors ; and which had
been, fallacioufly, reprefented  as courting their ac-
ceptance,  and loading their untoiling  hands  with
every gift  of fortune.—The real bleffings of our go-
vernment  and country are precious and ineftimable;
but they are of a nature not to be felt and enjoyed by
minds depraved by ignorance and detmfed by flavery. 
TO  DR. W. BUEL.              8l
 That temperate enjoyment of the goods  of liic,  and
 moderate exercife of the bleffings of independence,
 which, alone,enlightened liberty fanctions,can neither
 be conceived of, nor relifhed, by thofe who have been
 accuftomedtocrouchbeneath theironrodof defpotifm.
 Liberty, according to their ideas, was the reverfe of all
 they felt; and independence, the unlimited gratifica-
 tion of ail their appetites. The mifreprefentations, tee,
 of fpeculating and unprincipled men, who were inte-
 refted in the fale of large tracts of unfettled territorv,
 had  foftered and extended thefe erroneous concep-
 tions.  Hence, when the poor and miferable emi-
 grants, on their arrival here, found that neither gold,
 nor farms, folicited their acceptance; that, in Ame-
 rica, as well as in Europe, their life was alike deftined
 to be a life of toil; when they perceived that licen-
 tioufnefs, the only liberty of which they had any no-
 tion, brought punifhment along with it; thedifappoint-
 ment, new and unexpected,  became a powerful ag-
 gravation to every other caufe of difeafe.  You  wiU
 not underftand me as extending thefe laft remarks to
 all emigrants to  this country,  nor fuppofe that de-
 ceived hope was prefent, or active, in every cafe.  On
 fome, even of the better fort,  it undoubtedly had a
 very pernicious influence ; on the poor and friendlefs,
 effects ftill more melancholy.—But to return:—-Two
 motives, then, poverty and oppreffion at home, and
 the hope of independence and wealth abroad, con-
 curred to draw to the United States, an aftonifhing
 number of the inhabitants of Europe; and as thefe
 motives were moftly active among the very poor and
 very wretched, people of  this defcription emigrated in
 the greateft number.  Of thefe, the largeft portions fell
 to the fhare of the States of Pennfylvania and New-
 York ; and the moft  worthlefs and profligate, proba.^
bly, relied in the capitals of thofe States. 
  82      LETTERS FROM DR. E. H. SMITH,

   The diftrcffes in the Weft-Indies, efpecially thofe
 occafioned  by the deflruction of  Cape  Francaife,
 obliged  numbers of the inlanders, white,  mulatto
 and black, to take refuge here.   This circumftanc%
 harmlefs, in  great meafure,  to  the people  them-!
 felves, can fcarcely be  confidered as fo, in  relation
 to  the whole.  Whatever effect it may have had,
 all things confidered, it feems irrational to fuppofe it
 to have been good.

   This collection of ftrangers, from various parts of
 Europe and America, which had been rapidly form-
 ing for two or three years, was greatly increafed by
 repeated arrivals  of large importations from Great-
 Britain and Ireland, during the fall  of 1794, and the
 fpring and fummer of 1795.   One or two fhips came
 into this port, after the commencement of the fever,
 filled with emigrants.

   If, then, the opinion of Dr. Blane, corroborated
 by the teftimony of Dr. Rufh, be founded in truth ;
 that the fudden intermingling of people of various and
 difcordant habits,  climates and nations, be  a circum-
 ftance favoring the production of difeafe ;  this caufe
 of fever was certainly prefent, in New-York,  in the.
 year 1795.

  II.  " Men who exchange their native, for a diftant
 " climate, may be  confidered"—fays Dr. Lind, page
 id, of his Effay on the difeafes incidental  to Euro-
peans in hot climates—" as  affected in  a manner
 " fome\vhat analogous  to  plants removed  into  a
 " foreign foil: where the utmoft care and attention
 " are required to keep them in health, and to  inure
 " them to their  new fituation;  fince,  thus tranf-
 :i planted, fome change muft  happen  in the confti-
<v tutions of both.
/ 
TO DR. W. BUEL.
83
  " Some climates"—he continues—"are healthy and
 " favorable to European  conftitutions, as fome foils
 " are favorable to the production of European plants.
 " But mofl of the countries beyond the limits  of
 " Europe,  which are frequented by Europeans, un-
 ".fortunately, prove very unhealthy to them."

   The healthinefs and  unhealthinefs of a climate, or
 the effect wrought on  the  human conftitution  by a
 change of climate, muft be  more or lefs confiderable,
 according to  the extent of its connection with other
 circumftances.   How far fuch a connection was ob-
 fervable in  this city, in  refpect to the Fever of 1795,
 will appear by and bye.

   Two remarks may be made,  concerning the  emi-
 grants from the Weft-Indies.   The firft is, that they
 generally bear the firft winter, after their arrival in
 the middle  and northern  ftates, better than the na-
 tives, while they are lefs incommoded by the  fum-
 mer heats.   The fecond is, that they fuffer lefs from
 Fevers, during the fultry feafon,  than Emigrants from
Europe.  It feems difficult  to explain the firft men-
tioned fact; the fecond  I fhall attempt to account for,
hereafter.

   The climate of this  part of America1 differs fiom
 that of Great-Britain and Ireland in the intenfer cold
 of its  winters;  more extreme and longer continued
 heat of its fummers ; and the greater variablenefs of
its temperature.

   The great body of emigrants come over to Ame-
 rica in large companies, crouded together  in one
 fhip, and ill-accommodated in every refpect.  After
a long voyage., under fuch  circumftances, they muft
 be fenlible, in an uncommon degree, to the influence
 of a new climate, and  to every  fudden  variation  of 
84      LETTERS FROM DR. E. H. SMITH,

temperature.   If they arrive, as is often the cafe, in   i
the fultry feafon, the effects of a change  of climate
muft be  felt  in all  their force.  The heats  of the   i
fummer muft render them lefs able to  cope with  the
ruggednefs of the following winter ; as the feverity'of  j
the winter makes them more unfit  to  endure  the  J
fcorching fun of the fucceeding fummer.   This will ,M
account for the fuffering of many who had paffed a   1
feafon in the country before.

   To this it may be added,  that, in  1795, the cli-  J
mate muft have been particularly bad ; fince it may  I
be fuppofed to have preternaturally affected the na-  ■
tives of the country.  This being admitted, it is not
difficult  to conceive of its  having had a pernicious^
influence on ftrangers; and being,  therefore, fairly  m
enumerable  among the caufes predifpofing  to  the.  I
fever of this feafon.                                m

   III.  An animal diet,  or a great ufe of animal food, fl
efpecially in fummer, and when there is general dif-  M
pofition to fevers, is thought by many phyficians, of  -M
our own and other countries, to favor their produe- M
tion ; and a vegetable diet, on the contrary,  to be a 1
preventative,  or prefervative,  againft them.   This,™
alfo, was the  opinion of the humane and celebrated ^
Howard, who is known to have abftained from thevjB
ufe of flefh, for many years previous to his death.—-m
Both  theory  and fact feem to concur in  eftablifhin^J
the truth cf this doctrine ;  for a fatisfactory illuftra-
tion of which I  may fafely refer you to the publica-
tions of Drs. Rufh and MitchilL,                      <

   The  proportion  of  animal, to vegetable  food,
eaten at the  beft provided tables in  America, is fo   '
great  as to  aftonifh  a European.    This may  be
laid of the country  generally—bat is  efpecially true 
TO DR. W. BUEL.
85
of the cities of New-York  and Philadelphia.  An
objection, too, has been made by Europeans, particu-
larly by the French,  to our mode of cooking meats.
They complain, and  with apparent juftice, of the im-
perfect action which fire is  allowed to exert upon
them ; and reprefent us as little better than the Aby-
fmians, who devour  a part of the ox, while he is yet
expiring.—It is certain that  a great change is obferv-
able in the appearance and kind of difeafes, in the
United States, fince our citizens have fubftituted frefh
meats, for falted, in  fummer.—Some reafons may be
affigned for this  effect, which would countenance
the opinion  of the  French ;  but they will fuggeft
themfelves to your own mind, and would require
more room than I  can allow them, in this place.—
But,  furely, if meats be prejudicial to health, in our
hot feafons; if they expofe us, by their ufe, to difeafes
of the kind, which prevailed here, laft year ; how pe-
culiarly muft this  evil have  been felt by us, when
they were in a condition fo uncommonly bad as the
year 1795—If the wealthy  often had meats brought
upon their tables, in a ftate  of incipient putrefcency,
what muft have been the ftate of thofe which were
confumed by the  poor ?—Add to  this,  that the vege-
tables principally ufed among us,are not diftinguifhed
for their  afcefcency.—Thefe remarks apply to all
ranks of  our inhabitants; and  plaifily  fliew that the
fituation of our city, the laft year, was unufually bad,
in this  refpect, for  natives, as well as  foreigners.
Other circumftances aflifted to heighten the evil, in
relation to thefe laft.

   The poor of Europe, and efpecially of Ireland, are
but fparingly accuftomed to the ufe of meat.  In that
Hland, it is not uncommon for people to pafs through
life, without ever having tailed it, except by ftealth,
accident,  or on holydays.—In this country, the great 
$6*     LETTERS FROM .DR.  E. H. SMITH,

ufe of meat produces a comparative fcantinefs in the
fupply  of vegetables; and a proportionate poornefs,
and dearnefs* of thenu  This is fufficient to determine
the choice of the poor towards the ufe of meat; and
produce, in the emigrant poor,  an almoft total and
fudden change, in their aliment.  When, too, we re-
collect  that animal food  is more gratifying to a de-
praved tafte ; that it provokes to greater repletion,
than vegetable food ; that it is more neceffary to hard
laborers ; and that it is moft craved by  thofe who  in-
dulge in the habitual ufe of ardent fpirits; we are
alive, at once, to the full perception of the mifchiev-
ous effects arifing from fuch a fubftitute, to their for-
mer  bland and fcanty meals.   In thofe,  with  whom
this change of diet took place the  laft  year, for the
firft, the confequences muft have been  ftill more per-
nicious.  For  we ought to confider that if the poor
always confume the worft provifions, thofe who were
ftrangers, as well as poor, were leaft likely to procure*
thofe which were good ; and the flighteft obfervation
is  fufficient to convince us, that their bad  qualities
could not have been much obviated by the prepara-
tion  common among the confumers.

   May we  not,  then, conclude—that  the alimenti
ufed by the citizens, generally, was favorable  to the
production of dif«afe—and that the great and fudden i
change of diet, among the  emigrants, confidering the
nature of their food in  1795, muft have difpofdl
them,  in a particular manner, to be affected  by the
fever of the country ?

   IV.  If unwhokfome aliment affifted  in the produc-
tion, or aggravation, of the fever of 1795, improper
drinks were fcarcely lefs active, to the fame end.—
The ufe of ardent fpirits,  among  all  claffes of citi-
zens, and efpecially among the laboring claffes, is af- 
TO DR. W. BUEL.             87
tonifhingly great and general, throughout the United
States.   No country in the world, in all probability,
confumes an equal quantity,  in proportion to its po-
pulation.   In  vain has the eloquence of the moft en-
lightened phyficians  and moralifts  been  exerted
againft them,  for centuries: governments  conftitute
it the intereft  of individuals to prepare and circulate
them ;   they  withhold from men  that knowledge
which would teach them to  fliun,  or elevate them
above the ufe of, intoxicating liquors ; and prejudices
are excited and foftered in their favor, that the igno-
rant and depraved, to whom they form a congenial
gratification, may continue to confume them; to the
deftruction of morals, the emolument of diftillers, and
the augmentation of the revenue.  As they are more
eafily and cheaply obtained in America, than in Eu-
rope ; as the wages of laborers are more confiderable
here, than there,  and therefore  permit them  greater
indulgences ;  as there is  every encouragement from
example ; and as a fiercer fun, according to common
notions, juftifies a more prodigal  ufe  of them ; it is
naturally fuppofeable that the emigrants of the la-
boring clafs indulged in them, to an unufual degree.
Unquestionably, the ufe of intoxicating liquors was
highly pernicious to thofe moft accuftomed to them ;
to thofe not fo habituated, it was, as unqueftionably,
ftill more pernicious.   In Philadelphia in 1793, when
the fever was prevalent, Dr. Rufh remarks that—" a
" plentiful meal, and a few extra glaffes of wine, fel-
" dom failed of exciting the feve'v."  With us the
difeafe was lefs ferocious and lefs  active ;  but,  as  if
no  means of caufing it to become more fo  were to
be neglected, an idea was, moft unhappily circulated
—and, it fhould feem, was countenanced by  perfons
bearing the title of phyficians,—that free living, the
plentiful ufe of vinous and ardent "liquors, vas a povr-
                       N 
 88'     LETTERS FROM DR. E. H. SMITH,

 erful preventative of  the fever.   The dreadful con-
 fluences which  a belief of this fort produced, were
 numerous,  and fhocking to the  laft degree.   The
 fear of death,  fo active in ignorant minds, when once
 aroufed ;  idlenefs, the parent of every vice, and lift-
 leffnefs, the confequence of want of employment; all
 confpired, with this pernicious doctrine, to effect the
 ruin of numbers.  Never, I believe, was drunkenefs fo
 common.   Not a day paffed that I did not meet per-
 fons reeling through the ftreets, or ftretched  on the
 pavement—fometimes in the noon-day fun, unfhel-
 tered, and fometimes expofed to the heavieft rains.
 I have feen  three men, lying in this condition, in one
 little ftreet.   Thefe were all,  as  you may fuppofe,
 among the  moft depraved of our poor ;  and moft of
 them were foreigners.

   Is it poffible that conduct fuch as this fhould fail of
 giving new  activity to every other caufe of difeafe ?

   V.  I have,  in a former letter,  given you fome ac-
 ce.unt of the  condition of that part of the town,
 where the Fever moft prevailed ; it is now to  be no-
 ticed that it is in  that diftrict that the greateft num-
 ber ofthe poor, efpecially the emigrant poor,  refide.
 In thofe  numerous miferable dwellings, were thefe
 wretched people crowded together ;  many families
 in one houfe ; and not infrequently many families of
 different nations.  In fome  inftances, a finoie room
 m one of thofe half-under-ground huts, ferved as bed-
 room, kitchen and  fliop, to a whole  family ;  while
 underneath  them, acelbr, half filled with mud and
 water, fent up its peftilential fleams ; and under their
' wmdow, a yard in the fame condition, was rendered
 fiifl more noxious, by receiving the offals call out
 from" every  part of the houfe. 
TO  DR. W. BUIL.
89
   VI. But,  if the fordid and almoft unavoidable fil-
thinefs of their dwellings were promotive of the dif-
eafe, under  which  the wretched  inhabitants  lan-
guifhed or fuffered, ftill  more fo, in fome inftances,
muft have been their inattention to  perfonal cleanli-
nefs.

   It was  well remarked, formerly, by a foreigner,  of
the Englifh ladies, and is applicable, with but little de-
duction to our own fair country-women,—That they
were whited fepulchres; beauteous and clean, without j
but within-----You know the reft.-----

   Were  our country-women difciples  of Zoroafter,
they could not more fludioufly  hold facred the ele-
 ment of  water.—How many of  thofe  houfe-wives,
 how many of thofe maidens, the cleanlinefs of whofe
houfes, and the neatnefs of whofe apparel, we often
 have occafion to admire  and commend, think you,
 have applied to any other parts of their perfons, than
 their hands and faces, this purifying element ?*—The
 infrequency  of  bathing  among  both  fexes and  all
 conditions, efpecially among females  and the  poor,
 in America, is furprizing.—In this  refpect, the emi-
' grant poor are in no wife<more commendable ; and,
 in every other kind of cleanlinefs, ftill more back-
 ward.  The French,  alone, exhibit a laudable con-
 duct, in every grade of life, as perfonal ablution is re-
 garded.

       * " Who can come in, and fay, that I  mean her ;
     '• When fuch a one as the, fuch is her neighbor ?
     ".......Let me fee  wherein
     «« My tongue hath wrong'd her ; if it do  her right,
     «' Then (he hath Wrong'd herfelf; if the be free,
     " Why then, my taxing, like a wild-goofe, flies
     " Unclaim'd of any one."
                                 As You Like Ir. 
go      LETTERS FROM DR. E. H. SMITH,
   To every phyfician, who knows the importance of
 cleanlinefs to  health, and how rigid an attention to<
 it is neceflary, in Fevers,  efpecially in thofe which
' are called malignant, it is ufelefs to infill on the con-
 fequences of negligence in this particular.

   I  fhall conclude  this letter with a few remarks,
 which the fubject naturally infpires.

   The preceding flatement is ftrictly applicable, in
 all its extent,  to great numbers of thofe who were
 fick of the Fever of 1795.  Your own mind will fug-
 geft to you that there muft have been many excep-
 tions ; and, likewife, among whom thofe exceptions
 were to be found.

   You will learn, from it, that  circumftances  un-
 friendly to foreigners were more numerous and for-
 cible, in  more inftances, than to natives ; and will
 perceive,  at the fame  time, what is appropriate to
 each, and what common to all.

   It will, further, be evident, that, though fome of
 thefe caufes may have been  fufficient,  fingly, to J
 create a predifpofition to difeafe,—and probably did,
 in fome inftances, create it; yet,  that predifpofition I
 muft have been more confiderable, and the difeafe- 1
 which followed  more fevere,  in proportion to  the m
 combination of two, or more,  of them.              1

   It now remains to take a comprehenfive view of 1
 the refults furnifhed to us by this letter, in connection V
 with the  two  immediately  preceding  it; but this I
 fhall defer to another opportunity. 
TO DR. W. BUEL.
&
                 LETTER FIFTH.

Recapitulation of Fads,  and an Opinion concerning the
           Origin of the Fever of 1795.

  From the  ftatements contained in the preceeding
letters it appears, that the Fever of 1795 was  moft
active in
Situations      where-—
There was the leaft chance for free ventilation ;
Where the fun exerted the greateft and longeft influ-
            ence ;
        there  was the leaft drain for water and filth ;
        the rains which fell flagnated ;
        there  were, conftantly, ftagnant pools;
        the ftreets narrow, crooked, unpaved ;
        the houfes partly under-ground, wooden, de-
            cayed or flight;
        there  were confiderable collections of vegeta-
            ble and  animal matters  fuffered to re-
            main and putrify; and
        where the exhalations  from the fewers and
           docks extended:—
  The fever firft appeared and continued to be mor-
tal in a
Season—
        which was unufually fultry and wet;
        throughout which efculent vegetables  were
             fcanty and poor; 
 <J2      LETTERS FROM DR. E. H.  SMITH,

       meats  tended rapidly  to putrefaction, and
            were often confumed in a ftate of inci-
            pient putrefcency;—
During which—
             Infects were very numerous  and nox-
                  ious ;
             there was fcarcely any thunder and
                  lightning;
             there were feveral violent  and fudden
                  alternations of heat and cold ; and
             the city was, in the evening, often im-
                  merfed in a very peculiar and per-
                  nicious fog:—
The Fever proved  moft  fatal—
     to the poor j
     to emigrants more than natives;
     to the emigrant poor  moft of all;—and they—
     lived in fituations,  moftly,  fuch as  above-men-
          tioned ;
     were, often, crowded together, in fuch houfes;
     mingled, without diftinction of nation, climate
          and habits;
     changed a mild vegetable, for an animal diet;—
          perhaps a femi-putrid animal diet j
     were chiefly laborers  in the open fun j
     were unufually intemperate ; and

     were inexcufably inattentive to the cleanlinefs
          of  their  houfes and perfons.

  Such are the facts:—what inferences would rea-
fon,  unperverted by prejudice, intereftednefs, or  ig-
norance,  deduce from them ?  How would fhe decide 
TO DR. W. BUEL.
93
   on the fo-much-agitated queftion of domeflic,  or fo-
   reign, origin ?—Were a rational being to fee hundreds
.'  of men, women and children, removed from a tem-
,   perate and equable climate, to a climate fubject to
   the extremes of heat and cold, and to fudden and ex-
\. ceffive alternations of temperature; were he to obferve
   this removal to take place in crowded, ill-provided,
   fliips, which were a long time at fea, and whofe ar-
   rival was at fuch a time as to fubject them to the ri-
   gors of a winter, fevere beyond their knowledge, and
i  under all the  inconveniences attendant on poverty,
  I- ignorance,  and vice in a ftrange  land—or to the
   terrors of a fummer equally intolerable to them, from
   its inexperienced fultrinefs; were he to view them, af-
   ter fuftaining,  one, or more, fuch feafons, or  immedi-
   ately, expofed to  the influence of a feafon fultry and
   moifl beyond the common courfe,in this new climate;
   fliould he learn that they exchanged oppreffion for li-
|*  centioufnefs, and, in fome cafes, found all their hopes
E  illufory ; that they  fubftituted  a  fcanty fupply of
|  wretched vegetables and a gluttonous  ufe of femi-
v putrid, ill-cooked, meats, for a  fparing confumption
£  of mild and healthy vegetable food ; that they were
fff  often perfecuted  by fwarms of infects, whofe bites
*  raifed fwellings  or  caufed  ulcers, when, till  now,
j£ they had been unaccuftomed to any ;  fhould he fee
   them indulging, habitually,  in  the ufe  of intoxicat-
   ing liquors, to which many of them had hitherto been
  ;. ftrangers ; were he to find them dwelling in narrow,
 /unpaved,  funken,  and illy-ventilated ftreets,  in
$- which large collections of putrid matter  were allowed
   to remain, where there were  puddles of  flagnant
   water, or open fewers,  and in the neighborhoods of
''$ pools or docks, whofe  noxious  qualities were heigh-
 v tened by the admixture of putrefying vegetable and
   animal fubftances ;—were he to difcover the houfes
   in which they dwelt, to be decayed or flight,  and 
 94      LETTERS FROM DR. £. H. SMITH,

fometimes pervious to fun and rain,—in part, below
the furface  of the earth,  and  with  yards equally  j
low, and in the condition of  the pools and docks  ,
above-mentioned; fhould he, on entering thefe habi- , I
tations, find them mingled  with  emigrants from va-
rious other climates, or with natives of that to which  j
they had removed, equally debafed, and perhaps ftill
more fo, than themfelves—with  people of difcordant
habits, colours,  languages  and  countries,—and  all,
alike, inattentive to perfonal and houfehold cleanli-  1
nefs ;—I fay, were a rational being to obferve all  a
this, and perceive all the circumftances, juft enume- m
rated, to be concurrent, in refpect to time,  would he, m
think you, find  it neceffary to recur to the Ealt or  1
to the Weft-Indies, for caufes of difeafe ?  Would he
deem  it of much importance whether a fingle  man
died on board this, or that, veffel ?  Or whether con-
tagion might,  or might not, be imported ?—Would ;
not thefe circumftances, of themfelves, when viewed i
in connection  with each other, and compared with
the known and eftablifhed laws of health and difeafe,
imprefs on his mind, with all the force of intuition,  a
conviction of the  domeftic origin  of  the Fever of j
1795?  Is it  poffible that he fhould have any  other j
opinion than that the caufes, cure,  and prevention, j
are equally local, and disconnected with the preva- ;
lence or abfence of fimilar difeafes in other countries ?
But, certain as I feel that this muft  be the inevitable  '.
conclufion from a candid attention to the facts above-
difplayed, I  am pleafed to be able to declare that  it  ';
is unneceffary to truft to their teftimony, alone, for
fupport to the opinion derived from their confidera- M
■tion.—No dired, no clear, evidence, ever has been, or  J
can be, produced, in favor of the opinion  that the Fever  1
was imported.—I ftiall defer the attempt to fubftan-
tiate this aifertion, to a future  opportunity; in the
mean time, permit me once more to remark—That, 
TO DR. W. BUEL.
95
tfnough all the circumftances, enumerated in this let-
 ter, as concurring to produce the Fever, did, often-
 times, in reality concur, it is not to be fuppofed that
 they did fo  uniformly.   So  much  is  true, beyond
 difpute—-A concurrence of the  greater number of
 fome^ or other,  of them, was obfervabie in a vaft
.majority of the cafes of ficknefs.  More than this
 was not neceffary :—for, expofe the moft temperate
 and cleanly native, to the full influence of all  the
 caufes predifpofing to this fever, befide thofe which
 his birth, cleanlinefs, and temperance, would difarm,
 and his chance for continued health muft have been   «
 fmall; efpecially, after the additional aid which they,
 Queftionlefs, derived from great numbers of fick and
 dead, and from the reign of terror. The number of na-
 tives, of this defeription, who died, was very inconfi-
 derable;  and, of thofe few,  perhaps there was not
 an individual whofe fituation, conftitution, or office,
 did not peculiarly  expofe him  to the attacks of the
 Fever.  To which may be added, the chance of  his
 falling a facrifice  to an inert,  or deftructive practice.
                  LETTER SIXTH.

-On the Evidence of the Importation of the Fever of I fg$.
v
   " No direct, no clear evidence ever has been, or
 " can be produced, in favor  of the opinion that the
 " Fever was imported."

   The authority on which the advocates of importa-
 tion chiefly reft, for the fupport of their doctrine, is,
 as far as I can difcover, the letter of the Health Com-
 mittee to  the Governor,  of the 8th  of September
                       O 
g6
LETTERS FROM DR. L. 11. SMITH,
 1795 :  or, more properly, on what is there reported
 to' be  the fact.—I fhall quote, from this letter, the
 paffage referred to.

   " On the 20th day of July, Doctor Malachi Treat,
 " the late Health-Officer of this port, vifited the brig
 " Zephyr, from Port-au-Prince;  on board of which
 " he found three perfons ill of fever, and the corpfe
 " of one who died that morning.   The Doctor  calls
 " the Fever, in his report, a Bilious-remitting Fever,
 " The brig was. ordered to ride quarantine.  On the
 "2 2d day of July, Dr. Treat was taken ill, and died
 " on the 30'tb, of a.fever marked by a yellow  fkin,
 " hemorrhages, vomiting of black matter, refembling
 " coffee-grounds, and atl fuch fyrnptoms  as charac-
 " ferize bilious fevers of the malignant  kind.—On
 " the 25th day of July,  four perfons, from on board
 "the ffiip vV'ill:::m, from. Liverpool,  which. arrived
 " here  feveral weeks  before (all the crew having,
 " previous to that day, and during the voyage, been
 " perfectly healthy) were taken ill of Fever, attended
 " with  fimilar fyrnptoms; and all  died within feven
<: days.

  " This  {hip lay at a wharf at the foot  of Dover-  :
 " ftreet, in the fouth-eaflerly* part of this city, which
 " Ivas exceedingly low,  is much of it made-ground,
 " has an eaftern expofure, and (from the ftreets hav-
 " ing been 1 aifed,about three years ago, which threw
 " the  lots and yards into hollows of confiderable* 'jfl
 " depth) is almoft unavoidably liable to great collec-
 " tions of offal, and filth of all kinds ; is a part of the
 " town very much crowded by poor inhabitants, and
 " contains a  great,number of lodging-houfes,  in
 " vvhich feamen arid ftrangers of the poorer clafs, com-

     A milt'.ke of the Prefs iox-rHtiorlh-eafterlj. 
TO DR. W. BUEL.
97
   <z monly refide ; and ever has fuffered moft from the
   " regular autumnal difeafes, as well as from any new
   " and uncommon complaint.   From all which cir-
   " cumftances,  we entertain no doubt but that the
   " feamen of the fhip William contracted the difeafe,
   *' of which they died,  here, and did net introduce it
   f into the city.

      " A little before, and immediately after, the attack
   " of the feamen  of the  fhip William, which firft
   " called the attention of thisCommitteej feveral other
   " perfons, in Water and Front-ftreets, and in the
   " neighborhood of  Dover-ftreet,  were feized  with
    " fever, which, efpecially in thofe cafes which proved
    " mortal, was  marked by fevere vomitings, a yellow
    " fkin, hemorrhagy, and, in fome cafes, a vomiting a.
   " black   matter,  refembling  coffee-grounds,—and
   " which generally terminated within feven days, and
   " proved fatal to more, in proportion to the number
    " feized, than  is ufual in the ordinary complaints of
    " the feafon, in this city."

      Two remarks of confiderable importance are natu-
    rally fuggefted by a careful examination of the above
I   quotation :  Firft, that the Committee appear to have
P   fuppofed Dr. Treat, alone,  to have received the dif-
C- ;«eafe of which  he died, from the Zephyr;  and, fe-
   condly,  that they have, in fome  fort, admitted the
   poffibility of fuch a difeafe as the Fever of  1795,
  ',, originating  here, in their flatement of the circum-
   ftances relative to the  fhip William.   It is true that
    they are inexplicit, in both inftances ; and the only
    abfolute conclufion  which we are juftified in deduc-
   ing from what they fay is, that the  difeafe was not
    introduced into this city by the fhip William.  This,
    however, narrows the ground of  controverfy,  confi-
    derably ; for no veffels befide the William and the 
 98      LETTERS TROM DR. E. H. SMITH,

 Zephyr, as far as I can learn, have ever been fufpe£ted
 of introducing any difeafe, of this kind, into this city;
 It is neceffary, therefore, only to difprove the affer-
 tion, in refpect to the Zephyr, and the whole founda-
 tion of the doctrine of importation is deftroyed.-*.
 But, even were we to admit  that Dr. Treat did actu-
 ally derive the fever of which he died,  from the Ze-
phyr, as no other perfon is  known to have been in-
 fected by that veffel, and as the doctor communi-
 cated it to no perfon, the advocates for importation
 would not be greatly benefited by our  conceffion.
 But, no fuch conceffion is neceffary.  The following
 papers,  copies of which  I am  kindly  permitted to
 tranfmit to you, appear to me, to eftablifh it, beyond
 contradiction, that neither Dr. Treat, nor any other
perfon, contracted a Fever, fuch as prevailed in New-
Yoik, in 1795, from any fick, or dead, man, or any
thing elfe, connected with the veflel in  queftion.
.no 1.
■Letter from  the  Captain  of the brig Zephyr, to  Dr*
                     Dingley.
                         New-York, Sept.  8, 1795.;
       Sir,
  Having been informed that many people have re*
ported that the lateHealth-Officer,of this port, caught
the difeafe with which he  died, on board  the  brig
Zephyr,  I  have thought it a duty which I owed  to
the public,  to contradict the report..   TJiis, I truft,
will be fatisfactorily done, to the minds of all reafon-
able men, by my depofition, taken before C. Dunn,' 
TO DR. W. BUEL.
99
}tin.  one of the juftices for the city and  county  of
New-York; which I defire you to publifh, for the
information of the citizens, as foon as you  may think
proper.—My departure from this  city is theoccafion
cf giving you this trouble.

                    I am, fir, your friend &
                         feumble fervant,
                           COMFORT'BIRD.
  Dr. Dingley.
        no n.

Captain Bird's Depofition.
   Captain Comfort Bird, commander of the brig Ze-
phyr, of Bofton, failed from Port-au-Prince on the ift
of July, and arrived at New-York on the  20th of the
fame month.   The mate and one mariner had the Fe-
ver and Ague feventeen days on fhore, and came on
board with the fame difeafe ;  and the captain himfelf
,had a Dyfentery on his arrival in New-York ;—and
John Wheeler, aged 16 years, died on the day of the
arrival of the brig at New-York, by worms crawling
up into his throat and choaking him.  He was fewed
up in a piece of canvafs, and ready to  be committed
to the  deep,  when the  late Health-OfEcer came  on
board, who defired the captain  to have the canvafs
opened, that he might infpect  the body—and he only
cut the canvafs open over the face, and  viewed the
countenance,  but did not make any other examina-
tion of the body,—which was, foon after, carried to
Governor's Ifland,  and there interred.—The young 
ICO     LETTERS FROM DR. E. H. SMITH,

man who died as above-mentioned, had fuffered chro-7
nic complaints, but no fever of a dangerous nature.—>
Eighteen paffengers came in  the  above brig, all in
good health,—who have continued in this ftate to the
prefent day.—Three days after the above event, the
Health-Officer vifited the fame brig, in as good health
as ufual.
                     Signed

                         COMFORT BIRD.

    Sworn before me, this feventh day of Septem-
       ber, one thoufand feven hundred and ninety-
       five, in the City of New-York.
                             C. DUNN,  Jun.
  Of the undoubted veracity of Captain Bird I am
afiured by Dr. Dingley, who is perfonally acquainted
with him, and  attended  him, at the time, for the
dyfentery mentioned in the depofition. The opinion,
therefore, that  the Yellow Fever, or a contagious
difeafe,  was brought into the city, laft year, 'by the
brig Zephyr, feems wholly unfupported by evidence.
Neither is it neceffary that any imputation fhould reft
on the memory of Dr. Treat. He faw the mariners  after
they had been long affected by theFever and ague, and *
perhaps with fome fever upon them at the time ; and;'
from the yellownefs of the fkin, common to the ad-
vanced ftate of that difeafe, efpecially in hot climates,
might be eafily induced  to fuppofe  it  a remittent*.
This, however, is mere conjecture, and not  neceflary
to be admitted, fince the fact of the men having been
fick feventeen days,  previous to their embarking for
our coaft, is ample proof that they  could  not  have'
been affected by the fever which prevailed and was 
TO DR.  W. BUEL.
101
   fo mortal, here.—Indeed, the whole  teftirnony in
   favor of the idea of importation, is too loofe and flight
   to build any rational opinion upon.  The very words
   of the Committee are calculated to ftrengthen a con-'
   trary opinion, if rightly confidered ; for they not only
   countenance the idea that the people of the fhip Wil-
   liam became fick from  the unhealthinefs of the place
   where they dwelt, but, alfo, that the Fever had made
   its appearance, in various other of  the neighboring
   houfes and ftreets, previous to their being feized with
   it.   And .what confirms the truth of this  opinion is,
   that perfons were taken with the diftemper, about
   this time,  in other parts of the city,  who had no
   connection with the brig Zephyr, nor with any other
[   veffel, and whofe illnefs  may be  fatisfactorily  ac-
i   counted for from their fituation, in other refpects.
1   An inftance of this kind fell under my own obferva-
\   tion, the laft of July ;  feveral fimilar cafes  have been
I  related to me ; and one, if I  am net mifinformed,
J  occurred  in the New-York Alms-houfe,  where the
\. difeafe was diftinctly marked,  before Dr. Treat's ill—
,.  nefs.—The following  flatement  of facts, too,  will
ff,  convince every candid mind,  that we ought to look
I  at home, for the caufe of this Fever.

      The fhip Connecticut came to Fitch's wharf, about
   the 20th of July—I think it  was on rhe  21ft :  fhe
H had  juft arrived from fome part cf England,  and
   the  people were  perfectly  healthy.    No veffel
   fufpected  of being infected,  came  to  this  wharf,
■\J. during the feafon; though the fhip William lay at
f f* the next wharf, at the diftance of about two hundred
   feet,—and Mr. Fitch gives the moft pofitive affuran-
   ces that all the  articles  in his flore, at this time, were
   in good condition.   At this wharf the fhip Connec-
   ticut continued till after the middle of Auguft. The
   owner was employed  about the fhip, 'great part of 
 IP2     LETTERS PROM DR. E. H. SMITH,

the day ; but ate and flept in an airy part of the town.
The people of the fhip either flayed on board, or at
public houfes near by.—On the evening of the 25th
of July, the owner was feized with the fever;  I faw
him the 27th ;  he had good accommodations, was
in a favorable part of the town, in the thh d flory of
the houfe, and recovered after an illnefs of about ten
days,  which was never very dangerous, though  the
p.ttack%'as fevere.—About this time, one of the mates*
the fteward, and two of the mariners, of the fhip Con-
necticut, were feized in the fame  way, and witli  the
fame  fyrnptoms, as the owner.   They continued in
the fhip, or its neighborhood, and all died.   I did
not fee them, but  was informed, by the owner, that
the mate, in particular, vomited  large quantities of
blood,  and expired delirious.

  Three perfons,  who were  in  Mr.  Fitch's ftore^
were taken fick, and two died, of the Fever.   One
fickened on the 26th of July, one on the 6th,  and
the other on the 9th of Auguft-  It was common for
all thefe perfons to fit ct feveral hours, in the  morn-
" ing, in the flore, with empty ftomachs,—inhaling
" the effluvia of the night."

  One of the firft perfons, who died  of the  Fever,
was one " who lived at the head  of the wharf, and
" had been confined for feveral months with a rheun
" matic complaint."

  For the facts contained in the two laft paragraphs,
I am indebted to a communication from Mr. Fitch to
Dr. Dinghy, which that gentleman has allowed  tne
to make ufe of on this occafion.  The  account which'
it contains of the  condition of the wharves  in his
neighborhood, adds new force to the other teftimonj.
in favor  of the opinion that the Fever originates
here ; and is too much to the purpofe  to be omitted.
Thefe are his  words:— 
TO  DR. W. BUEL.
103
  u I am pofitive that the diforder  has  originated
" from local caufes—becaufe, it has appeared in this
" quarter, at the fame feafon, for feveral years paft:
*' the caufe why it has is, to me, myfterious ;  but
*' what appears to  me moft probable is, the central
" fituation,  and the motion of  the  tides.   The
*< tide of flood fets directly into thefe wharves; col-
" lecting all the vapors and  effluvia of thej^city.-—
" The fituation of the ground, between  Water and
" Cherry-ftreets, is  rendered  noxious  by railing
" Water-ftreet, and confining the ftagnant waters.—
" The emptying of tubs into the head of the docks,
" inftead of the end of  the wharves,  although not
" peculiar to this part of the city, is a horrible nui-
" fance ; particularly in time of ficknefs.—-The  pon-
" ding  of water,  by running a bulk-head athwart a
" dock,  and  leaving the vacancy for years, to be
" filled up with every fpecies of filth and putridity, is
" an object  worth your attention."

   A confirmation of the facts, and fome of the opi-
nions, contained in this extract, may be found  in  a
very lingular epiftle from the late Dr. Wm- Pitt Smith,
to Dr. Duffield fen.  of Philadelphia, dated Septem-
ber ift, 1795 ; which I prefume you have feen and
are poffefled of.

   On the whole, though I am not prepared to main-
tain that infectious  difeafes,  and the Yellow Feyer
among others, may not be, and have not been,  im-
ported,  and thus fpread over parts  of our country,
yet this  is the moft that can be allowed to the coun-
tenancers of  the doctrine.  For, after all, the  tefti-
mony of numerous fads furnifhes clear, indubitable,
and decifive evidence, that other and peculiar  cir-
cumftances muft  concur with fuch  importation,  to
                        P 
S0-4-     LETTERS FROM T>R. E. H. SMITH,
 effect any general diftribution, circulation,' or influ-
> ence cf the difeafe.  Frequent inftances have occurred,
 nay do occur every year, of perfons returning, from
 the Weft-Indies, fick with the Yellow Fever; Ian-
 guifhing,  for fome time,  in the houfes of their pa-
 rents, or friends; recovering, or dying ; attended by
 numbers,  during their illnefs;  their very clothes,'
 where ijaey have died, afterwards worn by their re-
 lations ; and  yet no ill effects following therefrom.—
 While I refided at Wethersfield, in Connecticut, I
 had opportunity of obtaining precife information of
 feveral fuch cafes ; and it is a well-eftablifhed fact, in
 many inftances during our Fever, and efpecially dur-
 ing that of Philadelphia, in  1793.

   The whole, therefore,  that can  be  granted, or
 ought to be affumed by thofe who maintain the dift
 eafe which prevailed in New-York in 1795, to have
 been imported is,—That infection may be brought
 into any place (and  therefore into this  city) from
 abroad ;  that, under certain circumftances  of the
 place,  where it is introduced, it becomes very active
 and  deftructive ; but that, when thefe circumftances
 do not exift,  however the  perfon  immediately af-
fected,—if it be introduced by a fick perfon—may
fuffer, it is harmlefs, fo far as the general health of
 that place is concerned.—If the fubject were viewed
hi this  light,  as moft affuredly it ought to be, the
queftion of importation, or non-importation,  would
fink into it's  merited infignificance ;  the efficient
eaufe,  the  caufaf.ne qua non, of fuch Fevers,  would
be clearly difcerned  as depending on local circum-
ftances ., capable of being wholly changed ;  the abfo-
 hite  madnefs  of further delay, in  effecting fuch  a
 change, would be diftinctly and deeply felt; a becom-'
 ing fpirit would animate the citizens;  and fuitable
 exertions fpeedily place us beyond the  poffibility of 
TO DR. V. BUEL.
105
being fubjecled to a misfortune, fimilar to that which
has been already fuftained.   For it is inconceivable
that the nature and extent of the evil fhould  be un-
dcrftood, and the  remedy not be  applied: and a
comparatively flight and temporary facrifice of pro-
perty,  would  render this  city, in reality,  what the
miftaken policy, or pride, of fome of its inhabitants now
falfely reprefent it,—as healthy as any in the world ;
and leave nothing  to fear, either from the Fevers of
the Indies,  or the Plague of the Levant.—But,  while
people continue to fofter a  ridiculous  vanity, con-
cerning the city in which they refide ; while they fear
that its reputation will be wounded, by  permitting
an idea to get abroad,  that  it is unhealthy;  while
thofe engaged in commerce cherifh the error,  from
an  apprehenfion that their interefts would fuffer from
a difclofure of the truth ; while men, inverted with
the facred character of phyficians, countenance falfe
opinions, either through ignorance, a reprehenfible ti-
midity, or that they may gather undeferved popularity
andwealth; and while the magiftracy are more actuated
by a mean regard for offices dependent on popular opi-
nion, and maintained by a compliance with it, at all
hazards, than by a juft and  enlightened zeal for  the
fafety and happinefs of their fellow-citizens ; Truth
may be fpoken, but there is no hope  that it will be
attended to.   Confederations of fuppofed intereft, h
various and fo forcible, take deep root in  the minds
of men who look  only to the prefent moment, and
are either incapable of comprehending the whole of
a fubject, or unwilling  to beftow on it the neceffary
confideration.  Thus circurnftanced,  they  ftrive to
banifh from  others, and to  fmother in  their own
breafts, thofe convictions which  irrefiftible evidence
forces  upon them: as if it were  poffible that  truth
could be noxious.—Nothing can be more melancho-
ly than to obferve this  wilful blindnefs, this  obili-
nate perfiftency in error, the confequences of which 
 ICQ"     LETTERS FROM DR. E. H. SMITH,

have  been fo dreadful already, and threaten to be
ftill more fo  hereafter.—Were it poffible to imprefs
the truth vividly on the minds of the great body of.
citizens;  to  rouze men into  action; to  excite a.
generous difregard for temporary advantages, and a
lively intereft for the future welfare of themfelves
and their pofterity ; a few weeks might enable us to
bid defiance to death, in many of the forms in which
he nowlffails us.
               LETTER SEVENTH.

Was the  Fever of ijgs an  Epidemic?  Was it Con-
                     tagious ?

  Having determined, to my own fatisfaction at leaft,
what were the remote or predifpofing caufes of the
Fever of 1795,1 might now proceed to a defcription
of the difeafe itfelf,  were it not proper to take  fome'
notice of two queftions, which have been confidera-
bly agitated,  viz.  Whether the  Fever  was, as  the
Health Committee term it, an Epidemic ?—And, as
fome fuppofe, Contagious ?—On both thefe queftions,
I fhall deliver my opinion, inasfuccinct a manner as
the fubject will permit.

   Was the Fever epidemic ?—A principal difficulty oc-
curs in the very outfet of this enquiry ; for different
writers have  made  ufe  of the term Epidemic, diffe-
rently ; fome giving it a rsii:eral, others a morepartkui'
lar and precife lignification. Thus Van Swieten, in his
Commentary on the 1380th Aphorifm of Boerhaave,
places epidemic in conrradiitinction  to endemic ;  while
Cleghorn, a writer of deferved authority, in the In-
troduction to his Obfervations on the Difeafes,  &<.\ 
TO DR. W. BUEL.            lojf
  of Minorca, p. 74. conftitutesa clafs of  endemic dif-
  eafes, which he divides into epidemic and fporadic.—
  Examples of like diffimilarities, in the  ufe of thefe
  words, are frequently to be met with, in authors of
  equal credit.  And thus it may poffibly happen, in
  the prefent inftance, as  on many former occafions*
  that the whole contention arifes from different con-
  ceptions of the import of a particular word.—But our
  bufinefs is rather with facts, than with definitions ; I
  fhall ftate to you, therefore, what appears  to me to
  have been the truth ; and, perhaps, in the conclufion
  of my  ftatement, a definition will be found.

    In the firft place, every perfon converfant with the
  practice of phyfic in New-York, knows that a Fever,
  generally of the remittent or continued kind, and va-
  rioufly denominated  by medical writers, prevails in
  this city, to a greater or lefs degree, every year ; per-
  haps I may fay throughout the year—but, certainly,
  in every part of it, except the winter, and particularly
  from July to December : its greateft height being in
  the months of Auguft, September and October. The
  violence of this difeafe is increafed or diminifhed by
  conftitutional peculiarities, and by the particular fitu-
  ation of the patient in  refpect to air, temperature,
  &c. &c.  Its univerfality, likewife, may be confidered
  as dependent, in a degree, on the fame caufes.—Cir-
  cumftances, peculiar to fome fituations or individuals,
  occafion it to prove mortal, with high marks of ma,
*  lignity, in certain inftances, almoft every year.  That
  an  extenfion of thefe peculiarities,  fo  as  to  make
  them common to the citizens generally, would pro-
  duce the  fame effects on the  many, as on the few,
  feems hardly controvertible.  Now, this appears, to
  me, to have been the cafe, the laft year ; and I have
  no  doubt of the identity of the  Fever  which then
  raged  here,  with that which has prevailed here in 
 108     LETTERS I ROM DR. E. H. SMITH,

 former years ; and confider it only as a higher grade
 of the fame difeafe.—Compare the hiftory of Fevers,
 in Sheffield, with that of Fevers in New-York.—We
 have a Fever, every year, at a particular feafon, ufu-
 ally called the bilious-remitting Fever : in Sheffield
 at the fame feafon, a Fever prevails, called the inter*
 mitring Fever.   This  lafl evidently depends on the
 peculiarities of Sheffield—fuch as its ponds, marfhes*
 &c.—So, in my opinion, does the former arife fron^
 the peculiarities of New-York.—The feafon of 1795
 was  a remarkable one :  Was  there  any  apparent
 change in the Fever of  Sheffield ?  Yes :  the fyrnp-
 toms were remarkably  heightened;  fome  new  ap-
 pearances were obfervable ; and the difeafe aftonifh-
 ingly obftinate. And was not this, alfo, true of New-!
 York ? Wrho will venture  to deny it ?—Were either
 of thefe Fevers propagated to other, or neighboring,
 places ? No.  You have certified this of the Fever in
 Sheffield; and I have heard of no inftance of the kind,
 in relation to that of New-York.   Both Fevess, then,
 were proper to the places in which they prevailed ;
 and the inference which it would be natural to deduce
 from this is, that both were endemic, and not epidemic :
 for the term epidemic feems to include in it the ca-.(
 pability of diffufion or propagation, without refpect'
 to the fituation and conftitution of the patient; which
the term  endemic certainly does not.   But, which- .j
 ever of thefe titles may be regarded as moft appropri- '
 ate, the fact will not be varied by the  ufe of either;
 and that  you will underftand to be, according to my
belief, as  above-ftated:  That the Fever of 1795 was-
no other  than  a higher  grade of that which prevails
here, in the fame feafon, every year ; deriving its fe-
verity  entirely from the peculiarities  of the feafon,
 &c. as related, at large., in the preceding letters. 
TO DR. W. BUEL.
I09
     Was the Fever contagious ?  Concerning the anfwer
  to be made to this, as well as to the former queftion,
  there has been fome difpute;  but, in this cafe, as in
  that, as much difficulty has arifen in fettling the im-
  port of the phrafeology, as in determining the fact.

     If by the queftion it is  meant to inquire,  whether
  the well became affected with the Fever,  in confe-
  rence of the contact of a fick perfon, or the cloath-
f ing of a fick perfon, or from the performance of the
  offices of friendfhip, charity, and menialitv, to thofe
  who were fick,—I anfwer that no  fuch  cafes have
  come to my knowledge ; whereas numerous inftances
  of fuch contact fell under my obfervation, and have
  been related to me, to which no ill effects fucceeded.

     A number of perfons, not lefs than ten or twelve,
  removed, with the Fever  on them, from New-York
  to Stamford, 40 miles ; but no perfon in Stamford,
  befide them,  ever had the diforder.

     Mr. Fitch, the gentleman mentioned  in the pre-
|, ceding letter, attended the young men who had the
\ difeafe with him, and to ufe his  own words, " lodged
P "  in the bed, warm with  the effluvia of the body of
'  "  the young  man who died at  his houfe"—and  ne-
  verthelefs, he had no Fever.
     Dr. Treat, according to the account of the Health-
'  Committee,  and of his phyficians, died of the very
  worft degree  of the Fever ; yet he communicated it
  to nobody.

     A patient of Dr. Dingley's, in Ferry-ftreet, who
  was feized  with the difeafe, without any previous
  communication with any fick perfon, and as earlv as
  the 17th of  Auguft, and  who died with  it, commu-
  nicated it to none of his attendants.   And the fame
  is  true of feveral other patients of the fame gentle-
  man. 
HO    LETTERS FROM DR. E. H. SMITH,

  The writer of fome  ingenious  ftrictures on  Dr.
Mitchill's Pamphlet, remarks, in a note fubjoined to
his firft paper, that he has, " in common with many of
" his fellow-practitioners, indulged, without thefmallefo-,
" ill effed, a much more frequent intercourfe with his
" patients, in this difeafe, than ufual," &c.   And the
Doctor  himfelf, though he admits the poffibility of
fuch fevers becoming contagious, or being propagated
by contact, &c.  exprefsly denies the Fever  of i7g$
to have been fo.

  But there would be no end  to an enumeration 6?
fimilar facts; I fhall only add,  therefore, that I made
ufe  of no precaution whatever, in refpect to fuch com-
munication with patients; that I have been, for more
than two hours, fhut up in a fmall  room, with a  per-
fon laboring under the worft fyrnptoms of the Fever;
have watched feveral nights, and performed  the moft
fervile offices, with a near friend, who  was fick with
it; and never fuftained the leaft inconvenience from
fuch expofures*.

  But, perhaps the  advocates for the Contagious, or
Infectious, nature of the difeafe under confideration^
do not intend to confine the meaning of the term Con-
tagion to that fubftance, whatever  it is, which is ge»-
nerated in an unhealthy body, and by  application to
a found body,  excites  in it a fimilar  unhealthinefs.
They may mean to defcribe, or defignate, by it,  tha
ftructure, conftitution, or vice,  of the atmofphere
which difpofes to, or excites difeafe.   If fo, they arc
in fault—for  they employ the fame term  to defig-
naie two different  facts.—But  let us not  difpute
m
  * I might fuperadd to all this,  the ambiguous tcfthnony of
another Phyfician, who, in proof of the uninfcctieus nature of the
Fever, affirmed that he had " hr.d thirty patien:s with  it,  and
" had taken tlie breath of all of them." 
                   TO DR. W. BUEL.             II I

   about words.   Perhaps, the  following ftatement of
  ,«ny opinions, will lead us to the formation or attain-
   ment of fome more accurate notions on this point.

      Owing to a  variety of  caufes, which have  been
   enumerated in  the courfe of thefe letters, I fuppofe
   the atmofphere of New-York to have become vi*
   liated, in 1795, to an uncommon degree:  that there
   was either an unufual abfence of that principle necef-
   fary to fupport  healthy life, or an extraordinary con-
   centration, diffufion, or quantity, of fome other, un-
   friendly to healthy life.  From the operation of one,
   or other, of thefe ftates of the atmofphere,  and of
   the caufes  above-mentioned, on the bodies of the
   refidents in this  city, I  fuppofe a  predifpofition,
'   greater  or lefs, according to the fituation and other
   circumftances of individuals,  was formed, in the citi-
   zens, generally, to the Fever which  prevailed here
   that year.   With fome pterfons, this condition of the
   atmofphere, of itfelf, might.be fufficient to produce
   in them difeafe.   But, ordinarily, I believe, the aid
I  of fome caufe, which fhould difturb the regularity of
   the diftributions,  or functions, of the body, was re-
   quired to bring the fyftem into a ftate of febrile ac-
j[   tion.  Such, for inftance,  as intemperance in eating
   or drinking, fudden fright, fatigue,  or indeed, any
   eonfiderable irregularity in what Syftematics call the
   Npn-Naturals.

      This  condition of the atmofphere, I fuppofe, ac-
   quired ftrength, daily, as the feafon advanced; or, in
   other words, the  power  of the atmofphere, &c. to
   predifpofe to the Fever, was  increafed, as  the feafon
   progreffed.  I  fey to predifpofe,—for I fufpect it fel-
   dom, of itfelf, produced -the difeafe, after that had at-
   tained  its height,  in thofe who remained here  con- 
 2 12     LETTERS FROM DR. E. H. SMITtt,

 ftantly.   Though, on  perfons coming into the city,
 from, abroad, it doubtlefs operated with much greater^
 force, in many cafes, than on the citizens, at any tiraA'
 This is eafily accounted for, from the known effects*
 ofcuftom.  For                               Jv

 " The monfter Cuftom, who doth, &c.
 "  - '.......1S angel yet in this."

  The fyftems of thofe who continued here became
 habituated to the atmofphere ;  and while thofe who
 came here from the country, with ruddy faces, funk
 down in death, the pale and yellow beingswho ftalked
 through our ftreets, derided difeafe, and purfued their
 cUftomary occupations.—But, to return from this di-
 greffion.

  Not only am I convinced of the accuracy  of the
 preceding ideas, but I have*no doubt that this vice of
 the  atmofphere was rendered ftill greater by exhala-
tions  from the bodies of the fick——It is a  point
 well-eftablifhed in medicine, that the air of a  room
 is rendered  unfuitable for refpiration,  if a  num-
 ber  of healthy perfons are obliged to breathe it over.
feveral times, without the admiffion of frefh air from'
abroad.  So injurious is fuch a confinement,  in re-
fpect to air, to the human body, that it has,  in nume-
rous inftances, produced terrible febrile, difeafes.  And/
if fuch effects arife from the repeated breathing ovei
the  fame, or nearly the fame, air, by healthy perfons,
we fhould naturally conclude, as is the fact,  that fuch
repeated refpiration (efpecially when united with the
conftant exhalation  from their bodies) by  the fick,
muft be ftill more pernicious to health.—You will
pardon me for  the introduction of  remarks fo trite
and familiar, for the fake of the ufe I wifh to make of
them ; which is no other than  this—I have  mention- 
                    TO  DR. W. BUEL.            113

    ed it as my belief that the ftate of the atmofphere was
    fuch, in this city, the laft year, as, in conjunction with
    the general influence of the caufes producing that
    ftate, to predifpofe to, and,  in  fome inftances, pro-
    duce, the Fever; and that this ill-conditioned atmof-
    phere was rendered ftill more  noxious by means of
    the numbers who became fick,  in the courfe of the
    feafon ; and to this I would add, for the reafons con-
    tained  in the remarks above, that I think it not im-
 V  probable that fome were affected with  the Fever, in
    confequence of the further vitiation of the atmofphere
    by the fick, who, without that circumftance, would
    have remained free from difeafe.  So, likewife, there
    may be perfons, the.balance of whofe health is fo tre-
    muloufly fenfible to  every external influence,  as to
    preponderate to  the  fide of difeafe, on the flightelt
    impulfe of its caufes.  With fuch,  the meje conta&
    of a fick perfon, or a tranfitory expofure to. the efflu-
^    via arifing from a fick body, may be fufficient to pro-
te  -duce Fever; and inftances of this kind may have hap-
;'    pcned, in the courfe of the Fever in queftion.  Such
I1,  cafes, however,  muft have been extremely rare, if
jt'   there were any ; and no one has ever come to my
    knowledge.—But, with regard to Fevers produced by
    fuch a ftate of the air, as above-defcribed, even when
|'i  aided by the mixture of human efiluvia, arifing from
    fick bodies,—if thefe are to be called Contagious dif-
    eafes, and the caufe which excited them  Contagion, fo,
    hkewife,  may all other Fevers on the fame principle,
  f continued, remitting, intermitting, Fevers,—be called
    Contagious, and their caufes, as marfh  miafmata, &c,
 I;' f Contagion.—Now, to fuch a ufe of terms I have not
 ),  the leaft objection, provided the perfon who employs
    them, be uniform and explicit in his application of
    them. 
 114     LETTERS FROM DR. E. H. SMITH,

   To conclude,—If, in  fpeaking of  the  Fever ot*   j
 1795, the epithet Contagious is meant to exprefs that
it was communicated by contact, &c. like the Small-   j
pox, Meazles and Plague, I muft repeat it, I find no
good reafon for admitting this to have been the fact;   1
but, for the reafons before alledged, I think there is
juft ground for a belief that the Fever was never ex-
cited in this way.   But if, on the other  hand, the   ?
term Contagion be meant to convey an idea of the in-   ,..;
fluence  of the atmofphere to predifpofe to,  or pro-
duce, difeafe,—whether that influence arife from the
abftraction, or addition, of a principle, or be diftinct
from human effluvia, or combined with them—there
appears no feafon for denying the Fever of 1795 to  J
have been Contagious.—Still, as the term Contagion
is not generally ufed in a fenfe fo reftricted, as in this
fecond inftance, but is often employed by the fame
writer, to exprefs both the caufe of the difeafe  com-
municated by contact, &c. and of that produced by the
influence of the atmofphere, there  feems to be a pro-
priety in rejecting it altogether, in theprefent inftance,
or at leaft in confining the ufe of it, to defignate a
tingle mode of producing difeafe ; and, according as
it is applied in the former or latter inftance,  the Fe-
ver of 1795 may be denominated Contagious, or the
reverfe. ,

   I have now gone through with the confideration of jN
all the fubjects, preliminary to an  account of the dif- ffl
eafe itfelf.   In my next letter, I fhall lay before youfc'
the refult of thofe fcanty obfervations which I had  S
 opportunity to make.—Knowing the caufes  of their  S
 imperfections, you will  not fail of extending your  II
 charitable indulgence to their author.                 1 
TO DR. W. BUEL,
"5
LETTER  EIGHTH.
Some Account of the Symptoms of the  Fever of 179S'


  After the frequent confeffions, which occur in
the preceding "letters, of the circumfcribed fphere ot
mv obfervation, it were prefumptuous in me to pre-
tend to deliver a regular hiftory of the fyrnptoms of
the Fever of 1795.  You will obferve, from the ac-
count  which I fhall tranfmit to you, that the appear-
ances it exhibited were too various to authorize iucti
an attempt in any one who had not opportunity to ex-
amine them, in relation to numbers  of the fick.  It
is proper, therefore, that I warn you, once more, to
confider what is  here delivered as the refult of my
own obfervation  only—except where it is  exprefsly
mentioned to be otherwife.

   The Fever  of 1795 was, generally, fudden in its
 accefs; fo much fo, m fome inftances, as to referable
 convulfions.  In a lefs number of cafes, it came on
 gradually, and after  a flcwly-increafing^ illnels  ot
 feveral  days.    It began with  great  pain  of the
.head, heat and  rednefs. of the  face, and  fullnefs
 and rednefs of the eyes, accompanied by altrong,
 full, tenfe, pulfe, and an almoft univerfal cofhveneis.
 Pains in the back and limbs were common; but not
 as much fo as  of the head.   A great inquietude, or
 anxiety, of the  ftomach and breaft, was  common j
 approaching, fometimes, to fyncope, and  fometimes
 a vomiting, which foon ceafed, or continued, at in-
 tervals, through the diforder.—Tl^.Fever which now
 commenced was rarely adhered in by a chill, and con- 
 Il6     LETTERS I ROM DR. E. H. SMlT^,

 tjnued for a greater or lefler period, according to*   ]
 circumftances,  with fo many varieties and combina-
 tions of fyrnptoms, as to render it impoffible to purfue   ,
 a regular defcription.   I fhall, therefore, difpofe my
 remarks  under feveral  heads;  preferving  as much   J
 connection as circumftances will permit.

   I.  Though the pulfe was generally fujl,  ftrong,
 and tenfe, in the beginning of the Fever, it was not,  *a
 always fo.   It was fometimes weak and low,  but ftill  J
 tenfe—if it be proper to ufe this term, to point out a
 condition of the pulfe, as it appears to me,  wholly  -
 peculiar  to this Fever.  I well remember that, in a
 youth of 12, or 13,  years of age, the pulfe became
 much fuller after a plentiful bleeding ; though he was
 of a feeble conftitution, and had  been  flightly affected
 with the  Fever once before.—In two gentlemen, who
 were confiderably  affected by the fever, for'feveral
 weeks, but not to fuch a degree as to be confined to
 their beds, this peculiar pulfe was very diftinguifhable ;  '
 as much  fo, I think, as in any other perfons whofe
 pulfe I examined.

  Hemorrhages,  from various  parts,of the body,
 were frequent, efpecially in the advanced ftage ofj- ■'
 the difeafe, and where it  had been violent from the.>-)
firft. Thefe were from the nofe,  fauces, efpecially the {J
gums,  from punctures  made  in bloodletting, and
from the  ftomach : I faw no other. Bleeding from the  |
nofe and  fauces often occurred in the beginning of, 3H
the difeafe,  and was removable by the general reme-  ^
dies.  Bleedings from the punctures made in blood-   1
letting, were feen in the clofe of the difeafe, and were
reftrained with the greateft difficulty.   I recollect to
have been conftantly engaged  in an  attempt to re-.
ftrain fuch a hemorrhage,  in company with another
phyfician, two of  the moft melancholy hours I ever 
TO DR. W. BUEL.
Il7
   experienced.  Hemorrhagy from the ftomach I fhall
   mention more particularly hereafter.

     II. Symptoms of pulmonic affection were not un-
   common ; though I do not recollect to have obferved
   them till the laft of September, or beginning of Oc-
   tober.  They fometimes rofe nearly  to the height of
   pneumonia.

     Hiccough was a troublefome fymptom, and often
   accompanied vomiting ; and there was fometimes, as
   it appeared tome, a mingled hiccoughing and belch-
   ing.

     III. The marks of congeftion in the brain were tod
   numerous and unequivocal to be miftaken.—A vio-
   lent pain in the  head  was one of the earlieft, moft
   conftant, and  moft diftrefling, fyrnptoms of this dif-
   eafe---Coma was a very frequent fymptom ; and, as
   I thought, in  proportion to the feverity of the difor-
   der.  Towards the clofe, it amounted almoft to total
   ftupefaction;  it  being fcarcely poffible to roufe the
   patient.  Some degree of delirium was common ; par-
   ticularly at the commencement of an exacerbation of
   the Fever ;  manifefting itfelf in  the  hurried manner
l\  in whichjthe patient performed any action, and in the
   rambling manner in which he converfed.   That kind
   of delirium which fome have called  light-headednefs,
   was remarkably prefent, in one perfon,  at the clofe
 ;  of his diforder.  He often ftarted  up, wildly, without
   any apparent object, then lay down, and  commenced
   finging, in an interrupted,  incoherent manner;  but
   without any violence. And the day before his death,
   he continued to  fing,  with flight intervals, more than
   an hour.—At other times, he would fix on fome par-
   ticular words, and repeat them over, and over ; fome-
   times, with no  appearance of emotion; at  others, 
 Il8    LETTERS FROM DR. E. H. SMITH,

with fome glimmering of confcioufnefs.—In another
perfon, a patient of a phyfician of my acquaintance,   I
the affection of the brain was like that in  Phrenitis.   J
A bliftering-plafter applied, if I remember accurately,
for 24 hours,  to  the head, which had been  fhaven,
excited  no veffication,  and  fcarcely any rednefs,
though twice the  ufual  quantity of cantharides was
incorporated,  and the  patient was of a delicate ha-   ?:
bit.   In this cafe the affection of the brain took place
on the third day. and the patient died on the fifth or
fixth.—On examination and diffection of the contents  ■
of the cranium, all the membranes, and the very fub-  M
fiance of the brain, were difcovered to be in  a remark-
able and uncommon ftate of  inflammation.—1 have
been  the more particular in relating  this cafe, Ss  it
feems to contradict, in a degree, the ideas  of Dr.
Rufh, p. 50,of his Hiftory of the Philadelphia Fever :
our feafon  having been  unufually  wet.

  As connected with the ftate of the brain,  it  may be
proper to mention here, that the eyes were often fuf-  _
fufed, the whites of them tinged with  yellow, and the
fmall veflels turgid with blood. In fome patients they  ■
had an expreffion  of fingular wildnefs;  while, in
others, there was  a remarkable vacuity, or  abfence of  -
expreffion.—I faw no inftance of fquinting;  nor ob-
ferved any uncommon ftate of the pupil: but I ought  A
to acknowledge that my attention was not particularlvfllj
directed to the condition of the eyes, in this  refpect.™

   The  ftate  of the mind was very variable.   Some
were exceedingly impatient and irafcible ; others,   |
aftonifhingly  obftinate ; and this particularly, when,   |
as was often the cafe, there was a  lofs of memory, or   1
fome degree of mania.  A ftrong appeal to their good-   \
 fenfe, calling them by name,  feemed to effect a tem-
 porary reftoration of their docility  and recollection,—   3 
TO DR.  W. BUEL.            Il8
which  were foon loft.—Many were very confident,
at firft,fuppofing their illnefs  not be the Fever; but
gave themfelves up to defpair, immediately on being
convinced that it was the Fever.  Many were full of
dreadful  apprehenfions, from the  firft;  and often-
times, exceedingly aggravated  what would have been,
otherwife,  a  flight difeafe.  A few, were calm, col-
lected, undaunted, throughout their ficknefs.   And
here it may not be unfeafonable to remark, that thefe
fame varieties were, in a degree, obfervable in  thofe
who continued well.   Some phyficians thought they
could difcern a tendency, among the citizens, gene-
rally, to mania.   It is certain that fear was a terrible
evil, and frequently proved the exciting caufe of the
Fever.

   IV.  I have remarked that a great anxiety at theflo-
machwas fometimes felt, on the  patient's being firft feiz-
ed with the Fever. Thk anxiety, it may now be added,
in fome cafes, extended through the complaint;  but
was moft diftrefling when the Fever was moft violent. A
great fenfe of forenefs was often complained of, when
any thing was taken irfto the ftomach, as if it were
raw;—to ufe the words of one in whom it was ob-
ferved.   In fome, the fenfibility of this organ was fo
exceffive as to make it almoft impoffible to adminifter,
either food or medicine, by the mouth.

  Patients  were  often afflicted with extreme  pain-in
the bowels; but  more refembling that in  dyfentery,
than in cholic,   A difcharge, generally,  afforded a
prefent relief.

  Flatulency, both of the  ftomach and bowels, was
almoft  univerfal, and to an extraordinary  degree.—
The  abdomen was fometimes diftended with wind ;
                       R 
 119    LETTERS FROM DR. E. H. SMITH,

■but  the diftenfion fubfi'ded after a conderable  dif-
charge of wind,  downwards.   This  was often the
cafe in one of my' patients.

   Several diffections, as I  am informed by the gen.
tleman principally concerned in them, fhew the  fto-
mach to have been in a remarkable ftate of inflamm*.
tion and excoriation.  It appears to me that this dif-
eafe of the ftomach, or inflammation—(if it be pro-  „,
per  to call  it  fo) extended  through  the  whole
length of the Alimentary Canal; as  it is known to
do in Apthac and fome  other diforders; for one  ij
cafe of excoriation and partial mortification of  the  si
Rectum came within my  knowlege, and  I  have
heard of feveral others.
                                                 • ;
   I have mentioned, above, that Coftivenefs was al-
moft  univerfal at the commencement  of the Fever ;
but it was not always prefent*  For  though it was
obfervable in  the  greater number of patients,  fo
much fo as to deferve to be ranked among the cha-
racteriftic figns of the difeafej and though a conftant
tendency to a coflive.ftate, w&s general in thofe fick
with the diforder ;  yet, in fome, the Fever was at-  ■
tended from the firft, or for a while, by a Diarrhea;  )B
and  in one inftance, the whole of the Difeafe ap-  1
peared to me to be turned upon the bowels, and to  J
be  converted  into, or affume  the  form of a Diar-  I
rhea.                                             *

   Some were feized with vomiting at the firft, which'  \
was  foon  flopped, or ceafed fpontaneoufly, and ne-
ver returned.  One cafe of this kind, proved favora-  :
ble—the patient  recovering;  another unfavorable,  i
the patient dying.—In others, vomiting commenced
the difeafe,  and continued  through  it:  while  in
others, again, it  came on  in the courfe, or at  the 
TO DR. W. BUEL*
I 20
clofe of the diforder; and this both in fuccefsful and
unfuccefsfui cafe3.

   V.  The matters vomited up varied in colour and
confiftence, in different perfons, and indifferent pe-
riods of the difeafe.   The moft. common was of a
yellowifh, greenifh,  or a muddy green and yellow,
appearance, and very fluid.  Vomitings of this kind,
were  feen both in  thofe  who recovered,  and who
died ; and were both temporary and continued.—
Next, in frequency, was that of a blackifh appearance,
commonly defcrmed as refemblirig  coffee-grounds,
but bearing a nearer refemblance to blood partly
burnt, and diluted with muddy water.   Several who
had this vomiting recovered.—-I never faw an inftance
of  that  tar-like vomit,  which has been  noticed by
fome writers.  But, of all others,, that which ftruck
me as evidential of the greateft derangement of the
ftomach,  was the vomiting up of, what appeared to
be, thin blood, in which floated  a flaky, filmy fub-
ftance, which. I fuppofe to have been the villous coat
of the ftomach.—This I faw but in a fingle inftance,
a few hours, before death.   This difcharge was fre-
quent,, though fmall; and accompanied by a large
worm.

   I cannot help thinking that the matters vomited:
up, except it be thofe of the yellowifh  or  greenifh
caft, have all a portion of blood mingled with them;,
and that their various  appearances  depend—afide
from their mixture with  .the  contents  of the  fto-
mach—in great meafure, on the quantity of  blood
mingled with them. - It appears  to me that, in  this
difeafe, the fecretion of the Bile  is greatly affected;
and that, in many  inftances, the blood itfelf paffes
into the  biliary.veffels, .charged.with the Bile, de-
figned to have been feparatedj and being poured in- 
 121     LETTERS FROM DR. E. H. iMITII,

to the duodenum, and difcharged by flool or vomit-
ing, communicates the  blacknefs obferved  in thofe
evacuations.   Befide this, as appears from diffection,
and from  the cafe  juft mentioned, the coats of the
ftomach itfelf are deftroyed; and the numerous little
veffels, which, in a  healthy ftate,  diftill into  it a
limpid  and colourlefs fluid, now are  preternaturally
diftended, receive the blood, inftead of lymph, and
pour it, by their  numerous orifices,  into this organ.
This effufion of blood may be fuppofed to increafe,
as the difeafe increafe's in violence, till, at length, the
tender coats of the ftomach are feparated, and.thrown
up, mingled with pure blood.—If thefe ideas be juft,
it is clear that no vomiting can b^ more evidential
of a fatal termination of the difeafe, than this; none
can afford a more unequivocal fign to the phyfician,
that his attention is no longer ufeful*.

   The difcharges from the bowels  were very dark,
in general, even  where  no preparation  of mercury
was ufed.   They were,  likewife, in  moft cafes,  re-
markably  fluid,  where  the bowels  had been once.

  * If the ideas contained in the above paragraph are accurate,
they will tend to confirm both the general notions of the difeafe,,
and  of the  proper  mode of cure,  advanced in thefe letters.
For—
  ift. The effect of  Blood-letting, in  flopping the blach-vomt,
may  be explained on the fame principle as  in Hemoptoe—by*
weakening the circulation, and allowing time for coagulation.
  2d. The reafon why all  ilimulating fnbftances increafe the
particular difcharges from the ftomach, is  evident;  and, alfo,
why cold drinks, ice, &c. reftrain them.
  3d. The aftonifhing fluidity, or difTolution, as it is called, of the
Hood is accounted for, and feen fairly to correfpond with the
preceding circumftances: all of which—
  4th.  Demonftrate the nature of this difeafe; that it is not a
difeafe  of vafcular debility:—and eftabliih the propriety of em-
ploying evacuations,  and  whatever may lefTen the aftivity of the
circulations, to effe€t a cure. 
                TO DR. W. BUEL.            122

thoroughly, opened ;and, where the purgatives were
brifk, and in all fevere cafes, exceflively offenfive.—
They were, fometimes, of a dark, fhining appearance,
fomewhat like moiaffes, melted pitch, or black-lead.
But  I have  feen ftools of this colour,  in other dif-
eafes—particularly once  in the Croup—where calo-
mel was frequently ufed as a purge.—I mention this,
as it may fometimes happen, that phyficians  deceive
themfelves, in fuch cafes, afcribing that to the difor-
der, which  depends on medicines.

   Some were troubled,  with a retention of urine ;
but, more generally, with an unufual flow ; and this in
one  inftance, I diftinaiy recoiled, where  the quan-
tity of fluids taken into the body, was very fmall.

   In refpect to fweating, I difcovered nothing uni-
form.  In one cafe, the patient always had a profufe,
clammy, fweat, when he fell into a  reftlefs  fleep,
with  a rife of fever.   This was  often obfervable,
likewife, in that ftate of remarkable anxiety which
frequently preceded an evacuation by ftool.

   Blood drawn in this Fever,  was remarkably'want-
ing in floridity ; and this was  efpecially true of that
which was evacuated in the clofe of  the  difeafe—,
whether by art, or fpontaneous effufion.   In one  in-
ftance it feemed endowed with a cauftic quality, and
affected a lancet fo as to leave a permanent inequality
and difcolouration of its furface.

   VI.  Sleep,  for the moft part, appeared unnatural
and unrefreihing; attended by great reftleffnefs ;and
fometimes by great mobility of the mufcles, twitch-
ing of the  tendons, and frequent  flarting up.  One
 of my patients often raifed himfelf up, fuddenly, out
 of bed,  with every appearance of extraordinary  ter- 
 J 23     LETTERS FROM PR. «• H. SMITH,

 ror ; but with no evident or clear confcioufnefs of the
 act.  In one perfon, I faw remarkable fubfultus tendi*
 num.

   There was great variety in mufcular power, in difc
 ferent perfons.  A man who died with the very worft
 fyrnptoms of the Fever, the evening before  his death,
 rofe from his bed, ran down two flights of flair?, re.
 turned, and was only prevented from going down a
 fecond time by his nurfe's having locked him in his  I
 chamber.—In another cafe, where the  difeafe was  \
 mild, the patient felt perfectly eafy  and compofed,  .
 and in full pofleffion of mental and corporeal ftrength,
 while he lay on  his bed ; but, when he rofe,  and at-
 tempted to walk, a fenfe of univcrfal anxiety was felt,
 his ideas became confined, his ftrength feemed to de-
 fert him, a fudden faintnefs came over him,  and twice
 he funk down, unable to proceed.

   An evacuation, by flool, often fuddenly reftored
 the patient, who was lifted from bed, to fuch a degree
.of ftrength, that he continued for fome time after, to
 walk about the room, or fit up;

   VII.  I noticed no uncommon fenfibility to  light  {
 but in a  fingle cafe; and that was not of long dura-  '
 tion.

  Hearing, in one inftance, I obferved to be  unufually;B
 acute ; but generally, it was much impaired i  and, iH
 fometimes, feemed to be entirely loft. Perhaps this
 may account for the apparent lofs of memory in fome  \
 perfons.                                           '1

   The tafte was  either exceedingly impaired, or very
 fickle. The fame may be faid of the appetite.  When   ^
 the appetite began to return, and food to  be relifhed, 
TO DR. W. BUEL.
124
the fick were very voracious, but not eafily fuited.
They difcovered no partiality for animal food.  Thirfl
was moderate, in  a few inftances; but oftener excef-
five. I have feen Porter defired ; but it was not often
relifhed, when allowed.   The fame is true of coffee.
Water was, univerfally,  the moft agreeable drink y
and I allowed its free ufe.  One of my patients fre-
quently drank, in one night, when very feverifii and
reftlefs, three quarts of water.   The appearance  of
the tongue varied,  according  to the violence and du-
ration of the difeafe, from white, to yellow, darkifh,
and black, like burnt blood ; and the gums often af-
fumed this laft appearance, when  there had  been
bleeding from them.

   An  aftonifning infenfibility  to cold was  nearly
univerfal.—I remember, in one  of thofe  cold turns
which  we had in September, a remarkable inftance
of this.  One of my patients occupied a chamber in
the fecond ftory : the room was very large, extending
the whole width of the houfe, and having a chimney, a
large door, and  two windows at either end.   The
bed was hard,  in the. middle of the room, the  door
and all the windows open,  and he  covered with a
fingle fheet, frequently thrown off in his reftleffnefs,
yet he complained of no cold, while I was  chilled
through,  though  fheltered from the  draught of air,
with my  ufuaf cloaths on, and the addition of a fur-
tout and double cloak.

   VIII.  Yellownefs of  the fkin was not  conftantly
prefent in this difeafe ; at leaft, not in any remarkable
degree.  A tinge  of it was common ir the eyes and
on the fkin ; but not ftronger, in numerous inftances,
than in ordinary  Fevers.  Some were exceedingly
yellow, even  to  being  tawny—fo that the  bed
and body linen were ftained, both by the  fweat and
urine. 
 I2J    LETTERS FI'.OM DR. E. H. SMITH,

   I faw eruptions but in a fingle inftance*  They re-
fembled mufketo bites fo nearly, that, had I not been
forewarned of this fimilarity by Dr. Rufh,  in his ac-
count of the Philadelphia Fever, I fhould have mifta-
ken them, efpecially confidering the numbers of thefe
animals.—In this inftance, the  eruptions were on
every part of the body ; which had not been expofed
to their ravages.                                    i

   I have fometimes obferved  a coldnefs of the fkin,  I
on the body, generally, but efpecially of the feet, of
which  the patient was unconfeious,  while the face  fl
and breaft  were red and communicated a burning  I
fenfation to the touch.                              I

   IX.   I have, hitherto, faid nothing of the type o(  1
the Fever of  1795;  and,  in truth, it is a point on   I
which  I could wifh to be filent, as, of all others, con-.  J
nected with the Fever, it is the  one where my obferva-  I
tion is the Idaft fatisfactory. In  its mildeft form,theFe-  I
ver or pyrexia, appeared to me to be moderate and
conftant;  without any evident  or ftrongly-marked#<«
exacerbation : when fevere, it fell in with Dr. Cul-  I
Ien's idea of a Continued Fever, as ftated in his Firft  j
Lines § 27, more than with any other: but, in both Jm
cafes, I could not determine that there was  any regu-",*jj|
larity  in the rife,  or diminution of pyrexia ;  on theJ3
contrary, the remiffion (if it be proper to term it fo)"j9
was more or lefs protracted,  and the exacerbationJBB
fooner or later, moderate or fevere, in proportion as ^|
the patient preferved a regular ftate of body and  7|
mind, or was irregular in thefe refpects.  For exam-  ■
pie—any fudden agitation of  mind, as anger, pertur-   1
bation, &c. and any irregularity of body, fuch as eat-   I
ing improper food or too much food, drinking any
iHmulating drink, reftleffnefs, too long detention of
t>.j faces, &c. appeared to  hurry  on a return of all 
TO DR. W. BUEL,
I27
  the violent fyrnptoms ; while, on the other hand, the
  fick never failed to get through the day with more
  eafe to themfelves, when no fuch excefs, or irregula-
  rity, happened.

     In one cafe which came under my care, and which
  various caufes  contributed to render the moft inte-
  refting of any I attended, there were complete inter-
  miffions, during a part of the diforder ; but there was
  no kind of regularity, either in their commencement,
  or duration ;  and a flight excefs, in any  of the parti-
  culars mentioned in the preceeding paragraph,  was
  fufficient to bring on a fpeedy and violent turn of
  Fever.

     X. The period of convalefcence, as well as  of Fe-
  ver, was variable.  In the former part of the time, and
  before the weather began to grow.cool, patients fel-
  dom died after the tenth day—as far as  I can  learn ;
  but their deaths took place on the 3d, 4th, 5th, 6th,
  7th, rarely on the  8th, and ftill more rarely on the
  9th day.   After the cold  weather  appeared, they
  fometimes dropped off fuddenly, and after having ex-
  hibited all the marks of convalefcence,  three weeks
  from the time of their feizure.—So, of thofe who re-
  covered, fome regained their  health with  an  elaftic
(  quicknefs ; while others, were very flow in the ac-
  quifition  of ftrength; were  a long  time  troubled
  with great weaknefs in fome  of  their joints,  and
  ofteneft the knees ;  and were  afflicted by cedematous
^fwellings of the feet, ancles, and legs.
y"■'
  You have now before you the refult of my obfer-
vations, on the  appearances of the Fever of 1795 ;
and I fhall  conclude this letter by the fimple men-
                       S 
 128    LETTERS FROM DR. £. H. SMITH,

 tion of two  facts,  which will ferve to confirm the
 doctrine  of the great Sydenham,  concerning  the
 defpotic nature of the reigning ficknefs.

  The Meazles had begun to appear, when the Fe-
 ver came, and they difappeared; but no fooner was the
 Fever vanquifhed, than they returned more generally
 than ever, and have  continued  in this city ever
 fince.*

  I cannot learn that any febrile difeafe was obferv-
 ed in the  city,  while the Yellow-Fever was prefent. J
 I faw only one inftance of Intermitting-Fever in  a
 lady, who contracted  it  in the  country.  It was
 flight, and was foon cured on  her coming to  town,
by the ufual remedies.   Her  refidence in town, like-
wife, was  in a part to which the Yellow Fever never
came. Befide this, I heard of one other inftance, of a
gentleman coming hither, from fome other  place,
with the Fever and Ague ; which was, alfo, cured by
the ufual means.

  I fhall proceed, in my next letter,  to bring you ac-
 quainted with thofe means which  were moft fucceff-
 ful in the  removal of that difeafe  which  I have juft
defcribed.
                LETTER NINTH.

      Method of Cure, in the Fever of 1795.

  It  was obvious, to the flighteft obfervation, that
the miidnefs, or feverity, of the Fever of 1795,  de-
pended, in no fmall degree, on the fituation  of the
* April. 
TO DR. W. EUEL.
129
 patient.   That thofe who lived in the higher, drier,
 cleaner, and more airy parts of the town, were more
 lightly affected ; and that a removal, from the other
 quarters, into fuch as were fo circumftanced, was al-
 ways followed by beneficial effects to the perfon  re-
 moved. In confequenee, a milder treatment, in every
 refpect, efpecially a more fparing ufe of evacuations,
 was warrantable in  fome cafes, than in others ; and
 as fome practitioners were chiefly employed among
 thofe whofe favorable fituations protected them from
 the moft malignant attacks of the difeafe, you  will
 readily  conceive why  there  fhould prevail, in  the
 minds of fome, an opinion that very active remedies
 were unneceffary, and a recurrence to the lancet in-
 expedient, at leaft, if not pernicious. It is true that I
 did not always ufe it myfelf;  but it is alfo true, that
 I never failed to regret the omiffion.   And though I
 loft no  patient by the neglect, yet  I am convinced
 that,  in every fuch cafe,  however  flight the difeafe
 might appear, the cure was protracted.  But, if the
 remedies were not always the fame,  the principle on
 which they were adminiftered, was uniform;  and
 their operation the fame in kind, if not in degree.—
 And, after the Fever became  more general, and  the
 feafon confiderably advanced, there was but  little
 choice left in the ufe cf means.   Pofitive and fpeedy
 relief was required ; for to temporize, was to kill.—
 You  will  fufticiently comprehend, from thefe  re-
 marks,  how far the practice recommended below
 admitted of variety in the application ;  and I fhall de-
 tain you no longer from the confideration of the par-
 ticular remedies, which  are  meant to be arranged
 nearly in  the order of their comparative importance.

   I.   Blood-letting.-—This  was   indicated  by
the  fevere  pain,  heat,  and rednefs,  cf the  head
 and  countenance ;  by the  redaefs,  turgefcence, 
 I'3<3     LETTERS FROM DR.  £. ili SMITH,

 and  heavinefs,  of  the eyes ;  by  the oppreffion,
.piin, and anxiety, often obfervable  at the breaft;
 by the fullnefs, hardnefs,  tenfity,  or oppreffednefs   I
 of the  pulfe—and equally by  that  flender,  wiry,
 vermicular feeling which it fometimes had—commu*.  j|
 mcating an idea of approaching numbnefs to the finger   '
 which felt it.*
                                                *  ■
   The  effects of bleeding were,  in  every  inftance
 where I had an opportunity of obferving them, moft
 falutary.  The fick feldom failed of finding  immedi-  !
 ate relief  from it, and of  perceiving that relief in-
 creafed as the blood continued to flow. It diminifhed
 the pains in the head,  breaft,  and ftomach:  oppref-
 fion,  anxiety, faintnefs, and heat, were moderated :
 the eyes rarely failed to aflume  a clearer  and more
 natural  appearance : and it feemed to communicate a
 new energy to  the fyftem.—I remember an  inftance
 where a patient was fo unable to affift himfelf, on the
 fecond day of the difeafe, that,  when I wantec^ to
 bleed him, it required two perfons tofupport him, in
 paffing a few fleps from his bed, into the open air.—
 There,  he was feated and fupported in a chair.  He
 grew eafier, in  every refpect, as the blood flowed.—
 After taking  away about .twenty ounces,  and tying
 up his arm, he rofe without affiflance  ; walked feve-   Jj
 ral rods, to a Neceffary ; took  care  of himfelf; had  a  Jfl
 profufe evacuation, by which he feemed to gain addi-  fl
 tionaf ftrength ; and returned to his bed, without any  •■
 aid, and with a firm  flep.                            ■

   Such were the immediate effects of bleeding early
 in the difeafe.  The importance of this remedy was    \
 not diminifhed  by the duration of the diforder, nor

   * It is fearcely poffible to convey an idea, by words, of minute
 peculiarities in  the pulfe.  You will recoiled this, and pardon
 rnc, if I have failed in thio inftance. 
TO DR. W. BUEL.             I3I
 the neceffity for it leffened, while the fyrnptoms con-
 tinued which made it ufeful in the commencement.—
 On the contrary, it was oftentimes as requifite, and as
 beneficial, the fifth and the fixth days, as on the firft.
 But this neceffity for its ufe, at fo late a period, did
 not often occur,  where, it had been vigoroufly em-
 ployed,  in  connection  with other  remedies, at the
 firft.

   The following  cafe,  which I ftate briefly, k one
 among numbers,  in evidence  of  the  advantage  cf
 early, free, and repeated bleeding.

   A phyfician was called to a  young man, with all
 the fyrnptoms of the difeafe—as it generally appeared
 at the firft—in the evening.  He bled him 16 or 18
 ounces; directed purges, &c. in the manner hereaf-
 ter to be mentioned ; and though the weather was
 then cool, ordered the windows to be removed, both
 day and night.   The fyrnptoms were relieved ; but
 the next morning it was thought neceffary to repeat
 the bleeding;  which was done, to an equal quantity.
 The purges, &c. were alfo continued.   In the even-
 ing, a third bleeding was performed, and a like quan-
 tity of blood was taken away ;  and the  other reme-
 dies were continued.   On the ninth day, from the
 feizure, the  man was well, and able to purfue his bu-
 finefs ; though  his ftrength  was not perfectly ref-
 tored.

  In  one inftance which  came to  my knowledge,
bleeding removed an obftinate vomiting, of many
days continuance, which threatened the life of the pa-
tient, and which had refifted all other remedies.

  It feems hardly neceffary to add any  thing more,
in favor of this remedy, after it:? beneficial effects have 
 132     LETTERS FROM DR. E. H. SMITH,

been ftated, with fo much eloquence and perfpicuity,
by Dr. Rufh,  in his various publications, refpecting
the Yellow Fever.

  II.  Purging.  No cafe occurred, in my particular   ,
practice,  where, not with (landing the vomiting, ca-   j
thartics could not be adminiftered.  When this fymp.   *
torn was very troublefome, they were required to be  J
given in a folid form, at more confider able intervals,  »
and of as  fmall a fize as poffible.   The activity of  i
the purge was always to be proportioned to the vio-
lence of the fyrnptoms ; and it was important  that
all medicines of this kind fhould be given in divided  '
dofes—fo as to  promote a gradual and continued dif-
charge.—The operation was  often very much affifted
by clyfters ; for which water  alone was neceffary.

  The good effects of  cathartics were not lefs  obvi-
ous than thofe of venaefection.  They were indicated
by the conftipation, fo generally prefent; by pain in
the bowels, flatulency,  and tumefaction of the abdo-
men ; by pains of the head, heat and flufhings of the
face, and of the whole body ; and finally, by the vo-
mitings : and all thefe fyrnptoms they rarely failed to
obviate, or relieve.   This relief,  too, was oftentimes
fo fudden, as to feem like enchantment.—Frequently  ]
have I feen a patient, after an hour or  more of fevere
pain, reftleffnefs. heat, thirft, and inquietude of every *■
kind—feeble, exhaufted, and as it were, ready to ex- *■
pire—rife with the  greateft  difficulty, and  with the  |
aid of others, t6 the chair, and after his evacuation,  ^
feel  his pains  removed, his heat and reftleffnefs va-  1
nifhed, his ftrength renewed, and hinuelf able to fit
up, or walk about, and breathe the air with freedom:  |
and  fometimes, the difcharge was followed by a re-
 ffefhing fleep, and gentle perfpiration. 
TO DR. W. BUEL,
»33
 - Thefe benefits were neither fo certainly, nor fo fre-
quently, obtained, where the evacuations were violent
and fudden.  Indeed, it appears queftionable to me,
whether it be ever proper to excite fuch difcharges,
in Fevers.  Patients, when much reduced, are apt
to fink under fuch immediate and abundant evacua-
tions.

  III.  Cool Air.—It  was of the utmoft importance
to procure a conftant application of  cool  air to the
body of the patient, from the commencement of the
Fever.   The advantages which refulted, were univer-
fal and wonderful.—To this end,  the fick were or-
dered  to be placed on a hard bed,  with very little
covering, in the middle of the room  ; and the doors
 and  windows were, as much as poffible,  kept open
 day  and  night.—The good effects  of this  practice
were exceedingly increafed, where the application  of
the cool air could be made to the patient  in an erect
 pofture.  For, not only was it more equable, but the
head was alfo relieved,  thereby, from  that  fenfe  of
 fullnefs and oppreffion vvhich was  invariably experi-
 enced  in a recumbent pofture.  The fick, therefore,
 were directed to fit up, in the courfe of the day, with
 the  afliftance  of their attendants, as long  as their
 ftrength would permit,  without their becoming ex-
 hausted.   While in this fituation,  their feet and legs
 were covered more warmly than any other part of the
 body :  and if cloths, dipped in cold water, or vinegar,
 were often applied to the temples, the relief obtained
 was  ftill greater.

•" IV.   Cool Drinks.—The great thirft, which was
 nearly univerfal in this  Fever, from the firft, made the
 drinks, of nece|fity, an article of early attention.   It
 was obfervable that they never could be too cold. Pa- 
 Ij4     LETTERS FROM DR. E. H. SMITH,

tients  complained of  the  warmth of water  which
had been Handing but a fhort time; and feemed to   j
languifh for a fupply of frefh water, with an anxiety   j
which became truly painful,  when the  ufual hour of   1
its diftribution approached.*                          ]

   The good effects of a plentiful ufe of cool,  dilut-   j
ing drinks, were obvious.   They tempered the pre-   i
ternatural heat and anxiety of the ftomach ; often re-   !
{trained vomiting, and the  faucial hemorrhage; ferv-
ed to dilute, and carry off, the offenfive contents of
the inteftines ; and difpofed to a more equable and
aqueous fweat.—Of all other drinks, Water was moft   i
relifhed—and on many accounts, was the moft pro-
per.   A pleafant and fuitable drink was made,  by
pouring warm water on frefh apples, and fuffering it
to cool;  and likewife,' by  the addition of a piece of
toafted bread  to water.  Milk,  much diluted with
water, was relifhed by fome;  fome were fond of but-
ter-milk ; and as all thefe poffefled bland and nutriti-
ous, qualities, they were advantageoufly ufed, where a
variety of drinks was required by the capricious tafte
of the patient.                                       ■

  I had no opportunity of  trying the  effiacy of ice,  «
but the teftimony of a Phyficianf^in whofe judgements™
and veracity I place great confidence, is  ftfongly in
its-favor, and inclines me  to believe that it may be'  ■
ufed with high expectations  of advantage.  Under  fl
his direction, it anfwered, better than any thing elfe,'  fl
in relieving heat and fever; reftraining hemorrhagy $f

  * The water which is ufed for drinking, in this city, is moftly
drawn from a fingle pump, called the Tea-Water Pump ; and it
is diftribute.1, by means of large calks, which arc carted to every
part of the town ; once a day, in winter ; and every morning "and
afternoon, in fummer. 
TO DR. W. BUEL.
'35
and obviating, partially, or entirely, the vomiting-
even the black vomiting.

   V. Cleanliness.—This is of the utmoft impor-
tance,  and, in  a meafure,  indifpenfable.—The bed
and  body  linen fhould  be often changed ;  the
cloaths  neceffary about the bed, well aired, feveral
times a day : there fhould be tv/o beds, one of which
may be aired,  while the  other is in ufe: all unne-
ceffary furniture—particularly woollen, filk and cot-
ton—every thing which may abforb and retain efflu-
via and moifture—fhould  be removed: all utenfils
employed about the patient, frequently changed and
rinfed : the  room  mould  be often fprinkled  and
dufted : the face, mouth, eyes whole head, hands—
and, where it can be done, body of the patient, wafhed
with cool water, feveral times in the day.  The more
exactly—other  circumftances being regarded—thefe
directions can be put in execution, the  better for the
patient; and, as my own  experience convinces me,
the more certain and fpeedy will be his recovery.—
You will obferve that I fay  cool water ;  for I cannot
believe that the fhock which would follow from the
application of cold water to the body, would  be be-
neficial.—It is not here, as in the ufe of air ; for water
is fo much more perfect a conductor of heat, that the
abftraction would be univerfal and fudden, were  it
applied  cold.  And, befide, as much is effected per-
haps, by the ablution, as by the coldnefs, confequent
upon bathing.

   It  was not in my  power, in any cafe, to carry this
practice to the extent I wifhed ; but, ceteris paribus,
the relief of the  patient  was proportioned to the de-
gree  in which it was purfued.
                       T 
 136    LETTERS FROM DR. E. H. SMITH,

  VI.  Blisters.—The advantages ufually derived    ,
from  the  ufe of blifters, were not  evident.   It was
fometimes doubtful whether they were  any  way   j
ferviceable.   Yet  there were inftances  in  which   J
they afforded relief;  though moftly temporarily.—   I
I have  feen  them, applied to the breaft,  relieve   1
the oppreflion  at  the  lungs ; and applied  to  the   j
back of the neck, relieve  the head : in both cafc$,
when the difeafe had been of fome days continuance.  '
A phyfician, to whom I mentioned thefe remarks, in-
formed me that his experience juftified them, except  .i
when, as was often obferved by him,  a hemorrhage
enfued from the vefication, and continued for fome
days.   Perhaps it was neceffary to the efficacy of blif-   1
ters, that they fliould have been, always, preceded by
copious blood-letting.

  VII. The Tindura Sacra, given in fmall quantities,
at intervals, in water, was found by one Phyfician,  ^
to have the happieft effects, in relieving naufea, and
obviating the tendency to vomit, in all cafes where a
deftruction of the coats of the ftomach had not taken
place.  The fame gentleman derived much advantage
over  the  difeafe, where,  from  long-continued  vo-  •'
miting and effort to vomit, the ftomach appeared to
have fuftained confiderable injury, or abrafion, from
the ufe of 01. Oliv.  vel amygdal. dulc*—The oil co-  )
 vered the inflamed, or abraded, part, and protected it
 from mechanical flimulus, while it allayed the forenefs  i
 and irritation produced by the action of the difeafed
 fluids it contained.
                                                  :
   VIII. Food.—1 have before remarked that the fick   *
 fhewed no preference for animal food ; oft the con-
 trary, they very generally refufed it.  Some, -who
 requefted it to be prepared for them, found themfelves 
TO  DR. W. BUEL.
■137
unable to eat it,  when prefented to  them.-—Fruits,
milk, bifcuit boiled  in milk or  water, fago, falep,
hafty-pudding, and vegetable food, generally,  were
moft reliflied by them, both during their illnefs and
their convalefcence.—This was peculiarly fortunate,
as any indulgence in a contrary courfe, was fure to
be followed by diftrefling effects.   The more rigidly
attentive patients  were to preferving  a fimplicity of
diet, the more certain and pleafant was their recovery.
And, in all cafes  that I had opportunity to obferve,
their convalefcence was always extended or lhortened,
tedious or fatisfactory, in proportion as they returned
fuddenly to the ufe of meats and ftimulating drinks,
or adhered to vegetable food and water.



   I have now, my dear friend, made  you  acquainted
with that courfe which I generally purfued, in regard
to thofe who came under my care. The number was
not great, nor the fuccefs always complete—for I had
not always the  liberty  of employing the  means  I
wifhed to,  as fully and freely as was neceffary to com-
plete fuccefs.  But, I can truly fay, that I never faw
them do injury ;  and that they appeared to me to do
good, in every cafe,  where they were employed, and
in the proportion of their  trial and application.—
More than this no man can truly declare;  more than
this ought  never  to  be expected  from any remedies.
The znoft able practitioners are deftined to fee their
patients frequently expire, in fpite of all their care,
through the obftinacy of  the patients themfelves, and
the prejudices of  their friends, the careleffnefs of at-
tendants, or the intervention of unforefeen and una-
voidable accidents.  The confciofunefs of having done
their duty, of having acquitted themfelves, under cir- 
I38     LETTERS FROM DR. E. II. SMITH,

cumftances fo diftrefsful and embaraffing, to the beft
of their knowledge, and with purity of intention, will
prove a never-failing confolation, though the execra-
tions of ignorance, and the calumnies of hatred, may
purfue and perfecute them.—Happy,—at leaft in this
refpect,—are thofe, " the peaceful tenor of whofe way,"
while it excites  neither oppofition nor malice, and
neither elevates to opulence nor fame,  fecures them
from mifreprefentation and injultice.
                LETTER TENTH.

Mifcellaneous remarks on Medicines ufed as Remedies in
         the Fever, and general conclufions.

  You  wifh to obtain every poffible information,
reflecting the Fever of 1795 ; you are not fatisfjed
with knowing what remedies I employed, nor which
were  moft  fuccefsful; but you would learn all that
were  ufed;  the fuccefs, or failure of each.  I ap-
plaud your curiofity, my friend, for I am not ignorant
of the benevolent motives which excite it; but I fear
that there is little with which it is in my power fur-
ther to gratify it.  The practice which I faw, was
that which  I have recommended: other remedies I:
know were  ufed; but, not having had opportunity,
but in few inftances, to  mark their effects,  I ought
not,  from  my  own convictions, how well-founded
foever they  may appear to me, precipitately  to con-
demn either the prescriptions, or their authors.   In
the variety of cafes, conftitntions, and circumftances,
it might happen that fome of thofe very things, which 
TO DR. W. BUEL. '
139
appeared pernicious  when I  faw them ufed, were
fometimes proper  and falutary.   It would be pre-
fumptuous, therefore, in me, to decide without more
information ; but I may be allowed an opinion ; and
that opinion need not be with-held from a friend.—I
confefs, then, that from the fuccefs which attended
the antiphlogiftic plan of cure, I am perfuadH  that
no other can be  falutary, or fafe ; and the  fe"* in*
ftances in which the effects of a  different mode of
treating the Fever were obferved by me, ftrengttk aed
my previous convictions  of its  inutility and  dan-
ger.

  The medicines  chiefly  trufted to, by  thofe who
purfued a different courfe from that laid down in the
preceding letter, were, as  I am informed,  Calomel,
to  promote, or effect a Salivation,—Bark—Lauda-
num—Wine, and other'ftimulating drinks—with an
Animal diet.

  Of the effects of Salivation, not having feen it take
place, by nature nor art, in the Fever of 1795, I can
fay nothing.  Dr.  Rufh countenances the practice,'
in his Treatife on the Fever of Philadelphia, and adds
the teftimony of many refpectable authorities to his
OWn.—As  a Cathartic,  Calomel,  combined  with
other purgative fubftances, was unqueftionably ufe-
ful.  Some, I know, thought otherwife; andthat
other purgatives might be more fafely and efficaciouf-
ly employed; and, I confefs,  I  faw  fome  cafes in
which it appeared to  affect the ftomach very painful-
ly.   But a  Phyfician on  whofe judgment I  have
great reliance, informs me, that he faw reafon to re-
ject a fimilar opinion, which he had haftily adopted ;
repeated obfervation having convinced him, that all
the fyrnptoms of gaftric affection were worfe in thofe 
14©     LETTERS FROM DR. E. TL SMITH,
who had  not been purged with Calomel,  than in
thofe who had been evacuated by its affiftance.

  I gave Bark, in no form, but in three cafes.  Two
were in the early part  of the reign of the Fever, the
two firft patients that I had; and I am  convinced  it
retarded the cure  in both.   In the other inftance, it
was «wlminiftered after the Fever had left the Patient,
and he was convalefcent.  Here it was given as any
other Bitter, and  as much in compliance with his
opinions, as from any expectation of its doing good;
and, as far as I can judge, with very little effect of
any kind.—In the following cafe, its exhibition was
not fo harmlefs.

  A medical friend was called to vifit the  patient of
another Phyfician, who had /quitted town, on account
of his health.   The fick man was oppreft  by the
moft alarming fyrnptoms; of the number of which,
were hemorrhagy and the black vomit.  The ftimu-
lating fyftem had been fteadily purfued, and was con-
tinued, under the direction of a pupil of the phyfician^
firft employed.   In particular,  large  quantities  of
Bark were exhibited, throughout the day.—On the
entrance of the fecond phyfician, the Bark and all
other medicines of the kind, were laid afide; cool air
was freely admitted; and the antiphlogiftic  plan  of
cure ftrictly  adhered  to.   The confequence was,
that all the fyrnptoms were  relieved, and a profpect
opened on the patient of a recovery.   The vomiting
and hemorrhagy  had totally ceafed.  In  this  fitua-
tion, and while the Phyfician was attending to fome
perfons whofe condition was more  alarming, the
perfon who had the immediate charge of the fick man,
began, again, to adminifter the Bark.—The next day
—or the very fame, at night—all the bad fyrnptoms 
TO DR* W. BUEL.
141
recurred ; the  Bark was, neverthelefs, perfifted in j
and the man died.

  Several fimilar cafes have been reported to me;
but none fo minutely as to authorize an  attempt  to
ftate them to you.

  The extreme  reftleffnefs of a patient,  in whom I
had the ftrongeft intereft, and  for whofe fate the
deepeft anxiety,  induced me,  in violation of my
more fober judgement, to adminifter Laudanum.—
This I did not do, till he had fpent three nearly fleep-
lefs nights.—In  every inftance,  it undoubtedly,  in-
creafed the  reftleffnefs, clammy fweats,  thirft and
Fever.  I was obliged to difcontinue it.

  Wine,  brandy and water,  and efpecially porter,
when taken by any of my patients, had the moft per-
nicious effects.  I had occafion to fee an accefs  of
Fever, repeatedly brought on by the one,  and a re-
lapfe by the other; where they were ufed without my
knowlege, and contrary to my direction.

  Of the effects of Animal  Diet, I  have already
fpoken, and have nothing new to add.

  On the whole, it appears inconteftible  to me, that
what is called the antiphlogiftic treatment is to  be
adopted in Fevers like that which prevailed in New-
York, in 1795,  in all  its ftrictnefs, and adhered  to
with pertinacious refolution.   Both the fymptoms of
the difeafe, and the fuccefs attendant on the practice
recommended,  concur in eftablifhing  the  propriety
of employing it.—It is ajfo to be remembered that,
in this difeafe, not a moment is to be loft : a day,  an
hour, nay almoft an inftant of delay, may fometimes
be fatal;  and  the means practifed muft be powerful
in proportion to the violence of the fymptoms.  Nei- 
 I42     LETTERS FROM DR. E. H. SMITH,

 ther muft we be deceived  by the apparent mildnefs
 of the feizure—for a few hours may entirely change
 the face of things, and we may be left to lament that
 credulity which led us  to temporize, and  prevented  J
 the ufe of thofe remedies, which delay alone rendered  1
 ineffectual.                                        1

  But, while the Phyfician ftrenuoufly directs his ef-  i
 forts to the  removal of the fymptoms of this difeafe,
 let  him not overlook a paffion which never fails  to
 aggravate them.  Fear, the exciting caufe, in many in-  '
 ftances, of the Fever;  the fomenter of  all its evils ;
 and fometimes, as it were, the fole difeafe ; is a fre-  i
 quent and dreadful calamity, and one of the direft
 adverfaries with which  medicine has to contend.—Iri
 numerous inftances, during the continuance of the
 Fever of 1795, apprehenfion touched upon infanity;
 deftroying all  confidence in the Phyfician and in re-  j
 medies,or exciting an abfurd and enthufiaftic reliance  i
on pretenders and madmen : and utterly  difqualfying
the  patient for a proper attention to himfelf.—In the  ;
well, the evil was  fcarcely lefs.   The name, alone,  of
Yellow Fever, feemed fufficient to  induce difeafe,  to
banifli  discretion,  to fever the bonds of focialconriec-
tion, rend afunder the ties of parental, filial, and con-  ^
nubial  affection, and put reafon to  flight.—It was  in  jl
vain to point out  the folly of this terror; to declare M
the  difeafe not infectious, and eafy of prevention ;  to fl
offer mathematical demonftration that other diforders fl
were often more mortal, without exciting any alarm ;
it was ftill the Yellow Fever, and that was  an irrefi-  I
liable reply  to every argument.—The city of New-  ■
 Haven, fummer before  laft, loft about 50 of its inha-  i
bitants, with the Yellow Fever.   Univerfal confter-  j
nation  prevailed throughout: the place ; all bufinefs   j
was at  an end ; and moft of the  principal inhabitants  J
 fled.—Laft fummer, the Dyfentery raged there : more  _ 
TO DR. W. BUEL.
*43
   than 70 perfons died of it: but nobody fled; nobody
   was frightened ; and the Magiftrates, very  gravely,
   put a  flop  to all communication with New-York,
   for fear of the Yellow Fever; made veffels ride qua?
   rantine, and confined ftage-coach paffengers, that no
'   contagion might be diffufed, through the  city, from
   their trunks and their garments.-t-But, it is time to
   put an  end to this feries of letters;  and feek, by no-
   velty, to give new intereft to our correfpondence.  I
   fhall take my leave of the prefent fubject,  with an
   enumeration of the inferences  I have  drawn from
>   having viewed it, in the light here exhibited to you.

      1. The Fever of  1795 was Endemic :—i. e. gene-
'   rated by local caufes, producing a Fever every year,
   in this city.

      2. The peculiar ferocity of the Endemic of New-
   York, in 1795, is afcribable to the peculiarity of the
   feafon, together with a greater accumulation,  than
   ufual, of the ordinary caufes.

      3.   It was not Contagious:  i. e.  communicated
   by contact of difeafed  perfons, by cloaths, nor by
   vifiting the fick, &c.

      4. As it originated here, its prevention will depend
   on a change of the local and individual circumftances
   which  promote it.

      5. The Fever in 1795, exhibited fuch appearances
   as characterize what are cuftomarily denominated In-
   flammatory Difeafes.

      6. It is cured by the remedies fuited to remove In-
   flammatory  Difeafes.
                          U 
J44    LETTERS FROM DR. E. 11. SMITH.

   -. The fame caufes which converted the ordinary
Fever of New-York into the Yellow Fever, would
change the Fever which prevails around our Wef-
tern Lakes into the Yellow Fever ; and, as certainly,
the Intermitting  Fever of Sheffield :  while the efta-
blifhment  of a free ventilation,  the filling up of all
pools, vards, &c. and a fcrupulous attention to clean-
linefs and fimple diet, would reduce out Fever to a
fimple  Remittent or Intermittent, or remove it alto-
gether-, as the filling up and cultivation of your ponds
and marines, would forever banifli all Fevers of the
kind—as general difeafes—from Sheffield*
  I have now, my dear friend, performed the talk
demanded of me, in the heft manner I am able con-
liftent with my leifure, and my duty towards others.
i cannot conclude without once more foliciting your
indulgence, and requefting you to recollect with what
expectations and confeffions I entered on the compo-
fition of thefe letters.—I have taken the words of
Cicero for my motto—

    " Rationem, quo ea me cumque ducetfequar—"

  And  if I have erred in  my conceptions of what is
reafon, and what was fact, let my intentions prove mf\
ar-ology.
8.  7C.  zfmitL 
LETT  E  R
from
DOCTORS TAYLOR AND HANSFORD,
TO THE PUBLISHER. 
 
LETTER
                    FROM

DOCTORS  TAYLOR  AND HANSFORD/

           TO THE PUBLISHER.
               NORFOLK, VIRGINIA, DECEMBER, 1795

       SIR,

     If, in our attempts to add to your information
reflecting thefever, which prevailed here in Auguft
laft, we fhould  draw upon  us the illiberal farcafms,
which we have obferved to attend all who endeavor
to ferve their fellow creatures in this way,  we muft
leave it to you to  juftify our intentions, at leafi% be-
ing ourfelves unprepared to anfwer any thing which
may be  objected to what we fhall  advance.   We
mean to  ftate fads, or what we believe to  be fuch^
and  willing  to admit that there are feveral ways of
curing the fame difeafe.   It will not be underftood,
that we reprobate the practice of others who follow
a  different  mode of treatment.   Our obfervations
have been drawn from thirty years experience, with
the advantage of records  relating to fimilar difeafes
for a muchlonger period.  We  do not know of a
more regular mode of treating the fubject than by
anfwering your inquiries in the  order they occur,
vhich will perhaps comprehend every thing required
at prefent. 
I48   ACCOUNT OF THE FEVER IN NORFOLK.

  The Fever we believe has its origin in the feafon,,
and exifts every year in various grades,  beginning
generally in the month of Auguft, and difappearing.
about the middle of October.

  The precife time of its commencement and termi-
nation, and its degree of malignancy, depending upon
contingent caufes.  Vv e have been accuftomed to call |
it a Bilious Remittent,  with a tendency to putrefac-
tion ; whenever it proves uncommonly fatal,  it is
aggravated, according to the beft of our obfervation,.
by the prevalence  of fome unufual weather for  a
long time together—Thus we have feen this difeafe
equally malignant after a dry hot feafon, and after a
very rainy period.   The approach of frofty weather
being uniformly the cure for the effects of either.-—  j
The Fever of the laft autumnal feafon, appeared firft  I
on the river, then on the ftreets adjoining ; was foon  ]
after diffufed through  the town and  fuburbs,  and  ]
finally the  neighboring country ; though in this laft  j
not generally : as ufual it declined on the approach of  i
cold weather.—The month of  June had been very
cool, and at the change of the moon, or a little be-  ,(
fore, it began to rain in torrents, and fo continued to
do,  with fhort intervals of clofe fultry weather, till  1
Auguft, when a violent hurricane, attended with a  I
flood of rain, laid wafte the whole vegetable kingi. d
dom—afterwards the weather was as  before, fultry*;'«
and  moift, with profufe fhowers till the end of Sep*  l|
tember.—The  firft  appearance of  the Fever  was* 1
about the 1 oth of  Auguft; it increafed in violence  1
and  in extenfion during all that month ; it was per** J
ceived then to abate, and continued to do fo till the
laft day of September, when a few frofty nights fu-
pervening, it difappcarcd  almoft iuddenly  and en*-
tirelv. 
      ACCOUNT OF THE FEVER IN NORFOLK.   I49

  There were perhaps more deaths, than for many
years before ;  but whether greater in number to the
proportion of the fick, than is ufual from autumnal
difeafes, which prove as univerfal as that in queftion,
we cannot undertake to determine.   The fame mode
of  treatment  generally fucceeded—as in other  fea-
fons.   Our method was plentiful depletion in the be-
ginning,  not by bleeding, but by purging with Jalap,
Calomel, Scammony, Aloes, or by the milder purges,
the Neutral Salts—Sennse,  Rhubarb,  Manna,  &c.
as the age, fex and conftitution of the patient pointed
out,—taking care  that the  evacuation of the  firft
paffages was complete, by whatever means procured*
As foon as we judged that to be fufficient—which we
always endeavored to make fo with as little delay as
poffible—the bark was adminiftered in all and every
form that it could  be made to remain, without re-
gard to quantity, or  to the period, or height of the
fever,  with  wine, porter, and even brandy, if wine
was rejected by the inclination, habit, or ftomach of
the patient.  We can affure you, we have no reafon to
alter our mode of  practice in future.  In a multitude
of inftances,  fome will occur in all  difeafes, when  a
change, and fometimes  a material change of reme-
dies may  be neceffary—fuch cafes we found, and in
thofe we ufed Blifters, Emetics, Camphor, Opium.
and often  ventured upon Cupping—but never upon
Vensefection.—This laft, a long courfe of practice has
taught us to be at leaft, not advantageous.   In diffe-
rent climates,  and under other circumftances—when
the difeafe may have appeared in  other grades  than.
thofe we have experienced—that operation is perhaps
found ufeful.  We wifh not to impofe  our opinion,
as a rule for any perfon ; fenfible of the fallability of
all human judgment. We ever thought it our duty
to give up our own theories, when contradicted by
events.   We  only mean to r^conim^nd that y-hu, 
15©  ACCOUNT OF THE FEVER IN NORFOLK.         j

which long experience has taught us to be moft fuc-
cefsful,   There is no proof that this difeafe poffefled  ,
any fpecific infection.   It was rarely fatal to  the na-
tive inhabitants or  the old  fettlers, fpeaking  of the  ,
town only;  but we have been told that many of the  >
traders from the Rivers and diftant part of the State,
died immediately after leaving the port.  The terror  ;
which pervaded all parts of the country, and deprived  i
thofe victims of the common attentions of humanity,  j
will eafily account  for this without applying to the  1
malignancy of the difeafe. All,  or moft of thofe born  I
in, or who had  been accuftomed to a fouthern cli-  ■
mate, efcaped death, and when attacked, had the dif-  1
eafe in its milder form.

  A large number of the inhabitants  enjoyed  unin,-   I
terrupted health ;  moft of the deaths happened in  j
confined ftreets and  buildings, and in thofe  neareft  1
the river.—Thofe who were accuftomed to live well,  1
(as it is termed) did not fuffer fo much as the poorer
clafs—But the intemperate of every defcription be-   J
came vi&ims when attacked-—The fmall pox imme-  j
diately preceded this  fever.   We did  not  obferve  |
that thofe who had been the fubjects of it were par-  {
ticularly fufferers.—There had been  no malignant  ,
complaint in the preceding winter.

  A particular defcription of the fever, and its fymp- ;
toms, does not feem to be  here neceffary, became, it.
differed from the ordinary Bilious P.emittent, only in_
the rapidity with which it paffed through the feyer.irf'' i
ft ages, and in its malignancy.—-This laft circumftance
we are of opinion  was occafioned by the long eorn>  1
Xiued and uniyer&l heat  and moifture of the atrapfr   '
phere.—The air was evidently impregnated with pu^
trid ef^uvia, arifing from .decayed fubftances of every
fort, brought,sJo>yn upon the creeks and riyers by the 
         ACCOUNT OF THE FEVER IN NORFOLK.   15!

   floods of rain, and thence into the bafon immediately
   before the  town,  where the ftream being  wider, is
   lefs rapid than either above or below,  and where of
   courfe fuch  decayed fubftances,  together  with the
   filth, &c. thrown from the  fhipping and  docks, be-
1   came for a  certain time flationary.—This  may in
   fome meafure  account for the difeafe appearing firft
   in  the harbour.—The fame fever, with all its malig-
   nant anc\ uncontroulable fymptoms,  occurs every
•   year in fcattered inftances, and about the feafon.—In
   the preceding fummer 'and autumn, feveral died  with
   it.  A number of fhips and veffels, which occafionally
   put into this  port from James's River, and from
   North-Carolina, loft many of their people with a fe-
   ver of this fort, which they brought with them from
   the frefh and brakifh waters.   In the  prefent  year
:   (1795)  on board a fhip from Liverpool, which did
   not approach nearer than five miles to the town, and
[   with the crew of which the captain affured us—No
   communication had been from the fhore, except by
[   the health boat, almoft  every individual was attacked
   with the  difeafe, in ten days after her arrival, and one
   of them (a European) died, and this at a period when
   the difeafe had almoft difappeared in the town.   We
   have before obferved that the exhalations from the
 •  river, and  the  putrid  fubftances  carried  down its
 i  ftream, might have fome agency in producing or ag-
 '  gravating the Fever.  The  French fhips to which
 j you allude*, arrived fo long before the difeafe appear-
  ed, that it would be abfurd to fuppofe even a pofIL
*                         X

    * The French corvettes, part of the fquadron, three of which
i  were taken by the Thetis, Captain Cochran, arrived and anchored
  in Hampton Roads, May 18. The Fever  did not appear in
   Norfolk till Auguft.  Capt. Cochran's crew, however, took the
   Fever from the French prifoners, and twelve of them died before
  {i.t Thetis arrived at Hallifax.----Editor. 
 152  ACCOUNT OF THE FEVER IN NORFOLK.

 bility of its being derived from them.   We are of
 opinion, that there is not the moft diftant reafon to
 believe the Fever was imported at all.

   How far  in towns like ours,  the cuftomary diet ;
 and general mode of living, may operate in  produc-
 ing putrid difeafes, remains for future  obfervation
 to determine.

   It has  been noticed  by feveral medical  writers,
that frefh  meats, and particularly beef in fouthern '■
climates, apparently generate fluxes and other ma- ;
lignant difeafes ;—upon the latter kind of food, and \
on frefh fifh (both of' them frequently not of the beft
quality)  the  poorer clafs of inhabitants fubfift during
the fummers.   Thofe whofe circumftances permit
them to  purchafe the beft kind of meats and fifh, cer- ,
tainly experience no inconvenience from thefe kinds
of food.

   It has gone  forth that the town of Norfolk is un- ;
healthy and  fubject to malignant difeafes in a greater
degree than others.  We may venture to affert and J
truft can prove, that there are as few deaths  in Nor-
folk in the average of three years, as in any  town of m
the fame fize—not only in America, but in any part 1
of Europe,  Afia or Africa, and with regard to  its .1
natural  population, a view of the ftreets  will prove m
that there  are as many children raifed in it, as in anyM
town whatfoever.   It fhould be remembered  that the II
place has arifen from its afhes, in the courfe of a few
years—that  moft of the new fettlers have been Eu-
ropeans, a people from northern climes.   That there
are always a thoufand or more failors, and ftrangers
who are fubject to the difeafes of new comers—that
almoft all who die, are carried for interment through
the principal ftreet.  . Hence, thofe who  are unac- 
      ACCOUNT OF THE FEVER IN NORFOLK.   153

quainted with the town, may naturally fuppofe, that
deaths are more frequent, becaufe nearly ail that hap-
pen, are actually brought into the view of every paf-
fenger.

   Thus far we have attempted to lay before you as
well as our leifure will permit, the beft information in
our power.  We have not prefumed'to enlarge up-
on fpeculative opinions, but if our endeavours fhall
meet the approbation of thofe who may perufe thefe
meets, and you fhall think our correfpondence wor-
thy of further folicitation; we will be ready to com-
municate whatever we know, or may hereafter learn,
on a fubject fo interefting to the American commu-
 nity.

                 2fcmlor  8f  J%!an<iforclT 
EXTRACT
of dr. ramsay's (of Norfolk, Virginia) letter

   to mr. mitchill ;--concerning the pes-

      TILENTIAL SICKNESS IN NORFOLK, IN

          THE SUMMER AND AUTUMN

                   OF 1795.
     I OUR papers afforded a teftimony of efteem,
which will be a pleafant renewal of our intimacy in
Europe.  The little comprehenfive pamphlet on con-
tagion, as  you required, I have read often;  upon
that I intend now to addrefs you, without entering
upon a theoretical queftion.—Names and terms have
fettered much medical fcience in its progrefs to  that
degree of perfection, the prefent ftate of the human
mind can attain to.   I fhall fend, with little comment,
a ftatement of a Fever which prevailed with great,
mortality here,  in  Auguft and September 1795.
Confining myfelf to my own obfervations and the
fentiments of Dr. Taylor,  a veteran of 25 or 30 years
practice ; and Hansford, his co-partner, of 14.   You
remember when it  began.   The feafon very warm ;
uncommonly fo—(as the winter has been)—frequent ,
fnowersof rain—of very fhort duration, often  pro-'Jf-l
fufe—Site of the town low,  on a perfect level  with
drains on  the fides  of the walks;  not over ten or
twelve  feet from  the windows; thofe obftructed—
Animal and vegetable matter,  and  dirty linen often,
in them—Town moft rapidly enlarging—Houfes
chiefly  of wood—A great part where death made his
fweep,and dreadful was the hawl—In a part where the 
         ACCOUNT OF THE FE>ER IN NORFOLK.   155

   buildings flood upon large log frames, filled in with
   fmaller wood of pine (chiefly  the whole) that foon
   decays; this made Terra Firma by mud—Salt mud—
   Many of thofe large log pens, over which ftand tene-
   ments, now even are not filled in, but actually ferve
   as a receptacle for the offals of large and poor fami-
   lies, fo great a majority, as nearly to conftitute the
   whole inhabitants of that part  of the town.   Being
t  foreigners, they dealt lavifhly in beef, fifh, and all
(,  kinds of frefh food—obferve, this beef was driven
]  perhaps from one to two hundred miles.before killed,
 E  then expofed  in a hot market to vend ;  that by one
   o'clock, their  dining hour,  I always did, and do be-
 '  lieve, it muft have been tainted—Obferve, the fifh all
   dead by break of day, and brought  by land  from
   twenty down to twelve miles—hard drinkers of fpi-
   rits, moftly.   The firft perfon who died, was Dr.
\  Williams, a fat man, with very lax fibres, a very free
   liver, a grog drinker : he  was taken with the ufual
 ;  fymptoms of what an old writer upon the difeafes of
 I  the Weft-Indies, calls a Bilious  Remittent; he vo-
 •  mited vaft quantities of bile; evacuated freely, as
I  appeared to me below, but had always a prodigious
4,  fenfe of weight in the region of his ftomach.  Belched
I  wonderful quantities of wind ; this relieved him for a
m  time.   The moft fuffufion of bile in his eyes, nay all
\  over the body I ever faw, which increafed as he vo-
   mited, and continued until  petechias came on, with
....,  a vomiting of black offenfive matter, which continued
   24 hours, when a fit or two terminated his career.—
|£: -How he was treated, I never inquired, though he was
!;  my friend.  One or two more natural born  citizens,
   were the whole, out of upwards of two hundred and
]•  twenty, who in the fpace of fix weeks, fell a victim
   to this difeafe.   The fymptoms were the fame  in all5j
   except  an  obftinate  coflivenefs—The natives live
   chiefly  on  falted meats and fowls, or other kinds of 
1^6  ACCOUNT OF THE FEVER IN NORFOLK.

poultry, which are killed but a little time before dreiT-
ing, and the better fort have the greateft variety of   j
vegetables, are in more airy fituations, and  not   j
crouded  together; and upon my word, far  more   J
healthy this year than I have feen them before.   We   .>,
need not extend our views acrofs the Atlantic for   <
fources of difeafes; there are too many among our-  ,
felves  as you remark, and  whether the principle'
takes Culkn's, RuHTs,  or your own name, putrid
animal vegetable matter, united or mixed in water,
by the heat of the fun,  produces fomething  noxious.
to life.                                            !

  The object  then deferves the attention of the po-
lice, and when medical  aid is needed, my plan is to
allay the irritability of the ftomach ;  to exhibit injec-
tions ; to increafe the action of the alimentary canal
downwards,  which  gives  me an  opportunity  of
throwing in a  cathartic to evacuate the whole tract;   J
this I fometimes repeat, if the diftenfion of the  fto-
mach returns.  Often when the vomiting inclined me
to believe there would be a difficulty in my intention
of evacuating as above; I have ufed with fuccefs, co-
pious draughts of hike warm water, fometimes grog—
the patient puked eafier,  and generally more  bile,.;
and the fpirits  acted as a moderate ftimulus.  An in-  ,
fuiion of Serpent. Rad. in every ftage of the difeafe
after the foregoing practice, which appeared to claim ^
a preference to the cortix  peruv. it often  bringing™
on  a return of the naufea and puking, two of the moffcjH
dangerous  fymptoms.  The Bark, Columbo and Ma-  ■
deira wine, whenever it could be received with quiet-  ,i|
ude to the fymptom, were our fheet anchors.—'By this
mode 1 have fuccceded well. 
SUMMARY  VIEW
OF DR. MITCHILL S OPINION CONCERNING THE

      CAUSES OF  EPIDEMIC  DISTEMPERS.
     JTlE begins by examining the conitituent parts
of the atmofphere, and agrees with the modem phi-
lofophers, that it confifls of a little more than a fourth
part of oxigene gas or refpirable air, and fomewhat
lefs than three-fourths of mephitic air or azotic gas.
Thefe exift together in the form of a mechanical mix-
ture, but not in a ftate of chemical combination ; and
thus the volume of atmofpherical air, whofe two forts
of particles, move freely to and among esch other, in
common circumftances, contributes to thefupportof
fire and animation.

   But though the ingredients of the atmofphere exiit
in a diftinct and feparate form in ordinary cafes,  yet
this  is not univerfally the fact.   Oxi^er.s, the bafis of
vital air, and azote, the bafe  of foul air, though fre-
quently disjoined, do however poffefs attractive pow-
ers,  ftrong enough to make them oftentimes  com-
bine.  The chief impediment  to their union,  is  the
clofer affinity which they, in their gafeous or  aerial
forms, poffefs for the caloric or matter o*  heat con-
nected with them, and from which they derive their
properties  as  elaltic fluids.  Whenever,  therefore,
oxigenp  and azote can come together without aflum-
ing the intervening form of gas or air, then they wail
unite according to the law of chemical affinities, and
conftitute by their junction,  a body or compound, 
I58     DR. MITCHILL, ON CONTAGION.

pofTeffing qualities very different from either of the
conitituent elements.

  It is known from experiment, that both thefe ele-
ments enter into the compofition of animal and vege-
table fubftances.  When oxigene unites with mere
caloric, as  in Fontana's experiments on infects, and
Ingenhoufe's trials upon plants, then vital air will be
the miafma proceeding therefrom.   When azote ef-
capes in connection with  caloric only, as  in  Mr.
Mitchill's own experiments,upon the lean and mufcu-
lar parts of animals, and upon the air collected in the
tumid bellies of animals, drowned or ftrangled, the
effluvium is atmofpherical mephitis.  When the two
fubftances enter into  combination with each other
directly and immediately, without firft taking upon
themfelves the aerial form, as in Maffey's experiments,
the product is an acid,  which, on addition of pot-afh
to it, forms nitre or falt-petre.

  Here, then, during the decompofition or putrefac-
tion of  organifed bodies, as in Thouvenel's  experi-
ments, in a range of heat equal to that which the fur-
face of the earth acquires on the American continent,
in the fummer time, is an acid compound, formed by
chemical agency, from the fame materials which con-
ftitute in their feparate  ftate, atmofpherical air;  and
capable as in Lavoifier's experiment, of being refolv-
ed into it by analyfis.   This acid, which is thus af-
forded  during  the decay  or refolution of organic
matter, confifts of the like ingredients as the air we'
live in, and differs from it but in two refpedts, to wit,
the chemical  connection of the materials and their
different proportion.   And the analogy between the.
atmofphere, plants and animals, and the acid of falt-
petre, as to their formation  arid conftitution, muft be
thus very apparent. 
         DR. MITCHILL, ON CONTAGION.      159

  Thefe points being determined,  profeffor Mitchill
crilicifes the preceding chymifts for their miftake in
claffing this acid among the mineral fubftances, con-
tends upon the authority of their own conceffions,
that it is generally the  refult of animal putrefaction ;
and profeffes a reform of the French Nomenclature,
that the language of fcience may truly correfpond to
facts.    He accordingly derives the name of the radi-
cal term, from the Greek word, fepo, to putrefy, and
calls the azote of the French academicians fepton, the
putrid principle or principle of putrefadion.   He calls
azotic air by  the  name of feptous gas, dephlogiflicated
nitrous air, gafeous oxyd of fepton, nitrous air,fepticgas,
nitrous acid, feptous acid, nitric acid,feptic acid, &c. &c.
and thereby, in the very phrafeology, the origin and
formation  of the productions, are invariably fuggeft-
ed to  the mind.

  Having  in  this way  reformed  the  language  of
Chymiftry, the profeffor goes on to inquire, what is
the evidence of nitrous or feptous acid exifting  in
the atmofphere, or in  any of its modifications, af-
fuming a volatile or aerial form. That there is fome-
thing unwholefome and noxious in  the exhalation
from  corrupting  bodies, both of the vegetable and
animal  kind, has  been  long miferably experienced,
though the precife nature of this has fcarcely been
imagined,  but has rather been confidered  as lying
beyond the reach of human refearch. He finds with
Margraaf that this very acid exifts in rain water, and
concludes with Watfon, that fnow-water is not free
from  a  tincture of it.   He agrees with  Chalmers in
afcribing to its operation, the fpeedy rufting of me-
tals in hot latitudes, where the prefence of an acid is
Y 
 ~b£>             LiR. MirCHILL,                    j

 manifeft in the atmofphere.  But he docs not flop   ]
 here ; for on  confidering that the plaifter and wall of
old buildings, has become impregnated with the fep-   1
 tous or nitrous acid in the courfe of time, efpecially   I
 if the inhabitants have lived in an unclean manner,   "i
 and the houfes have flood in the neighborhood of foul   J
 and corrupt vapours, he thinks the conclufion unde-   I
 niable that this acid muft have exifted in a gafeous or   1
 vaporific form, before it was attracted by the clay or  i
 lime of the mortar.   While in countries where falt-
 petre is found fpontaneoufly formed and  ftrewed over
 the furface of the ground, the unhealthinefs of fuch
 regions is to  be afcribed to the agency  of that very
 gas, which united in a more concentrated  ftate with
 potafli, conftitutes afterwards the nitre of the foil.——
 The tarnifhing of metallic fubftances, highly colored
 iilks, the human  fkin and countenance, he confiders
 as caufed in a great  degree by the operation of the
 fame deleterious fluid, extricated from putrefying bo-
 dies.
                                                    i
   Such  a gafeous exhalation being  now proved to
 exill, the profeflor endeavors to fliow that epidemic   .
 difeafes muft be  occafioned by it, and  not  by any
 other known  fpecies of aerial fluid.   This  mifchiev-   i
 ous matter cannot be carbonic acid or fixed air,  be-
 caufeits effects upon animal bodies are entirely of a   \
 different kind, from thofe manifefted by  infectious   ,
 ailments.   Nor can it be inflammable air or hydrogene
gas, whofe extreme  levity foon elevates it  high into
the atmofphere,  or whofe inflammability or odorous
 nature would directly make its prefence evident to the   ]
 fenfes.  Still  lefs  can it be alkaline air or ammoniacal
gas, which though  commonly  efteemed one  of  the
 refults of putrefaction, is feldom or ever afforded but
 by force of artificial fire, and if it was fpontaneoufly
 evolved in low temperatures, would inftantly lofc it? 
ON CONTAGION.              l6"l
properties by combination with  fixed air, or exhibit
them to  the noftrils  by mingling with water.   And
nobody has ever imagined it was azotic or feptous gas.

  It being thus negatively eftablifhed, that contagious
air can be neither of the fluids now enumerated, Mr.
M. inquires whether that very curious and wonderful
modification of feptous acid, called by Priestly,
dcpblogiflicated nitrous air, and by Troostwyck and
Deimann,  the gafeous oxyd of azote is not in moft
cafes the very caufes of endemic maladies ? This opi-
nion he adopts, with this latitude and extent however,
that  the feptous acid, as well in any other volatile form,
as in that of the oxyd, may be, and is productive of
extenfive and dreadful ficknefs.   It is very abun-
dantly produced in the operations of nature, and may
not only be confidered as evaporating from putrefying
fubftances, but as formed in the atmofphere,  by the
inftrumentality of lightning, after the manner  of its
production by electrical explofions in Cavendifhh ex-
periment.

   The  reafons why this plentiful  production has ge-
nerally   been hitherto overlooked,  are, ift.  That
as it has ever been confidered a mineral fubftance,
becaufe of its being  ufually procured by the decom-
pofition of nitre, no one has thought of inveftigating
its hiftory, as an animal production:  and  2ndly.
Though it is fatal to breathing animals, yet it poi-
feffes at the fame time a  power to  fupport combuf-
tion, and has few obvioufly fenfible qualities, fo that
perfons who have lived half their lives in an air more
or lefs infected with it, never once imagined the ex-
iflence  of fuch a thing.

   To thefe products of putrefaction, all of which Mr.
M. has made the fubjects of public experiments, are 
i6z
DR. MlTCHILL,
 the phenomena afcribed to human  and marfh  miaf-
 mata, to be referred.   The copious  extrication of
 fuch gafes, their local origin, their limited diffufion,   j
 their deleterious effects, all point to fome modification   ,
 of the nitrous  acid  as their caufe.   And upon the   j
 prevalence and action of this kind of fluid in the at-  J
 mofphere,  does  he account for  the frequency and
 univerfality  of endemic and epidemic  diforders; re-  j
 jeering altogether the  pretended  diftinction between.  |
 contagion and miafma,  concluding with Gardiner,
 Bingle and Carburi, that they are  but varieties of the   J
 fame thing, and differ from each other but  in de-   j
 gree.

   The exhalation from graves  mentioned  by Faur*
 crni, and from diffecting rooms defcribed by St. jfohn,
 as well as the Harmattan breezes of Guinea noticed by
 Lind, and the Simaom  blafts of Arabia, witneffed by
 Bruce ; he thinks are, in all probability, modifications
 of a fimilar aerial production.  And this may  ferve
 to give an idea  of the extent and fcope  of his reafon-
 ing on  the  occafional production of a gas, which
 while it continues to furround and inveft the inhabit-
 ants of particular fpots or countries; often deftroys   J
 their lives, or at leaft impairs their health.   The ef-  I
 feet of  this being  manifefted upon the  fkin  and  1
 lungs only,  appears in the form  of intermitting and  1
 remitting -its, and in thofe peculiar cafes of anxious  ■
 and iuill.eating fever,  cf which fome extreme and  |
 exquuite relations have been made by Lind, Chifholm
 and jackfon.

   The fame reafoning by which Mr. M. became
 convinced of the exiftence and agency of thofe vari-   \
 ous compounds of  the feptous principles, in cities,
fwamps,  and ir.nrfhes^  led him to examine whether 
ON CONTAGION.
163
    they were not fometimes produced  within the Hu-
    man flomach.   The worft diftempers we  hear  of in
!    hot climates,  occur lefs among the Natives, than
I   among the Europeans, who for the purpofes of com-
V   nierce or warfare, vifit the torrid zone.  They adapt
>    their drefs to the climate, but rarely  make any alter-
?    ation in their grofs aiid northern diet.  In hot  coun-
    tries, the digeftive powers are very apt to fail.   The
\    aliment,  particularly among the  Anglo-Americans
    and Englifh,  who  love  to eat their meat half raw,
\    foon runs into a putrefactive  mafs, and the corrofive
    acid formed in the fceptic p'rocefs,  excites that fad
    and  fhocking train  of fymptoms,  which conftitute
    and characterize the Yellow-Fever. This malady, the
    very name of which ftrikes the  citizens of the United
    States  with  terror, is fo particularly inherent  in the
    ftomach and  bowels, that Richter,Wade, and other
    well-informed practifers,  have boldly termed diftem-
    pers of this type, Inteflbial, or  Gqflric, or Dyfenieric
    Fevers.

      That the food of moft perfons who fuffer by thefe
1    complaints is in a confiderable proportion, animal,
    and putrifies in the ftomach and interlines,  no body
    has ever doubted.   In a  range of  heat, not  much
    greater than  occurs in the fubjacent earth, or fur-
    rounding air,  the products of  putrefaction muft be
    nearly the fame, in the ftomach, as cut of it; and
    the feptous principle, in fome or other of its modifi-
I   cations, be the refult.  The greennefs of the bilious
    difcharges, is  evidence enough  in many cafes of the
    exiftence of an acid in the alimentary canal; and was
    there not too  much of it produced to be neutralized
    by that  alkaline liquor,   the bile, far lefs mifchief
    would be done by it.   And while fefli-eaters are mi-
    ferably afflicted, he obferves that the Arabians, Gen-
    toos, Chinefe and Negroes, who, though inhabitants 
164             DR. MITCHILL,

of fultry climates, fubfift chiefly on vegetable fare, are
very little affected by this kind of ficknefs—Moft ve-
getable fubftances being either lefs prone to corrupt,
or if they putrefy, affording little or none of that pe-  j
culiar azotic produd which renders animal rottennefs-
fo foul and deftructive.

   Thus, upon the idea of fceptic acids and vapours,
vitiating the pulmonic functions, and thereby imped-
ing breathing, or interrupting the digeltive procefs,
and eroding and inflaming the ftomach and inteftines,
Mr. Mitchill, thinks the phenomena of moft febrile
ailments, whether of the endemic, epidemic, or dyfen-
teric ; contagious, infectious or gaftric, intermittent,
remittent or continued forms, may fully and fairly be
explained.

   Having by this mode of experimental inquiry af-
certained the proximate caufe of fever, the profeffor   1
proceeds to give a theory of it; and after the manner
of Cullen, takes a fingle paroxyfm of an intermittent
as an inftance.  Judging from its effects, he confiders
contagious air as always in fome degree ftimulant •,
though from  its non-refpirable property, operating   3
upon the lungs in breathing,  in fuch a way as by fub-   1
ducting heat and cxygene from the body, to diminifh   1
action and energy, and thus  induces a ftate of dired   ■
debility.  This debilitating procefs may  be carried  ■
fuddenly to a fatal extreme, as when the concentrated  M
peftilential air, inhaled, kills upon the fpot; or when  1
in a lefs noxious f irm,  it may not extinguifh life im-  I
mediately, but caufe  an anomalous difeafe  of three   ]
days continuance, without remiffion, or in  which   J
there are five  or fix hot and cold  fits,  in twenty-four
hours, eventually terminating in death.   In a form
yet more dilute and mild, epidemic air may occafion
common remittent and intermittent diftempers. 
ON CONTAGION.             165
   '  The cold ftage of fever, Mr. Mitchill confiders as
  depending upon impeded refpiration, and the impeded
  refpiration as  depending upon the vitiated quality cf
  the air taken  into the lungs; or in  fome flighter
  cafes,  where the flomach is originally thrown into a
  difordered condition, the lungs by affociation with that
  organ, are thrown into a diforder  too, and for a time
  perform their functions imperfectly.

     Thus  he prefumes it is, that the impeded ftate of
  refpiration, is  attended with a fmaller evolution of
  heat and oxygene in  the lungs, and confequently
  with more or lefs diminution of the circulation of the
  blood, and a proportional degree of chillinefs or cold-
  nefs throughout the body.  The duration and degree
  of the cold fit will correfpond to the continuance and
  power of the caufes difturbing the pulmonic organs,
  either by acting  upon them diredly  or indiredly
  through the medium of the ftomach.

     From the fmall quantity of heat and oxigene, com-
   municated to the blood in the lungs, and its confe-
   quent flow and feeble  circulation, can the fhrinking,
   palenefs, tremors, coldnefs, debility  and other fymp-
   toms, be fufficiently explained, as the conftitution is
   now deprived of  its two chief flimulants.   But, why,
  it may be afked, does  not the continued  operation of
   the vitiated air upon the lungs, or the affociated con-
   (dition of the lungs with the ftomach, go on in an in-
   creafing feries even unto death ?  It is a fact that fun-
   dry poifonous fubftances grow by degrees habitual to
*:.  the human conftitution,  and by  cuflom lofe theirpri-
•   mary  operation.  This difpofition to become familia-
   rized  to contagious  air, is particularly  evident, as re-
   fpects the inhabitants of Guinea and the Weft-Indies.
   The conflitutions of thefe  people are fo feafoned to
   the air  and clinuite they live in, that  in  ordinary 
 l6j             DR. MITCHILL,

 cafes, it excites in them no difturbance at all.  Now,
 common paroxyfms  of intermitting  fever, are in-
 ftances of temporary feafonings, which the conftitution
experiences,  of a kind quite analogous to what is
perpetual with the Africans and Creoles.

   The  cold fit does fometimes terminate  in death;
 and this happens when the conftitution  cannot ac^'
 quire the habit of enduring the noxious caufe with
 impunity.  In the generality of cafes, however, the
 infectious gas lofes its power of operation,  before the
 conftitution is  debilitated to death, and as  foon as it
 becomes for this time fo much accuftomed to the con-
 tagious  fluid; as no longer  to be difturbed by its pre-
 fence,the cold fit ends. The length and violence of the
 cold fit will thus be, other circumftances being  equal,
 in a compound ratio, of the impediment  given  to the
 refpiration  by  the infectious  gas,  and  the facility
 wherewith  the conftitution accommodates itfelf to its
 action.   If three perfons then inhabit one houfe, it is
poffible  that one of them may become fo quickly ac-
 cuftomed to the air, as to have no diftemper ; a fecond
 may have a moderate difeafe of a few fits; while the
 third, pcffeffed of a  conftitution not eafily moulded
 to  a  new habit,  may be incommoded by a violent
 and obftinate difeafe.

   In every paroxyfm of an intermittent, the infection
 thus wears itfelf out; but this is only a temporary recon-
 cilement of the body to its  action.   When after a re-
 petition  of fits, the diforder becomes milder  and
 milder, and after a while wholly ceafes, this is a cafe
 of lafrinv reconcilement.  And in  this  way, may a
 large proportion of fmall intermittents cure themfelves,
 while the credit of it is given to the bark!  This pow-
 er of balm daily does wonders, and labors more effect 
ON CONTAGION.
167
  tually for the good of the fick than bark, opium and
  antimony put together.

1    The attack of contagion being thus for a time over-
\  come, refpiration grows free, full and frequent; the
■  lungs ceafe to be molefted by  it; more vital air is
  decompounded there,  and more flimulus is applied
I  to the heart and arteries, by means of the increafed
.  heat and oxygene  now in the blood.  The flimuli ope-
  rate more powerfully on account of the accumulated
  excitability of the body ; and a degree of excitement
  is thence produced, which fometimes ends in death,
  fometimes caufes delirium, and in almoft.  every cafe
  exceeds the  healthy range of heat.  Perfons there-
.  fore who die in the hot fit, die of the indired debility
  induced by the  increafed heat and oxygene,  acting
  upon the increafedfufceptibility of the fyftem.

    The duration and violence of the hot ftage will be,
  other things being alike, in a compound ratio of the
  excitability accumulated in the cold ftage, and the heat
  and oxygene evolved in the hot one.  When the ex-
  citability is exhaufted by the operation of the flimuli,
  the violence of action will ceafe, and the body grow
  cool.

    The fweating ftage follows  of courfe, as  in other
 i-cafes of the fubfidence of violent action.  For after
  the exhaufted excitability of the'conftitution allows
 i exceffive action to go  on no longer, the refpiration
  grows more moderate  and eafy, the heart  beats with
S lefs frequency and force, and the arterial contractions
f.are more regular and health-like ; and as  thefe alte-
'  rations  go on, the hydrogene  and oxygene of the
•  blood, now run together in the extreme veffels of the
'  fkin, and forms the moifture which bedews, the fur-
Z 
ioci
DR. MlTClllLi.,
si
 face, and  this afterwards  flying off by evaporation
 cools by degrees the whole  body down to its ordinary
 temperature.   And as the  arterial extremities of the
 reft of the body, affume their ordinary condition by
 the  fubfidence of excitement, the other fccretions
 which had generally been  fufpended during the fit,
 now return as before.   After this, the conftitution,
 fo far accuflomed to the contagious poifon, regains its
 former  vigour and fundions, as far as the exercife
 endured^ and  the functions injured during the feveral
 fiacres, will allow.

    His doctrine of fever in fhort, is concifely this :__
 The contagious fluid, by interfering with pulmonic
 action, brings on the cold flage,  and would continue
 the fame until its termination in death, did not the
 conftitution in  the mean time, acquire fuch a habit
 as to gain a temporary infenfibility to its action.  This
 habit being induced, the cold  ftage abates by reafon
 of the ftate of  dired debility into  which the  body
 had  been  brought;  refpiration  becomes   conse-
 quently quicker ; heat  and oxygene are let loofe  in
 the lungs, and becoming incorporated with the blood
 now warm, itimulate  every  part  with more than
 ufual power, and occafion the  phenomena of the hot
flage, which terminates as foon as  the accumulated
 excitability  of the fyftem is  fufficiently exhaufted.—
 The fweating ftage next enfues, which after what has
 been faid, hardly requires any further explanation.

   The interval between one fit and the fucceeding:
 one, will be proportionate to  theflrength and duration'.
 of the habit acquired,  Some perfons thus experience
 but one fit,  and the  difeafe vaniflies; for under the
fame  circumftances,  they are never  invaded by a fe-'\
 cond.  Others fuffer two fits, or a fucceffion of fits, and ij
 after a  while become fo accuflomed  to the ftimulus, 
ON CONTAGION.
160
that if always applied in the fame degree offirength;
its effect is no longer felt upon the body.  In other
inftances again, fo hard is it for the conftitution to be
moulded to  a fettled habit of oppofition, that after en-
during a  great  number of invafions,  it  becomes
fo enervated and worn down, as at length to  die
exhaufted.

   The fpecies of fevers whether quotidian, tertian,
quartan, or  of whatever type, will be determined by
the readinefs or tardinefs wherewith the  contagion
gains  a new afcendancy over  the body, or breaks the
habit.  And to this mobility of the animal frame, or
eafe with which the habit is broken, is to be afcrib-
ed, as well the frequency of the returns, as the length
and feverity of the paraxyoms.

   The anomalous cafes of .fevers,  which have puzzled
Phyficians to explain and nofologifts to arrange, are
as Mr. M. thinks, thus very natur .lly accounted for ;
fince according to the variation of the caufe (fince the
contagious atmofphere may be more or lefs denfe or
concentrated, and may be more or lefs charged with
carbonic acid, hydrogene gas, and other non-refpir-
able airs) will be the variety in the effect produced;
and as there may be infinite  gradations in the noxious
caufe, fo there may be endlefs variations in the morbid
effect, which it  would  be impoffible to defcribe  in
words, and ufelefs if it could be  accomplifhed.

   Hence he explains why a fucceffion of fits long conti-
?iued, may difpofe the conftitution to a repetition  of
fits,  even when the morbid caufe is away.   For
though there may be a habit produced of infenfibiiity
to contagion, yet  a habit  may in the mean time be
eftablifhed in the  bodily motions, of falling periodi-
cally into trains cf adion,  ever,  when the original 
 170     DR.  MITCHILL, ON CO!

 caufe is withheld or removed.   Her    jn there will
 be produced a  habit of having pan yfms after the
 manner of temporary feafonings, while at the fame time
 there may be a habit formed of refilling  contagion
 altogether, or  of.obtaining a permanent feafoning as to   J
 that.                                               1

   And to this principle of the animal frame, he thinks   I.
 may be referred all the febrile ailments from the   1
 moft  trifling intermittent to the more ferious remit-   I
 tent, and to the folemn forms  of continued fevers ;
 without calling in the  aid, even  mentioning the   |
 names of fpafm, vis medicatrix,  or readion of the fyf-
 tem :  always wifhing to be  underftood as compre-
 hending within the prefent theory, the animal move-
ments referable to the before-mentioned caufes folely,
and not extending it to embrace common catarrh,
quinfy, pleurify,  peripneumony,  rhumatifm  and
other  difeafes of the pyrexious type, which Mr. Mit-
chill fuppofes to proceed from  another and  a very
different caufe. 
      TWO   LETTERS

  RELATIVE  TO THE  YELLOW FEVER,

AS IT APPEARED IN NEW-HAVEN, IN THE STATE
     OF CONNECTICUT, IN THE YEAR 1794.
I.  Letter from Dr. Monfon, jun. to the Publiflier,
   on the Origin, Symptoms, Progrefs,  and  Difap-
   pearance of the Yellow Fever,  in New-Haven—
   &c. &c.

II. Letter from Dr. Monfon, fen. on the Treatment
  purfued, and moft fuccefsful,  in the Cure of the
  Yellow Fever in New-Haven—Sec. &c. 
 
TWO  LETTERS
  RELATIVE TO THE YELLOW FEVER,

AS IT APPEARED IN NEW-HAVEN, IN THE STATE OF

       CONNECTICUT, IN THE YEAR 1794.
                LETTER FIRST.        ,fj

On the Origin, Symptoms, &c. of the Tellow Fever, in
                  New-Haven.
       a.
     DR. MONSON, JUN. TO THE PUBLISHER.
       A
        SIR,

     IN giving a hiftory of the origin of the Yellow,
or Peftilential Fever, as it appeared  in this City, in
the year 1794,  it will be neceffary to premife fome
account of thofe difeafes which prevailed here, imme-
diately before; that the Public may be  enabled to
judge whether there is  any  analogy  between them
and the Fever in queftion.

   Sometime in 1792  and  1793, the Scarlet Fever,
or Ulcerous Sore  Throat,  made its appearance in
Litchfield, Water-town, and the towns in  the vicinity
of New-Haven; and raged with great mortality.

   In September and Odober  1793, many of the
Inhabitants  of this town were affected  with a flight
Influenza;  flinging  pains in their jaws and limbs,
forenefs in the  mufcles of the neck, with  a light Fe- 
 174     LETTER FROM DR. MONSON, JUN.

 Ver.—In November and December following, feveral
 children were affected with the Ulcerous Sore Throat.
 The fymptoms were not alarming ; and in every in-
 ftance it  terminated favorably.—In January  1794,
 the  difeafe  affumed a more malignant appearance.
 In February, March, April,  May, June and July, it
 was highly putrid ; and many  fell victims to its ma-
 lignity.

   On the 1 oth  of June  1794, the Peftilential, or
 Yellow Fever, appeared here.—Doctor Hotchkifs vi-
 fited  Ifaac Gorham's wife,  on the Long-Wharf.—'
 She complained of a violent pain in her head, back
 and limbs ; her eyes were dull,  and flightly inflamed 5
 fhe had  naufea at ftomach, was obftinately coflive,
 with a moderate degree of Fever.  No  marks of in-
 flammation were  difcoverable,  by  inflection, in the
 throat.—The diftrefsful fymptoms, above-mentioned,
 continued till  the fourteenth ; when  her pain and
 diftrefs fuddenly fubfided j  and (he was elated with
 the profpect of a  fpeedy recovery.  In the evening,
 flie vomited matter refembling  coffee-grounds ; and
 died on the 15th.—The Phyfician, who attended her,
 was ignorant of her complaint  till he faw what fhe
 vomited.   He  then declared her difeafe to be  the
 Yellow Fever.

  On the 15th of June,  I vifited Elias Gorham's
daughter, a child of 8 years of age, in Chapel-ftreet,
three quarters of a mile from Ifaac Gorham's houfe.
She had been fick  three days; her countenance was
fiufhed with a deep  red  colour; her eyes were
dull, and highly inflamed ; fhe had violent pain in
her head, back, and limbs; naufea, and  frequent vo-
miting ; obftinate coftivenefs ;  a quick, full,  hard,
throbbing pulfe ; her fkin was  hot and dry ;  and her
tongue covered with a thick  white  fur.   On  the 
TO THE PUBLISHER.
175
   16th,  her pain and diftrefs fuddenly abated;  in a
   few hours, fhe vomited up matter refembling coffee-
t   grounds; and died the next  day.—I  infpected her
   throat, during her illnefs, and  could difcover no
   marks of inflammation.

     I was  furprifed at the fingular appearance of the
   difeafe, and hearing of the death of Mrs. Gorham
   (Ifaac  Gorham's wife)  inquired of the  mother if
   her daughter  had been on the wharf.  She informed
   me that the child had lived with her aunt (Ifaac  Gor-
   ham's wife) nearly a week.

     The 23d of June, I vifited the child's mother. She
   complained of violent pain in her head,  back, and
   limbs; naufea; frequent vomiting j  obftinate cof-
   tivenefs ;  with a confiderable degree of fever. Thef©
   fymptoms continued five or fix  days; then gradu-
   ally abated ; and foon after fhe recovered  her ufual
   health.

     On  the 20th  of June, Mr. Elijah Auftin died in
   New-York; and his clerk, Henry Hubbard, died in
   Derby.  They  complained  within three or  four
   hours  of  each other;  and Mr. Hubbard vomited
   matter refembling coffee-grounds.

     The  inhabitants  of  this town were alarmed at
   thefe fudden deaths, and requefted the Seled-Men to
   make  diligent inquiry into  the  origin of this dif-
 ■  eafe.

     On  examination, it  appeared-—That, in the be-
*  ginning of June, Capt. Truman arrived from Mar-
   tinico, in a floop that was infected with the contagion
f   of the Yellow Fever: that this veffel lay at the wharf,
!•   within a few rods of Ifaac Gorham's houfe: that fhe 
    Tf6    LETTER FROM DR. MONSON, JUN.

    had on board a chcfl of clothes, which had belonged
    to a mariner, who died of the Yellow Fever, in Mar-
    rinico ; and that his cheft was carried into Mr. Auf-
    itn's ftore, and opened in the prefence of Capt. Tru-
    man, Mr. Auftin, Henry Hubbard,  and Polly Gor-
    ham ; the three laft mentioned of whom, died,  in a
    fhort time after their expofure to the contents of the
    cheft.—Hence it is highly probable  that Mrs, Gor-
    ham caught the difeafe from the infected floop, or
    clothing.   Mr. Auftin's ftore (lands within three or
    four rods of Ifaac Gorham's houfe; and no perfon
    in town was known to have the Yellow Fever previ-.
    ous to Capt. Truman's arrival.

      June 26th,  Ifaac Gotham loft an infant child with
    the Yellow Fever ; and foon after his fon and daugh-
    ter were affected with it:—the former died.-—Solo-
    mon Mudge died on  the  30th; Jacob Thomfon's
    negro woman, on the ift of July ; Archibald M'Neil
>.    on the 9th ; Polly Brown on the 3d of Auguft ;. John
    Storer, jun. and John Hide, on the 8th : and widow  \
    Thomfon,  on the  10th.—Jacob Itiomfon's  negro
    woman, Solomon Mudge, Johr. Storer, jun. and John
    Hide, had vifited Mr. Gorham's houfe, a few days
    before their illnefs; Polly Brown and Mrs.  Thorn- v,
    fon, nurfed in Mr. Gorham's family ; and Archibald
    M'Neil nurfed Solomon Mudge.—Elias Gill, died on J
    the 12th of Auguft ; and Samuel Grifwold's wife, on M
    the 7th: the former, vifited Mr. Gorham's  houfe j 1
    the latter nurfed in his family.

      There were a number of perforfs  who caught the
    difeafe at Mr. Gorham's houfe, and  recovered.

      Mrs. Thomfon, on the firft day of her illnefs,  was
    iT'Oved half a mile from Mr. Gorham's, into George-
    :;r:-ec.  Luther Fitch caught the difeafe from Mrs. 
TO THE PUBLISHER.
'77
Thomfon, and communicated it to his  fervant maid.
Both recovered.—Mr. Fitch lives in College-ftreeJ,
nearly three quarters of a mile diftant from Mr. Gor-
ham's houfe.—I  could trace  the difeafe throughout
the town.   No-perfon had the Yellow Fever, unlefs
in confequence of attending the fick, or of being ex-
pofed by nurfes,  infected- houfes, clothing, or furni-
ture.

   I have  inquired  of feveral aged perfons  in  this
town, relative to the Yellow Fever, whether they knew
of its having ever been here, previous to June 1794,
and there  is but  a fingle inftance ; the facts relating
to which are  thefe:—In the year 1743,  a tranfient
perfon, by the name of Nevins, who came from the
Weft-Indies,   lodged at the  houfe  of  Nathaniel
Brown, an inn-keeper, in this city.  The man was
taken  very fick, in  the night;  and died  Inertly
afterwards ; and his  body was  very  yellow,  after
death.—Mr. Brown's wife fickened  in a fhort time,
and died,  of the  fame complaint; which was, at that
time, fuppofed to be the Yellow Fever.

   I am credibly informed that feveral perfons, at Milv-
River, in Fairfield county, and alfo at New-London,
died with  the Yellow Fever, in Auguft and Septem-
ber 1795..  It was propagated there by infected per-
fons from New-York.

   Capt. John Smith died in this town, the 20th of
Auguft 1795.   He  caught the difeafe in New-York,
and communicated it to one of his negro fervants. 
t78
LETTER FROM DR. MONSO.M. • JN.
   The following is an account of t-   number who
 died, with the Yellow Fever, in  Ne .-Haven, in the
 different months of the year 1794.

         June.......6
         July.....>  •   3
         Auguft......16
         September.....26
         October......12
          November.....1

                     Total,          64


   Of this  number, forty-eight  vomited matter re-
fembling coffee-grounds, or port wine.—There were
about a hundred and  fixty perfons who had  the
Yellow Fever.—Three perfons recovered who  vo-
mitted matter like  coffee-grounds;  but none  re-
covered, that I remember, who vomited  matter re-
fembling port wine.—Some vomited a vifcid, tough
mucus, fimilar to the white of an egg ;  others, mat-
ter like chocolate;  which were as fatal as the black
vomit.

   The Yellow-Fever was attended with fpecific con-
tagion in every inftance, and proved equally  mortal
in every part  of  the  town,  in  proportion  to  the
number that were fick.   No age, nor fex, were  ex-
empted from it's ravages.   All defcriptions of peo-
ple were alike fufceptible  of  receiving the  conta-i
gion.

   In  the month of September,  when  the Yellow
Fever ^ raged with the greateft violence, the inhabit-
ants,  in general,  were almoft entirely  free from
every other complaint.  It was remarked by the 
TO THE PUBLISHER.
179
citizens,  that they never knew it fo healthy, at that
feafon of the year—excepting the Yellow Fever.
  The following is an accurate regifter of the r;uia-
ber who died of the Scarlet-Fever, or Ulcerous Sore
Throat, in 1794.
February . . March . . April . . May . .	• 3 • 5 • 5 . 10	July . . Auguft September October	• 7 • 3 2 . 2
June . .	• • J5		—
	38		14 33
Total,
52
  It was computed that 750 perfons had the Scarlet
Fever.—This difeafe appeared in almoft every family
in town, indifcriminately;  and was  evidently,  an
Epidemical  difeafe,  which originated in the confti-
tution of the air,—while the Yellow Fever was prci-
pagated only by contagion.
  The  fymptoms  of the  Yellow Fever, generr.ily,
were as follow:—Languor ; laffitude ; rigors; a dull,
heavy, inflamed eye, with a dilated pupil;  the coun-
tenance flufhed, with a deep red color ;  violent pain,
in the head, back, and limbs; naufea;  frequent vo-
miting of matter highly bilious ;  bitter  tafte in the
mouth ; tongue covered with a thick, whitiffi or yel-
low fur ; a very quick,  full, hard, throbbing pulfe;
fkin hot and dry ;  thirft very inconfiderable ; obfti- 
l8o    LETTER FROM DR. MONSON, JUN.

nate coftivenefs—and  when flools were  procured,
they were of a bottle-green color, or refembled tar,
or molaffes :—Thefe were the general characteriftics  'J
of the difeafe; when it appeared highly inflammato-
ry.—In fome  inftances, the pulfe was very flow-—  J
diminifhed in frequency below the healthy flandard—r- -J
and very feeble ; there was great oppreffion about   :
the precordia ; faintnefs ; difpofition to coma; a filly *m
look of the eye ; exquifite irritability of the ftomach ;
conftant vomiting; faultering in the fpeech; the coun-  j
tenance of a tawny, or copper color ; tongue moift,
without any fur, and  of  a bluilh or coal black ap-  '
pearance.—In  fome I obferved a  tort,  quick, fmall
pulfe, and fometimes flow, which would rife on bleed-
ing, and become quicker and fuller.

   Where the difeafe raged with great violence, and
was highly malignant, the remiffions of Fever were  ;
fcarcely perceptible to  the moft attentive obferver.     '

   The pulfe would continue hard and full, till within
a  few hours before death; when the pain,  diftrefs,  J
and fever, would fuddenly abate, and the pulfe  re-  J
turn to its healthy flandard.  Soon after,  the  fick  J
were affected with a vomiting of matter,  refembling  J
coffee-grounds, or port-wine ; or with a  coldnefs of  :
the extremities, which gradually increafed,  till death  1
clofed the fcene..                                 M

   When  the difeafe terminated favorably, there was  1
a  gradual remiffion of the fever,  pain, diftrefs, nau~ J
fea, and vomiting.                                 1

   Some were affected, on the third or fourth day,
with  hemorrhage,  from the nofe  and gums ; and. .J|
fometimes,  thefe fymptoms would'occur at a later
period. 
TO THE PUBLISHER.
181
     Others were affected with petechias, carbuncles,
   and livid fpots, on the face and breaft, as large as a
   dollar.   One patient had a number of livid blotches,
   as large as a damfon ;  fome of which difcharged a
   dark-colored, bloody matter.  This patient recovered,
   on the  27th day of the difeafe.

     A young woman had the black vomit, on the third
   day of  her illnefs.  On the fixth, fhe had a large ab-
1   fcefs form,  on the fuperior part of the right thigh,
   near the head of the Os Femoris;  and a large car-
   buncle, on her loins, of the bignefs of  a common
   fized bread cake,  and of a  livid color.   It  fuppu-
   rated on the tenth day; the mortified parts floughed
   off, and denuded the fpine.   On the fame day,  fhe
   had a deep abfcefs form on the left thigh, nearly op-
   pofite to the one on her right.   Thefe abfceffes pro-
   duced deep, finuous ulcers, which  did not heal till
[   the fourth month of her ficknefs. On the fifth month,
   fhe was able to walk, with the affiftance of crutches;
   and foon after regained her health.

     Capt. David Phipps's wife, on the ninth day  of
   her illnefs, was affected with the hiccoughs, and died
   on the  eighteenth.  On the feventeenth, fhe expec-
|   torated matter of an orange green colour, and ex-
[   tremely fetid.—I have mentioned this circumftance
;,   as a rare occurrence ; very  few being affected with
   hiccoughing, or fubfultus tendinum.

f    The Yellow Fever generally proved fatal on  the
1  third, fourth, fifth, and fixth days. There were three
J  or  four inftances of its terminating fatally in thirty-
   fix hours.  If the patient furvived the feventh day,
,  .he almoft always recovered.  At this.period the fever
   frequently appeared to make a  complete  crifis.   On
   the eighth day, it affumed the type of a double re- 
  182     LiTTER FRX3M DR. MONSON, JUN.

  mittent:  two diftinct renditions were evident in the
  courfe of twenty-four hours, accompanied by profufe
  and intolerably fetid fweats, and often with white and
  read miliary eruptions.  This fever feldom made any   |
  regular  crifis.   It  often continued till the  twenty
  third or twenty fourth day, and abated gradually.—
  In the courfe of the difeafe,  they often vomited  a
  large quantity  of  green bile,—refembling  the ex-  J
  preffed juice  of red pepper  leaves.   This  evacu-
  ation  feemed  to  relieve the  difagreeable  naufea
  which moft of them were  affected with.—The dif-
  charge of bile was commonly the effort of nature ;
  gentle emetics, feldom or never, procuring a dif-
,  charge of bile.

   I faw two inftances of reinfection.

   The effects of the contagion were, generally, obvi-
  ous on the third, fourth, or fifth day, after expofure.
  In one inftance they did  not  appear till the  thir-
  teenth.
                                                     i
   The bodies,  of thofe who died of the Yellow Fe-   ;
  ver, were either of a tawny, or copper color : Some   j
  were of a deep yellow ; and one almoft of an orange  J
  green.  Three appeared as if  they were fprinkled  i
  with ink.                                          1
  In refpect to the origin and nature of the difeafe   <
under confideration, I efteem it juftifiable to reafon   i
from facts alone.   I am fully  of opinion that  the.
Yellow Fever is feldom,  or never, generated in this
country, and that it is always imported from abroad.   *j
An objection to the idea of its being generated in this
country is, that it was never known in the interior of
this ftate,  or of the United States; fo far as I can 
TO THE PUBLISHER.
•83
  learn.   Had it ever appeared in Connecticut, before
  the year 1743* and June 1794, we fhould, undoubt-
  edly, have had fome record of the fact.  There is no
  fuch record, and no perfon remembers to have heard
  of fuch a difeafe, but at thefe  periods, prevailing in
  any part of the ftate.   There are numbers of aged
t  perfons in New-Haven, who remember  the Putrid
  Ulcerous Sore Throat, Small-pox, Meazles, Dyfen-
  tery, &c. raging here, with great mortality ; but have
  no recollection of any Yellow Fever.  Hence we may
'  rationally conclude that it never did  appear, in this
  ftate, but in the years 1743, and 1794.

     It is evident,  from facts before-mentioned, in this
  letter, that the Yellow Fever was propagated in no
  other way than by contagion ; and that this  is a. fpe-
  cific contagion, and no  more diverfified, in its opera-
  tion on the human fyftem,  than that of the Small-
  pox and Meazles.
     If the citizens of large commercial cities were  at-
 : tentive in tracing the origin of the Yellow Fever, on
  its firft appearing among them, they would often find
  that the difeafe was imported.  In fome inftances it
  would be extremely difficult to difcover the origin.—
  But the mifchief lies in this—that the inhabitants of
  fuch cities, whenever a contagious difeafe makes its:
 ; appearance among th»em,  endeavor to  fupprefs all
 I rumor of it, from an apprehenfion of alarming  the
 ■ country, and injuring their commerce : unwilling to
 J' believe  that there is evil in the city, till the difeafe
5. fpreads  in every direction.   Then, indeed, when it
| is too late, they are folicitous in the ufe of means to
( arreft its progrefs,  As it extends itfelf flowly, at firft,

                        B b 
184    LETTER FROM DR. MONSON, SEN.

feafonable exertion might both detect its fource, and
prevent its iricreafe ;  but when it is diftufed through
a city, it fpreads with rapidity, and it is no longer pof-
fible to difcover where it began.—But as, whenever!
the Yellow Fever has appeared in the United States,
it has always been in fea-port towns, and originated
near wharves, docks, and warehoufes, there feems to
be high probability that the difeafe is imported.

                   With  fincere efteem,

                      I am yours, &c.

                          ELIJAH  MONSON.

  New-Haven, April 24, 1796.
LETTER SECOND.
I
On the Treatment  moft fuccefsful in the Cure of the
  Yclkzo Fever, in New-Haven, in 1794, &c. &c.

      DR. MONSON,  SEN. TO THE  PUBLISHER.

       DEAR SIR,

   The  communication which accompanies ^ this,
from  my  Son,  contains  an account,  fufficiently
minute,  of  the origin, fymptoms, fatality, &c. of
the Yellow Fever, as it appeared  in New-Haven, in
1794, together with  his reafons for believing it to be
a difeafe  of foreign  derivation, and of fpecific conta-
gion.—I  have referved  to myfelf the talk of convey-
ing to you fome  information refpecting the plan of
cure generally  adopted ;  on the juvantia and ceden-
tia;  and relative to  fporadic cafes  with fimilar fymp-
toms.
I 
TO THE PUBLISHER.
l85
  In June 1794,  when  the peftilential  or Yellow
Fever, made its firft appearance here, the Scarlatina
Anginofa  was rife, with great malignancy.  It did
not, at all, admit of the  ufe of the lancet; but, on
the contrary, we found the bark, mineral acids, and
high flimulating cordials, moft fuccefsful in promot-
ing the cure.  This Fever exhibited confiderable va-
riety  of  fymptoms, in different circumftances and
habits.  Sometimes, the forenefs of the throat pre-
ceded the fcarlatinous  efflorefcence ; at others, the
cuticular eruption appeared previous to the difficulty
of  fwallowing  and forenefs  of the throat: and in
others, again, there was  no  eruption on the fkin,
from firft to laft, and only  a temporary complaint in
the throat, but a gangrenous affection of the Tenuis,
which was foon communicated  to the habit, and
proved fuddenly fatal.   The Scarlatina Anginofa be-
ing thus  the conftitutional Epidemic,  and ufhered
in with many of the fame fymptoms with the fuper-
vening Peftilential Fever, it will not  appear very ex-
traordinary that,  on its  firft appearance, the one
fhould be miftaken for the other.  This  was the cafe,
in refpect to a number of thofe firft feized with the
Yellow Fever ; who  being treated  with bark and
cordials,  without much previous evacuation,  rarely
recovered.   Indeed, of feventeen, or eighteen, who
were earlieft affected, fourteen died.  But, whether
this fliould  be afcribed to  the  treatment,  at this
period, folely, or to the nature and virulence of the
infection, I am not fatisfied.  For I am confident that
the Fever affumed a more malignant afpect in thofe
who  received the infection from the Fcmites of the
difeafe  (which  was moftly the  cafe at  firft)  than
where it was derived immediately from  the bodies pf
the fick : which obfervation, if juft, confirms the opi-
nion of Dr.  Cullen, refpecting contagion. 
I 86     LETTER FROM DR. MONSON, SEN.
  This extraordinary mortality having convinced us
of the impropriety of trufting to, or ufing, cordials,
bark, &c. we, with one accord,  had recourfe to the
lancet;  endeavoring, at the fame time,  early  to
cleanfe the firft paffages with ftrong purges, compofed
of Jalap, Calomel, and Aloes : for the fick were ob-
ftinately coflive, in general, and required much phy-
fic to move them, and frequent repetitions  to  keep
the bowels open.  Thefe evacuations were very evi-
dently attended with the moft fpeedy relief  of head-
ach, naufea, and oppreffion ;  the flools procured, by
the purges, were commonly of a greenifh, or dark bi-
lious tinge ; and, where the bile was brought off co-
pioufly,  it was not ufual to fee that yellowifh fuffufion
of the eyes,  and furface of the fkin, throughout the
courfe of the difeafe, which was formerly accounted
a principal  diagnoftic,  and has  given name to the
Fever.

  The repetition of the lancet was neceffary, to third
or fourth day, in fome habits, as were the mercurial
purges.

  There was little dependence to be placed on diapo-
retics, by reafon of the extreme irritability of the
ftomach.

  Baths and fomentations, in fome cafes, were highly
palliative.

   The fermenting mixture, fometimes reftrained the
vomiting.  This effect  was,  likewife, produced by
blifters, applied to the region of the ftomach.  When
applied  juft above the knees, they  appeared to be
attended by  decided  advantage, in diminifliing the
frequency of vomiting,  relieving the head, palliating
nervous affections, removing coma, and encouraging
diaphorefis. 
TO THE PUBLISHER.
187
     Clyfters,  often  thrown up into  the bowels, were
  peculiarly ferviceable, not only to  affifl in effecting
  the more eafy and thorough tranfit of the Phyfic,but
  to cool the bowels, attenuate the vifcid colluvies, and
  difpofe to perfpiration.

     The Bark, in the decline of the Fever, anfwered a
  good purpofe, where it could be retained; but there
  were but very few  who  could bear it in fubftance,
  and not many in any form.

     Opium, whether adminiftered to relieve pain, or
  flay  the vomiting, was obferved to have the moft
  pernicious effects ; efpecially in the early ftage of the
  difeafe.  A man and his wife, who had been accuf-
  tomed to the ufe of Laudanum, on former occafions,
  when feized  with the diftrefling fymptoms of this
  Fever, had recourfe (in the beginning of their illnefs,
  and previous  to any  medical advice) to  the liberal
  ufe of that medicine, for the relief of their pains ; and
  both died in about thirty fix-hours.

     A free, cool, well-ventilated apartment was of the
  greateft importance.

     The paffions of the mind had a very fenfible effect
  on the fick.—The paffion of fear, in particular, was
  not only highly predifpofing to the reception of the
  contagion, but a very fatal concomitant.  Hence the
[  pufillanimous and fearful, when expofed to the caufe
  of the difeafe, rarely efcaped ; and  hence the  fatal
|  confequences  which, in fundry inftances, followed
  from funeral knells, which  were, in general, mani-
  feftly detrimental.

     On the 6th of September, I was myfelf feized
  with the common fymptoms of the Fever.   My ha-
  bit being liendcr, and as  I had been worn down with 
I 88     LETTER FROM DR. MONSON, SEN.

fatigue and much expofed to the night air, I was cau-
tious of ufing the phyfic in the quantity I had been wont
to  give it to my patients ; at the fame time  fearful I
fliould not be able  to retain it on my ftomach.   I
found, by the gradual introduction of it, I had, by
the third  day,  confiderably affected my habit with
the mercury.  I no fooner perceived my gums and
fauces touched, than I found that almoft intolerable
oppreffion  about the precordia yeilding and fubfid-
ing.—Upon reflection, I recollected a circumftance
which before I had not attended to—That, where
the mercury, in the purging pills  generally ufed, had
fo  far infinuated itfelf into the habit as to produce
any forenefs of the  mouth and gums, the patients had
univerfally recovered. I mentioned this circumftance
to my brethren of  the faculty, who, on recollection,
sffured me that their uniform experience confirmed
the fact: none of them having loft a patient, where
the mercury had produced ptyalifm.

   Thenceforward  our main  object, after  cleanfing
the firft paffages, was to introduce mercury into the
fvftem, as fall as poffible, both by the ftomach "and
by friction.—This  appeared to be a more eligible and
fuccefsful treatment,  than to  repeat the  mercurial
purges; through the courfe of the Fever.

   Notwithftanding the evident fymptoms of inflam-
mation, in this Fever, I cannot fay but that, in fundry
inftances, large  and repeated bleedings appeared  to
fink the patient,  and proved detrimental;  and purg-
ing, alfo,  was fometimes, carried to excefs.   Yet, in
no inftance, v as bleeding pufhed to near that extre-
■irty, as was often practifed in Philadelphia.—I would
ra t,  however, be underltood,  in any meafure,  to
c:nfure the practice of the faculty in Philadelphia ;
£.'!• it is well known that  difeafes of the fame name 
              To THE PUBLISHER.           189

and type, at different times and  places,  require dif-
ferent treatment.   The Yellow Fever, too, when it
prevailed among us, may be fuppofed to  partake, in
fome degree, of the nature of the conftitutional epi-
demic  then exifting;—I mean the Scarlatina Angi-
nofa, in which nothing  was more fatal than the lan-
cet :  for, whatever inflammatory fymptoms appeared
in the beginning, there was almoft univerfally, a fud-
den transition, from the inflammatory, to the putrid
diathefis, which  called for  the early ufe of tonics,
and highly ftimulating  cordials.  And  the Yellow
Fever,  though ufhered in with ftrong inflammatory
fymptoms,  yet terminated,  when fatal, with thofe of
an oppofite nature.
     There were no diffections made in this town ;  but,
   from all the fymptoms attending, I could , not have
   entertained a doubt of finding a morbid affection  of
   the liver, had not gentlemen of the faculty, and emi-
?•  uent in their profeffion, in Philadelphia, and in other
   places where this Fever has prevailed,  decided to the
   contrary.   But there has never been,  I believe, any
;   uniform appearance of this Vifcus difcovered on the
[   diffection of thofe who have fallen a facrifice to this
   difeafe.—But  if  the liver be not primarily affected,
;   may it not be a queftion whether the remarkable yel-
   lownefs, noted in the eye, and over the whole furface
   of the body, be any thing more than a confequence
;i  of that  coftive, torpid ftate of the inteftines, in the
< v early ftage  of the  difeafe, which, by retaining the
   bile,  now conftantly pouring into them in its ufual,
   or perhaps increafed quantity (as may be fuppofed
[   from increafed excitement  of Fever)  allows an ab-
f   forption by the Cacteals to take place, and thus pro-
['•'  duce  this phenomenon—according to  the fuggeftion
   of M. Portal ? 
190     LETTER FROM DR. MONSON, SEN.
   Many circumftances feem  to favor the idea that
the liver is affected primarily : fuch is the pain, either   ,
dull or acute, fo univerfally perceptible on preffure   <
with the hand  on the  region of that  vifcus,  and   !
which increafes with the difeafe;—(and I have known  j
it to that degree, that  half the weight of one's hand  m
would  produce  fwooning)—and fuch, alfo, is  that  1
tenfity  and  diftention  of  the integuments.—Both
Warren and Hillary fuppofed the liver to be the feat
of the Fever ; and Dr. Broag, who performed many
difiections in this Fever, and  in the Dyfentery of hot
climates, obferves that the liver was almoft always
found  difeafed.   And Dr. Hunter remarks, that a
difeafed ftate of the liver and fpleen has an intimate
connection with  the difeafes of hot climates.

   But  whether the difeafe of the ftomach and intef-
tines precede that of the liver,  or the reverfe, they
muft all be more or lefs affected, in the progrefs of
the Fever.   For it cannot be fuppofed that fo violent
and long-continued a derangement of the alimentary
canal, as is evident in the Yellow Fever, could take   j
place, without extending its diforder to the functions   ..
of the liver, if not to  its  very fubftance.—But per-  U
haps a decition on this point can make little altera-*' jj
tion in the method of cure;  a local inflammation in  J
any of the Vifcera being, doubtlefs, to be fubmitted-^
to the fame general plan of treatment.              V
  There is nothing in the hiftories of the Yellow   i
Fever, which  I have feen, more extraordinary than
that  gentlemen, clearly eminent in  the  profeffion,
fhould fo decidedly give it as their opinion that the  A
difeafe is not infectious.  Dr. Hunter remarks that,   I
in no inftance, did the Yellow Fever prove more in-   1 
                  TO THE PUBLISHER.            I9I

   fectious than the Remittent; and that it was to  him
   matter of confolation to be able to declare it not to
   be an infectious difeafe.  And Dr. Mofely, if I am
,,   not miftaken, is of the like fentiment.—Now, with us,
   the contrary of this is demonftrated by the moft ob-
I  vious facts.

      In a climate where the  difeafe is not epidemical,
 i  and  where it is not  generated,  we are under advan-
   tages to decide, with much  more certainty, in refpect
 1  to its infectious nature, than we fhould  be  in a hot
   climate ; where the long-continued heat, in conjunc-
   tion with a number  of  other caufes, is productive of
   the diforder, and where it would, therefore, be very
   difficult to determine when the Fever was conftitu-
   tional, and when propagated by contagion.

      We have never, in this part of the country (except
I  in a  fingle inftance in  the year 17435 mentioned in
[  the  preceding letter) been  acquainted with a Fever
■  altogether  fimilar to the   one  in  queftion.  True,
I  fome chronic complaints in the vifcera, as well as
§  acute fporadic fevers,  ending in fphacelation,  have
i  been attended with the vomiting of a fluid, putting
I  on the  appearance of coffee-grounds, and terminated
JL  in a  black vomit.  We have often feen continual en-
p  demial  fevers, intermittent, and  remittent bilious
   fevers, originating from the putrid gafes of animals
m  and  vegetables  commixed,—as from  draining of
■  ponds and ftagnant waters:—but no difeafe  from
   thefe fources, or any in our climate, I conceive,  ever
 V  compared with what is generally known by the name
 :  of the Yellow Fever—no  difeafe  attended  with fo
   great rapidity, or characterized by that deep-fhaded,
 K  univerfal yellownefs, and vomiting of black-colored
1   matter—oozing from the furface of the ftomach.
                         C  c 
192     LETTER FROM DR. MONSON, SEN.

  Dr. Ferrier obferves, that peftilential diforders are
not to be afcribed  to  animal putridity.   Inftances
have been adduced in which thoufands of dead bo-
dies, have been left to putrify  on fields of battle,
without producing peftilential fever ; nor have fevers
been obferved to originate, or to rage more feverely, ^
in houfes furrounding Church-yards;  though the M
ftench is often  infufferably  offenfive. And, fays the J
fame author, it is a queftion whether the dead body
of a perfon who perifhed with the plague or fever, be 1
capable  of communicating  infection.—I conclude, 1
then, that the contagion of the Yellow Fever is ifpe-  I
cific contagion ; and that, in this climate, it is propa-  I
gated by animal poifon, in a gafeous form, proceeding
from a living human body difeafed—and in no other
way—and fuppofe it to act immediately on the  ner-
vous fyftem.
  In hot climates, where the Yellow Fever is gene-  ,
rated, there is a combination of caufes that  do not
exift here.  There is, Dr. Blane tells us, fomenting
peculiarly noxious in the land air.—The moft perni- J
cious practice, to Europeans, when newly arrived in
hot climates, is exercife in the heat of the fun.  This,
joined to intemperance, renders fuch climates fo fatal
to foreigners.—Befides the obvious effects of bad air, M
depending on heat and moifture ; the Dr. mentions W
feveral inftances of the fingular quality of air in par- ■
ticular places—which, though its influence cannot be  1
accounted for, has yet certainly the effect of produc- M
ing the  difeafes peculiar to fuch places. 
TO THE PUBLISHER.
J93
  I regret that my leifure, from the avocations of bu-
finefs,  will not permit me to furnifh you with a more
ample and better arranged ftatement of the facts and
reafonings, in relation to the prefent fubject.—Next
to our  acquaintance with the Deity, and  the terms
of acceptance with  him, the knowledge of the natu-
ral evils to which human nature is fubjected, and the
means of avoiding,  and removing them, demand our
higheft and molt ferious attention.—To this end,  I
highly approve of  your defign ;  and that profperity
may attend  you, in your laudable undertaking, for
thefe purpofes, is the ardent wifh of

                     Your Friend, and

                       Humble Servant.

                          ENEAS MONSON

   New-Haven, April, 1796. 
 
                      ■f
        LETTER,
OF DR. REYNOLDS, TO THE PUBLISHER.
         SIR,

       1 AM happy to hear that you purpofe collect-
  ing a hiftory of  the Epidemic Bilious Fever that has
  of late made fuch ravage in feveral places in  Ame-
  rica. By thus placing within fo fmall a compafs, the
  practical experience of thofe who have had an op-
  portunity of treating and being acquainted with that
  difeafe, much ufeful knowledge of the fubject may be
  diffeminated, and the  general good of mankind pro-
  moted.

     To aid this undertaking, I fend you the following,
j  which if you think worthy of notice,  will find a place
  in your collection.

y     For the fall and winter of the year 1792,  and in
  the  fummer following,  an Epidemic Bilious  Fever,
  appeared with much violence in the town of New-
[  Galway.

     In general the firft attack was not fevere—for one
\ or two of the firft days, the patient might rather be
\  faid to be unwell, than fick.—But this ftate continued
\  not  long—foon  a violent fever,- with fevere pains in
  various  parts of  the body, commenced—very fre-
  quently a naufea and vomiting, and fometimes a vio-
  lent purging, were early companions of this difeafe.
  In patients "of a delicate conftitution, the pulfe was 
ig6       LETTER FROM DR. REYNOLS,

fmall  and quick from the beginning; but in others
of a more robuft  habit, the pulfe was  full and in
fome  cafes very regular, although  the  other fymp-
toms  were much  aggravated.—They feldom com-   ;
plained of much  thirft after four or five days, al-
though the mouth and tongue were dry and foul.—   *
Moft  of  thofe cafes that proved fatal continued till
after the twelfth day, and  many till the twentieth  $
from  the onfet of the diforder.
                                                  3
                                                  I
   In  fome few  cafes  at the beginning of the  difeafe,
bleeding appeared to  give fome relief.  But in moft
of the inftances where I had an opportunity of ob-
ferving its effect, it was evidently hurtful.—The fame
I can teftify  with refpect to  frequent purging.

   My general  mode of treating this difeafe, I pub-
lifhed in  the Albany Regifter (a copy of which I fend   ]
inclofed)—And I have fince frequently had the fatif-   ;
faction to hear  from  gentlemen of the  faculty, that
my mercurial method had proved remarkably bene-
ficial  within their experience.—'Tis not within my   ,
power to trace the origin of this difeafe,  in this place,
to any known caufe.   The country  has been im-
proved  about ten years, and  previous to this,  and
fince, has been remarkably healthy, except a  fmall
number of cafes of the Maligna Angina, which not (
only  occurred  in  this,  but in all  the neighboring!
towns, where nothing of the Bilious Fever followed.'
It began late in the fummer, and continued till the
the next fpring.  It was expected that the winter
would check its  malignancy ; but on  the contrary,  1
 many of the worlt cafes happened in December.     1

   In the fummer following, a very extraordinary cafe  1
happened.   Upon the border  of a marfliy piece  of  ■»
land, ahorfedied, and was fuffered to  remain above 
TO THE PUBLISHER.
I97
ground and putrify.  A young woman who lived near
the place  having frequent occafion to pafs near the
carcafe, was feized with a violent pain in her head and
ficknefs at the ftomach.   On the  fecond day from
the attack, a phyfician was  called,  who let  blood
from the arm ; but her fever increafed, and fhe foon
became delirious.  On the third day when I firft faw
her, every fymptom appeared fatal.  Upon her feet
and hands, fingers and toes, a number of blifters, fur-
rounded by inflammation, appeared—and a real mor-
tification had already begun upon the ends of fome of
her toes—The blifters and places  of mortification
continued to increafe till the morning of the fourth
day, when fhe died.

   The fatality attending this cafe, will fhew the ne-
ceffity of burying all animals that may die in the fum-
mer feafon near any habitation.   A precaution little
attended to in the country.

                    STEPHEN  REYNOLDS.

   Montgomery County, State of New-York,
           December 27th,  l795- 
 I98      LETTER FROM DR. REYNOLDS,
                  v
 Thefollowing is the Paper mentioned in theforegpingLetter.

          FOR THE ALBANY REGISTER.
   The  method recommended by  Dr.  Rufh  of   |
 treating  the contagious Fever  now fo prevalent in   ■■
 Philadelphia, is by fome  phyficians objected to, be-  'M
 treating the  Contagious Fever now fo prevalent in  ^
 caufe fo fimple ; by others, from an idea that mercury  a
 can never be advantageoufly ufed in fevers, efpecially  I
 in thofe  of  a putrid kind.   Fully convinced that   s
 thofe objections  are made either from prejudice  or
 miftaken theory, I view  it an  obligation incumbent
 on me to bear this public teftimony in favor of this
 new mode of treating putrid fevers.

  In the neighborhood of New-Galway, for feveral  ',
 months paft, an Epidemic Fever, attended with the  ■
fame fymptoms  as that in Philadelphia, has raged to  ■;
an alarming  degree, and many have fallen victims to   •
its fury.—To a  number of thofe cafes I have been
called, and have treated them in  the following man-
 ner, with the happieft fuccefs.                       !
                          •
  In the firft or inflammatory ftage of the difeafe, I  j
 gave calomel from 20 to 30 grains, fufficient to prove  1
 cathartic, with a moderate opiate after the operation. ^M
The next day,  and during the continuance of the  ■
 fever, gave 2 grains of calomel, morning, noon, and  M
 night, and opiates occasionally—giving frequently an  1
 infufion  of  Rad. Serpent. Virg. in water ; at the  \
 fame time ordering that wine or lemonade  be mixed   j
 in all their drinks.  This method purfued in the early
 ftage of the diforder, a copious fweat will enfue, and  \
 the patient foon recover.  If this happy time for relief  ,[
 is neglected, the fever puts on the higheft fymptoms
 of putrefaction, and often terminates in  death.—I
 ought  to mention that the fymptoms attending thofe 
                  TO THE PUBLISHER.           199

   «afes that I have feen, have not been fo violent or fud-
t   denly fatal as it is faid of that in Philadelphia—owing3
   probably, to a difference in the climate.

     Let thofe who condemn this practice, confider that
v   the Materia Medica furnifhes nothing that will fo ef-
   fectually open all the fecretions at once, as Mercury.
   From thence I  think this conclufion  is eafy, that
   nothing will fo fpeedily difcfcarge from the circulation
i.   whatever matter may happen to be prefent,  as this
f   Divine Medicine.

     That the art of phyfic may fo improve, that old
   age fhall be the only weapon ufed by death, is the

            Sincere wifh of a Servant to the Sick,

                               S.  REYNOLDS,

I   Montgomery,
[   Oci.  1795.
D d 
4 
1 ~ -.Uiau,. L .'—r---—7-r——----r

           R  ,E  ,M  ARKS


ON CERTAIN CAUSES OF DISEASE IN LARGE CITIES,

    AND THE MEANS OF PREVENTING THEM.


            WRITTEN IN DECEMBER,  I795-
     THE prevalence of the bilious remitting Yel-
low, Fever, in this and the neighboring States, for a
few years paft, and its fatal effetts,  in many of the
large towns, render an inveftigation into-the caufes
that, have produced, it, highly interefting to the  citi-
zens of the United States, and efpecially of the mer-
cantile towns.

   The queftion whether the Epidemic, which has
proved deftructive in Philadelphia, New-York, New-
Haven, Baltimore and Norfolk, was the pffspring of
local caufes in our own country, or of imported in-
fection, has been much agitated, and to this moment,
well-informed men are divided in opinion on the fub-
ject.

   Without giving  any opinion at prefent  on this
point, one thing may  fafely be averred, that, whether
imported,  or generated by local caufes in our  own
country, the  epidemic influence and deftructive ef-
fects of this malignant bilious fever, are greatly in-
creafed by local caufes, which are wholly within the
command of human power.  It can be demonftrated
to the fatisfadion of all  rational,  candid men, that
whatever be the origin of the difeafe, a great proportion
 of its deleterious effe&s, is to be fairly afcribed to the 
202        REMARKS ON CLEANLINESS

negligence  of men.   This point muft be admitted j
for it can be proved by a feries of decifive  facts in
this city ;  and I am informed alfo, by facts in Phila-
delphia, Baltimore, Norfolk and New-Haven.  This
circumftance leffens very much the importance of
deciding the queftion, whether imported or not;  for
if imported, it  does not fpread, unlefs its progrefs is
favored by unwholefome air in this country.

   My main defign is to perfuade  my fellow-citizens,
that the general health of this  metropolis  depends
greatly on their, own exertions ;  and that although
human power cannot guard againft every inftance of    '
difeafe, yet it may prevent, in all cafes, a difeafe pro-
pagated by contagion, from fpreading fo as to become
a general calamity in a populous city.  To enforce a
conviction of this kind, I fhall produce only  the  evi-
dence of inconteftible facts or acknowledged truths,    \
and the conclufions fairly deducible from them.

   Difeafes,  for my  purpofe, fhall be divided in the    ;
following kinds.

   I,  Thofe  which are neither contagious nor epide-    ;
mic, but  generated in particular perfons  by local    .
and  temporary  caufes, as the  peripneumony  and   j
pleurify.                                          j

   II. Thofe which are propagated  folely by conta-  %
gion, as the fmail-pox.                             '
                                                   ■
   IIL  Thofe which are epidemic and are not ordi-   j
narily communicated by infection, as common colds,    ;
and the intermittent fever.

   IV.  Thofe which may be both epidemic and con-
tagious ; as the  Dvfentery,  Scarlet  Fever, Yellow   \
Fever, &c. 
AND VENTILATION.
203
  The firft clafs, depending moftly on accident, or
the negligence or vices of individuals, are not the ob-
jects of my prefent inquiries.

  The fecond are for the moft part eafily avoided by
preventing a communication with the difeafed. Some
remarks  that will hereafter occur may be applicable
to cafes of this kind.

  The third clafs are for  the moft part out of the
reach of public regulations.  Individual precaution
may do much to prevent or mitigate epidemics; but
this is foreign to my prefent fubject.

  The fourth clafs of difeafes are more or  lefs under
the controul of human regulations, according as they
depend more or lefs for propagation on an epidemic
imperceptible influence, or on  contagion  by means
of  a communication with the fick.   The  influenza
which appeared in 1789 and 1790,  was faid to be
contagious ;  but if this  was true,  the difeafe could
not have fpread by communication with the difeafed;
for hundreds and thoufands of perfons were feized
in a day, without any intercourfe with each other.-—
Its  propagation therefore  muft have been by means
of invifible caufes exifting in the atmofphere.

   What then are the caufes of epidemic  difeafes of
the peftilential kind ?

   It is evident there are two principal fources of dif-
eafe.—The  firft is the  air we breathe—The fecond,
our food and drink.  Thefe  caufes may,  and often
do, act  feparately;  and not unfrequently they act
jointly in producing difeafe.

   Irregularities in diet and the ufe of improper  food
are things  that depend  moftly on  the will of indivi- 
&c#
REMAPS ON CLEANLINESS
 *LuaIs;  and if they produce lefs difeafe at? one time
 fhan another,  it is becaufe the feafon;is more or lefs
 favorable.   The object of my prefent  inquiries,  is
 principally to explain the other great fource of pefti-
 lential difeafes,  impure mr ;  to  demonftrate how
 much it is in our  power  to prevent  its exiftence  ',
 or lefferiits effects, efpecially in populous cities ;  and
 hence to enfore the neceffity of a total and thorough
 reform in our police.
                                                     <
   'It is a fact that is evident to  all the world, that, the
 ?natural ftate of air, unmixed with  any fubftances ex-
 haled from  our earth, is-the moft. fit for refpiration
 and perfectly falubrious.  Atmofpheric air, even in
 its, pureft ftate,  is found to be a compound fluid.-—
 IThe parts, when feparated by chymical procefs, are
 unfit for refpiration, and a portion may be extracted
 rfrom the pureft air, which is inftantly fatal to the life
 of animals.  Chymifts fuppofe they have afcertained   |
 the proportion'  of the parts of  good and bad air,
 which exifts in the natural ftate  of the atmofphere*.  ■
 "This  is not material to my purpofe.  It is fufficient  <
 ■for the purpofes of common utility, to know that air
 is falubrious when it is pure ; that is, in its natural
 (late, unmixed with  effluvia from the furface  of the  1
 earth—and on the other hand,  that the air is un-  J
-.wkoLefome and.unfavorable t0 nre> ln proportion as  J
 it is impregnated with morbid exhalations from the ■
 earth.                                            m

   ; The, morbid exhalations .which affe£l  the, air, pro-  \
 _ ceed moftly,rfrom , fermeritjng animal „ and vegeta-
 ;bie fubftances. rJn,what proportion thefe fubftances  •<

   * See an ingenious little treatiie  on Contagion, lately pu'o-  fl
 fliftxcd„ by, Pr. S. L. Mitphill; in which, notvfithftanding the  1
 technical terms employed, a common reader may find much m-
 ftraction. 
AND VENTILATION.
205
  produce fuch  noxious effluvia;, is not material;  a? it-
  is a given point that both may produce them.  That
  ftate of animal and vegetable fubftance which feems
  to  generate the poifonous air in greateft quantities'
  and with moft rapidity, is the ftate of putrefadion ;
  which is the natural procefs by which fuch fubftances
  are decompounded and  refolved into their original;
  component parts.

     Putrefaction is carried on  by air, heat and rttbif"
  ture.   Without air, all a&ion ceafes in the animal
  and vegetable world; and the greater the heat and
  moifture to which fuch fubftances are expofed, the
  more rapid will be the procefs of putrefaction.

     As all animal and vegetable fubftances contain a
  quantity of noxious matter; and  as  they muft  be
  continually decaying and putrefying, in greater  or
  lefs Quantities,  on the furface of the earth ; and as
t  they necelTarily  difcharge, during this procefs, a poi-
  fonous effluvia into the atmofphere; it becomes a fe-
  rious queftion, efpecially for the inhabitants of  large
  towns,   and  in  the neighborhood  of extenfive
  marfhes, by what  means they can avoid the inconve-
  niences and fatal effects of fuch  an atmofphere.  Let
1  us then  attend to  the following  considerations.

     The exhalations of a deleterious  kind, like fhe ef-
  fluvia of all other  kinds, proceed from certain objects
.  as from  the centre of a circle ; and if not forced from
|  their direction by  winds, probably diverge in ftraight
'  lines.   Near the objects from which they proceed,
;  they are in their moft  denfe or concentrated ftate ;
\  and as the  objects  ufually lye on or near the earth,  the
  air near the  earth muft  be impregnated with  the
  greateft  quantity  of this morbid  matter.   Perhaps
  alfo the fpecific gravity of this  foul  air  may  be 
20O\
REMARKS ON CLEANLINESS
greater, than of pure air.   But it is probable that it
Is capable of rifing and  diffusing itfelf in the atmof-
phere ;  and that it becomes attenuated by occupying
a larger  fpace  in the common  air, until  it is  tho-
roughly  incorporated.   In this manner,  it  is moft    ,■
dangerous, becaufe moft concentrated near the earth;   J
and at a diftance, is more harmlefs.
                                                   ,/
  The means of avoiding the injurious effects of thefe   )
exhalations are various.                              •

  I.  By removing  the animal or vegetable  fub-
ftances, which generate noxious air.  This  is an  arti-
cle of infinite confequence to cities.

  II.  When the fources of poifon  cannot  be re-
moved, as with refpect to large  marfhes which  can-
not be drained, the obvious method of avoiding the
ill effects, is to avoid, as much as poffible, breathing.   f[
the  air  in  the neighborhood.   Farmers would do-    '
well to fet their houfes as far as is poffibly confiftent .   ■
with their bufinefs, from fuch low grounds.

  III. When people neceffarily live in places where    J
large quantities of morbid effluvia ufually impregnate   j
the atmofphere, ventilation of their ftreets and houfes    >
is among the  moft effectual means of  preventing   |
the concentration of the poifon and its fatal, confe-. ,a|
quences.                                           1

  So far as regards the police  of a city, the whole  / j
doctrine of preventing or mitigating the injurious ef-
fe£ls of bad air, is comprehended in the following
articles—to remove the  fources  of the poifon, or to
diffipate it as much as poffible.

  To remove the fources  of the evil, infinite  care
fhould be taken in building cities, to leave  no  low    I 
               AND VENTILATION.           207

grounds or  hollow places among  the buildings,  as
receptacles  of water and  filth.   The  back  yards
fliould, in every cafe, be raifed above the pavement
of the ftreets, and the ftreets fhould be  fo raifed, as
to give a confiderable defcent into the adjoining river
or fea. No trouble or  expenfe will juftify a neglect
of this regulation.   The health and the lives of citi-
zens abfolutely  depend on this precaution.   If the
land  in the  rear  of the building lots is  naturally
lower than in front, it fhould be raifed by carting in
earth.  It fhould be an article of the police of every
city, that no man fhould erect a houfe, without at the
fame time, raifing the back yard, to give a defcent in-
to the ftreet.  The yard fhould alfo be paved, if a-
mong other buildings in a compact part of the city ;
and no filthy water from the houfe fhould be fuffered
to lodge in  back yards.  People fhould learn  that it
is not large piles of animal or vegetable fubftances
alone, that  generate foul air;  but every fmall fiib-
flance, and all the water that has been ufed in a fa-
mily,  add to the fources of this evil.   Water itfelf
may be abforbed in the earth or evaporate; but any
filthy fubftance it may contain, lodges on the furface
of the earth, expofed to the action of the fun,  and
furnifhes a portion of poifonous effluvia.   Hence in
cities, fmooth pavements, though they may augment
the heat of  the air in fome fmall degree, contribute
not  a little  to  preferve a pure air,  by facilitating
cleanlinefs.   And it is a remarkable fact that the in-
habitants  of the fuburbs or fkirts of many of the
large towns in America, who live beyond the pave-
ments, are  much more fubject to  the common au-
tumnal complaints, than thofe who refide within the
pavements.

  Water is perhaps the beft  purifyer of the houfes
and ftreets of cities, as well as of infected clothes.—
                       E  e 
208        REMARKS ON CLEANLINESS
The ufe of water cannot be too  liberal;  but  care
fliould be taken that none of it remains to ftagnate
about or near buildings.  Water  imbibes the poifon
of foul fubftances, and therefore when houfes, back
vards and ftreets are wafhed, the water fhould be
enabled, by fuitable channels, to run  off  into  the
fewers or adjoining river.  If the natural furface of
the earth  is too level for this, no pains fhould be
fpared to remedy this inconvenience by artificial ele-
vations."  It is no excufe for neglecting thefe things,
to fay they are expenfive ;  becaufe  they cannot be fo
expenfive as epidemic difeafes.   The lofs of bufinefs
for one feafon, in fuch a city as Philadelphia or New-
York, would build all the ftreets  in this city, where
the fever has been moft fatal*.  But when we  take
into confideration the lofs of life,  the tears,  the dif-
treffes of bereaved parents,  and of helplefs widows
and orphans—the  idea of expenfe, for the purpofe
of preventing  fuch calamities, lofes all  its  terror.—
Labor and perfeverence will conquer all difficulties of
this kind ;  and if all poffible means of rendering ci-
ties healthy are not ufed,  why are they built at all ?
Why fhould cities be erected, if they are to be only
the tombs of men ?  A frequent recurrence  of malig-
nant and fatal epidemics will befides leffen the bufi-
nefs of a town, and this  finks the value of real eftate.
It is therefore the proprietor's interefi as well as his
duty to attend to every circumftance that can infure
the health of his tenants.

   But as among a multitude of people, the artificial
caufes  of difeafe muft be numerous, and much dirt
and filth will be found, to produce impure  air, what-
ever pains  are taken to preferve  cleanlinefs;  it  be-

  * Half a million of dollars is probably a low eflimate of the
lofs incurred by New-York the laft feafon. 
AND VENTILATION.
209
    comes a ferious inquiry how ftreets  and buildings
    may be beft conftructed for  ventilation.  As  water
    abforbs the poifon of filth or wafhes it  away ; fo wind
    diffipates the morbid effluvia, and renders it altoge-
    ther harmlefs :  or at leaft diffufes it fo as to leffen its
'    action upon the fyftem.   If we examine the progrefs
    of the late fever in this city, we fhall find its ravages
    in a dire£l proportion to the want of cleanlinefs and
i    ventilation in the feveral ftreets and houfes.

      To know how much depends on a free air  in the
    cure of fevers, moft perfons need only  to attend to the
    facts within their obfervation.  But this is a circum-
    ftance of fo  much importance  to a city, that it de-
    ferves particular confideration.

      Air,  as well as water, is  a fluid,  which,  by the
    laws of nature, is kept in almoft continual agitation.
>    Its  natural ftate, as before obferved, is perfectly falu-
k   brious ;  that is,  fitted for  the purpofe of preferving
    life and health.  Whatever poifonous qualities  it may
[    contain, it receives them fromfubftances within the hu-
    man body, or ort the furface of the earth.  But it is a
|   law of fluids to purify themfelves by motion.  Thus
    whatever impure qualities  the air may  receive from
    putrifying fubftances,  and which may be raifed by
    heat and float in  a ftagnant air,  may, by violent agi-
    tation, either be fo attenuated or diffufed, or fo  inti-
    mately combined with other parts of the air, as to be
    rendered totally harmlefs.  Whatever therefore tends
    to obftruct the motion of the air near  the earth ; that
'    region  of air which  men conftantly  breathe ;  re-
l   ftrains, in a greater or lefs  degree, the natural  ten-
;    dency of the air to purify itfelf.  Hence the infinite
I    importance of attending to the means  of giving a free
\   current of air through houfes and the ftreets of a po-
    pulous city. 
2IO'       REMARKS ON CLEANLINESS

  The ftreets of a city fhould, if poffible, be ftrait.—
The flale notion of cenfuring uniformity in a city, is     j
worthy only of weak minds.   Crooked or winding
ftreets tend to break the  force  of the wind ; as with     .
a ftream of water, which is retarded at every bend.
This article however is not of the firft confequence.    ?

  It has been doubted whether wide ftreets in a large   m
town  are very beneficial; as the action of the fun on    j
the pavement is violent, and the heat is increafed, and    1
as the quantity of fhade is lefs in proportion in wide    1
ftreets than  in  narrow ones.   But wide  ftreets, if   M
kept clean, are doubtlefs the moft healthy, as they ad-    1
mit a larger quantity of pure air, and a more free cir-
culation.
  Another article in the laying  out  of ftreets for
healthinefs, is, a fuitable elevation of the parts diftant
from  the  fewers or river, to give a defcent for the
water to run off with fome force and rapidity.  A
moderate  elevation is not fufficient; for though, in     j
fuch a cafe, the water itfelf may drain off liowly, yet    J
it leaves moft of the filth  behind, which is the fourCe    I
of  poifon to  the inhabitants.   In  this particular,    1
Front-ftreet and Water-ftreet, in this city, are very   j
ill conftructcd.   The natural pofition of thofe ftreets,    I
which are made along the fhore of the Eaft River, is
nearly on a level.  It was the bufinefs of the police   M
to remedy this, in the mode of paving.

   Two obvious modes of preventing the inconveni-  1
ences of level ground, fuggeft  themfelves.  Firft to    1
raife  the middle of the ftreet, then to give the whole    I
a more round or fpherical form, than is neceffary on    }
a declivity.  Where a confiderable declivity occurs,
the water will run off with force,  whatever be the   ;
 form of the pavement.   But on a level, fome artifi-   \
 cial elevation muft be contrived.  On a declivity, the   ; 
AND VENTILATION.
211
form of the pavement fhould be the fection of a large
circle—on level ground, the lection of a fmall circle,
is a better form.

  The fecond improvement in making ftreets on le*
vel ground, is to raife the land in the centre, between
two gutters or fewers.   Thu3  for  inftance Water-
ltreet^between Pine-ftreet and the Fly-market, fhould
be railed much higher than at prefent, in the central
point between the two ftreets.   The  inconvenience
of an elevation of two or three feet in fuch a diftance,
is trifling,  when put in competition with cleanlinefs.

  Perhaps alfo fmooth gutters along the fides of the
ftreets, next  the foot walk, might be  made of hewn
ftone, and fo  laid  as to be durable.  This would
amazingly facilitate the cleaning of ftreets which are
nearly level.

  Another article in conftructing a city for health, is,
that as few ftreets as poffible fhould terminate within
the  city;  that is, inclofed,  at the ends as well as
fides,  by ranges  of buildings.  Wherever a ftreet
terminates by a block of houfes, the circulation of
air is obftructed.  Violent winds indeed penetrate into
every place; but moft of our fummer winds are light,
and in the fultry  feafon,  when ventilation is  moft
wanted, becaufe the exhalations of a noxious quality
are moft confiderable, there is very little wind in the
open country ; and in the confined ftreets of a city,
none at  all.

   Lumber-ftreet, is an example of a ftreet terminated
by three flory buildings in Liberty-ftreet.  There are
 many others of the fame kind, and fome with no di-
 rect  opening to either river, as Garden-ftreet and
 Batavia-ftreet.  This circumftance makes  no  fmall 
J
 212        REMARKS ON CLEANLINESS

 difference in  the free circulation,  and cohfequently
in the purity of the air*.

   In the conftruction of dwelling houfes, equal at-
 tention  is  required to  the form and" pofition, in
order to promote ventilation.   Under ground ftories
for the habitation  of families,  it  would  be well to
prohibit altogether.  As work-fhops they  are  lefs
pernicious; but  are generally unfavorable to health.
In fome cafes, rooms partly below ground are fo fitu-
ated, as to admit a current of air through them.   In
fuch  cafes, they may be occupied with more fafety.

   The circumftance of admitting frefh  air  through
rooms by oppofite correfponding  windows or doors,
is one that ought never to be neglected,  in low fitu-
ations and crouded places.   The difference in the
circulation of air, is immenfe, when the air  can pafs
through  a  room in a direct line.  Side doors  and
windows do not  effectually anfwer the purpofe; and
when  there is no opening into a  room,  but on one
fide, there  can be very  little circulation.  It might
be  well  worth  the attention  of people who build
houfes, to confider  whether it would not favor health

  * Let a dam be ere£ted five feet high, acrofs a ftream of ten
feet depth.  This dam would  check the current near the bottom j
of the river, for a confiderable diftance.   The fame is true of air,
in a lefs degree.
  Every perfon has obferved the effect of friction in retarding the
current of  a river.  The current near the fides  and bottom is
flc.ver than in the middle ; by means of the friction of the water
ag:1.:-ift the earth.-  A remarkable proof of this is, that the tide in
riv•:••-- no vs and raifes the water 6 or 8 inches, before the ebb cur-
rent has done running on the furface of the water.  The flood tide
.-r.eets with lefs refillance fi-.>m the flow under current, than from
the  rapid current above—it checks the under current firft, and
thus raifes the water, whii" the ebb current on the furface is yet
runiiiiig-. 
AND VENTILATION.
213
   materially,  to  conftruct doors or windows between
   the front and back rooms  of their houfes, in  fuch a
   manner, that they might  be ufed in  fummer, but
   clofed and concealed in winter.   In many fituations,
   this arrangement would prove highly agreeable, and
   contribute greatly to health.

     If the foregoing principles are juft, it is worthy of
   our attention to compare the actual fituation of New-
   York, as it relates to the means of preferving health,
   cleanlinefs and ventiliation.

     The natural fituation of a great part of this  city,
   is as well calculated for falubrity of air, as it is poffi-
   ble to conceive one to be.   The form of the Ifland is
   adapted for cleanlinefs in a remarkable manner; the
   land gradually rifing from each river,  the  filth is, by
   every rain, wafhed down the declivity on each fide
   towards the river, and where it is not obftructed in
   its paflage, by fome artificial means, is carried into
   the water and fwept away  by the tides.  The city is
;   open on the fouth  weft point to refrefhing breezes
   from the bay ; and  the reftriction which prevents the
   corporation or citizens from  ever  converting the
   walk at what  is called the battery,  into ftreets and
   houfe lots to be inclofed and covered with buildings,
j   has infured the lives and health of thoufands  of citi-
   izens.   Frefh  air   enters  Broad-way, Greenwich-
1   ftreet,  Broad-ftreet, &c.  and penetrates freely into
   the city; ventilating thofe fpacious  ftreets and diffi-
!   pating the noxious air neceffarily generated in a large
'   town.   On the weft, the ftreets which crofs the Ifl-
   and, are open  to frefh air, from the Hudfon, and the
   ftraight  direction and the breadth of thofe  ftreets,
   confpire with the declivity of the ground, to give all
   that part of the city, the advantage of ventilation and
   cleanlinefs. 
 214        REMARKS ON CLEANLINESS

   On the eaft fide of the Ifland, the declivity of the
 ground is favorable to cleanlinefs, from the height of
 the land to Pearl-ftreet, the laft ftreet erected on the
 natural earth.   Water-ftreet and Front-fireet are built
 on made land—the water  every  tide penetrates, by
 fubterraneous paffages, to the cellars in Water-ftreet,
 and what is perhaps worfe,  the ftreets are fo level,  \|
 that not only the filth made on them, but great part   i
 of what is brought down from the higher land  in
 John-ftreet, Maiden-lane, Pine-ftreet and Wall-ftreet,   '
 lodges upon the  pavements  or in  the  fewers.  In
 paving and building on  this made land, no effectual
 provifion was adopted to carry off the water and filth;
 and the inhabitants feverely feel the confequences of   ;
 that neglect.

   Here then we find, if not in all  cafes the fources*
 yet the peculiar region, of fatal maladies.   Here dif-
 eafes of a malignant kind in hot weather firft appear,
 and from fome point, take their departure and  ipread   :
defolation.

   If we proceed further northward, we fhall find, in
what was called the Swamp, a ftill more fatal neglect
of the means  of preferving  health.  The ground
now covered by  Roofevelt-ftreet,  James-ftreet and  J
 Catherine-ftreet,  extending  from  the Eaft  River W
 towards  the Tea-water Pump, was a few years ago  M
 covered with a pond of water.  The ground is arti-  1
 ficial;  and not only fo, when  the ftreets, a few years   ■■
 ago, were paved,  they were raifed from two  to
 four  feet above the foundation  of  the  original
 houfes.  The back yards are few of them paved, and
 being lower than the ftreets, they are the  refervoirs   *
 of every fpecies of filth. 
AND VENTILATION.
215
      So far as regards falubrity, this part of the city  is
I   moft  unfortunate; indeed it  is fcarcely poffible to
|   conceive of a fituation worfe calculated for preferv-
f   ing the lives of the inhabitants.

      !The natural fituation of this quarter of the city is
    not favorable for cleanlinefs  and  ventilation.   A
    ilraight  line  from the  Battery  to  Corlaer's  hook
    would pafs by Beekman's-flip,  Peck-flip,  New-flip,
    &c. at feveral hundred feet diftance ; the fhore being
    a curve. By this means, the part of the city forming
    this curve,  is fhielded from the dire£l courfe of the
    wefterly winds, the moft falubrious that blow on this
    continent and which prevail nine months in the year.
    On the north weft, the higher ground and buildings
I   prevent the direct accefs of the  wind ;  fo that that
    part of the  city, which is the oldeft,  belt-fettled, and
    where filth  is moft apt  to collect, has the leaft ad-
    vantage of  free air.   The direct courfe of the  wind
    being broken by the higher  ground on the north
 '   weft and the fouthern point of the ifland,  the pure
    air from thofe points feldom blows with violence
    along  the eaflern fhore, and the light  breezes  of
    fummer, inftead of fweeping currents, afford  httle
    more than gentle eddies that are infufficient  to pu-
    rify the atmofphere which the citizens breathe.

      The high ground in the  rear of the fhip-yards and
   above George-ftreet  are very injurious, in prevent-
   ing ventilation.  The land  is nearly  on a level  with
 *  the chimnies of the houfes  from George-ftreet to
l^  Roofevelt-ftreet.  This breaks the current of air in
m almoft every direction;  for it has been  before ob-
f jferved, that the under  current of air is checked by
   objects to the height of thofe objects.
Ff 
 2l6,       REMARKS ON CLEANLINESS

   Thofe natural difadvantages of fituation are not
remedied by the mode of building and paving the
ftreets below.  The ftreets are nearly level;  the
back yards are unpaved and receive every fpecies of
filth, which accumulates the whole year, and in fum-
mer muft fupply a prodigious quantity of foul exha-
lations.  It is impoffible for the inhabitants of fuch
ftreets to be healthy in a hot feafon.

   The eaflern part of Water-ftreet is in a fimilar
ftate.   The pavement is raifed above the firft floors
of the buildings and above the ground between that
ftreet and Cherry-ftreet.  Of courfe  water and filth
collect in the rear of the buildings and in the cellars.
The wharfing is  equally bad ;  fome of  the wharfs
only half finifhed admit the tide;  but prevent the
filth received from the ftreets and houfes, from being
fwept away.  This is the cafe about the place where
the fever appeared the fummer paft.  The wharfs
fhould be made folid and complete and well paved—
folid to admit of the leaft poffible fubterranean filth
and itagnant water, and well paved to carry off what
is formed on the furface.

   Such are the facts relative to the  fituation of this
city, as adapted  to cleanlinefs and  ventilation.  A
great  portion of the city is high, cleanly and well_&2
ventilated—but fome parts are low,  level, and dirty,
and covered from wefterly  winds.   The former has
invariably  efcaped the  ravages  of epidemic bilious
fevers, and the latter has repeatedly fuffered by their
fatal effects.  Let  any candid man  walk over the
city, and examine the fituation of each ftreet, and he
will find  that the  epidemic has been fatal, in a very  j]
exact proportion to the caufes of difeafe which have
been defcribed. 
AND VENTILATION.           217
  Before I conclude this fubject, I would make fome
remarks on the manner of conftructing the common
fewers, as alfo the wharves and docks.

  The principal fewers in the city, fuch as thofe In
Broad-ftreet, Fly-market and Burling-flip, are built
on ground,  fubject to a flux  and reflux of tide.  If
the tide  penetrates through  them, it  carries  back
the filth which is received from the ftreets, and pre-
vents it being fwept into  the fea, for 6 hours every
flood.   If any part of the fewer is above high water,
a great portion of the filth will be met by the tide,
and lodged ; and, what is worfe,  if the fewers are
wholly above high water, and  not waflied  by the
tides, and if they are nearly in a horizontal pofition,
great quantities of filthy putrefying fubftances will
always  be collected in them.  In all thefe cafes, a
fetid air is generated  and emitted  from thefe  refer-
voirs of  impure matter.

   Thefe confiderations fuggeft the impropriety of all
fewers under ground, unlefs in places where tides or
running water  conftantly wafh them clean.   If all
the water of a city is drained off on the furface of the
earth, any  collection of  filth, by  means of fudden
fhowers or  other caufes,  is vifible, and may be eafily
removed.

   Never was a greater miftake than conftructing an
arched fewer  under  ground, in Fly-market.   The
 land in  Maiden-lane is fo high, that it would have
 been very eafy to conduct the water above ground
 into  the dock; and nothing could have been more
 cleanly and falutary, than to have had the market
 wafhed by  the copious ftreams of water  which are
 collected, every fhower,  from William-ftreet  and
 Liberty-ftreet, and united juft above the market.  It
 Jfeems as  if nature had  contrived a fituation in tha 
218
REMARKS ON CLEANLINESS
fpot, for a clean wholefome market,  and that all the
ingenuity of the corporation  had been formerly ex-
ercifed, to defeat her beneficent intentions.  So  well
adapted for this purpofe have been the means ufed,
that the water  is directed under  ground, at the very
point where it  is moft wanted above ground.   As all
the water is thus  carried off, and as the ftreet  is
nearly level, all the filth of the dirtieft place in the
city, is left as a nuifanceto annoy half the inhabitants
of the  city, who are obliged to refort to that market.

   As if this was not enough, a floor  is made  to the
market, and fo loofely put together, as to fuffer filth
and offal to get beneath  the boards, where it is out
of the  reach of any flight attempts to fweep the mar-
ket.  This is an inexcufeable fault—becaufe the ex-
penfe of removing the floor, and laying a fmooth brick
pavement, which is eafily wafhed and always firm, is
too'inconfiderable  to be noticed.   The cleanlinefs of
the Philadelphia market, which is thus paved,  fhould
have fuggefted this improvement, long before this
time*.

   Equally ill-conftructed are the wharves. Docks,
in which all manner of filth is collected,  are left dry
at low water, which never ought  to be the  cafe.
For although the water of  the fea, and  pure earth
covered  with  it,  are not  unwholefome, yet when
mixed with other  fubftances, the compound  may
prove  highly  noxious.   It appears to  me that the
docks  fhould be filled out fo far as  that the earth
fnould, at low  water,  be entirely  covered.   The
wharves fhould  be made as folid as poffible, to pre-
vent water from penetrating and flagnating in them,
or conveying into  the interior ftrutture of them, ve-

   *  Since writing the above, this market is undergoing a ma-
terial alteration. 
AND VENTILATION^
21^
getable and animal fubftances which may lodge and
putrefy.  They fliould alfo be fo conftructed on the
top as to be eafily kept clean.   The deep holes and
miry places about our wharves in rainy weather, are
as unhealthy in hot  weather,  as they are inconve-
nient at all times.  They are in many places fo nar-
row, as to endanger the legs and lives of men among
the carts, hogfheads and bowfprits, and in the hur-
rying feafon of autumn, it is not too much to calcu-
late that ten per cent, of the labor of men employed
on them is loft by their interfering with each other.

  What complete remedy can be fuggefted for thefe
evils, I will not undertake to decide.  It is a common
concern, and among the citizens who are interefted
in a general  and thorough correction, fome will be
found  to point  out the principles.

  It feems obvious however, that a total flop fhould
be put to extending the made-ground into the rivers.
This artificial earth is always porous ; it admits and
retains water;  of courfe all cellars in fuch ground
are  damp and unwholefome.  Perhaps  it might be
well to fill up  the docks,  and give the  front of the
folid wharves a  ftrait direction—leaving no ground
bare at low water ;  fo that every fubftance, waflied
or fwept into the water, fhould be floated away.—
The wharfing might be extended to any convenient
diftance into the rivers, by erecting piers, connected
by bridges.   It  appears,  however, proper, that all
the wharves fhould be permitted to extend only equal
diftances—the fame of the flores on the wharves—
they fhould prefent  a uniform front.  This would
render them all more airy and healthy ;  and no man
could obftruct his neighbor's air or view ; a  matter
of no  fmall confequence, as it regards pleafure and
health. 
220
MEDICAL OBSERVATIONS.
  It is a fact clearly afcertained,  that the procefs of
vegetation contributes to the falubrity of the air.—
The more  trees, grafs-plots and  flowers can be cul-
tivated  in  a  city, the more healthy.  All  broad
ftreets, will admit  the growth of Trees, and thefe
are as ornamental as they are ufeful.   The objection   '
to them in cities on account of their obftructing the  _,
ufe of engines in fires, is not of much weight.   A
cafe of this kind  can rarely happen ;  and when it   .'
does,  an ax or two  will  level the tree almoft in a
moment.   Befides, the objection is more than  ba-
lanced by the  fecurity they afford one half the  year
againft fire.  A tree, when full of green leaves, may
break the force of a fire and fave a houfe.

   An inftance like this happened in Bofton, where
a thick coat of creepers on the fide of a  houfe next   i
the approaching  fire, fo far  broke the flames, as to   I
be a principal means of faving the  building.  It is   j
ufeful therefore to encourage the planting of  trees   '
in  this city, in every fituation, where commanding   '
reafons do not prohibit it.


              —s
 1be following Remarks are judged worthy of a place in   J
                  this Colledion.                    a

     From the French and American Gazette.       '1

         MEDICAL OBSERVATIONS.            1

   The inhabitants of New-York, as juftly alarmed
aj the Philadelphians were two years ago, at the ha-  ^
vcc of difeafe, faw, if not with a  jealous, at leaft with
an amazed eye, a Frenchman dwelling under the fame   ;
roof with himfelf, enjoy the pureft health, whilft he   !
fell, as it were, ftruck with a thunder bolt,  without   i 
MEDICAL OBSERVATIONS.
221
    being able to experience  any relief from medical
i    fkill; we, ourfelves, furprifed at this fingularity, have
    fcrutinized into the wonderful fecrets of nature, as
i    far as can be allowed to an human, and of courfe a
|    weak eye ; and we  attributed the difference to the
i    manner of living, cuftomary  to  both nations, and
I    their treating themfelves.

      The more we examine the modes of  living of an
    American and Frenchman, whether  indifpofed or in
    good health, the more we perfift  in our fyftem, and
    in the idea that the American cannot totally preferve
    himfelf free from this raging fever, which commonly
    breaks out in hot weather,  but by following another
    regimen directly oppofite to that  which he has till
    now ufed.

f    Although the American  feems commonly to enjoy
    the beft health,  though his  high color announces the
    ftrongeft conftitution,  yet  we  are much inclined to
    think that he  would not run fo many rifks in the
    fummer time, were he to  live more foberly during
    the other feafons; were he to live upon more whole-
    fome food ; were he lefs fond of  ftrong  liquors, tea,
    and green fruits, and would he make a frequent ufe
  ■  of baths and  lotions; which  are as wholefome for
    the inteftines, as neceffary for  exterior cleanlinefs.

      We will not follow the Americans through the
    paths of private life; but we fhall fay that, in general,
    temperance is not obfervable among them, nor that
    moderation of which the French daily reap the ad-
    vantage ;  the latter  relifh Burgundy and old Bour-
    deaux wine,  and feldom allow themfelves to drink
    fpirituous  liquors ;  while  the former difapprove of
    Claret, as too  weak, and  prefer  Madeira, Sherry,
j    Port, Rum, and Gin^ which muft, of courfe, inflame 
222
MEDICAL OBSERVATIONS.
 and throw the blood into a fermentation.  Notwith-
 standing this, we fee Americans, who fay they have
 been advifed to ufe them, efpecially during the difor-
 der, in order to give tone to the ftomach.

  The French never drink any tea,unlefs they feel their
 ftomach uneafy.  In the morning and in the evening,
 the Americans feem to fwim in tea, which is fo ftrong,
 that an Englifh tea pot would make as many as twen-
 ty, according to the French  fafhion.   Should what
 has been faid by fkilful and learned Doctors be true,
 that tea is one of the moft corrofive  vegetables, the
 juice or effence of it muft of courfe make a flow but
 ftrong impreffion  on the nerves, and  occafion the
 diffolutionofthe blood.   It is likewife  cuftomaryto
 eat with their tea, heavy  cakes of all kinds, and toafts
 which are not reckoned to be good unlefs they  are
 thickly covered   with butter;  which increafes  the
 bilious mafs of humour.

  We fhall not repeat  the  obfervations which we
 have heretofore made, upon the averfenefs the Amer-
 icans feel for foup and  reftorative broths, on their
 eating their meat running with blood, with fcarcely
 any bread, and plenty of heavy potatoes, the only\
 vegetables which are feen on their tables; whiift  the
 French always give the preference to vegetables, and
 efpecially to  thofe which are  light and wholefome.
 But we cannot help obferving, that in the months of
 May, June and July, the ftreets and markets were feen
in the morning furnifhed with an immenfe quantity of
fruits,  the moft part of which are either green  or
 unripe.   In  the  evening ail thofe fruits have difap-
peared and have been eaten ;  hence,  bloody  fluxes,
 dyferneries and bad chyles,- which unwjiolfome food
 muft undoubtedly produce, 
               MEDICAL OBSERVATIONS.        223

     As to baths,  baths  of cleannefs, injections, &c.
   there are few French, in the leaft careful of their
   health, who do not make ufe of them.
 >
     The Americans, far from practifing thofe ufeful
   and wholefome tokens, look upon them as ridiculous
   and unbecoming.

     It is no longer furprifing that Americans, heedlefs
   of their health,  living on  unwholefome  foods and
   drinking heating liquors, fhould prove fo little dif-
   pofed to  refill  the  impreffion  of fcorching  hot
   weather, which opens the pores, and occafions, if we
".-  may  be allowed the expreffion, a continual depreda-
   tion on the vital principles, through a thoufand iffues,
 ,  always open.   It is not to be  wondered that heat
   and dampnefs, which  on this continent more rapidly
   fucceed each other than in any other climate, fhould
   foon  bring into a ftate of fermentation,  humors im-
   pregnated  with fo many   principles  of  putridity.
   Will  any one wonder  at feeing the unfortunate feized
   with  the fever, fall fo fuddenly victims to it, when
   they  are feen to  fwallow remedies  which, far from
   keeping  down and cooling the fermentation, increafe
f *it 5 when they are feen undergoing copious  bleed-
|  ings,  ftoring in emetics, bark, Madeira, and other
I  fpirits called  tonical, producing in the  body the
■ fame  effects as oil or  fire ?  Finally,  we fee when
■thefe  unfortunate people are left^by themfelves, de-
■ferted, and given up by their neareft relation, whom
Ha panic keeps as far from them as from perfons  in-
Rfecled with the plague,  forrow'and defpair,  much
H^nore  than the moft violent remedies with which they
■are treated, hurries them to an unavoidable death.

I   For thefe two years,  the  French have  been no-
l*  ticing thefe falutary obfervations  to  the  Americans, 
■"-4
OBSERVATIONS FROM THIt
who liften to them with coolnefs, although many of
them perceive the juftnefs of thefe hints, but habit is
a fecond nature.   As foon as the epidemic feems to
abate, as foon as the coolnefs of the weather brings
back the hope of feeing it difappear, they will haftily re-
turn to their homes, go on with their old habits, their
ufual way of living, and on the fmalleft indifpofition,]
fend for their dear doctor, who exclufively is mafter of
their confidence.   We are  acquainted  with French
phyficians, who at Philadelphia treated with fuccefs
two hundred perfons  taken with the diforder,  and
thofe very fame perfons have not  afterwards vouch-
fafed to fend for thofe to whom they were indebted
for their lives, even to be bled by them.


 The following Obfervations from the Manchefter Mer-
   cury, contain ufeful hints, and cannot be inapplicable
   to many fituations in the United States.
        Manchester Mercury, Feb. 2.
     Mr. Harrop,
   After having endeavored, for the laft four years,
to call the public attention to the dangerous fituation
of the poor in this town and neighborhood; it gives
me the higheft fatisfaction that a number  of the moiij
 refpcetable inhabitants have  been induced to adopt j
 the ideas which I had fuggefted, refpeding the regu;
 lation of Cotton Mills, and the   erection of  Fever
 Wa-ds.   As it is of great importance, that a know-
 ledge of the  facts, and reafoning,  on which their de-
 termination has been founded, fliould be extenfively^
 communicated, you will  oblige me by^ mferting the
 following extracts from a Memoir, which I drew up
 at the defire of the original meeting.
         I am, Sir, your very obedient fervant,
  Da-4on.firecU ?                 J- FERRIAR. *
 Jan. 18, 1796. 5 
MANCHESTER MERCURY..
225
  TO THE GENTLEMEN  MEETING AT THE
             BRIDGEWATER  ARMS.

       Gentlemen,

     At the requeft of fome of your number,  who ori-
  ginally propofed this meeting, I fubmit to your con-
  fideration a few remarks towards the formation cf a
  Board, or Committee for fuperintending the health
  of  the manufacturing poor in  Manchefter and Sal-
  ford.  A principal object  of this Committee, muft
  be that of diminifhing the frequency of the Epidemic
  Fever, which has fo often alarmed us in this place,
  which is now very prevalent in  fome parts of  the
  town, and has  fpread itfelf to a very unufhal extent
  in  fome  of the neighboring towns.  The circum-
  ftances which  produce and propagate this difeafe,
,  feem to require more immediately the interference of
*  a public body, and thefe once remedied, the general
i health of the poor muft be greatly improved.  Hav-
  ing already publifhed my fentiments pretty full  on
   this fubject; I fhall remark, without entering into
   any reafoning, that the principal fources  of fever
   among our poor, are lodging-houfes, cellars, cotton-
   mills, and the  incautious intercourfe of the poor with
   each other,-tn  places infected.

      1. Refpecting lodging-houfes, I have obferved elfe-
   where, that the moft definable means of prevention,
   would be to fubject them to licenfos, which  would
   bring them under the controul  of the magiftrates.—
   At prefent, as the town is much lefs crouded than it
   was in 1792, the mifchief arifing from thefe houfes
;■  is  lefs ;  and until  the  Committee  can acquire  the
   proper powers ; it  would perhaps be fufficient to be
k   at the expenfe of white-wafhing fuch as fhall be re-
   ported to be infected and dirty,  or  where they  are 
  226        OBSERVATIONS FROM THE

  found to be over-crouded, to prevail on fome of the
  lodgers to remove, which may be readily done.

    2.  The number of damp,  and very ill-ventilated
  cellars, inhabited in many parts of the town, is a more
  extenfive and permanent evil.  It may be neceffary   ,,
  to. explain to gentlemen who have  not vifited fuch   j
  places; that they each confift of two rooms  under  ?|
  ground, the front  apartment of which, ufed as a  t
  kitchen, though frequently noxious by its dampnefs
  and clofenefs, is  greatly preferable to the back room;
  the latter has only one fmall window, which though
  on a level with the outer ground,  is near the roof of
  the cellar ; it is  often patched with boards or paper ;   ,
  and, in its beft ftate,  is fo much covered with mud,
  as  to admit very little either of air or light.   In  this
  cell, the beds of the whole family, fometimes confift-   j
  ing of feven or eight, are placed.   The floor of  this  1
  room is  often unpaved ;  the beds are fixed  on the   1
  damp earth.  But the floor, even when paved, is al-   I
 ways damp.   In fuch  places, where a candle is. re-   J
t quired even at rtoon-day to examine the patient,I have
 feen the fick without bedfteads, lying on rags; they  {
 can feldom afford ftraw.                            "

   This deplorable ftate of mifery becomes frequently
 the  origin,  and certainly  fupports in a great  degree
 the  progrefs of infectious  fevers.   I have been able <
 in many inftances to trace  the infection from cellar
 to cellar, and  to fay where it  might have been ..'
 flopped by prudent management on the part of the
 infecled  family.   But it  is  likewife very difficult to
 eradicate the fever, when it feizes a family thus fitu-
 ated.   It generally attacks  them  all in fucceffion,  j
 and the .convalefcents, from their  confinement in
 the  midftrof infection, have  frequent relapfes, attend-
 ed with increafing danger,  fo that the difeafe conti-  , 
MANCHESTER MERCURY.
227
nues in the fame fpot for feveral months together.—
The recovery even of thofe who do not relapfe, is alfo
tedious and imperfect, beyond the conception of any
who have not experienced cafes of this nature.  The
want of proper nurfes muft be added as none of the
leaft evils attending this unfortunate clafs of people.
I have no hefitation in afferting that many lives are
annually loft, from this caufe alone.  It is extremely-
difficult at prefent to procure  a nurfe of good cha-
racter upon any terms ; and it is often neceffary to
employ  perfons on whom little dependence  can be
placed, that the fick  may not be entirely deftitute of
affiftance.

   Great advantages would therefore be  derived from
removing the infected, and in fome inftances, perhaps,
the whole family, from fuch dreadful habitations as
I have defcrlbed,into a clean, airy houfe, which fhould
be provided by the Committee, till  their own cellars
could be wbite-wafhed, and  fweetened  by flacking
quick-lime on the floors.  It is a  queftion for the
deeifion of the Committee, whether they would pre-
fer renting a  houfe, or building a fever-ward for this
purpofe.  I confefs,  that I fhould incline to the let-
ter, for thefe reafons:

   1. In the erection of a fever-ward, fituation, air,
and convenience would  be  better  confulted;  in
renting  a houfe, fome of thefe very important objects
raight be unavoidably fuperfeded.

   2. Upon fuch a permanent  eftablifhment,  one or
more women of decent character might be induced
to undertake  the office of nurfes.

   3. By thus bringing the word and moft neglected
cafes under one roof, the chance of fpreading infec- 
228
OBSERVATIONS FROM THE
tion would be diminifhed, while attention to the pa-
tients on the part of the nurfes would be better fe-
cured, than if the patients were difperfed in different     j
houfes, as, in reality, it would be very difficult to ob-     3
tain a complete houfe, upon any rent, for fuch a pur-     J
pofe.                                                 |

   To explain this obfervation, I  muft beg leave to   §|
repeat a circumftance which  I have flated in my laft    1
volume of Medical Effays.  Previous to the building
of our difpenfary, when  a  patient happened to be
feized with an  infectious fever in  the Infirmary, the
difeafe was apt to fprcad to an alarming degree, fo as
to require a general difmiffion  of  the patients.   But
fince a few rooms have been added to the  Difpen-
fary,  for  the purpofe of fecluding perfons thus  at-     j
tacked, from the reft of the patients, though bad fe-
vers have been accidentally introduced, yet by remov-   '
ing the patients on the firft attack into the fever-ward,
the difeafe has  always been prevented from extend-
ing, without the neceffity of difmiffing a fingle patient.
In like manner, I conceive, that by building a fever-
ward in each of the Infirmary diftricts, and removing
into them the worft cafes, from the worft houfes, the
progrefs of infection would  be materially checked,
and a great quantity of difeafe and mortality would
annually be prevented.  This plan would alfo  give  Jfl
additional  fuccefs to the Infirmary Phyficians.   It  ^Lm
would add the chances  arifing  from cleanlinefs,  free   ■
ventilation, and careful  nurfing,  to the efficacy of   ■
medicines.                                         m

   4. In a feparate building, the accefi of unneceffary   1
vifitors would be better prevented.  It may give the   ■
Committee a clearer idea  of the extent of this danger,   ™
to mention, that an elderly  woman, juft recovering    j
from  the  fever,  informed me, that  fhe had fifteen    j 
MANCHESTER MERCURY.
229
 children,  all fettled in the town, and all of whom
 had undergone the  fever within thefe two months.

    At prefent, perhaps, it  would be moft expedient
 for the Committee to try the effect of a fingle fever-
 ward, in fome part of the town where infection more
 frequently prevails.   In a town like this, fuch build-
 ings can never become entirely ufelefs, even  if the
 plans of the Committee fhould extend to the length
 at which I have hinted.  The want of proper fewers
 in feveral of the ftreets, and the  offal of flaughter-
 houfes,  left  to putrefy  before the doors  in  feveral
 places, are nuifances which deferve the ferious atten-
 tion of the Committee.

   5. On the fubject of the propagation of infection
 in Cotton Mills, it may be neceffary to obferve, that
 although it has been fuppofed that fever may be im-
 ported in the Cotton,  and though  this opinion does
 not  feem improbable in itfelf, yet no  direct proof of
 fevers originating from this fource has ever been ob-
 tained.   On the appearance of the prefent Epidemic
 at Afhton, an alarm  of this kind was fpread, becaufe
 the fever broke out in the picker's  room of a manu-
 factory  there;  but  I am  informed,  from very re-
 fpectable authority, that  the infection was actually
 carried  thither from  Manchefter, by a girl who went
 to be employed as a  picker at Afhton.   I apprehend
 that the mifchief arifing from fome Cotton Mills,  as
 they are at prefent managed, refults from

   I. The cuftom of working all night.

   II.  Negligence in  wafhing the floors and frames.

   III. Negligence reflecting the perfonal cleanlinefs
of the work-people, and efpecially of the children. 
230
OBSERVATIONS FROM THE
   IV. Imprudence in permitting  convalefcents, or
 perfons coming from infected houfes, to refume their
 work, with their clothes faturated with infection.

   V. Want of proper ventilation, particularly during
 the night labor, when the air of the room is render-
 ed additionally impure by the candles.

   With regard to the three firft articles, I am uncer-
 tain how far the Committee could with propriety in-
 terfere.   If the proprietors  and overfeers of manu-
 factories could be interefted in the views of the Com-
 mittee, very advantageous regulations might be form-
 ed.

   The  cuftom of working all night totally fruftrates
 every attempt  to  ventilate the mills thoroughly,
 while the dirtinefs  of the perfons employed  renders
 them  more difpofed to receive the infection of fever.
 This cuftom fhould, if poffible, be difcontinued.

   The other circumftances might be eafily regulated
by the overfeers, who would perhaps be induced to
pay more attention to them, if premiums were held
out, to  overfeers who preferved a given degree of
health among the perfons under their care.

   The remonftrance  of  fo  refpectable a body as a
 Committee of this nature, may alfo be expected to
 have a proper influence, when they call the atten-
 tion of the proprietors of manufactories, to practices
 evidently deftructive of health and life.

   The great difference in the healthinefs of different
 cotton mills, which it would be invidious to point out
 here,  but which mvy may be eafily learnt from the
 lifts of  home-patients kept  at the Infirmary, for the
 laft five years, fufficiently proves the benefits  of care 
             MANCHESTER MERCURY.         231

reflecting the circumftances I have mentioned, and
the danger of inattention.

   The readmiffion of convalefcents into manufacto-
ries,  while they are  in a ftate  capable of  infecting
others, is an  obvious caufe of increaiing and  perpe-
tuating fevers.   To prevent this, it would be  proper
to retain patients in the fever-wards, till their clothes
and  perfons  fhould  be  fufficiently purified, and to
caution the overfeers of manufactories againft  the re-
ception of irregular  patients, who  might return to
their  employment without leave  from their  phyfi-
cian.

   A fimilar hazard,  which arifes from incautious vi-
fits to the fick, may be moft effectually counteracted
by regulations in the fever-wards,   it would be cru-
elty to refufe accefs to  near relations, in dangerous
cafes; but they might be taught to leffen the danger
of receiving infection", by placing themfelves between
the patient's bed and the window—by averting the
face while the patient fpeaks—and by carefully avoid-
ing to fit down upon the bed.

   All linen belonging to the patients fliould be waffl-
ed in the fever-wards, for the fame reafon.

         I have the  honor to be, Gentlemen,

             Your very obedient Servant,

                                j. FERRIAR.
H h 
 2j2             OBSERVATIONS.     J

 PREVENTION and SUPPRESSION of FEVER.

 Extrads of a letter from Dr. Haygarth, of Chefler,
     io Dr. Percival, dated January 6tht*iyg6.

   " You may remember  that in the Chefler Infir-    ,
 mary, we have, for the laft twelve years, received all    J
 infectious fever patients that require our affiftance,    1
 into the Fever-wards, one for each fex, appropriated    1
 to this  purpofe.—During  this period, it never was    i
fjsfeded, that infection has been communicated to a    \
 fingle patient in other parts of  the houfe..—In  the    fl
 prefent war,  Chefler has been unufually expofed to    I
 the danger of infectious putrid Fevers.  Many new    I
 raifed  regiments, coming from Ireland, with nu-
 merous recruits taken out of jails, remained in Chefler
 for a few weeks after their voyage.  Great numbers
 of thefe foldiers and their  women  were ill of putrid
 fevers, and were immediately received into the Fever
 wards of our  Infirmary.   If fuch contagious patients
 had  been diftributed  in  the  fmall ale-houfes  and
 poor  lodging-houfes through  the city,  the  confe-
 ouences to many of our inhabitants muft have been
 dreadful.

   By taking out of a houfe the firft perfon who fick-
 ens of  a Fever, we preferve the reft of the family
 from infection, together with indefinite number of
 their neighbors, who would otherwife catch the in-
 fection.  At  this very time, when the inhabitants of
 Mauchefter and many other places, are afflicted with
 a fatal contagious Epidemic, only  two patients  are
 now in our Fever-wards, and  both  convalefcent:
 And the Apothecary to the Infirmary, who attends
 the Out-poor of the whole city, informs me that he    -1
 has now not a fingle  fever patient under  his care.
 Sometimes, but very feldom,  our two Fever-wards 
           CONCLUDING OBSERVATIONS.      233

have been fomewhat crowded with patients.  I fhould
judge that about four, or fix fpacious Wards might
be fufficient for Manchefter, though  the inhabitants
are much more numerous, and perhaps more liable
to  fevers from   their unhealthy  dwellings,  occu-
pations, &c.—I am  confident that our  two  Fever
wards do ten times more real good in the prevention
of mifery, than all the other parts of the Infirmary.
      CONCLUDING OBSERVATIONS.

  From the preceding  papers, in union  with other
accounts of the Yellow Fever, already public, it ap-
pears that the following points are well eftablifned.

  I. That the Yellow Fever, fo called, is only the
moft malignant degree of ordinary bilious fever.

  II.  That this Fever may be, and often is generated
in the United States,  efpecially in  the more filthy
parts of populous towns.

  III.  That it is not ordinarily infectious, that is,  at-
tended with fpecific contagion ; but may be  render-
ed fo, by peculiar circumftances, that confpire to  in-
creafe its  malignancy.

  It feems  to  be proved  that in New-Haven, the
difeafe was introduced  and propagated by  infection.
In Philadelphia, it  is  admitted to have been, to a
confiderable degree, contagious. In New-York and
Norfolk, it is equally clear, the difeafe was not intro-
duced nor generally propagated by infection.  Our
beft accounts from Baltimore ftate, that the difeafe
there was not infectious. 
 234      CONCLUDING'OBSERVATIONS.

   IV. It  is demonftrated, beyond all controverfy,
 that bilious fevers are ordinarily produced by the im-
 pure air generated by the putrefaction of vegetable
 and animal  fubftances.   To  this effect  there  muft
 concur the following  caufes—vegetable or animal
 matter, heat  and water.   Heat and water acting on
 vegetables, or heat alone on animal matter.   With-
 draw any one of thefe cauies, and the effects  ceafe.
 Hence, this important leffon is deducible.

   High and  dry fituations, in the country, and  re-
 mote  from ftagnant  water, fhould be feleded for
 healthinefs—and fimilar pofitions for cities; but with
 this additional caution—to  keep  them clean.   The
 people of a city make filth  enough every week, to
 generate peftilence, in the hot feafon, and it will pro-
 duce ficknefs, more or lefs every feafon, unlefs the
 ftreets and yards are conftantly, not only fwept, but
 wafljed.   Wafhing the ftreets and back-yards fliould
 be as much a  bufinefs of police  from June to No-
 vember, as lighting lamps or regulating weights and
 meafures.  It fliould  alfo be an object of police to
 calculate the mode of paving and draining ftreets, for
 cleanlinefs, and to direct individuals to do the  fame
 on their back yards.   A vigilant police  will infpect
 every  article  of building, and fee that no sources of
pefiriler.ee and  death are  lurking behind  houfes and
 ftores.

   V.  Another important conclufion refults from the
 facts ftated ;  this is, that country people have not the
 fmalleft reafon for alarm, on account of  the fpreati-
 m«- of the Yellow  Fever.   It is indeed certain that
 people from the country, during the exiftence of this
 fever  in town,  are more expofed (if they vifi: the
 town and breathe the air of it) than the inhabitants.
 But it h demonftrated by experience that thi*  fever 
           CONCLUDING- OBSERVATIONS.       235

..ill not fpre? i in a pure air.  It did not fpread even in
New-York, oar the weftern and well-ventilated part
of the city.   Hei.-ce when the fick remove from town
into the country ,or when citizens are taken ill with the
fever, after ler.v.ng the city, the people in the country
have no oeo;fiou to avoid the  fick, or neglect to ad-
mi nifter to '.'... .1 all poi :blc comfort and relief; for
there is little danger of taking it in a free wholefome
air.  Place the ';<>:. in v   pen airy room and keep it
clean,  2:11 •±•: attendiats are  in little danger of re-
ceiving it.

   It ; panic that feized the whole continent,  when
the d  -rt'e ap aircu in Philadelphia, is now found to
have  )eer needier anl w! aoutjut  caufe;  and it is
prefuiu it  that luch inhuman  caution and barbarous
mc/urc-: as were adopted on that occafion, will  ne-
ver avi.i:. diigracc  cur country.   Inftead of fhutting
d-j^r;; againft  the fiving citizens., let every one open
his houle and give them an  hcfpitable reception.

   VI.  The laft remark on this  occafion is that though
the immediate cau.es of epidemics may be well un-
derftood in moft caies;  yet there appears to be a ne-
ceffity,  in other  cafes, to re:ort to a general predif-
pofing influence in the atmolphere.

   Sometimes it  happens that very malignant difeafes
will not fpread  in a  country,  even when introduced
■from abroad.  At other times, a fmall fpark will en-
kindle a flame that cannot  be  refifted.

   In one year,  the putrid  fore throat fpreads  its ra-
vages in one town—the  next year,  in  a  bordering
town.   This year the dyfentery attacks one town, or
perhaps a fingle  ftreet, with fatal  malignity—the
next that town is free from it, and the adjacent town
% 
236       CONCLUDING OBSERVATIONS.

is attacked.   Thefe facts are within every man's re-
mark.

  But there  has been for 6 or 7 years paft, an ex-
traordinary run (to ufe a vulgar phrafe) of malignant
difeafes and epidemics.  The Influenza,  in the fum-
mer  of 1789, firft made its appearance at the  fouth-
ward.  It travelled regularly northward, and reached
Bofton the firft week in November. The next fpring,   T
it began in our frontier  fettlements,  in  March, and
travelling fouthward, reached  the Atlantic towns in
May.  Of this  fact, I was a witnefs.

  The fcarlet fever fucceeded.  It appeared in 1789,
cr '90, in the ftate of New-York, and has  paffed    '
flowly through the eaflern flates, reaching Bofton    j
and  Portfmouth the laft year, and it  has not yet dis-
appeared in that quarter.                            .

  To  thefe fucceeded the Yellow Fever, in various
places, which has alfo had its run.

  During the autumnal feafons, a few years paft, dy-   '
fenteries have alio proved  uncommonly mortal, in
various parts of the country.

  During the fame feafons, the Yellow Fever  has   '
been uuufually  frequent and fatal, on  the coaft of  j
Africa, and in the Weft-Indies.                      1

   To what caufe fhall we attribute this general pre-
valence of malignant difeafes in various quarters of
the globe, at the°famc time ?  Specific contagion  can-
not  be the caufe; it will not  even account for the
rapid  progrefs  of the Influenza in  Europe,  and in
thb country, for whole to was were feized with it in a
day.  The Scarletina Anginofa is highly infectious ,
but it v..;.:- r.ot propagated generally nor principally by 
             CONCLUDING OBSERVATIONS.       237
;
   infection.   On the other  hand, children were feized
   with it in various parts of the country, remote from
   the difeafed, and  without having the leaft connection
   with them.

     Nay more,  I can witnefs that when the difeafe was
   fatal to multitudes in New-York in 1791,  and the
   year before in its worft forms  in  Connecticut, the
   fame difeafe,  with flighter fymptoms, was even epi-
 :  demic in Hartford.   The mild form in which it ap-
   peared, feemed  to be but  a  prelude  to the difeafe
   which in the two fucceeding years proved fo fatal.  I
   was witnefs to it,  in this mild form in my own family:
 ,  a fevere catarrhal affection,  accompanied with high
   fever, and a partial efflorefcence of the fkin about the
   throat and breaft.
 L
 .   -This fact would feem to prove, not only a general
   predifpofing caufe in the atmofphere, but a progrefifive
 Jlate of that caufei'

 ,    Another fact would feem to juftify this remark.  It
   is well known  that foreigners, coming from other cli-
   mates,  are very eafily affected with the difeafes pre-
 .  valent at the time of their arrival,  and more eafily
   take fuch diforders than natives.—Now it  is a fact
 'within  my obfervation,   that  foreigners  arriving
 [froni Europe  at  New-York  in  1794,  were feized
 I'wiih  the  . fcarlet  fever,  after  it had  ceafed  to
 (affect native'citizens.   The  refult  of this  obferva-
   tion is, that the decreafe of the predifpofing influence
   of the atmofphere, is progrefifive, and that it was fuffi-
   cient to affect foreigners, for fome time, after it ceafed
   to affect perfons accuftomed to breathe the air of our
I  climate. 
 238       CONCLUDING OBSERVATIONS.

   Indeed fomething of  the  fame kind is true, with
 refpect  to the  Yellow Fever, in New-YorK.  The
 fame difeafe had appeared, in a few inftances, for two
 or  three feafons preceding the  year  1795.   Several
 cafes occurred in  1794.   Thefe cafes itemed  to L»e
 harbingers of the more general mortality of  the laft
 feafon.

   I  do  not know that this difeafe appeared in Phila-
 delphia, in the laft feafon preceding the fatal autumn
 of 1793 ; but feveral cafes have occured the two laft
years.   A friend of mine who loft two clerks in the
fatal feafon of 1793, loft two others in 1794, and one
in 1795 ; all from the fame  counting houfe.

   In thefe cafes, there is no pretence of infection.—
The difeafe  muft have fprung from  local caufes,  or
the predifpofing  influence of the air inhaled by thefe
unfortunate people.

  I am therefore inclined to believe that independent
of local caufes, the atmofphere  may  be and is often
affected  by fome general invifible caufes, which, at
particular feafons,  difpofe the human body to parti-
cular difeafes.  Whether this difpofition in  the air
proceeds from the prevalence of particular winds—
of rains—of heat—or of froft ; or whether  the af-
pects of the planets,  or the various action of that all-
powerful  elementary fluid, electric fire,  which feems
to be the-moft energetic principle in the fyftem, may
not  vary the combination of fubftances  compofing
vital air,  are queftions  for the inveftigation of the
 philofopher.  The facts  which are within common
 obfervation are fufficient to point to the proximate
 caufes of  difeafe, and  that  when thefe are^ known,
 moft of the evils of ficknefs, are brought within the
 influence  of human management—many of  them
 may be  obviated—all of them, mitigated. 
           CONCLUDING OBSERVATIONS.       239

  If it is clearly  afcertained,  that the gas generated
by  the decompofition of animal and vegetable fub-
ftances, in putrefadion, is fatal to healthy life ;  then
it becomes a duty to depofit fuch fubftances  in places
where they cannot annoy us.  It is as much the duty
of  the citizens of populous towns,  to cleanfe their
ftreets, and their back yards, wafh their houfes and
bathe their perfons, as it is to provide a Hofpital tor
the indigent fick, or a grave for the dead.

   Thus in the country, people fhould choofe dry
frtuations  for  their  houfes,  remote from marfhy
grounds.   They fhould  particularly guard againft
the noxious effeas of the heat on land juft drained of
water.  While land is covered with water, even if
flagnant, no very pernicious  effects are to be appre-
hended ;  but terrible are the effects  of a hot fun on
the putrid fubftances that line the bottoms of ponds,
when  they are fuddenly expofed, by  the draining off
of the water.

   Thus,alfo,fettlers on new lands are toguard againft
the firft effeas of clearing moift land.   While veget-
nble  fubftances  are covered with water,  they are
harmlefs; and while marfhy  grounds are fnaded by
thick  forefts, they produce no difeafe.  The heat is
not fufficient in the deep  fhade of a foreft, to extri-
cate the noxious Gas*.   But on opening thofe mar-
fhy grounds  to  the aaion of the fun, all the latent
feeds  of difeafe are fet in motion and impregnate the
 furrounding atmofphere.   Then the inhabitants be-
 come fickly, and continue,  more or lefs?< to be  fo in
 hot weather, till the furface of the earth is effeaually
 dried  or cleanfed by ploughing and cultivation.

                        I  i
   T It is faid that a degree of heat equal to  8o° by  Farenhelt's
 fcale, is neceffary to extricate the deleterious gas from vegetable
 fubftances—^ degree never felt i» the recefles  of 3 fhady foreft. 
2r0          ADDITIONAL REMARKS. [J

          ADDITIONAL REMARKS.

  Since the preceding obfervations were compofed,
ihe Editor has received the following remarks, from a
friend, with liberty  to  make them public.  And as
they appear to him of fufficient importance to juitify
an infertion in this place, he prefumes no apology is
neccfiary for fo doing ;  although they are, in part, a
repetition of his own.   A fubjea fo important to the
welfare of the  citizens of the United  States, can
hardiv be exhibited in too many points of view.
  The means of prevention, not only of Yellow Fe-
vers, but of all other fevers, in any degree of the fame
nature, are principally two : and this is equally true
in refpea to individuals and communities.  Thefe two
means are  temperance and cleanliness.

  I.  Temperance.   No truth is more  certain,  or
more eafily demonftrable by numerous and important
{act?, than that  different climates  require different
modes of living.   It  is from inattention to this Am-
ple truth that a large fliarc of all the phyfical evfts of
men arife.—Thus, many kinds of  food  and various
liquors,  are harmlefs, and even  neceffary in cold
countries, which are  abfolutely pernicious in hot  cli-
mates.   Thus, exercife in the open air, is highly  ad-
vantageous and healthful, at all hours in the day, in
temperate regions; while in many parts of the world,
beneath the torrid zone more efpecially, an expofure
to the fogs of the  morning, the heats of the noon-
tide, or the dews of  the night, are  certainly deftruc-
tive.—Confiderations of this nature„,are very little
;bought of, and ftill lefs attended to, among people at 
             ADDITIONAL REMARKS.          24 :

large :  and  indeed .the mafs of population, in the
greater part of the earth, are incapable of appreciat-
ing the confequences of the obfervance or neglect.—
In all their changes of place, they carry with them
the fame cuftoms ; v and it is by  long  experience only
that they  are taught the neceffity of adapting  their
habits to their new fituations.

   By far the largeft portion of the United States lau
been peopled by emigrants from the northern coun-
tries of  Europe.   Wherever they have fettled they
have continued, with very trifling deviations, to-pur-
fue their accuftomed occupations and modes of living.
Meats and ftimulating liquors are more ufed in north-
ern climates, than in fouthern, and with lefs diiacr-
vantage.  Our anceftors continued to confume them
after their  fettlement in this country, in the  fame
manner as before ; the confequences have been un-
fortunate ; of late, by conneaion with other circumftan-
ces, they have become ftill more deftructive, and we
are beginning to be alarmed.—A numerous  train of
faas ; the example of almoft all Afia, Africa, and the
fouth of Europe ; demonfhate the advantages of tem-
perance, both in foods and drinks, and the fatal effefts
of adeparture therefrom.  Rice,and other grains, fruits,
and water, form nearly the fole articles of confumption,
among the inhabitants of thefe countries, during the
fultry feafon.   It is  only on their fea-coafts, where
commerce has colkaed  foreigners from all part.;,
and efpecially from Europe, and where every fp-cies
of riot and intemperance  is common, that the neiii-
 lential Fevers, of which we hear fo much, prevail.—
In the fouth of  Europe, in Italy, for inftance, even
in the maritime cities, where the people either from
neceffity cr choice, abftain from meats, wines and 
24^        ADDITIONAL REMARKS.

other intoxicating liquors, during great part  of the
year, general and peftilential difeafes rarely appear:
particularly, among  thofe  nations who are attentive
to cleanlinefs.

   The city of Naples  contains about four hundred
thoufand inhabitants ;  of whom thirty  or forty thou-
fand are faid to belong to the clafs  of beggars.—In
that climate the rains prevail, with little intermiffion,
for three months—from  February  to  May.   From
May to September,  a drouth,  equally fevere,  and
fcarcely allayed, in many years, by a fingle plentiful
rain, renders the heat almoft intolerable.  The wages
of a laborer not exceeding eight pence this currency,
a day, and meat  being rarely had in  their markets
for lefs than four pence  the pound, and  vinous li-
quors in the fame proportion,—the mafs of popula-
tion is excluded from  any fhare of thefe luxuries ;
of confcquence they fupport themfelves on vegetables,'
roots, fallads, fruits,  &c.—and dilute their food,  and
animate their  fpirits, with water and  lemonade.—
Yet this city has, for  a great number of years, known
no  general difeafe.   And for  ten years, no febrile
difeafe, of  any fort-, was common among them.—
They, alio, pay great attention to perfonal cleanlinefs.
Facts of this fort  are very important,  and form the
belt comment on the  difcordant opinions of our phyfi-
ciau-a

   II. Cleanliness.  It is fo  the rigid obfefvance
which the  eaflern nations  pay to  ablution, that, in
connection with their habitual temperance, we are to
afcribe their fuperior health and longevity ; and to
the neglea of the  inhabitants of the fouthern parts of
America,  in refpect  of both thefe particulars;, their 
             ADDITIONAL REMARKS.         243

ficknefs and mortality.—It is impoffible to prefs this
matter too forcibly upon nations, communities, fami-
lies, and individuals.  All are concerned in it.—The
people of the United States, as a people,  are noted
for houfehold cleanlinefs.   They are far  below the
Dutch in refpea to the falubrity and purity of their
towns; and  below the French, Italians,  and  even
Swedes and Ruffians, in regard to perfonal cleanlinefs.

   In  many parts of Italy, public baths are more nu-
merous than coffee-houfes and taverns.   In France,
machines and utenfils for bathing, form an effential
part of the houfehold furniture of  every well-regu-
lated  family ; and a woman would  as foon think of
going into company, with unwafhed hands and un-
combed hair, as without having made ufe of the bath.
In Sweden and Ruffia, the pooreft and moft abjea
of both fexes,  would hold themfelves  unworthy to
appear before the Deity in his temple, on the Sab-
bath,  if they had not devoted fome part of the pre-
ceding day to perfonal ablution. This is not the cafe
in England ; and the confequences  of thefe national
cuftoms may be  traced in the hiftory of our own
country.  Who  does not recollea  the  mortality
which prevailed among the early Englifh colonifts in
Virginia ?  Who has not read,  or heard, of the long '
fevers,  as they were called, of the  New-England
flates f—But did ever any perfon learn that thefe mif-
fortunes.afHiaed Pennfylvania and New-Jerfey while
they  were  called New-Sweden ?—Philadelphia and
the neighboring parts of New-Jerfey, were originally
fettled by Swedes.  Thefe people were neither  more
rebuff, nor more circumfpea, in the generality of
things, than the Englifh  fettlers ;  but  they brought
with  them  their habits of perfonal  cleanlinefs, and 
244         ADDITIONAL REMARKS.

they were rarely vifited by difeafes.—Even fo late as
when Profeffor Kalm vifited this  country, the prac-
tice of univerfal weekly bathing,  was ftill preferved,
among the remnant of the Swedifh inhabitants.

  In former ages, and among the celebrated nations
of antiquity, perfonal, as well  as general cleanlinefs,
was confecrated by numerous rites, and  incorporated
into every religion.  Among a barbarous and igno-
norant people,  this was, perhaps, the only means of
fecuring a proper obfervance  of this duty.   It were
fortunate  for the United States if the old  difpenfa-
tion were revived, in this particular.  The  laws of
Mofes,  in relation to the virtue of cleanlinefs, bear
imprefied on their front, the charaaers  of a wifdom
nothing fhort of divine.—The days of prophets  and
of miracles are paft ; but finely, in a matter of fuch
effential importance to the well-being of  our country,
the care of  leghiation  fhould  be  extended to fupply
the neglea  of  the moralift.   Thofe rulers but par-
tially confult the durable felicity of  the people they
govern, who through ignorance, indolence, or a fpirit
of pariimony, mifcalled economy, overlook, or fail to
remedy, a defect fo interefting to private and  public
happinefs, to individual and general tranquility  and
virtue.
  In addition to  the preceding obfervations, one re-
mark further may be addreffed to  the people of the
United States, generally, but more particularly to the
fettlers on the new lands.—Great and fudden altera-
tions in the face of a  country, rarely fail of being fol-*
lowed by changes in the  ftate of the inhabitant of 
ADDITIONAL REMARKS.
245
that country, proportionably rapid and confiderable.
The opening of new land and water communications,
the draining of marfhes and deftruaion of forefts,
have a moft extenfive,  and often unfortunate influ-
ence,  for a time,  on the country in which they take
place.  As one of the fureft means of preventing bad
confequences, the attention of the people engaged in
undertakings of this kind, fhould be  turned to the
inducing as rapid and luxuriant a vegetation, on all
fuch  clearings  up, as  poffible.   It behoves them,
'ike wife, to-pay a double regard to the duties of
*«^er, temperance, and cleanlinefs.  The moft fatal
effeas fbttvar from ntslea in thefe particulars; and
efpecially  from that free <tfe of  fpirituous I:q
which from erroneous notions  of their utjiky,"
commonly refcrted to. 
 
MedL. Miarlc
   no

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