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THE PREFACE.

THE delay of the following publication has been occasioned by the want of health to prepare it for the press, during the winter months. It now goes forward, under the great disadvantages, of having been hastily copied from my notes, amidst frequent pro|fessional interruptions. Its imperfections I hope will be overlooked, when it is con|sidered, that my only design in publishing thus prematurely, was to obviate as much as possible, the danger of the disease, should it unhappily appear in our city in the course of the present season.

Page  iv In the history of the fever, I have intro|duced an account of the symptoms and prognosis, in such places as they occurred most naturally, without a strict regard to the artificial order of the schools.

In the detail of the symptoms, I have divided the body into different systems. This division I have found to accord more easily with the principles of medicine which I have adopted, than the common method of describing them, as they appear in the animal, natural, and vital functions.

In republishing an account of the con|troversies between the physicians of Phila|delphia, my motives were, to prevent the revival of certain opinions and modes of practice, by bringing them forward under the patronage of respectable names, and to justify in a great measure, from their influ|ence, the want of universal success, by the Page  v only safe, and proper mode of treating the yellow fever. I hope I shall be excused for this part of the following work, when it is perceived, that I have been more minute in relating my own mistakes, than those of other Physicians; and that I have connected no names with the opinions and modes of practice which I have opposed, but such as were given to the public by their au|thors, during the prevalence of the fever.

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CONTENTS.

• AN account of the diseases which preceded the yellow fever▪ 1
• Of the first cases of it, 8
• Correspondence between Dr Hutchinson, and the Author, upon the subject of the fever, 16, 17
• Proceedings and publication of the College of Phy|sicians. 21
• Predisposing and exciting causes of the fever, 29
• Premonitory signs of an attack of the fever, 36
• History of its symptoms, 39
• As they appeared in the blood-vessels, 40
• —in the liver and brain, 47
• —in the stomach and bowels, 51
• —in the secretions and excretions, 54
• —in the nervous system, 61
• —in the senses and appetites, 66
• —in the lymphatic and glandular system, 68
• —on the skin, 69
• —in the blood, 73
• Anomalous circumstances belonging to the history of the fever, 78
• Its banishment of, or mixture with, other fevers, 84
• Page  viii Account of persons, most subject to the disease, 93
• —of those who escaped it, 101
• Signs of the universal prevalence of the exhalation, and contagion in the city, 104
• State of the atmosphere during the prevalence of the fever, 108
• Proofs of reinfection, 112
• State of the body after death, 113
• Appearances of the dead body exhibited by dissection, 115
• State of the City during the prevalence of the fever, 122
• Amount of deaths, and the number on each day from the 1st of August to the 9th of Novem|ber, 128, 129
• The causes which checked the disorder, 131
• The diseases which succeeded the yellow fever, 138
• The means used to purify houses and cloaths, 141
• Sporadic cases of yellow fever in 1763, 144
• Of the origin of the fever, 145
• Symptoms, and circumstances, of agreement and disagreement, between the yellow fever and the plague, 169
• —of the yellow and jail fever, 175
• Different grades or states of bilious fever, 178
• Premonitory signs of great and mortal epidemics, or of a sickly autumn, 179
• Register of the weather from the 1st of January to the 9th of November, 1793. 185
• Of the Method of Cure, 193
• Of the remedies for the fever, 203
• Origin of the dissentions among the physicians, 207
• Four modes of treating the fever, 243
• I. Of purging, 245
• Objections to it answered, 248
• Page  ix Of blood-letting, 258
• The appearances of the blood, 261
• Objections to blood-letting answered, 274
• Advantages of obtaining evacuations in a gradual manner in certain cases, 277
• Of cool and fresh air, 284
• Of the drinks and diet used in the first stage of the fever, 285, 286
• Of the application of cold water to the body, 287
• Of the advantages of a salivation in the cure of the fever, 290
• Of blisters, 291
• Of the drinks and diet in the second stage of the fever, 291, 292
• Of the remedies which were used to relieve painful or distressing symptoms, 292
• Symptoms which attended the convalescence, 294
• Of the benefits of bleeding, purging, and low diet in preventing or mitigating the disease, 295
• II. Observations on the use of bark, in the fever, 289
• —of wine, 299
• —of laudanum, 299
• —of the cold bath, 300
• III. Observations on the combined use of evacuations, and tonic medicines, 302
• IV. Observations on the use of the French remedies, 302
• Inquiry into the comparative success of each of the four modes of practice, which have been mentioned, 303
• Of the tonic method, 303
• Of the antiphlogistic method, 308
• Of the combination of the tonic and antiphlogistic methods and of the French practice, 319, 320
• Page  x Observations on the success of the antiphlogistic remedies, in the hands of persons not educated to the profession of physic, 320
• Inferences from their success, and from other consi|derations, in favour of teaching the people at large to cure themselves of the yellow fever, and of all other pestilential fevers, 325
• Narrative of the state of the Author's body and mind during the prevalence of the fever, 339

☞ The reader will please to correct the following errors:

for Dr. Physic, read Dr. Physick.

• In p. 41, line 2.
• —p. 49, line 6.
• —p. 55, line 9,
• —p. 119, l. 8,

• —p. 144, line 6, insert sporadic before case.
• —p. 144, line 19, insert prevailed, instead of occurred.

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AN ACCOUNT OF THE Bilious remitting Yellow Fever, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1793.

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AN ACCOUNT, &c.

BEFORE I proceed to describe the fever which is to be the subject of this Essay, it will be proper to give a short account of the diseases which preceded it.

The state of the weather during the first seven months of the year, and during the time in which the fever prevailed in the city, as recorded by Mr Rittenhouse, will be inserted immediately after the history of the disease.

The MUMPS which made their appearance in December 1792, continued to prevail during the month of January 1793. Besides this disorder, there were many cases of catarrh in the city, Page  4 brought on chiefly by the inhabitants exposing themselves for several hours on the damp ground in viewing the aerial voyage of Mr Blanchard on the 9th day of the month.

The weather which had been moderate in De|cember and January became cold in February. The mumps continued to prevail during this month with symptoms so inflammatory, as to require in some cases two bleedings. Many people com|plained this month of pains and swellings in the jaws. A few had the scarlatina anginosa.

The mumps, pains in the jaws, and scarlatina continued throughout the month of March. I was called to two cases of pleurisy in this month, which terminated in a temporary mania. One of them was in a woman of ninety years of age, who re|covered. The blood drawn in the other case, (a gentleman from Maryland) was dissolved. The continuance of a tense pulse, induced me notwith|standing to repeat the bleeding. The blood was now sizy. A third bleeding was prescribed, and my patient recovered. Several cases of obstinate erysipelas succeeded inoculation in children during this, and the next month, one of which proved fatal.

Page  5 Blossoms were universal on the fruit-trees, in the gardens of Philadelphia, on the first day of April. The scarlatina anginosa continued to be the reigning epidemic in this month.

There were several warm days in May, but the city was in general healthy. The birds ap|peared two weeks sooner this spring than usual.

The register of the weather shews, that there were many warm days in June. The scarlatina continued to maintain its empire during this month.

The weather was uniformly warm in July. The scarlatina continued during the beginning of this month, with symptoms of great violence. A son of James Sharswood, aged seven years, had with the common symptoms of this disorder, great pains and swellings in his limbs, accompanied with a tense pulse. I attempted in vain to relieve him by vomits and purges. On the 10th day of the month, I ordered six ounces of blood to be drawn from his arm, which I observed afterwards to be very sizy. The next day he was nearly well. Be|tween the 22d and the 24th days of the month, there died three persons whose respective ages were 80, 92, and 96½. The weather at this time Page  6 was extremely warm. I have elsewhere taken no|tice of the fatal influence of extreme heat, as well as cold, upon human life in old people. A few bilious remitting fevers appeared towards the close of this month. One of them under my care, ended in a tedious typhus mitior, from which the patient was recovered with great difficulty. It was the son of Dr Hutchins of the island of Bar|badoes.

The weather for the first two or three weeks in August was temperate, and pleasant. The colera morbus, and remitting fevers were now common. The latter were attended with some inflammatory action in the pulse, and a determination to the breast. Several dysenteries appeared at this time, both in the city and in its neighbourhood. During the latter part of July, and the beginning of this month, a number of the distressed inhabitants of St Domingo, who had escaped the desolation of fire and sword, arrived in the city. Soon after their arrival, the influenza made its appearance, and spread rapidly among our citizens. The scar|latina still kept up a feeble existence among chil|dren. The above diseases were universal, but they were not attended with much mortality. They prevailed in different parts of the city, and each seemed to appear occasionally to be the ruling Page  7 epidemic. The weather continued to be warm and dry. There was a heavy rain on the 25th of the month, which was remembered by the citi|zens of Philadelphia as the last that fell, for many weeks afterwards.

There was something in the heat and drought of the summer months, which was uncom|mon, in their influence upon the human body. Labourers every where gave out (to use the coun|try phrase) in harvest, and frequently too when the mercury in Fahrenheit's thermometer was un|der 84°. It was ascribed by the country people to the calmness of the weather, which left the sweat produced by heat and labour, to dry slowly upon the body.

The crops of grain and grass were impaired by the drought. The summer fruits were as plentiful as usual, particularly the melons, which were of an excellent quality. The influence of the weather upon the autumnal fruits, and upon vegetation in general, shall be mentioned hereafter.

I beg pardon for the length of this introduction. Some parts of it, I hope, will not appear useless in the sequel of this work.

Page  8 I now enter upon a detail of some solitary cases of the epidemic, which soon afterwards spread distress through our city, and terror throughout the United States.

On the 5th of August, I was requested by Dr Hodge to visit his child. I found it ill with a fever of the billious kind, which terminated (with a yellow skin) in death on the 7th of the same month.

On the 6th of August, I was called to Mrs Bradford, the wife of Mr Thomas Bradford. She had all the symptoms of a bilious remittent, but they were so acute, as to require two bleedings, and several successive doses of physic. The last purge she took was a dose of calomel, which ope|rated plentifully. For several days after her re-recovery, her eyes and face were of a yellow colour.

On the same day, I was called to the son of Mrs M'Nair, who had been seized violently with all the usual symptoms of a bilious fever. I purged him plentifully with salts and creamor tartar, and took ten or twelve ounces of blood from his arm. His symptoms appeared to yield to these remedies; but on the 10th of the month Page  9 an haemorrhage from the nose came on, and on the morning of the 12th he died.

On the 7th of this month I was called to visit Richard Palmer, a son of Mrs Palmer in Ches|nut-street. He had been indisposed for seve|ral days with a sick stomach and vomiting after eating. He now complained of a fever and head-ach. I gave him the usual remedies for the bilious fever, and he recovered in a few days. On the 15th day of the same month, I was sent for to visit his brother William, who was seized with all the symptoms of the same disorder. On the 5th day his head-ach became extremely acute, and his pulse fell to sixty strokes in a minute. I suspected congestion to have taken place in his brain, and ordered him to lose eight ounces of blood. His pulse became more frequent, and less tense after bleeding, and he recovered in a day or two after|wards.

On the 14th day of this month I was sent for to visit Mrs Leaming, the wife of Mr Thomas Lea|ming. I suspected at first that she had the influ|enza, but in a day or two, her fever put on bili|ous symptoms. She was affected with an uncom|mon disposition to faint. Her pulse was languid, but tense. I took a few ounces of blood from her, Page  10 and purged her with salts, and calomel. I after|wards gave her a small dose of laudanum which disagreed with her. In my note book, I find I have recorded, that "she was the worse for it." I was led to make this remark by its being so very uncommon, for a person who had been properly bled and purged, to take laudanum in a com|mon bilious fever, without being benefited by it. She recovered however slowly, and was yellow for many days afterwards.

On the morning of the 18th of this month, I was requested to visit Peter Aston, in Vine-street▪ in consultation with Dr Say. I found him on the 3d day of a most acute bilious fever. His eyes were inflamed, and his face flushed with a deep red colour. His pulse seemed to forbid evacua|tions. We prescribed the strongest cordials; but to no purpose. We found him at 6 o'clock in the evening, sitting upon the side of his bed, per|fectly sensible, but without a pulse, with cold clam|my hands, and his face of a yellowish colour. He died a few hours after we left him.

None of the cases which I have mentioned, excited the least apprehension of the existence of a yellow fever in our city; for I had frequently seen sporadic cases in which the common bilious fever Page  11 of Philadelphia, had put on symptoms of great ma|lignity, and terminated fatally in a few days, and now and then with a yellow colour on the skin, before, or immediately after death.

On the 19th of this month I was requested to visit the wife of Mr Peter Le Maigre, in Water-street, between Arch and Race-streets, in consul|tation with Dr Foulke and Dr Hodge. I found her in the last stage of a highly bilious fever. She vomited constantly, and complained of great heat and burning in her stomach. The most powerful cordials, and tonics were prescribed, but to no pur|pose. She died on the evening of the next day.

Upon coming out of Mrs Le Maigre's room, I remarked to Dr Foulke and Dr Hodge, that I had seen an unusual number of bilious fevers, ac|companied with symptoms of uncommon malig|nity, and that I suspected all was not right in our city. Dr Hodge immediately replied, that a fever of a most malignant kind had carried off four or five persons within sight of Mr Le Maigre's door, and that one of them had died in twelve hours af|ter the attack of the disorder. This information satisfied me that my apprehensions were well found|ed. The origin of this fever was discovered to Page  12 me at the same time, from the account which Dr Foulke gave me of a quantity of damaged coffee which had been thrown upon Mr Ball's wharf, and in the adjoining dock, on the 24th of July, nearly in a line with Mr Le Maigre's house, and which had putrefied there to the great annoyance of the whole neighbourhood.

After this consultation I was soon able to trace all the cases of fever which I have mentioned to this source. Dr Hodge lived a few doors above Mr Le Maigre's, where his child had been expo|sed to the exhalation from the coffee for several days. Mrs Bradford had spent an afternoon in a house directly opposite to the wharf and dock on which the putrid coffee had emitted its noxious effluvia, a few days before her sickness, and had been much incommoded by it. Her sister Mrs Leaming had visited her during her illness, and probably caught the fever from her, for she per|fectly recollected perceiving a peculiar smell unlike to any thing she had been accustomed to in a sick room, as soon as she entered the chamber where her sister lay. Young Mr M'Nair and Mrs Pal|mer's two sons had spent whole days in a compting house, near where the coffee was exposed, and each of them had complained of having been made Page  13 sick by its offensive smell, and Mr Aston had fre|quently been in Water-street near the source of the exhalation.

This discovery of the malignity—extent—and origin of a fever which I knew to be highly con|tagious, as well as mortal, gave me great pain. I did not hesitate to name it, the Bilious remitting Yellow Fever. I had once seen it epidemic in Philadelphia, in the year 1762. Its symptoms were among the first impressions which diseases made upon my mind. I had recorded some of these symptoms. I had likewise recorded its mor|tality. I shall here introduce a short account of it from a note book which I kept during my ap|prenticeship.

I have taken notice in my note book, of the principal remedy which was prescribed in this fever by my preceptor in medicine, but this shall be mentioned hereafter.

Upon my leaving Mrs Le Maigre's, I expressed my distress at what I had discovered, to several of my fellow citizens. The report of a malignant and contagious fever being in town, spread in eve|ry direction, but it did not gain universal credit. Some of those physicians who had not seen pati|ents in it, denied that any such fever existed, and asserted (though its mortality was not denied) that it was nothing but the common annual re|mittent

Page  13〈1 page duplicate〉Page  16〈1 page missing〉

of it, and into the nature of the disease. In con|sequence of this order, I received the following letter from Dr Hutchinson.

Page  17 To this letter I wrote the following answer a few hours after it came to hand.

A FEW days afterwards, the following publica|cation, by Dr Hutchinson, appeared in the Ame|rican Daily Advertiser of August 28th.

Page  18 THE governor having directed an inquiry to ascertain the facts, respecting the existence of a contagious fever in the city, and the probable means of removing it, Dr Hutchinson, the physician of the port, has made the fol|lowing statement upon the subject, in a letter to Natha|niel Falconer, Esq. health-officer of the port of Phila|delphia.

The disease continued to spread, and with a de|gree of mortality that had long been unknown by common fevers.

On the 25th of the month, the college of physi|cians was summoned by their president to meet, in order to consult about the best methods of treating this fever, and of checking its progress in the city. After some consideration upon the nature of the dis|ease, a committee was appointed to draw up some directions for those purposes; and the next day the following were presented to the college, and adopt|ed unanimously by them. They were afterwards published in most of the news papers.

From a conviction that the disease originated in the putrid exhalations from the damaged coffee, I published in the American Daily Advertiser of Au|gust 29th, the following short address to the citi|zens of Philadelphia, with a view of directing the public attention to the spot where the coffee lay, and thereby of checking the progress of the fever as far as it was continued by the original cause.

This publication had no other effect, than to produce fresh clamours against the author; for the citizens as well as most of the physicians of Phila|delphia had adopted a traditional opinion, that the yellow fever could exist among us, only by impor|tation from the West Indies.

In consequence, however, of a letter from Dr Foulke to the Mayor of the city, in which he had de|cided, in a positive manner in favour of the genera|tion of the fever from the putrid coffee; the mayor gave orders for the removal of the coffee, and the Page  27 cleaning of the wharf and dock. It was said that measures were taken for this purpose; but Dr Foulke, who visited the place where the coffee lay, has repeatedly assured me, that they were so far from being effectual, that an offensive smell was exhaled from it many days afterwards.

I shall pass over for the present, the facts and arguments on which I ground my assertion of the generation of this fever in our city. They will come in more properly in the close of the history of the disease.

The seeds of the fever, whether received into the body, from the putrid effluvia of the coffee, or by contagion, generally excited the disease in a few days. I met with several cases in which it acted, so as to produce a fever on the same day, in which it was received into the system, and I heard of two cases in which it excited sickness, fainting, and fever, within one hour after the persons were exposed to it. I met with no instance in which there was a longer interval than sixteen days, be|tween the contagion being received into the body, and the production of the disease.

This poison acted differently in different consti|tutions, according to previous habits, to the de|grees Page  28 of predisposing debililty, or to the quantity and concentration of the contagion which was ap|plied to the body.

In some constitutions the contagion was at once a remote, a predisposing, and an exciting cause of the disease; hence some persons were affected by it, who had not departed in any instance from their or|dinary habits of living, as to diet, dress, and exer|cise. But it was more frequently brought on by some predisposing, or exciting cause. I shall briefly enumerate each of them.

Whatever be the specific quality of the matter which produced the fever, it is certain, that it acted as a stimulus upon the whole system. In a moderate degree, it produced only a quickness and fulness of the pulse, but when it was more active, it induced that species of debility which has been happily called indirect. It is the reverse of direct debility, which is produced by the ab|straction of natural, and usual stimuli from the body. When the contagion acted with so much force, as to induce indirect debility, a fever some|times followed without the aid of an exciting cause, but this was seldom the case. In ninety-nine cases out of an hundred, which came under my notice, I could distinctly trace the formation Page  29 of the disease to some of the following causes, act|ing separately, or in greater or less combination, and inducing indirect or direct debility upon the system. The causes which induced indirect debi|lity were,

1. FATIGUE of body or mind, induced by labour, by walking, riding, watching, or the like. It was labour which excited the disease so universally a|mong the lower class of people. A long walk often induced it. Few escaped it after a day, or even a few hours spent in gunning. A hard trotting horse brought it on two of my patients. Perhaps, riding on horseback, and in the sun, was the ex|citing cause of the disease in most of the citizens and strangers who were affected by it in their flight from the city. A fall excited it in a girl, and a stroke upon the head excited it in a young man who came under my care. Many people were seized with the disorder in consequence of their exertions on the night of the 7th of Septem|ber, in extinguishing the fire which consumed Mr Dobson's printing-office, and even the less violent exercise of working the fire engines for the pur|pose of laying the dust in the streets, added fre|quently to the number of the sick.

Page  30 2. HEAT, from every cause, but more especially the heat of the sun, was a very common exciting cause of the disorder. It aided the stimulus of the contagion in bringing on indirect debility. The re|gister of the weather during the latter end of Au|gust—the whole of September, and the first two weeks in October, will shew how much the heat of the sun must have contributed to excite the dis|ease, more especially among labouring people. The heat of common fires, likewise became a fre|quent cause of the activity of the contagion, where it had been received into the body; hence the greater mortality of the disease among bakers, blacksmiths, and hatters, than among any other class of people.

3. INTEMPERANCE in eating or drinking. A plentiful meal, and a few extra-glasses of wine, sel|dom failed of exciting the fever. But where the body was strongly impregnated with the contagion, even the smallest deviation from the customary stimulus of diet, in respect to quality or quantity, roused the contagion into action. A supper of twelve oysters in one, and only three, in another of my patients, produced the disease. A half an ounce of meat rendered the contagion active in a lady, who had lived by my advice for two Page  31 weeks upon milk and vegetables. A supper of sallad dressed after the French fashion, excited it in one of Dr Mease's patients. It is because men are more predisposed by their constitution, and employments, to indirect debility than wo|men, and that young and middle aged persons are more predisposed to this species of debility than old people; that more men than women, and more young than old people, were affected by the disorder.

There were several exciting causes of the disease, which acted by inducing direct debility upon the system. It may appear difficult at first sight to ex|plain, how causes so opposite in their nature, as in|direct and direct debility should produce exactly the same effect. The difficulty vanishes when we reflect, that the abstraction of one stimulus, by accumulating the excitability of the system, en|creases the force of those which remain. The contagion when received into the body, was fre|quently innocent, until it was aided by the addi|tion of a new, or by the abstraction of a customary stimulus. The causes which acted in the latter way were,

1. FEAR. This passion debilitates, only be|cause it abstracts its antagonist passion of courage. Page  32 In many people the disease was excited by a sud|den paroxism of fear; but I saw some remarkable instances where timid people escaped the disease, although they were constantly exposed to it. Per|haps a moderate degree of fear served to balance the tendency of the system to indirect debility from the excessive stimulus of the contagion, and there|by to preserve it in a state of healthy equilibrium. I am certain that fear did no harm, after the dis|ease was formed, in those cases where a morbid excess of action, or prostration of the moving powers from excess of stimulus, had taken place. It was an early discovery of this fact which led me not to conceal from my patients the true name of this fever, when I was called to them on the day of their being attacked by it. The fear, co-ope|rated with some of my remedies (to be mention|ed hereafter) in reducing the morbid excitement of the arterial system.

2. GRIEF. It was remarkable that the great|est concentration of the contagion did not pro|duce the disease in many cases in the atten|dants upon the sick, while there was a hope of their recovery. The grief which followed the extinction of hope, by death, frequently produ|ced the disease within a day or two afterwards, and that, not in one person only, but often in most Page  33 of the near relations of the diseased. But the dis|ease was also produced by a change in the state of the mind directly opposite to that which has been mentioned. Many persons that attended patients who recovered, were seized with the disorder a day or two after they were relieved from the toils and anxiety of nursing. The collapse of the mind from the abstraction of the stimulus of hope and desire, by their ample gratification, probably pro|duced that debility, and loss of the equilibrium in the system which favoured the activity of the contagion.

The effects of both the states of mind which have been described, have been happily illustrated by two facts which are recorded by Dr Jackson.* He tells us that the garrisons of Savannah and York Town, were both healthy during the siege of those towns, but that the former became sick|ly as soon as the French and American armies re|treated from before it, and the latter, immediately after its capitulation.

3. COLD. It will not be necessary to pause here, to prove that cold is a negative quality, and produced only by the absence of heat. Its action Page  34 in exciting the disease, depended upon the dimi|nution of the necessary and natural heat of the bo|dy, and thereby so far destroying the equilibrium of the system, as to enable the contagion to pro|duce excessive or convulsive motions in the blood vessels. The night air, even in the warm month of September, was often so cool as to excite the disease where the dress and bed clothes were not accommodated to it. It was excited in one case by a person's only wetting his feet in the month of October, and neglecting afterwards to change his shoes and stockings. Every change in the weather, that was short of producing frost, evi|dently encreased the number of sick people. This was obvious after the 18th and 19th of September, when the mercury fell to 44°, and 45°. The hopes of the city received a severe disappoint|ment upon this occasion, for I well recollect there was a general expectation that this change in the weather would have checked the disorder. The same increase of the number of sick, was observ|ed to follow the cool weather which succeeded the 6th and 7th of October, on which days the mercury fell to 43° and 46°.

It was observed that those persons who were habitually exposed to the cool air, were less liable to the disease than others. I ascribe it to the ha|bitualPage  35 impression of the cool night air upon the bodies of the city watchmen, that only four or five of them out of 25 were affected by the dis|order.

After the body had been heated by violent ex|ercise, a breeze of cool air sometimes excited the disease in those cases where there had been no change in the temperature of the weather.

4. SLEEP. A great proportion of all who were affected by this fever, were attacked in the night. Sleep induced direct debility, and thereby dispo|sed the contagion which floated in the blood, to act with such force upon the system as to destroy its equilibrium, and thus to excite a fever. The influence of sleep as a predisposing, and exciting cause was often assisted by the want of bed cloaths, suited to the midnight or morning coolness of the air.

5. IMMODERATE EVACUATIONS. The efficacy of moderate purging and bleeding in preventing the disease, led some people to use those remedies in an excess, which both predisposed to the dis|ease, and excited it. The morbid effects of these evacuations, were much aided by fear, for it was this passion which perverted the judgment in such Page  36 a manner, as to lead to the excessive use of reme|dies, which to be effectual, should only be used in moderate quantities.

The disease appeared with different symptoms, and in different degrees, in different people. They both varied likewise with the weather. In describing the disease I shall take notice of the changes in the symptoms, which were produced by changes in the temperature of the air.

The precursors, or premonitory signs of this fever were, costiveness, a dull pain in the right side, defect of appetite, flatulency, perverted taste, heat in the stomach, giddiness, or pain in the head, a dull—watery—brilliant, yellow or red eye, dim and imperfect vision, a hoarseness, or slight sore throat, low spirits, or unusual vivacity, a moisture on the hands, a disposition to sweat at nights, or after moderate exercise, or a sudden suppression of night sweats. The dull eye, and the lowness of spirits appeared to be the effects of such an excess in the stimulus of the contagion as to induce indirect debility, while the brilliant eye, and the unusual vivacity, seemed to have been produced by a less quantity of the contagion act|ing as a cordial upon the system. More or less of these symptoms, frequently continued for two or Page  37 three days before the patients were confined to their beds, and in some people they continued du|ring the whole time of its prevalence in the city, without producing the disease. I wish these symp|toms to be remembered by the reader. They will form the corner stone of a system which I hope will either eradicate the disorder altogether, or render it as safe as an intermitting fever, or as the small pox when it is received by inoculation.

Frequent as these precursors of the fever were, they were not universal. Many went to bed in good health, and awoke in the night with a chilly fit. Many rose in the morning after regular and natural sleep, and were seized at their work, or after a walk with a sudden and unexpected attack of the fever. In most of these cases the disease came on with a chilly fit, which afforded by its violence or duration a tolerable presage of the issue of the disorder.

Upon entering a sick room where a patient was confined by this fever, the first thing that struck the eye of a physician, was the countenance. It was as much unlike that which is exhibited in the common bilions fever, as the face of a wild, is unlike the face of a mild domestic animal. The eyes were sad, watery, and so inflamed in Page  38 some cases as to resemble two balls of fire. Some|times they had a most brilliant or ferocious ap|pearance▪ The face was suffused with blood, or of a dusky colour, and the whole countenance was downcast and clouded. After the 10th of Sep|tember, when a determination of blood to the brain became universal, there was a preternatural dilatation of the pupil. Sighing attended in al|most every case. The skin was dry, and frequent|ly of its natural temperature. These were the principal symptoms which discovered themselves to the eye, and hand of a physician. The an|swers to the first questions proposed upon visiting a patient, were calculated to produce a belief in the mind of a physician, that the disease under which the patient laboured, was not the prevail|ing malignant epidemic. I did not for many weeks meet with a dozen patients, who acknowledged that they had any other indisposition than a com|mon cold, or a slight remitting, or intermitting fever. I was particularly struck with this self de|ception in many persons, who had nursed relations that had died with the yellow fever, or who had been exposed to its contagion in families, or neigh|bourhoods, where it had prevailed for days and even weeks with great mortality. I shall hereaf|ter trace a part of this disposition in the sick to deceive themselves, to the influence of certain Page  39 publications which appeared soon after the disease became epidemic in the city.

In the further history of this fever, I shall de|scribe its symptoms as they appeared.

• I. In the sanguiferous system.
• II. In the liver, lungs, and brain.
• III. In the alimentary canal; in which I include the stomach as well as the bowels.
• IV. In the secretions and excretions.
• V. In the nervous system.
• VI. In the senses and appetites.
• VII. In the lymphatic and glandular system.
• VIII. Upon the skin.
• IX. In the blood.

After having finished this detail, I shall men|tion some general characters of the disease, and Page  40 afterwards subdivide it into classes, according to its degrees and duration.

I. The BLOOD VESSELS (and not the stomach and bowels according to Dr Warren) are the "seat and throne" of this as well as of all other fevers. I have publicly taught for seve|ral years, that a fever is occasioned by a convul|sion in the arterial system. When the epidemic, which we are now considering, came on with a full, tense, and quick pulse, this convulsion was very perceptible; but it frequently came on with a weak pulse; often without any preternatu|ral frequency or quickness, and sometimes so low as not to be perceived without pressing the artery at the wrists. In many cases the pulse intermitted after the 4th, in some after the 5th, and in others after the 14th stroke. These intermissions occur|red in several persons who were infected, but who were not confined by the fever. They likewise continued in several of my patients for many days after their recovery. This was the case in particu|lar in Mrs Clymer, Mrs Palmer's son William, and in a son of Mr William Compton. In some there was a preternatural slowness of the pulse. It beat 44 strokes in a minute in Mr B. W. Morris—48 in Mr Thomas Wharton, Jun. and 64 in Mr William Page  41 Sansom, at a time when they were in the most im|minent danger. Dr Physic informed me, that in one of his patients the pulse was reduced in fre|quency to 30 strokes in a minute. All these different states of the pulse have been taken notice of by authors who have described pestilential fe|vers.* They have been improperly ascribed to the absence of fever: I would rather suppose that they are occasioned by the stimulus of the conta|gion, acting upon the arteries with too much force to admit of their being excited into quick and con|vulsive motions. The remedy which removed it (to be mentioned hereafter) will render this expla|nation of its cause still more probable. Milton describes a darkness, from an excess of light. In like manner, we observe in this small intermitting and slow pulse, a deficiency of strength from an excess of force applied to it. In every case of it which came under my notice, it was likewise tense or chorded. This species of pulse occurred chief|ly in the month of August, and in the first ten days in September. I had met with it former|ly in a sporadic case of yellow fever. It was new to all my pupils. One of them, Mr Wash|ington, Page  42 gave it the name of the "undiscribable pulse." It aided in determining the specific na|ture of this fever before the common bilious re|mittent disappeared in the city. For a while, I ascribed this peculiarity in the pulse, more especi|ally its slowness, to an affection of the brain only, and suspected that it was produced, by what I have taken the liberty elsewhere to call the phrenicula, or inflammatory state of the internal dropsy of the brain, and which I have remarked to be an occa|sional symptom and consequence of remitting fe|ver.* I was the more disposed to adopt this opi|nion, from perceiving this slow and intermitting pulse more frequently in children than in adults. Impressed with this idea, I requested Mr Coxe, one of my pupils, to assist me in examining the state of the eye. For two days we discovered no change in it, but on the third day after we began to in|spect the eyes, we both perceived a preternatural dilatation of the pupils in different patients; and we seldom afterwards saw an eye in which it was absent. In Dr Say it was attended by a squinting, a symptom which marks a high degree of a mor|bid affection of the brain. Had this slowness or intermission in the pulse occurred only after signs of inflammation or congestion had appeared in the Page  43 brain, I should have supposed that it had been de|rived wholly from that cause; but I well recollect having felt it several days before I could discover the least change in the pupil of the eye. I am for|ced therefore to call in the operation of another cause, to assist in accounting for this state of the pulse, and this I take to be a spasmodic affection, accompanied with preternatural dilatation or con|traction of the heart. Lieutaud mentions this spe|cies of pulse in several places, as occurring with an undue enlargement of this muscle*. Dr Ferriar describes a case, in which a low, irregular, inter|mitting and hardly perceptible pulse, attended a morbid dilatation of the heart.† In a letter I lately received from Mr Hugh Ferguson, a stu|dent of medicine in the college of Edinburgh, written from Dublin, during the time of a visit to his father, and dated September 30th, 1793, I find a fact which throws additional light upon this sub|ject. "A case (says my young correspondent) where a remarkable intermission of pulse was ob|served, occurred in this city last year. A gentle|man of the medical profession, middle aged, of a de|licate habit of body, and who had formerly suffer|ed Page  44 phthisical attacks, was attacked with the acute rheumatism. Some days after he was taken ill, he complained of uncommon fulness, and a very peculiar kind of sensation about the praecordia, which it was judged proper to relieve by copious blood-letting. This being done, the uneasiness went off. It returned however three or four times, and was as often relieved by bleeding. During each of his fits (if I may call them so), the pa|tient experienced an almost total remission of his pains in his limbs; but they returned with equal or greater violence after blood-letting. During the fit there was an intermission of the pulse (the first time) of no less than thirteen strokes. It was when beating full, strong, and slow. The third intermission was of nine strokes. The gentleman soon recovered, and has enjoyed good health for ten months past. The opinion of some of his phy|sicians was, that the heart was affected as a mus|cle, by the rheumatism, and alternated with the limbs."

I am the more inclined to believe the peculia|rity in the pulse which has been mentioned in the yellow fever, arose in part from a spasmodic affec|tion of the heart, from the frequency of an uncom|mon palpitation of this muscle, which I discovered in this disorder, more especially in old people. Page  45 The disposition likewise to syncope and sighing, which so often occurred, can be explained upon no other principle than inflammation, spasm, dilata|tion, or congestion in the heart. After the 10th of September this undescribable or sulky pulse (for by the latter epithet I sometimes called it) became less observable: and in proportion as the weather became cool, it totally disappeared. It was gradually succeeded by a pulse, full, tense, quick, and as fre|quent as in pleurisy or rheumatism. It differed how|ever from a pleuritic or rheumatic pulse, in impar|ting a very different sensation to the fingers. No two strokes seemed to be exactly alike. Its ac|tion was of a hobbling nature. It was at this time so familiar to me, that I think I could have distin|guished the disease by it, without seeing the pati|ent. It was remarkable, that this pulse attended the yellow fever even when it appeared in the mild form of an intermittent, and in those cases where the patients were able to walk about, or go a|broad. It was nearly as tense in the remissions and intermissions of the fever, as it was in the ex|acerbations. It was an alarming symptom, and when the only remedy which was effectual to re|move it, was neglected, such a change in the sys|tem was induced, as frequently brought on death in a few days.

Page  46 This change in the pulse, from extreme low|ness, to fulness and activity, appeared to be owing to the diminution of the heat of the weather, which by its stimulus, added to that of the con|tagion, had induced those symptoms of indirect debility in the pulse, which have been mentioned.

The pulse most frequently lessened in its ful|ness, and became gradually weak, frequent, and imperceptible before death, but I met with several cases in which it was full, active, and even tense in the last hours of life.

HEMORRHAGIES belong to the symptoms of this fever as they appeared in the sanguiferous sys|tem. They occurred in the beginning of the dis|order chiefly from the nose and uterus. Some|times but a few drops of blood distilled from the nose. The menses were unusual in their quantity, when they appeared at their stated periods, but they often came on a week or two before the usual time of their appearance. I saw one case of an hemorrhage from the lungs on the first day of the fever, which was mistaken for a common hemop|tysis. As the disease advanced, the discharges of blood became more universal. They occurred from the gums, ears, stomach, bowels, and urinary pas|sages. Drops of blood issued from the inner Can|thus Page  47 of the left eye of Mr Josiah Coates. Dr Wood|house attended a lady who bled from the holes in her ears, which had been made by ear rings. Many bled from the orifices which had been made by bleeding, several days after they appeared to have been healed, and some from wounds which had been made in veins in unsuccessful attempts to draw blood. These last hemorrhages were very troublesome, and in some cases precipitated death.

II. I come now to mention the symptoms of this fever as they appeared in the LIVER, the LUNGS, and the BRAIN. From the histories which I had read of this disorder, I was early led to ex|amine the state of the LIVER, but I was surprised to find so few marks of hepatic affection. I met with but two cases in which the patient could lie only on the right side. Many complained of a dull pain in the region of the liver, but very few complained of that soreness to the touch, about the pit of the stomach which is taken notice of by authors, and which was universal in the yellow fever in 1762. In proportion as the cool weather advanced, a preternatural determination of the blood took place chiefly to the lungs and brain. Many were affected with pneumonic symptoms, Page  48 and some appeared to die of sudden effusions of blood or serum in the lungs. It was an unex|pected effusion of this kind which put an end to the life of Mrs Keppele after she had exhibited hopeful signs of a recovery.

I saw one person who recovered from an affection of the lungs, by means of a copious expectoration of yellow phlegm and mucus. But the BRAIN was principally affected with morbid congestion in this disorder. It was indicated by the suffusion of blood in the face, by the redness of the eyes, by a dila|tation of the pupils, by the pain in the head, by the hemorrhagies from the nose and ears, by the sickness, or vomiting, and by an almost universal costive state of the bowels. I wish to impress the reader with these facts, for they formed one of the strongest indications for the use of the remedies which I adopted for the cure of this disorder. It is difficult to determine the exact state of these viscera in every case of bilious and yellow fever. Inflammation certainly takes place in some cases, and internal hemorrhagies in others; but I believe the most frequent affection of these viscera consists in a certain morbid accumulation of blood in them, which has been happily called by Dr Clark an engorgement or choaking of the blood vessels. I Page  49 believe further with Dr Clark* and Dr Balfour†, that death in most cases in bilious fevers is the effect of these morbid congestions, and wholly un|connected with direct debility or a supposed putre|faction in the fluids. It is true the dissections of Dr Physic and Dr Cathrall discovered no morbid appearances in either of the viscera which have been mentioned, but it should be remembered, that these dissections were made early in the disorder. Dr Annan attended the dissection of a brain of a patient who died at Bush-hill some days afterwards, and observed the blood vessels to be unusually turgid. In those cases where con|gestion only takes place, it is as easy to conceive that all morbid appearances in the brain may cease after death, as that the suffusion of blood in the face should disappear after the retreat of the blood from the extremities of the vessels in the last mo|ments of life. It is no new thing for morbid affections of the brain to leave either slender or no marks of disease after death. Dr Quin has given a dissection of the brain of a child that died with all the symptoms of hydrocephalus inter|nus, and yet nothing was discovered in the brain but a slight turgescence of its blood vessels. Dr Page  50 Girdlestone says, no injury appeared in the brains of those persons who died of the symptomatic apo|plexy, which occurred in a spasmodic disease which he describes in the East Indies; and Mr Clark in|forms us, that the brain was in a natural state in every case of death from puerperile fever, not|withstanding it seemed to be affected in many cases soon after the attack of that disorder*.

I wish it to be remembered here, that the yellow fever like all other diseases is influenced by cli|mate and season. The determination of the fluids is seldom the same in different years, and I am sure it varied with the weather in the disease which I am now describing. Dr Jackson speaks of the head being most affected in the West India fevers in dry situations. Dr Hillary says, that there was an unusual determination of the blood towards the brain after a hot and dry season in the fevers of Barbadoes in the year 1753, and Dr Ferriar in his account of an epidemic jail fever in Manchester in 1789, 1790, informs us, that as soon as frost set in, a delirium became a more frequent symptom of that disorder, than it had been in more tem|perate weather.

Page  51 III. The STOMACH and BOWELS Were affected in many ways in this fever. The disease seldom appeared without nausea or vomiting. In some cases, they both occurred for several days, or a week before they were accompanied by any fever. This was more frequently the case, where the dis|ease was taken by exhalation from the putrid coffee, than by contagion. Sometimes a pain, known by the name of gastrodynia, ushered in the disease. The stomach was so extremely irritable as to reject drinks of every kind. Sometimes green or yellow bile was rejected on the first day of the disorder, by vomiting; but I much oftener saw it continue for two days without discharging any thing from the stomach, but the drinks which were taken by the patient. If the fever in any case came on without vomiting, or if it had been checked by remedies that were ineffectual, to remove it altogether, it generally appeared, or returned, on the 4th or 5th day of the disorder. I dreaded this symptom on those days, for although it was not always the forerun|ner of death, yet it generally rendered the reco|very more difficult and tedious. In some cases the vomiting was more or less constant from the be|ginning to the end of the disorder, whether it ter|minated in life or death.

Page  52 The vomiting which came on about the 4th or 5th day, was accompanied with a burning pain in the region of the stomach. It produced great anxiety and tossing of the body from one part of the bed to another. In some cases this painful burning occurred before any vomiting had taken place. Drinks were now rejected from the stomach so suddenly as often to be discharged over the hand that lifted them to the head of the patient. The contents of the stomach (to be mentioned here|after) were sometimes thrown up with a convulsive motion, that propelled them in a stream to a great distance, and in some cases all over the clothes of the by-standers.

Flatulency was an almost universal symptom in every stage of this disorder. It was very distres|sing in many cases. It occurred chiefly in the sto|mach.

The BOWELS were generally costive, and in some patients, as obstinately so, as in the dry gripes. In some cases there was all the pain and distress of a bilious colic, and in others, the tenes|mus, and mucous and bloody discharges of a true dysentery. A diarrhoea introduced the disease in in a few persons, but it was chiefly in those who had been previously indisposed with weak bowels. Page  53 A painful tension of the abdomen took place in many, accompanied in some instances by a dull, and in others, by an acute pain in the lower part of the belly.

The vomiting and costiveness in the first stage of this fever, I believe were occasioned chiefly by the morbid state of the brain. But the vomiting and burning in the stomach, and the pain in the bowels which occurred on the 4th and 5th days, appeared to be the effects of inflammation induced in part by the effusion of acrid bile into the alimentary canal, and in part by a change in the action of the coats of the stomach and bowels, induced by effu|sions of serum or red blood, similar to those which take place on the skin in malignant fevers, and which are known by the name of petechiae. I am the more disposed to ascribe a large portion of the inflammation, erosions, and mortifications, which have been observed after death in the stomach and bowels in this fever, to the latter cause, from the discovery which has been made of petechiae and carbuncles in the bowels in the plague, exactly simi|lar to those which are found on the external parts of the body in that disorder*.

Page  54 IV. I come now to describe the state of the SECRETIONS and EXCRETIONS, as they appeared in different stages of this fever.

There appeared to be a preternatural secretion and excretion of bile. It was discharged from the stomach and bowels in large quantities, and of very different qualities and colours.

1. On the first and second days of the disorder, many patients puked from half a pint to nearly a quart of green or yellow bile. Four cases came under my notice in which black bile was dis|charged on the first day. Three of these patients recovered. I ascribed their recovery, to the bile not having as yet acquired acrimony enough to in|flame, or-corrode the stomach.

2. There was frequently on the 4th or 5th day, a discharge of matter from the stomach, resembling coffee impregnated with its grounds. This was always an alarming symptom. I believed it at first to be a modification of vitiated bile, but I was led afterwards by its resemblance to the urine (to be described hereafter) to suspect that it was pro|duced by a morbid secretion in the liver, and ef|fused from it into the stomach. Many recovered who discharged this coffee-coloured matter.

Page  55 3. Towards the close of the disease, there was a discharge of matter of a deep or pale black colour, from the stomach. Flakey substances frequent|ly floated in the bason or chamber-pot upon the surface of this matter. It appeared to be bile in a highly acrid state. That the bile may become ex|tremely acrid in this stage of the disorder is evident from several observations and experiments. Dr Physic's hand was inflamed in consequence of its being wetted by bile in this state, in dissecting a dead body. Dr Arthaud examined the body of a soldier who died of the yellow fever at the French Cape on the 16th of May 1789, whose bile im|parted a green colour*, to the tincture of radishes. I am not certain that the black matter, which was discharged in the last stage of this disorder, was al|ways vitiated or acrid bile. It was probably in some cases, the matter which was formed in con|sequence of the mortification of the stomach. The matter which was discharged from carbuncles on the skin, as I shall say hereafter, was always of a dark colour. Several dissections of persons who have died of the yellow fever, have shewn abscesses in the stomach, not unlike external carbuncles. May not the black matter in some cases be derived from these internal carbuncle-like abscesses?

Page  56 4. There was frequently discharged from the stomach in the close of the disease, a large quan|tity of grumous blood, which exhibited a dark co|lour on its outside, resembling that of some of the matters which have been described, and which I believe was frequently mistaken for what is com|monly known by the name of the black vomiting. Several of my patients did me the honour to say, I had cured them, after that symptom of approaching dissolution had made its appear|ance; but I am inclined to believe, dark-coloured blood only, or the coffee coloured matter, was mistaken for the matters which constitute the fatal black vomiting. I except here the black discharge before mentioned, which took place in three cases on the first day of the disorder. This I have no doubt was bile, but it had not acquired its greatest acrimony, and it was dis|charged before mortification, or even inflamma|tion could have taken place in the stomach. Se|veral persons died without a black vomiting of any kind.

Along with all the discharges from the stomach which have been described, there was occasionally a large worm, and frequently large quantities of mucus and tough phlegm.

Page  57 The colour, quality, and quantity of the faeces depended very much upon the treatment of the disease. Where active purges had been given, the stools were copious, foetid, and of a black or dark colour. Where they were spontaneous, or excited by weak purges, they had a more natural ap|pearance. In both cases, they were sometimes of a green, and sometimes of an olive colour. Their smell was more or less foetid, according to the time in which they had been detained in the bowels. I visited a lady who had passed several days with|out a stool, and who had been treated with tonic remedies. I gave her a purge, which in a few hours procured a discharge of faeces so ex|tremely foetid, that they produced fainting in an old woman who attended her. The acrimony of the faeces was such as to excoriate the rectum, and sometimes to produce an extensive inflammation all around its external termination. The quantity of the stools produced by a single purge was in many cases very great. They could be accounted for only by calling in the constant, and rapid formation of them, by preternatural effusions of bile into the bowels.

I attended one person, and heard of two others, in whom the stools were as white as in the jaun|dice. I suspected in these cases, the bile was so Page  58 impacted in the gall bladder, or in its ducts, as not to be discharged in a sufficient quantity to co|lour the foeces. Large round worms were fre|quently discharged with the stools.

The urine was in some cases plentiful, and of a high colour. It was at times clear, and at other times turbid. About the 4th or 5th day it some|times assumed a dark colour, and resembled strong coffee. This colour continued in one instance for several days after the patient recovered. In some, the discharge was accompanied by a burning pain resembling that which takes place in a gonorrhoea. I met with one case in which this burning came on only in the evening, with the exacerbation of the fever, and went off with its remission in the morning.

A total deficiency of the urine took place in many people for a day or two, without pain. Dr Sydenham takes notice of the same symptom in the highly inflammatory small pox.* It general|ly accompanied, or portended great danger. I suspected that it was connected in this disease, as in the hydrocephalus internus, with a morbid state of the brain. I heard of one case in which there Page  59 was a suppression of urine, which could not be re|lieved without the use of the catheter.

A young man was attended by Mr Fisher, one of my pupils, who discharged several quarts of limpid urine just before he died.

Dr Arthaud informs us in the history of the dissection before quoted, that the urine after death imparted a green colour to the tincture of radishes.

Many people were relieved by copious sweats on the first day of the disorder. They were in some instances spontaneous, and in others, they were excited by diluting drinks, or by strong purges. These sweats were often of a yellow co|lour, and sometimes had an offensive smell. They were in some cases cold, and attended at the same time with a full pulse. In general, the skin was dry in the beginning as well as in the subsequent stages of the disorder. I saw but few instances of the disease terminating like common fevers, by sweat after the third day. I wish this fact to be remembered by the reader, for it laid part of the foundation of my method of curing this fever.

Page  60 There was in some cases a preternatural secre|tion and excretion of mucus from the glands of the throat. It was discharged by an almost con|stant hawking and spitting. All who had this symptom recovered.

The TONGUE was in every case moist, and of a white colour on the first and second days of the fever. As the disease advanced, it as|sumed a red colour, and a smooth shining ap|pearance. It was not quite dry in this state Towards the close of the fever, a dry black streak appeared in its middle, which gradu|ally extended to every part of it. Few reco|vered after this appearance on the tongue took place.

V. In the NERVOUS SYSTEM the symptoms of the fever were different according as it affected the brain—the muscles—the nerves—or the mind. The sudden and violent action of the contagion, induced apoplexy in several people. In some, it brought on syncope, and in others, convulsions in every part of the body. The apoplectic cases generally proved fatal, for they fell chiefly upon hard drinkers. Persons affected by syncope, or convulsions, sometimes fell down in the streets. Two cases of this kind happened near my house. Page  61 One of them came under my notice. He was supposed by the bye-standers to be drunken, but his countenance, and convulsive motions, soon convinced me that this was not the case.

A coma was observed in some people, or an obstinate wakefulness in every stage of the disor|der. The latter symptom most frequently attended the convalescence. Many were affected with im|mobility, or numbness in their limbs.

These symptoms were constant, or temporary, according to the nature of the remedies which were made use of, to remove them. They ex|tended to all the limbs, in some cases, and only to a part of them in others. In some, a violent cramp both in the arms, and legs attended the first attack of the fever. I met with one case in which there was a difficulty of swallowing from a spasmodic affection of the throat, such as occurs in the locked-jaw.

A hiccup attended the last stage of this disor|der, but I think less frequently than the last stage of the common bilious fever. I saw only five cases of recovery where this symptom took place.

There was in some instances a deficiency of sen|sibility, but in others a degree of it, extending to Page  62 every part of the body, which rendered the appli|cation of common rum to the skin, and even the least motion of the limbs painful.

I was surprised to observe the last stage of this fever to exhibit so few of the symptoms of the common typhus or nervous fever. Tremors of the limbs and twitchings of the tendons were un|common. They occurred only in those cases in which there was a predisposition to nervous dis|eases, and chiefly in the convalescent state of the disorder.

While the muscles and nerves in many cases ex|hibited so many marks of preternatural weak|ness, in some, they appeared to be affected with preternatural excitement. Hence patients in the close of the disorder often rose from their beds, walked across their rooms, or came down stairs, with as much ease as if they had been in perfect health. I lost a patient in whom this state of mor|bid strength occurred to such a degree, that he stood up before his glass, and shaved himself on the day in which he died.

The mind suffered with the morbid states of the brain and nerves. A delirium was a common symptom. It alternated in some cases with the exacerbations and remissions of the fever. In Page  63 some, it continued without a remission, until a few hours before death. Many, however, passed through the whole course of the disease without the least derangement in their ideas, even where there were evident signs of a morbid congestion in the brain. Some were seized with maniacal symptoms. In these, there was an apparent ab|sence of fever. Such was the degree of this ma|nia in one man, that he stripped of his shirt, left his bed, and ran through the streets with no other covering than a napkin on his head, at 8 o'clock at night, to the great terror of all who met him. The symptoms of mania occurred most frequently towards the close of the disease, and sometimes continued for many days, and weeks, after all the febrile symptoms had disappeared.

The temper was much affected in this fever. There were few, in whom it did not produce great depression of spirits. This was the case in many, in whom pious habits had subdued the fear of death. In some the temper became very irritable. Two cases of this kind came under my notice, in persons who in good health, were distinguished for uncommon sweetness of disposition and man|ners.

I observed in several persons the operations of the understanding to be unimpaired, throughout Page  64 the whole course of the fever, who retained no remembrance of any thing that passed in their sickness. My pupil Mr Fisher furnished a remark|able example of this correctness of understanding with a suspension of memory. He neither said, nor did any thing during his illness, that indicated the least derangement of mind, and yet he recol|lected nothing that passed in his room, except my visits to him. His memory awakened upon my taking him by the hand on the morning of the 6th day of his disorder, and congratulating him upon his escape from the grave.

In some, there was a weakness, or total defect of memory for several weeks after their recovery. Dr Woodhouse informed me that he had met with a woman who after she had recovered, could not recollect her own name.

Perhaps it would be proper to rank that self-deception with respect to the nature and danger of the disease which was so universal, among the instances of derangement of mind.

The pain which attended the disorder was dif|ferent according as the system was affected by direct or indirect debility. In those cases in which the system sunk under the violent impression of the contagion, there was little or no pain. In Page  65 proportion as the system was relieved from this oppression it recovered its sensibility. The pain in the head, was acute and distressing. It affected the eye balls in a peculiar manner. A pain ex|tended in some cases from the back of the head, down the neck. The ears were affected in several persons with a painful sensation, which they com|pared to a string drawing their two ears together through the brain. The sides, and the regions of the stomach, liver and bowels, were all, in differ|ent people, the scats of either dull or acute pains. The stomach towards the close of the disorder was affected with a burning or spasmodic pain of the most distressing nature. It produced in some cases great anguish of body and mind. In others it pro|duced cries and shrieks which were often heard on the opposite side of the streets to where the patients lay. The back suffered very much in this disorder. The stoutest men complained, and even groaned un|der it. An acute pain extended in some cases from the back, to one or both thighs. The arms and legs sympathized with every other part of the body. One of my patients, upon whose limbs the disease fell, with its principal force, said that his legs felt as if they had been scraped with a sharp instru|ment. The sympathy of friends with the distresses of the sick, extended to a small part of their misery, when it did not include their sufferings from pain. Page  66 One of the dearest friends I ever lost by death, declared in the height of her illness, that "no one knew the pains of a yellow fever, but those who felt them."

VI. The senses and appetites exhibited several marks of the universal ravages of this fever upon the body. A deafness attended in many cases, but it was not often as in the nervous fever, a favourable symptom. A dimness of sight, was very common in the beginning of the disease. Many were affected with temporary blindness. In some there was a loss of sight in consequence of gutta serena, or a total destruction of the substance of the eye. There was in many persons a soreness to the touch, which extended all over the body. I have often observed this symptom to be the fore|runner of a favourable issue of a nervous fever, but it was less frequently the case in this disorder.

The thirst was moderate or absent in some cases, but it occurred in the greatest number of persons whom I saw in this fever. Sometimes it was very intense. One of my patients who suf|fered by an excessive draught of cold water, de|clared just before he died, that "he could drink up the Delaware." It was always an alarming symptom, when this thirst came on in this extra|vagant Page  67 degree in the last stage of the disorder. In the beginning of the fever, it generally abated upon the appearance of a moist skin. Water, was preferred to all other drinks.

The appetite for food was impaired in this, as in all other fevers, but it returned much sooner than is common after the patient began to recover. Coffee was relished in the remissions of the fever, in every stage of the disorder. So keen was the appetite for solid, and more especially for animal food, after the solution of the fever, that many suffered from eating aliment that was improper from its quality or quantity. There was a general disrelish for wine, but malt liquors were frequently grateful to the appetite.

Many people retained a relish for tobacco much longer after they were attacked by this fever, and acquired a relish for it much sooner after they began to recover, than are common in any other febrile disease. I met with one case in which my patient, who was so ill as to require two bleedings, continued to chew tobacco through every stage of his fever.

The convalescence from this disorder was mark|ed in some instances, by a sudden revival of the Page  68 venereal appetite. Several weddings took place in the city between persons who had recovered from the fever. Twelve took place among the con|valescents in the hospital at Bush-hill. I wish I could add, that the passion of the sexes for each other, among those subjects of public charity, was always gratified only in a lawful way. Delicacy forbids a detail of the scenes of debauchery which were practised near the hospital in some of the tents, which had been appropriated for the recep|tion of convalescents. It is not peculiar to the yellow fever to produce this morbid excitability of the venereal appetite. It was produced in a much higher degree by the plague which raged in Messina in the year 1743.

VII. The lymphatic and glandular system did not escape without some signs of the infection of this disease. I met with three cases of swellings in the inguinal, two in the parotid, and one in the cervical glands: all these patients recovered without a suppuration of their swellings. They were ex|tremely painful in one case in which no redness or inflammation appeared. In the others, there was considerable inflammation, and but little pain.

In one of the cases of inguinal buboes, the whole force of the disease seemed to be collected into the Page  69 lymphatic system. The patient walked about, and had no fever nor pain in any part of his body, except in his groin. In another case which came under my care, a swelling and pain extended from the groin along the spermatic cord into one of the testicles. These glandular swellings were not pe|culiar to our late epidemic. They occurred in the yellow fever of Jamaica as described by Dr Williams, and always with a happy issue of the disorder*. A similar concentration of the con|tagion of the plague in the lymphatic glands, is taken notice of by Dr Patrick Russel.

VIII. The SKIN exhibited many marks of this fever. It was preternaturally warm in some cases, but it was often preternaturally cool. In some there was a distressing coldness in the limbs for two or three days. The yellow colour from which this fever has derived its name, was not universal. It seldom appeared where purges had been given in sufficient doses. The yellowness rarely appear|ed before the third, and generally about the fifth or seventh day of the fever. Its early appearance always denoted great danger. It sometimes appear|ed first on the neck and breast, instead of the eyes. In one of my patients it discovered itself first be|hind Page  70 one of his ears, and on the crown of his head, which had been bald for several years. The re|missions and exacerbations of the fever seemed to have an influence upon this colour, for it appeared and disappeared altogether, or with fainter or deep|er shades of yellow, two or three times in the course of the disorder. The eyes seldom escaped a yellow tinge; and yet I saw a number of cases in which the disease appeared with uncommon ma|lignity and danger, without the presence of this symptom. Two very different causes have been supposed to produce this yellow colour of the skin. By some it has been attributed to the dissolution of the blood; but I shall say hereafter, that the blood was seldom dissolved in this fever. The yel|low colour, moreover, occurred in those cases where the blood exhibited an inflammatory crust, and it continued in many persons for five or six weeks after their recovery. From these facts it is evi|dent, that the yellowness was in all cases the effect of an absorption and mixture of bile with the blood.

There was a clay-coloured appearance in the face in some cases, which was very different from the yellow colour which has been described. It occurred in the last stage of the fever, and in no instance did I see a recovery after it.

Page  71 There were eruptions of various kinds on the skin, each of which I shall briefly describe.

1. I met with two cases of an eruption on the skin, resembling that which occurs in the scarlet fever. Dr Hume says, pimples often appear on the pit of the stomach in the yellow fever of Ja|maica. I examined the external region of the sto|mach in many of my patients, without discovering this symptom.

2. I met with one case, in which there was an eruption of watery blisters, which after bursting, ended in deep, black sores.

3. There was an eruption about the mouth in many people, which ended in scabs, similar to those which take place in the common bilious fe|ver. They always afforded a prospect of a favour|able issue of the disease.

4. Many persons had eruptions which resem|bled moschetto bites. They were red and circum|scribed. They appeared chiefly on the arms, but they sometimes extended to the breast. Like the yellow colour of the skin, they appeared and dis|appeared two or three times in the course of the disorder.

Page  72 5. Petechiae were common in the latter stage of the fever. They sometimes came on in large, and at other times in small red blotches; but they soon acquired a dark colour. In most, cases they were the harbingers of death.

6. Several cases of carbuncles, such as occur in the plague, came under my notice. They were large and hard swellings on the limbs, with a black apex, which upon being opened, discharged a thin, dark-coloured, bloody matter. From one of these malignant sores, an hemorrhage took place, which precipitated the death of the amiable widow of Dr John Morris.

7. A large and painful anthrax on the back suc|ceeded a favourable issue of the fever in the Rev. Dr Blackwell.

8. I met with a woman who shewed me the marks of a number of small boils on her face and neck, which accompanied her fever.

Notwithstanding this disposition to cutaneous eruptions in this disorder, it was remarkable that blisters were much less disposed to mortify than in the common nervous fever. I met with only one case in which a deep-seated ulcer followed the ap|plication Page  73 of blisters to the legs. Such was the in|sensibility of the skin in some people, that blisters made no impression upon it.

IX. How far the blood may be considered as the vehicle of the contagion, it is not my business at present to inquire; nor shall I in this place men|tion the different appearances it exhibited when drawn from a vein. It has been supposed to un|dergo a change from a healthy to a putrid state; and many of the symptoms of the fever which have been described, particularly the hemorrhagies and eruptions on the skin, have been ascribed to this supposed putrefaction of the blood. It would be easy to multiply arguments to prove, that no such thing as putrefaction can take place in the blood; and that the symptoms which have been supposed to prove its existence, are all effects of a sudden, violent, and rapid inflammatory ac|tion, or pressure upon the blood-vessels; and hence the external and internal hemorrhagies. The pe|techiae on the surface of the skin depend upon the same cause. They are nothing but effusions of se|rum or red blood, from a rupture or preternatural dilatation of the capillary vessels*. The smell Page  74 emitted from persons affected by this disease was far from being of a putrid nature; and if this had been the case, it would not have proved the exi|stence of putrefaction in the blood; for a putrid smell is often discharged from the lungs, and from the pores in sweat, which is wholly unconnected with a putrid, or perhaps any other morbid state of the blood. There are plants which discharge an odor, which conveys to the nose a sensation like that of putrefaction; and yet these plants exist at the same time, in a state of the most healthy vege|tation: nor does the early putrid smell of a body which perishes with this fever, prove a putrid change to have taken place in the blood before death. All animals which die suddenly, and with|out loss of blood, are disposed to a speedy putre|faction. This has long been remarked in animals that have been killed after a chace, or by light|ning. The poisonous air called samiel, which is described by Chardin, produces, when it destroys life, instant putrefaction. The bodies of men who die of violent passions, or after strong convulsions, or even after great muscular exertion, putrefy in a few hours after death. The healthy state of Page  75 the body depends upon a certain state of arrange|ment in the fluids. A derangement of these fluids is the natural consequence of the violent and ra|pid motions, or of the undue pressure upon the so|lids, which have been mentioned. It occurs in every case of death from indirect debility, whe|ther it be induced by the excessive stimulus of con|tagion, by the volatile vitriolic acid which is sup|posed to constitute the destructive samiel wind, or by violent commotions excited in the body by ex|ternal or internal causes. The practice among fishermen in some countries, of breaking the heads of their fish as soon as they are taken out of the wa|ter, in order to retard their putrefaction, proves the truth of the explanation I have given of its cause, soon after death. The sudden extinction of life in the fish, prevents those convulsive or violent mo|tions which induce sudden disorganization in their bodies. It was remarkable that putrefaction took place most speedily after death from the yellow fever, where the commotions of the system were not relieved by evacuations. In those cases where purges and bleeding had been used, putrefaction did not take place sooner after death than is com|mon in any other febrile disease, under equal cir|cumstances of heat and air.

There is a fact mentioned by Dr Ferriar, from Dr Hamilton, late professor of anatomy at Glas|gow, Page  76 which may seem at first sight to militate against the facts I have mentioned. He says that he had observed bodies which were brought into the dissecting room, that had petechiae on them, were longer in putrefying than any others. The fevers of which the poor (the common subjects of dissection) die, are generally of the low ner|vous kind. Great direct debility is the charac|teristic of these fevers. The petechiae which oc|cur in them, appear in the last stage of this direct debility. They are the effect, not of too much impetus in the blood, as in the yellow fever, but of a defect or total absence of it in the last hours of life. The slow progress of the body to pu|trefaction after death, in the instances mentioned by Dr Hamilton, seems to depend upon the same cause as that to which I have ascribed it in those cases of death from the yellow fever, in which e|vacuations had been used, viz. direct debility. In the former cases this slowness of putrefaction is induced by nature—in the latter by art. The effects of debility from both causes are, notwith|standing, the same.

Thus have I described the symptoms of this fe|ver. From the history I have given, it appears that it counterfeited nearly all the acute and chronic diseases, to which the human body is sub|ject. An epitome, both of its symptoms and its the|ory, Page  77 is happily delivered by Dr Sydenham in the following words. After describing the epidemic cough, pleurisy, and peripneumony of 1675, he adds, "But in other epidemics, the symptoms are so slight from the disturbance raised in the blood by the morbific particles contained in the mass, that nature being in a manner oppressed, is rendered unable to produce regular symptoms that are suitable to the disease; and almost all the phaenomena that happen are irregular, by reason of the entire subversion of the animal oeconomy; in which case the fever is often depressed, which of its own nature, would be very high. Some|times also fewer signs of a fever appear than the nature of the disease requires, from a translation of the malignant cause, either to the nervous sy|stem, to some other parts of the body, or to some of the juices not contained in the blood; whilst the morbific matter is yet turgid"*.

The disease ended in death in various ways. In some it was sudden; in others it came on by gra|dual approaches. In some the last hours of life were marked with great pain, and strong convul|sions; but in many more, death seemed to insinu|ate itself into the system, with all the gentleness of Page  78 natural sleep. Mr Powell expired with a smile on his countenance. Dr Griffitts informed me that Dr Johnson exhibited the same symptom in the last hours of his life. This placid appearance of the countenance, in the act of dying, was not new to me. It frequently occurs in diseases which affect the brain and nerves. I lost a patient three years ago in the gout, who not only smiled, but laughed, a few minutes before he expired.

I proceed now to mention some peculiarities of the fever which could not be brought in under any of the foregoing heads.

In every case of this disorder which came under my notice, there were evident remissions, or inter|missions of the fever, or of such symptoms as were substituted for fever. I have long considered with Mr Senac, a tertian as the only original type of all fevers. The bilious yellow fever indicated its descent from this parent disorder. I met with many cases of regular tertians in which the pa|tients were so well on the intermediate days as to go abroad. It appeared in this form in Mr Van Berkel the minister of the United Netherlands. Nor was this mild form of the fever devoid of danger. Many died who neglected it as a trifling disorder, or who took the common remedies for Page  79 intermittents to cure it. It generally ended in a remittent before it destroyed the patient. The tertian type discovered itself in some people after the more violent symptoms of the fever had been subdued, and continued in them for several weeks. It changed from a tertian to a quartan type in Mr Thomas Willing, nearly a month after his reco|very from the more acute and inflammatory symp|toms of the disorder.

It is nothing new for a malignant fever to ap|pear in the form of a tertian. It is frequently the garb of the plague. Riverius describes a tertian fever which proved fatal on the third day, which was evidently derived from the same exhalation which produced a continual malignant fever.*

The remissions were more evident in this, than in the common bilious fever. They generally oc|curred in the forenoon. It was my misfortune to be deprived by the great number of my patients, of that command of time which was necessary to watch the exacerbations of this fever under all their various changes, as to time, force, and duration. From all the observations that were suggested by Page  80 visits, at hours that were seldom left to my choice, I was led to conclude, that the fever exhibited in different people all that variety of forms which has been described by Dr Cleghorn in his account of the tertian fever of Minorca. A violent ex|acerbation on even days was evidently attended with more danger than on odd days. The same thing was observed by Dr Mitchell in the Yellow Fever of Virginia in the year 1741.

The deaths which occurred on the 3d, 5th, and 7th days, appeared frequently to be the effects of the commotions or depression, produced in the system on the 2nd, 4th, and 6th days.

The remission on the third day, was frequently such as to beget a belief that the disease had run its course, and that all danger was over. A vio|lent attack of the fever on the 4th day removed this deception, and if a relaxation had taken place in the use of proper remedies on the 3d day, death frequently occurred on the 5th or the se|venth.

Page  81 The termination of this fever in life, and death, was much more frequent on the 3d, 5th, 7th, 9th and 11th days, than is common in the mild remitting fever. Where death occurred on the even days, it seemed to be the effect of a violent paroxism of the fever, or of great vigour of con|stitution, or of the force of medicines which pro|tracted some of the motions of life beyond the close of the odd days which have been mentioned.

I think I observed the fever to terminate on the third day more frequently in August, and during the first ten days in September, than it did after the weather became cool. In this, it resembled the common bilious remittents of our city, also the simple tertians described by Dr Cleghorn*. The danger seemed to be in proportion to the tendency of the disease to a speedy crisis, hence more died in August in proportion to the number who were affected than in September or October, when the disease was left to itself. But, however strange after this remark it may appear, the dis|ease yielded to the remedies which finally subdued it, more speedily and certainly upon its first ap|pearance in the city, than it did two or three weeks afterwards.

Page  82 The disease continued for fifteen, twenty, and even thirty days in some people. Its duration was much influenced by the weather, and by the use or neglect of certain remedies (to be men|tioned hereafter) in the first stage of the disorder.

It has been common with authors to divide the symptoms of this fever into three different stages. The order I have pursued in the history of those symptoms, will render this division unnecessary. It will I hope be more useful to divide the patients affected with the disorder into three classes.

The first includes those in whom the stimulus of the contagion, produced the symptoms of indi|rect debility, such as coma, languor, sighing, a dis|position to syncope, and a weak, or slow pulse.

The second includes those in whom the conta|gion acted with less force, producing great pain in the head, and other parts of the body; deli|rium, vomiting, heat, thirst, and a quick, tense, or full pulse, with obvious remissions or intermissions of the fever.

The third class includes all those persons in whom the stimulus of the contagion acted so fee|bly as not to confine them to their beds or houses. Page  83 This class of persons affected by the yellow fever, was very numerous. Many of them recovered without medical aid, or by the use of domestic prescriptions; many of them recovered in conse|quence of a spontaneous diarrhoea, or plentiful sweats; many were saved by moderate bleeding, and purging; while some died, who conceived their complaints to be occasioned by a common cold, and neglected to take proper care of them|selves, or to use the necessary means for their re|covery. It is not peculiar to the contagion of the yellow fever to produce this feeble operation up|on the system. It has been observed in the south|ern states of America, that in those seasons in which the common bilious fever is epidemic "no body is quite well," and that what are called in those states "inward fevers" are universal. The small-pox even in the natural way, does not always confine the patient; and thousands pass through the plague without being confined to their beds or houses. Dr Hodges prescribed for this class of patients in his parlour in London in the year 1665, and Dr Patrick Russel did the same from a chamber window fifteen feet above the level of the street at Aleppo. Notwithstanding the mild form the plague put on in these cases, it often proved fatal according to Dr Russel. I have in|troduced these facts chiefly with a view of prepa|ring Page  84 the reader to reject the opinion that we had two species of fever in the city at the same time; and to shew that the yellow fever appears in a more simple form than with "strongly marked" characters; or in other words, with a yellow skin, and a black vomitting.

It was remarkable that this fever always found out the weak part of every constitution it attacked. The head, the lungs, the stomach, the bowels, and the limbs, suffered more or less, according as they were more or less debilitated by previous inflammatory, or nervous diseases, or by a mix|ture of both, as in the gout.

I have before remarked, that the influenza, the scarlatina, and a mild bilious remittent, prevailed in the city, before the yellow fever made its ap|pearance. In the course of a few weeks they all disappeared, or appeared with symptoms of the yellow fever; so that after the first week of Sep|tember, it was the solitary epidemic of the city.

The only case like influenza which I saw after the 5th of September, was in a girl of 14 years of age, on the 13th of the month. It came on with a sneezing and cough. I was called to her on the third day of her disorder. The instant I felt Page  85 her pulse, I pronounced her disease to be the yel|low fever. Her father was offended with this opinion, although he lived in a highly infected neighbourhood, and objected to the remedies I prescribed for her. In a few days she died. In the course of ten days, her father and sister were infected, and both died I was informed, with the usual symptoms of the yellow fever.

It has been an axiom in medicine, time imme|morial, that no two contagious fevers of unequal force can exist long together in the same place. As this axiom seems to have been forgotten by many of the physicians of Philadelphia, and as the ignorance or neglect of it, led to that contra|riety of opinion and practice, which unhappily took place in the treatment of the disorder, I hope I shall be excused by those physicians to whom this fact is as familiar as the most simple law of nature, if I fill a few pages with proofs of it, from practical writers.

Thucydides long ago remarked that the plague chased all other diseases from Athens, or obliged them to change their nature, by assuming some of its symptoms.

Page  86 Dr Sydenham makes the same remark upon the plague in London in 1665. Dr Hodges in his account of the same plague, says that "at the rise of the plague all other distempers, went into it, but at its declension, that it degenerated into others, as inflammations, headach, quinsies, dy|senteries, small-pox, measles, fevers, and hectics, wherein the plague yet predominated*."

During the prevalence of the plague in Grand Cairo, no sporadic disease of any kind makes its appearance. The same observation is made by Sauvage in his account of the plague at Alais in the province of Languedoc†.

The small-pox though a disease of less force than the plague, has often chased it from Constantino|ple, probably from its infecting at a greater distance than the plague. But this exclusive prevalence of a single epidemic is not confined to the plague and small-pox. Dr Sydenham's writings are full of proofs of the dominion of febrile diseases over each other: Hence after treating upon a sympto|matic Page  87 pleurisy, which sometimes accompanied a slow fever in the year 1675, and which had pro|bably been injudiciously treated by some of those physicians who prescribe for the name of a disease, he delivers the following aphorism, "whoever in the cure of fevers, hath not always in view, the constitution of the year, inasmuch as it tends to produce some particular epidemic disease, and likewise to reduce all the cotemporary diseases to its own form and likeness, proceeds in an uncer|tain and fallacious way*." It appears further from the writings of this excellent physician, that where the monarchy of a single disease was not immediately acknowledged, by a sudden retreat of all cotemporary diseases, they were forced to do homage to it, by wearing its livery. It would be easy to multiply proofs of this assertion, from the numerous histories of epidemics which are to be found in his works. I shall mention only one or two of them. A continual fever accompanied by a dry skin, had prevailed for some time in the city of London. During the continuance of this fever, the regular small-pox made its appearance. It is peculiar to the small-pox when of a distinct nature, to be attended by irregular sweats before the eruption of the pocks. The continual fever Page  88 now put on a new symptom. It was attended by sweats in its first stage, exactly like those which at|tended the eruptive fever of the small-pox*. This despotism of a powerful epidemic, extended it|self to the most trifling indispositions. It even blended itself, Dr Sydenham tells us, with the commotions excited in the system by the suppres|sion of the lochia, as well as with the common puerperile fever†. Dr Morton, has left testimo|nies behind him in different parts of his works, which establish, in the most ample manner, the truth of Dr Sydenham's observations. Dr Hux|ham describes the small-pox as blending some of its symptoms with those of a slow fever at Ply|mouth in the year 1729‡. Dr Cleghorn menti|ons a constitution of the air at Minorca, so highly inflammatory, "that not only tertian fevers, but even a common hurt or bruise required more plentiful evacuations than ordinary."§ Riverius informs us in his history of a pestilential fever that prevailed in France, that "it united itself with phrenitis, angina, pleurisy, peripneumony, hepa|titis, dysentery, and many other diseases‖."

Page  89 The bilious remitting fever which prevailed in Philadelphia in 1780, chased away every other febrile disease; and the scarlatina anginosa which prevailed in our city in 1783 and 1784, furnished a striking proof of the influence of epidemics over each other. In the account which I published of this disease, in the year 1789, there are the follow|ing remarks. "The intermitting fever which made its appearance in August, was not lost du|ring the month of September. It continued to prevail, but with several peculiar symptoms. In many persons it was accompanied by an eruption on the skin, and a swelling of the hands and feet. In some it was attended with sore throat, and pains behind the ears. Indeed such was the pre|valence of the contagion which produced the scar|latina anginosa, that many hundred people com|plained of sore throats, without any other symp|tom of indisposition. The slightest exciting cause, and particularly cold, seldom failed of producing the disorder*."

I shall mention only one more authority in fa|vour of the influence of a single epidemic upon diseases. It is taken from Mr Clark's essay on the epidemic disease of lying-in women, of the Page  90 years 1787 and 1788. "There does not appear to be any thing in a parturient state, which can prevent women from being affected by the gene|ral causes of disease at that time; and should they become ill, their complaints will probably partake of the nature of the reigning epidemic*." I have said that the fever sometimes put on the symp|toms of dysentery, pleurisy, rheumatism, colic, palsy, and even of the locked jaw. That these were not original diseases, but symptomatic af|fections only of the reigning epidemic, will appear from other histories of bilious fevers. Dr Bal|four tells us in his account of the intestinal remit|ting fever of Bengal†, that it often appeared with symptoms of dysentery, rheumatism, and pleurisy. Dr Cleghorn and Dr Lind mention many cases of the bilious fever appearing in the form of a dysentery. Dr Clark ascribes the dysentery, the diarrhoea, the colic, and even the palsy, to the same contagion which produced the bilious fever in the East Indies‡; and Dr Hunter, in his trea|tise upon the diseases of Jamaica, mentions the locked jaw as one of its occasional symptoms. Page  91 Even the different grades of this fever, from the mildest intermittent to the most acute continual fe|ver, have been distinctly traced by Lancissi to the same marsh exhalation*.

However irrefragably these numerous facts and authorities establish the assertion of the preva|lence of but one powerful epidemic at a time, the proposition will receive fresh support, from attend|ing to the effects of two impressions of unequal force made upon the system at the same time: only one of them is felt: hence the gout is said to cure all other diseases. By its superior pain it destroys sensations of a less painful nature. The small-pox and measles have sometimes existed to|gether in the body; but this has, I believe, sel|dom occurred, where one of them has not been the predominating disease†. In this respect, this combination of epidemics only conforms to the general law which has been mentioned.

I beg pardon for the length of this digression. I did not introduce it to expose the mistakes of those physicians who found as many diseases in our city, Page  92 as the yellow fever had symptoms, but to vindi|cate myself from the charge of innovation, in ha|ving uniformly and unequivocally asserted, after the first week in September, that the yellow fever was the only febrile disease which prevailed in the city. I shall hereafter mention some facts upon the subject of the extent of the contagion, which will add such weight to the assertion, as to render the disbelief of it, as much a mark of a deficiency of reason, as it is of reading and observation.

Science has much to deplore from the multipli|cation of diseases. It is as repugnant to truth in medicine, as polytheism is to truth in religion. The physician who considers every different affec|tion of the different systems in the body, or every affection of different parts of the same system, as distinct diseases, when they arise from one cause, resembles the Indian or African savage, who con|siders water, dew, ice, frost, and snow, as distinct essences: while the physician who considers the morbid affections of every part of the body, how|ever diversified they may be in their form or de|grees) as derived from one cause, resembles the philosopher, who considers dew, ice, frost, and snow, as different modifications of water, and as derived simply from the absence of heat.

Page  93 Humanity has likewise much to deplore from this paganism in medicine. The sword will pro|bably be sheathed for ever, as an instrument of death, before physicians will cease to add to the mortality of mankind, by prescribing for the names of diseases.

The facts I have delivered upon this subject will admit of a very important application to the cure, not only of the yellow fever, but of all other acute and dangerous epidemics. I shall hereafter assign a final cause for the law of epidemics which has been mentioned, which will discover an union of the goodness of the Supreme Being with one of the greatest calamities of human life.

All ages were affected by this fever, but per|sons between fourteen, and forty years of age, were most subject to it. Many old people had it, but it was not so fatal to them, as to robust per|sons in middle life. It affected children of all ages. I met with a violent case of the disorder, in a child of four months, and a moderate case of it, in a child of only ten weeks old. The latter had caught it from its mother. It had a deep yel|low skin. Both these children recovered.

Page  94 The proportion of children who suffered by this fever may be conceived from a single fact. Seventy five persons were buried in the grave|yard of the Swedish Church in the months of August, September, and October, twenty four of whom were children. They were buried chiefly in September and October; months, in which chil|dren, generally enjoy good health in our city.

Men were more subject to the disease than wo|men. Pregnancy seemed to expose women to it.

The refugees from the French West-Indies, universally escaped it. This was not the case with the natives of France, who had been settled in the city.

It is nothing new, for epidemics to affect per|sons of one nation, and to pass by persons of other nations in the same city or country. At Nimu|guen in the year 1736, Deigner informs us that the French people, (two old men excepted), and the Jews, escaped a dysentery which was univer|sal among persons of all other nations. Ramazini tells us that the Jews at Modena, escaped a tertian fever which affected nearly all the other inhabi|tants of the town. Shenkius says that the Dutch Page  95 and Italians escaped a plague which prevailed for two years in one of the towns of Switzerland, and Dr Bell, in an inaugural dissertaion published at Edinburgh in 1779, remarks that the jail fever which attacked the soldiers of the Duke of Buc|cleugh's regiment, spared the French prisoners who were guarded by them. It is difficult to account for these facts. However numerous their causes may be, a difference in diet which is as much a distinguishing mark of nations as dress, or man|ners, will probably be found to be one of them.

From the accounts of the yellow fever which had been published by many writers, I was led to believe that the negroes in our city would escape it. In consequence of this belief, I published the following extract from Dr Lining's history of the yellow fever as it had four times appeared in Charleston in South-Carolina.

The only design of this remark is, to suggest to our citizens the safety and propriety of employing black people to nurse and attend persons infected by this fever; also, to hint to the black people, that a noble opportunity is now put into their hands, of manifesting their gratitude to the inha|bitants of that city, which first planned their eman|cipation from slavery, and who have since afforded them so much protection and support, as to place them, in point of civil and religious privileges, upon a footing with themselves.

A day or two after this publication, the follow|ing letter from the Mayor of the city, to Mr Clay|poole the printer of the Mail, appeared in his paper.

It was not long after these worthy Africans undertook the execution of their humane offer of services to the sick, before I was convinced I had been mistaken. They took the disease, in com|mon with the white people, and many of them died with it. I think I observed the greatest num|ber of them to sicken after the mornings and evenings became cool. A large number of them were my patients. The disease was lighter in them, than in white people. I met with no case of hemorrhage in a black patient.

The tobacconists, and persons who used to|bacco did not escape the disease. I observed snuff-takers to be more devoted to their boxes than usual, during the prevalence of the fever.

Page  98 I have remarked formerly that servant maids suffered much by the disease. They were the only patients I lost in several large families. I ascribe their deaths to the following causes:

1st. To the great indirect debility induced upon their systems by fatigue in attending their masters and mistresses, or their children. Indirect debility, according to its degrees and duration seems to have had the same effect upon the mortality of this fever, that it has upon the mortality of an inflam|mation of the lungs. When it is moderate and of short duration, it predisposes only to a common pneumony, but when it is violent and protracted, in its degrees and duration, it predisposes to a pul|monary consumption.

2dly. To their receiving large quantities of contagion into their bodies, and in a most concen|trated state by being obliged to perform the most menial offices for the sick, and by washing, as well as removing infected linen, and the like.

3dly. To their being left more alone in con|fined or distant rooms, and thereby suffering from depression of spirits, or the want of a punctual supply of food and medicines.

Page  99 There did not appear to be any advantage from smelling vinegar, tar, camphor, or volatile salts, in preventing the disorder. Bark and wine were equally ineffectual for that purpose. I was called to many hundred people who were infected after using one or more of them. Nor did the white-washing of walls secure families from the action of the contagion. I am disposed to believe garlick was the only substance that was in any degree use|ful, in preventing the disorder. I met with seve|ral persons who chewed it constantly, and who were much exposed to the contagion, without being infected. All other substances seemed to do harm by begetting a false confidence in the mind, to the exclusion of more rational preserva|tives. I have suspected further, that such of them as were of a volatile nature, helped to spread the disease by affording a vehicle for the contagion through the air.

There was great mortality in all those families who lived in wooden houses. Whether this arose from the small size of these houses, or from the want of cleanliness of the people who occupied them, or from the contagion becoming more ac|cumulated, by adhering to the wood, I am unable to determine. Perhaps it was the effect of the co-operation of all three of those causes.

Page  100 I have said formerly that intemperance in drink|ing predisposed to the disease; but there were se|veral instances of persons having escaped it who were constantly under the influence of strong drink. The stimulus of ardent spirits, probably predominated over the stimulus of the contagion, and thus excited an artificial fever which defended the system from that which was epidemic.

I heard of some sea-faring people who lived on board their vessels who escaped the disease. The smell of the tar was supposed to have preserved them; but from its being ineffectual in other cases, I was led to ascribe their escape to the infected air of the city being diluted by a mixture with the pure air that came from the water.

Many people who were infected in the city, were attacked by the disease in the country, but they propagated it in very few instances, even to persons who slept in the same room with them.

Dr Lind informs us that many persons escaped the yellow fever which prevailed in Pensacola in the year 1765, by retiring to the ships which lay in the harbour, and that when the disease had been taken, the pure air of the water changed it Page  101 into an intermitting fever*. The same changes have frequently been produced in malignant fevers, by sending patients infected with them from the foul air of a city, into the pure air of the country.

Persons confined in the House of Employment, in the Hospital, and in the Jail, were preserved from the fever. The airy and remote situation of those buildings, was probably the chief means of their preservation. Perhaps they derived addi|tional security from their simple diet, their exemp|tion from hard labour, and from being constantly sheltered from heat and cold.

Several families who shut up their front and back doors and windows, and avoided going out of their houses except to procure provisions, esca|ped the disorder.

I have taken some pains to ascertain whether any class of tradesmen escaped the fever, or whe|ther there was any species of labour which pro|tected from it. The result of my inquiries is as follows: Three butchers only out of nearly one hundred who remained in the city, died with the disorder. Many of them attended the markets Page  102 every day. Two painters, who worked at their business during the whole time of the prevalence of the fever, and in exposed situations, escaped it. Out of forty scavengers who were employed in collecting and carrying away the dirt of the streets, only one caught the fever and died. Very few grave-diggers, compared with the number who were employed in that business, were infected; and it is well known, that scarcely an instance was heard of persons taking the disease, who were constantly employed in digging cellars. The fact is not new that grave-diggers escape the conta|gion of malignant fevers. It is taken notice of by Dr Clark. There seems to be something in the fresh earth which attracts or destroys by mixture, contagion of every kind. Clothes infected by the small-pox are more certainly purified by being bu|ried under ground, than in any other way. Even poisons are rendered inert, by the action of the earth upon them. Dogs have long ago established this fact, by scratching a hole in the ground, and burying their limbs or noses in it, when bitten by poisonous snakes. The practice I have been told, has been imitated with success by the settlers upon new lands in several parts of the United States.

It was said by some physicians in the public pa|pers, that the neighbourhood of the grave-yards Page  103 was more infected than other parts of the city. The reverse of this assertion was true in several cases, owing probably to the line of communica|tion of the contagion being broken by the absence of houses, and to its being diluted and weakened by its mixture with the air of the grave-yards; for this air was pure, compared with that which stagnated in the streets.

It was said further, that the disease was propa|gated by the inhabitants assembling on Sundays for public worship; and as a proof of this asser|tion, it was reported, that the deaths were more numerous on Sundays than on other days; occa|sioned by the contagion received on one Sunday, producing death on the succeding first day of the week. The register of the deaths shows that this was not the case. I am disposed to believe that few|er people sickened on Sundays, than on any other day of the week; owing to the general rest from labour, which I have before said was one of the exciting causes of the disease. From some facts to be mentioned presently, it will appear probable, that places of public worship, in consequence of their size, as well as of their being shut up during the greatest part of the week, were the freest from contagion of any houses in the city. It is agree|able to discover in this, as well as in all other cases Page  104 of public and private duty, that the means of health, and moral happiness are in no one instance opposed to each other.

There were for several weeks two sources of infection, viz. exhalation, and contagion. The ex|halation infected at the distance of three and four hundred yards; while the contagion infected only across the streets. The more narrow the street, the more certainly the contagion infected. Few escaped it in alleys. After the 15th of Septem|ber, the atmosphere of every street in the city was loaded with contagion; and there were few citi|zens in apparent good health, who did not ex|hibit one or more of the following marks of its presence in their bodies.

1. A yellowness in the eyes, and a sallow co|lour upon the skin.

2. A preternatural quickness in the pulse. I found but two exceptions to this remark, out of a great number of persons whose pulses I examined. In one of them it discovered several preternatural intermissions in the course of a minute. This quickness of pulse occurred in the negroes, as well as in the white people. I met with it in a woman who had had the yellow fever in 1762. Page  105 In two women, and in one man above 70, the pulse beat upwards of 90 strokes in a minute. This preternatural state of the pulse, during the prevalence of a pestilential fever in persons in health, is taken notice of by Reverius*.

3. Frequent and copious discharges by the skin of yellow sweats. In persons who were much ex|posed to the contagion, these sweats sometimes had an offensive smell, resembling that of the wash|ings of a gun.

4. A scanty discharge of high coloured or tur|bid urine.

5. A deficiency of appetite, or a greater degree of it than was natural.

6. Costiveness.

7. Wakefulness.

8. Head-ach.

9. A preternatural dilatation of the pupils.—This was universal. I was much struck in obser|ving Page  106 the pupil in one of the eyes of a young man who called upon me for advice, to be of an oblong figure. Whether it was natural, or the effect of the contagion acting on his brain, I could not determine.

It will be thought less strange, that the conta|gion should produce these changes in the systems of persons who resided constantly in the city, when I add, that many country people who spent but a few hours in the streets in the day, in attend|ing the markets, caught the disease, and sickened and died after they returned home; and that others, whom business compelled to spend a day or two in the city during the prevalence of the fever, but who escaped an attack of it, declared that they were indisposed during the whole time, with languor or head-ach.

I was led to observe and record the above ef|fects of the contagion upon persons in apparent good health, by a fact I met with in Dr Mitchell's history of the yellow fever in Virginia in the year 1741. In that fever, blood drawn from a vein was always dissolved. The same state of the blood was observed in many persons who had been ex|posed to the contagion, who discovered no other symptom of the disease.

Page  107 A woman whom I had formerly cured of a ma|nia, who lived in an infected neighbourhood, had a fresh attack of that disorder, accompanied by an unusual menstrual flux. I ascribed both these complaints to the action of the contagion upon her system.

Citizens thus impregnated with the contagion, communicated it in several instances to their coun|try friends. The disease produced in this way was very light, amounting in all the cases that came under my notice, to little more than a sickness at stomach or vomiting.

The smell of the contagion, as emitted from a patient in a clean room, was like that of the small-pox, but in most cases of a less disagreeable na|ture. Putrid smells in sick rooms were the ef|fects of a mixture of the contagion with some fil|thy matters. In small rooms, crouded in some in|stances with four or five sick people, there was an effluvia that produced giddiness, sickness at sto|mach, a weakness of the limbs, faintness, and in some cases a diarrhoea. I met with a fetid breath in one patient, which was not the effect of that medicine which sometimes produces it.

The contagion adhered to all kinds of cloath|ing, and seemed to be propagated by them. It Page  108 was in no instance communicated by means of pa|per; a circumstance which contributed both to lessen and encrease the distress produced by the dis|ease, by enabling the citizens to keep up an inter|course, by letters with their country friends.

The state of the atmosphere during the whole month of September, and the first two weeks in October favoured the accumulation of the conta|gion in the city.

The register of the weather, shews how little the air was agitated by winds during the above time. In vain were changes in the moon ex|pected to alter the state of the air. The light of the morning, mocked the hopes that were raised by a cloudy sky in the evening. The sun ceased to be viewed with pleasure. Hundreds sickened every day beneath the influence of his rays; and even where they did not excite the dis|ease, they produced a languor in the body un|known to the oldest inhabitant of the city, at the same season of the year.

A meteor was seen at two o'clock in the morn|ing on or about the twelfth of September. It fell between Third-street and the Hospital, nearly in a line with Pine-street. Moschetoes (the usual attendants of a sickly autumn) were uncommonly Page  109 numerous. Here and there a dead cat added to the impurity of the air of the streets; for many of those animals perished with hunger in the city, in consequence of so many houses being deserted by the inhabitants who had fled into the country.

It appears further, from the register of the wea|ther, that there was no rain between the 25th of August and the 15th of October, except a few drops, hardly enough to lay the dust of the streets on the 9th of September, and the 12th of Octo|ber. In consequence of this drought, the springs and wells failed in many parts of the country. The dust in some places extended two feet below the surface of the ground. The pastures were defi|cient, or burnt up. There was a scarcity of au|tumnal fruits in the neighbourhood of the city. But while vegetation drooped or died from the want of moisture in some places, it revived with preternatural vigor from unusual heat in others. Cherry-trees blossomed, and apple, pear, and plum-trees bore young fruit in several gardens in Trenton, thirty miles from Philadelphia, in the month of October.

However inoffensive uniform heat, when agita|ted by gentle breezes may be, there is, I believe, no record of a dry, warm and stagnating air, having Page  110 existed for any length of time without pro|ducing diseases. Hippocrates in describing a pes|tilential fever, says the year in which it prevailed, was without a breeze of wind*. The same state of the atmosphere for six weeks, is mentioned in many of the histories of the plague which prevail|ed in London in 1665. Even the sea air itself becomes unwholesome by stagnating; hence Dr Clark informs us, that sailors become sickly after long calms in East India voyages†. Sir John Pringle delivers the following aphorism from a number of similar observations upon this subject. "When the heats come on soon, and continue throughout autumn, not moderated by winds, or rains, the season proves sickly, distempers appear early, and are dangerous‡."

Who can review this account of the universal diffusion of the contagion of this disease, its uni|versal effects upon persons apparently in good health, and its accumulation and concentration, in consequence of the calmness of the air, and be+lieve, that it was possible for a febrile disease to Page  111 exist at that time in our city that was not derived from this contagion?

The West India writers upon the yellow fever have said, that it is seldom taken twice, except by persons who have spent some years in Europe or America in the interval between its first and second attack. I directed my inquiries to this question, and I now proceed to mention the result of them. I met with five persons during the prevalence of the disease, who had had it formerly; two of them in the year 1741, and three in 1762, who escaped it in 1793, although they were all more or less exposed to the contagion. One of them felt a constant pain in her head while the disease was in her family. Four of them were aged, and of course less liable to be acted upon by the conta|gion, than persons in early or middle life. Mr Thomas Shields furnished an unequivocal proof that the disease could be taken after an interval of many years. He had it in the year 1762, and narrowly escaped from a violent attack of it last year. Cases of reinfection were very common during the prevalence of this fever. They occur|red most frequently, where the first attack had been light. But they succeeded attacks that were severe in Dr Griffitts, Dr Mease, my pupil Page  112 Mr Coxe, and several others, whose cases came under my notice.

I have before remarked, that the contagion sometimes excited a fever as soon as it was taken into the body, but that it often lay there from one to sixteen days, before it produced the disease. How long it existed in the body after a recovery from the fever, I could not tell, for persons who recovered were in most cases exposed to the action of the contagion from external sources. The pre|ternatural dilatation of the pupils was a certain mark of the continuance of some portion of the contagion in the system. In one person who was attacked with the fever on the night of the 9th of October, the pupils did not contract to their natural dimensions, until the 7th of November.

Having described the effects of the contagion upon the body, I proceed now to mention the changes induced upon it by death.

Let us first take a view of it as it appeared soon after death. Some new light may perhaps be thrown upon the proximate cause of the disease, by this mode of examining the body.

Page  113 My information upon this subject was derived from the attendants upon the sick, and from the two African citizens who were employed in bury|ing the dead, viz. Richard Allen and Absalom Jones. The coincidence of the information I re|ceived from different persons, satisfied me that all that I shall here relate, is both accurate and just.

A deep yellow colour appeared in many cases within a few minutes after death. In some, the skin became purple, and in others black. I heard of one case in which the body was yellow above, and black below its middle. In some, the skin was as pale, as it is in persons who die of common fevers. A placid countenance was observed in many, resembling that which occurs in an easy and healthful sleep.

Some were stiff within one hour after death. Others were not so, for six hours afterwards. This sudden stiffness after death, Dr Valli informs us, occurred in persons who died of the plague in Smyrna in the year 1784*.

Some grew cold soon after death, while others retained a considerable degree of heat for six hours, more especially on their backs.

Page  114 A stream of tears appeared on the cheeks of a young woman, which seemed to have flowed after her death.

Some putrefied in a short time after their disso|lution, but others had no smell for twelve, eigh|teen and twenty hours afterwards. This absence of smell occurred in those cases in which evacua|tions had been used without success in the treat|ment of the disease.

Many discharged large quantities of black mat|ter from the bowels, and others blood from the nose, mouth and bowels after death. The fre|quency of these discharges, gave rise to the prac|tice of pitching the joints of the coffins which were used to bury the dead.

The morbid appearances of the internal parts of the body as they appear by dissection after death, from the yellow fever, are different in dif|ferent countries, and in the same countries in dif|ferent years. I consider them all as effects only of a stimulus acting upon the whole system, and determined more or less by accidental circumstan|ces, to particular viscera. Perhaps the stimulus of the contagion determines the fluids more vio|lently in most cases to the liver, stomach, and bow|els, and thereby disposes them more than other Page  115 parts to inflammation and mortification, and to similar effusions and eruptions with those which take place on the skin. There can be no doubt of the contagion acting specifically upon the liver, and thereby altering the qualities of the bile. I transcribe with great pleasure the following ac|count of the state of the bile in a female slave of forty years of age from Dr Mitchell's history of the yellow fever, as it prevailed in Virginia in the years 1737 and 1741, inasmuch as it was part of that clue which led me to adopt one of the remedies on which much of the success of my practice depended.

"The gall bladder (says the Doctor) appeared outwardly of a deep yellow, but within was full of a black ropy coagulated atrabilis, which sort of substance obstructed the pori biliarii, and duc|tus choledochus. This atrabilis was hardly fluid, but upon opening the gall bladder, it retained its form, and shape, without being evacuated, being of the consistence of a thin extract, and within, glutinous and ropy, like soap when boiling. This black matter seemed so much unlike bile, that I doubted if there were any bile in the gall-bladder. It more resembled bruised or mortified blood, eva|cuated from the mortified parts of the liver, sur|rounding it, although it would stain a knife or probe thrust into it of a yellow colour, which with Page  116 its ropy consistence, seemed more peculiar to a bi|lious humour."

The same appearance of the bile was disco|vered in several other subjects dissected by Dr Mitchell.

The liver in the abovementioned slave, was tur|gid and plump on its outside, but on its concave surface, two thirds of it were of a deep black co|lour, and round the gall-bladder, it seemed to be mortified and corrupted.

The duodenum was lined on its inside near the gall bladder with a viscid ropy bile, like that which has been described. Its villous coat was li|ned with a thick fur or slime, which when scraped or pealed off, the other vascular and muscular coats of the gut, appeared red and inflamed.

The omentum was so much wasted, that no|thing but its blood-vessels could be perceived.

The stomach was inflamed both on its outside and inside. It contained a quantity of bile of the same consistence, but of a blacker colour than that which was found in the gall bladder. Its villous coat like that of the duodenum, was covered with fuzzy and slimy matter. It moreover appeared to Page  117 be distended or swelled. This peculiarity in the inner coat of the stomach was universal in all the bodies that were opened, of persons who died of this disease.

The lungs instead of being collapsed, were in|flated as in inspiration. They were all over full of black or livid spots. On these spots were to be seen small vesicles or blisters, like those of an erysipelas or gangrene, containing a yellow hu|mour.

The blood-vessels in general seemed empty of blood, even the vena cava and its branches; but the vena portarum was full and distended as usual. The blood seemed collected in the viscera; for up|on cutting the lungs or sound liver or spleen, they bled freely.

The brain was not opened in this body, but it was not affected in three others whose brains were examined.

Dr Mackittrick, in his inaugural dissertation published at Edinburgh in the year 1766 "De fe|bre Indiae occidentalis, Maligna Flava," or upon the yellow fever of the West Indies, says, that in some of the patients who died of it, he found the Page  118 liver sphacelated, the gall bladder full of black bile, and the veins turgid with black fluid blood. In others he found the liver no ways enlarged, and its "texture only vitiated." The stomach, the duodenum, and ilium, were remarkably infla|med in all cases. The pericardium contained a viscid yellow serum, and in a larger quantity than common. The urinary bladder was a little infla|med. The lungs were sound.

Dr Hume in describing the yellow fever of Ja|maica, informs us, that in several dead bodies which he opened, he found the liver enlarged and turgid with bile, and of a pale yellow colour. In some he found the stomach and duodenum infla|med. In one case he discovered black spots in the stomach, of the size of a crown piece. To this account he adds, "that he had seen some sub|jects opened, on whose stomachs no marks of in|flammation could be discovered; and yet these had excessive vomiting."

Dr Lind has furnished us with an account of the state of the body after death in his short histo|ry of the yellow fever, which prevailed at Cadiz in the year 1764. "The stomach, (he says) me|sentery, and intestines were covered with gangre|nous spots: there were ulcers on the orifice of the Page  119 stomach, and the liver and lungs were of a putrid colour and texture*."

To these accounts of the morbid appearances of the body after death from the yellow fever, I shall only add the account of several dissections which was given to the public in Mr Brown's Ga|zette, during the prevalence of our late epidemic, by Dr Physic and Dr Cathrall.

Page  122 I have before remarked that these dissections were made early in the disorder, and that Dr Annan attended a dissection of a body at Bush-hill some time afterwards, in which an unu|sual turgescence appeared in the vessels of the brain.

Thus far have I delivered the history of the yel|low fever as it affected the human body with sick|ness and death. I shall now mention a few of those circumstances of public and private distress which attended it. I have before remarked, that the first reports of the existence of this fever were treated with neglect or contempt. A strange apa|thy pervaded all classes of people. While I bore my share of reproach for "terrifying our citizens with imaginary danger," I answered it by lament|ing "that they were not terrified enough." The publication from the college of physicians soon dissipated this indifference and incredulity. Fear or terror now sat upon every countenance. The disease appeared in many parts of the town, re|mote from the spot where it originated; although in every instance it was easily traced to it. This set the city in motion. The streets and roads leading from the city were crouded with families flying in every direction for safety to the country. Business began to languish. Water-street be|tween Market and Race-streets became a desart. Page  123 The poor were the first victims of the fever. From the sudden interruption of business, they suf|fered for a while from poverty, as well as disease. A large and airy house at Bush-hill about a mile from the city, was opened for their reception. This house, after it became the charge of a com|mittee appointed by the citizens on the 14th of September, was regulated and governed with the order and cleanliness of an old and established hos|pital. An American and French physician had the exclusive medical care of it after the 22d of September.

The contagion after the second week in Sep|tember, spared no rank of citizens. Whole fa|milies were confined by it. There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physi|cians from the desertion of some, and the sickness and death of others. At one time, there were only three physicians who were able to do busi|ness out of their houses, and at this time, there were probably not less than 6,000 persons ill with the fever.

During the first three or four weeks of the prevalence of the disorder, I seldom went into a Page  124 house the first time, without meeting the parents or children of the sick in tears. Many wept aloud in my entry, or parlour, who came to ask for ad|vice for their relations. Grief, after awhile de|scended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends, without shedding a tear, or manifesting any other of the common signs of grief.

A chearful countenance was scarcely to be seen in the city for six weeks. I recollect once in en|tering the house of a poor man, to have met a child of two years old that smiled in my face. I was strangely affected with this sight (so discordant to my feelings and the state of the city) before I recollected the age and ignorance of the child. I was confined the next day by an attack of the fever, and was sorry to hear upon my recovery, that the father and mother of this little creature died, a few days after my last visit to them.

The streets every where discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of Page  125 a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading, or driving a horse, with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city at every hour of the day, while the noise of the same wheels passing slowly over the pavements, kept alive anguish and fear in the sick and well, every hour of the night*.

Page  126 But a more serious source of the distress of the city arose from the dissentions of the physicians, about the nature and treatment of the fever. It was considered by some, as a modification of the influenza, and by others as the Jail fever. Its va|rious grades, and symptoms were considered as so many different diseases, all originating from differ|ent causes. There was the same contrariety in the practice of the physicians that there was in their principles. The newspapers conveyed ac|counts of both to the public, every day. The minds of the citizens were distracted by them, and hundreds suffered and died from the delays which were produced by an erroneous opinion of a plu|rality of diseases in the city, or by indecision in the choice, or a want of confidence in the reme|dies of their physician.

The science of medicine is related to every thing, and the philosopher as well as the Chris|tian will be gratified by knowing the effects of a great and mortal epidemic upon the morals of a people. It was some alleviation of the distress Page  127 produced by it, to observe its influence upon the obligations of morality and religion. It was re|marked during this time, by many people that the name of the Supreme Being was seldom profaned either in the streets, or in the intercourse of the citizens with each other. Two robberies only, and those of a trifling nature, occured in nearly two months, although many hundred houses were ex|posed to plunder, every hour of the day and night. Many of the religious societies met two or three times a week, and some of them every evening, to implore the interposition of heaven to save the city from desolation. Humanity and charity kept pace with devotion. The public have already seen accounts of their benevolent exercises in other publications. It was my lot to witness the uncom|mon activity of those virtues upon a smaller scale. I saw little to blame, but much to admire and praise in persons of different professions, both sexes, and of all colours. It would be foreign to the design of this work, to draw from the obscurity which they sought, the many acts of humanity and charity, of fortitude, patience, and perseve|rance which came under my notice. They will be made public, and applauded elsewhere.

But the virtues which were excited by our ca|lamity, were not confined to the city of Philadel|phia. Page  128 The United States wept for the distresses of their capital. In several of the states, and in many cities, and villages, days of humiliation and prayer were set apart to supplicate the Father of mercies in behalf of our afflicted city. Nor was this all. From nearly every state in the Union, the most liberal contributions of money, provisions, and fuel, were poured in for the relief and support of such as had been reduced to want, by the sus|pension of business, as well as by sickness, and the death of friends.

The number of deaths between the first of Au|gust and the ninth of November, amounted to four thousand and forty four. I shall here insert a register of the number which occurred on each day, beginning on the first of August and ending on the ninth of November. By comparing it with the register of the weather, it will shew the influence of the latter on the disease. Several of the deaths in August were from other acute dis|orders, and a few in the succeeding months were from such as were of a chronic nature.

Page  129

		died.			died.
August	1	9	Brought forward		325
	2	8	September	1	17
	3	9		2	18
	4	10		3	11
	5	10		4	23
	6	3		5	20
	7	12		6	24
	8	5		7	18
	9	11		8	42
	10	6		9	32
	11	7		10	29
	12	5		11	23
	13	11		12	33
	14	4		13	37
	15	9		14	48
	16	7		15	56
	17	6		16	67
	18	5		17	81
	19	9		18	68
	20	7		19	61
	21	8		20	67
	22	13		21	57
	23	10		22	76
	24	17		23	68
	25	12		24	96
	26	17		25	87
	27	12		26	52
	28	22		27	60
	29	24		28	51
	30	20		29	57
	31	17		30	63
		325			1768

Page  130

		died.			died.
Brought forward		1768	Brought forward		3318
October	1	74	October	21	59
	2	66		22	82
	3	78		23	54
	4	58		24	38
	5	71		25	35
	6	76		26	23
	7	82		27	13
	8	90		28	24
	9	102		29	17
	10	93		30	16
	11	119		31	21
	12	111	November	1	13
	13	104		2	21
	14	81		3	15
	15	80		4	15
	16	70		5	14
	17	80		6	11
	18	59		7	15
	19	65		8	8
	20	55		9	6
		3318		Total,	388•*

From this table it appears that the principal mortality was in the second week of October. A general expectation had obtained, that cold wea|ther was as fatal to the contagion of this fever as Page  131 heavy rains. The usual time for its arrival had come, but the weather was still not only moderate, but warm. In this awful situation, the stoutest hearts began to fail. Hope sickened, and despair succeeded distress in almost every countenance. On the fifteenth of October it pleased God to alter the state of the air. The clouds at last drop|ped health in showers of rain, which continued during the whole day, and which were succeeded for several nights afterwards by cold and frost. The effects of this change in the weather, appear|ed first in the sudden diminution of the sick, for the deaths continued for a week afterwards to be numerous, but they were of persons who had been confined before, or on the day in which the change had taken place in the weather.

The appearance of this rain was like a dove with an olive branch in its mouth, to the whole city. Public notice was given of its beneficial effects in a letter subscribed by the mayor, of Phi|ladelphia, who acted as president of the commit|tee, to the mayor of New York. I shall insert the whole of this letter. It contains, besides the above information, a record of the liberality of that city, to the distressed inhabitants of Phila|delphia.

Page  134 It is no new thing for bilious fevers of every description, to be checked, or subdued by wet and cold weather.

The yellow fever which raged in Philadelphia in 1699, and which is taken notice of by Thomas Story in his Journal, ceased about the latter end of October, or the beginning of November. Of this there are satisfactory proofs in the register of the interments in the Friends burying-ground, and in a letter dated November 9th, Old Style, 1699, from Isaac Norris to one of his correspon|dents, which his grand-son Mr Joseph P. Norris, politely put into my hands, with several others, which mention the disease, and all written in that memorable year in Philadelphia. The letter says, "It has pleased God to put a stop to our sore vi|sitation, and town and country are now generally healthy." The same disease was checked by wet and cold weather in the year 1741. Of this there is a proof in a letter from Dr Franklin to one of his brothers, who stopped at Burlington, on his way from Boston to Philadelphia on account of the fever, until he was assured by the Doctor, that a thunder gust which had cooled the air, had ren|dered it safe for him to come into the city*. Mr Page  135 Lynford Lardner in a letter to one of his English friends, dated September 24, 1747, Old Style, after mentioning the prevalence of the fever in the city, says "the weather is now much cooler, and those under the disorder revive. The symp|toms are less violent, and the fever gradually abates."

I have in vain attempted to procure an account of the time of the commencement of cold weather, in the autumn of 1762. In the short history of the fever of that year, which I have inserted from my note book, I have said that it continued to prevail in the months of November and Decem|ber. The register of the interments in the Friends burying-ground in those months, confirms that account. They were nearly as numerous in November and December, as in September and October. Viz. in September 22, in October 27, in November 19, and in December 26.

Page  136 The bilious remitting fever of 1780, yielded to cool weather, accompanied by rain, and an eas|terly wind*.

Sir John Pringle will furnish ample satisfaction, to such of my readers as wish for more proofs of the efficacy of heavy rains, and cold weather, in checking the progress and violence of autumnal remitting fevers†.

From the 15th of October, the disease not only declined, but assumed more obvious inflammatory symptoms. It was, as in the beginning, more ne|cessarily fatal where left to itself, but it yielded more certainly to art, than it did a few weeks be|fore. The duration of it was now more tedious, than in the warmer weather.

There were a few cases of yellow fever in No|vember, and December, after the citizens who had retired to the country, returned to the city.

I heard of only three persons who returned to the city being infected with the disorder; so com|pletely Page  137 was the contagion destroyed in the course of a few weeks.

In consequence of a proclamation by the Go|vernor, and a recommendation by the Clergy of Philadelphia, the 12th of December was observed as a day of thanksgiving throughout the state, for the extinction of the disorder in the city.

It was easy to distinguish in walking the streets, the persons who had returned from the country to the city, from those who had remained in it during the prevalence of the fever. The former appeared ruddy, and healthy, while the latter ap|peared of a pale or sallow colour.

It afforded a subject of equal surprise and joy to behold the suddenness with which the city reco|vered its former habits of business. In the course of six weeks after the disease had ceased, nothing but fresh graves, and the black dresses of many of the citizens, afforded a public tra•• of the dis|tress which had so lately prevailed in the city.

The month of November, and all the winter months which followed the autumnal epidemic, were in general healthy. A catarrh affected a Page  138 number of people in November. I suspected it to be the influenza which had revived from a dor|mant state; and which had not spent itself when it yielded to the predominance of the yellow fe|ver. This opinion derives some support from a curious fact related by the late Mr Hunter of the revival of the small-pox in a patient, in whom it had been suspended for some time by the mea|sles*. The few fevers which prevailed in the winter were highly inflammatory. The small-pox in the natural way was in several instances confluent; and in one or two fatal. I was prepared to expect this inflammatory diathe|sis in the fevers of the winter; for I had been taught by Dr Sydenham, that the diseases which follow a great and mortal epidemic, partake more or less of its general character. But the diseases of the winter had a peculiarity still more extraor|dinary; and that was, many of them had several of the symptoms of the yellow fever, particularly a puking of bile, dark-coloured stools, and a yel|low eye. Mr Samuel D. Alexander, a student of medicine from South Carolina, who was seized with a pneumony about Christmas, had with a yellow eye, a dilated pupil, and a hard pulse Page  139 which beat only 50 strokes in a minute. His blood was such as I had frequently observed in the yellow fever. Dr Griffitts informed me, that he attended a patient on the 9th of January in a pneumony, who had an universal yellowness on his skin. I met with a case of pneumony on the 20th of the same month, in which I observed the same degrees of redness in the eyes that were common in the yellow fever. My pupil Mr Coxe, lost blood in an inflammatory fever, on the 18th of February, which was dissolved. Mr James In|nis, the brewer, had a deep yellow colour in his eyes, on the fourth day of a pneumony, on the 27th of the same month; and Mr Magnus Miller had the same symptom of a similar disorder, on the 16th of March. None of these bilious and ano|malous symptoms of the inflammatory fevers of the winter and spring surprised me. I had been ear|ly taught by Dr Sydenham, that the epidemics of autumn often insinuate some of their symptoms in|to the winter diseases which follow them. Dr Cleghorn informs us, that "the pleurisies which succeeded the autumnal tertians in Minorca, were accompanied by a vomiting and purging of green or yellow bilious matters*.

Page  140 It belongs to powerful epidemics to be followed by some diseases after they disappear, as well as to run into others at their first appearance. In the former case it is occasioned by a peculiar state of the body, created by the epidemic constitution of the air, not having been changed by the weather which succeeded it.

The weather in March resembled that of May; while the weather in April resembled that of March in common years. A rash prevailed in many families in April, accompanied in a few cases by a sore throat. It was attended with an itching, a redness of the eyes, and a slight fever in a few instances. The small-pox by inoculation in this month was more mortal than in former years. However unimportant these facts may appear at this time, future observations may perhaps con|nect them with a similar constitution of the air which produced our late autumnal epidemic.

The appearance of bilious symptoms in the dis|eases of the winter, excited apprehensions in seve|ral instances of the revival of the yellow fever. The alarms though false, served to produce vigi|lance and industry in the corporation, in airing and purifying such houses and articles of furniture Page  141 as belonged to the poor; and which had been ne|glected in the autumn, after the ceasing of the dis|ease.

The modes of purifying houses, beds, and clothes were various. Fumigations of nitre and aromatic substances were used by some people. Burying infected articles of furniture under ground, and baking them in ovens, were used by others. Some destroyed all their beds and cloth|ing that had been infected, or threw them into the Delaware. Many white-washed their walls, and painted the wood-work of their house. Is did not conceive the contagion required all, or any of those means to destroy it. I believed cold and water to be sufficient for that purpose. I therefore advised keeping the windows of infected rooms open night and day, for a few days; to have the floors and walls of houses well washed; and to expose beds and such articles of household furniture as might be injured by washing, upon the bare earth for a week or two, taking care to turn them every day. I used no other methods of destroying the accumulated contagion in my house and furniture, and experience showed that they were sufficient. Those branches of my fa|mily who had been absent during the prevalence of the fever (amounting to eleven in number) re|turned Page  142 to the city on the 22d of November, and occupied the house and beds which had been highly infected, without suffering a moment's in|disposition from it. The weather of the winter favoured the complete destruction of the conta|gion. It was alternately moderate and cold; by which means the contagion, if accidentally revi|ved by the former, was more effectually destroyed by the latter state of the air.

It is possible a portion of the contagion may ex|ist in clothes or bedding, under such circumstan|ces of warmth, as to be excited into action in the course of the approaching summer and autumn; but it cannot spread without a corresponding con|stitution of the atmosphere. A trunk full of in|fected clothes, the property of Mr James Bing|ham, who died of the yellow fever in one of the West India islands about 40 years ago, was open|ed some months after they were received by his friends, by a young man who lived in his bro|ther's family. This young man took the disease, and died; but without infecting any of the fami|ly: nor did the disease spread afterwards in the city.

The father of Mr Joseph Paschall was infected with the yellow fever of 1741, by the smell of a Page  143 bed in passing through Norris's Alley, in the lat|ter end of December, after the disease had left the city. He died on the 25th of the month, but without reviving the fever in the city, or even in|fecting his family.

In a letter from Dr Senter of Newport, dated January 7th, 1794, I find the following fact, which I shall communicate in his own words. It is in|troduced to support the principle, that the yellow fever cannnot spread in any country without the concurrence of a predisposing constitution of air. "This place (says the Doctor) has traded formerly very much to the West India islands, and more or less of our people have died there every season, when the disease prevails in those parts. Clothes of these unfortunate people have been re|peatedly brought home to their friends, without any accident happening to them."

It is not peculiar to the contagion of the yellow fever to require the concurrence of a morbid consti|tution of the air to excite it into action. The con|tagion of the plague perished twice in the city of Larnica, without spreading, from the absence of that necessary state of the air, in the year 1759*.

Page  144 Several persons it is said died of the yellow fe|ver in the summer and autumn of 1763, the year after it had been epidemic in our city. I witnessed the symptoms which immediately preceded the death of one of them. Whether the disease in this case was produced by a revival of the conta|gion, or by miasmata generated in the city, I am unable to determine.

Dr Mitchell informs us, that the disease appear|ed in Virginia in the spring of 1742, after the au|tumn of 1741. In this case the contagion was probably kept alive during the winter by the want of cleanliness in the negro-quarters; and perhaps by moderate weather.

These are the only facts which support the fears of the return of the disease to our city, in the course of the present year. To aid our hopes, that this will not be the case, I have great pleasure in ad|ding, that it has never occurred in successive years either in this city or in Charleston; in one of which there are records of its having been five, and in the other four times epidemic.

I feel with my reader the fatigue of this long detail of facts, and equal impatience with him, to proceed to the history of the treatment of the fe|ver; Page  145 but I must beg leave to detain him a little longer from that part of the work, while I resume the subject of the origin of the fever. It is an in|teresting question, as it involves in it the means of preventing a return of the disorder.

Soon after the fever left the city, the governor of the state addressed a letter to the College of Physicians, requesting to know their opinion of its origin; if imported; from what place; at what time; and in what manner. The design of this in|quiry was to procure such information as was pro|per to lay before the legislature, in order to im|prove the laws for preventing the importation or generation of infectious diseases, or to enact new ones, if necessary for that purpose. To the go|vernor's letter, the College of Physicians sent the following answer:

Three members of the College dissented from the report contained in this letter. They were Dr Redman the President of the College, Dr Foulke, and Dr Leib.

Page  147 I am sorry to meet my brethren upon every ques|tion of our late epidemic in a field of controversy. In the present they will have a great advantage over me, for the prejudices of the citizens of Philadel|phia are in their favour. Loathsome and dangerous diseases have been considered by all nations as of foreign extraction. The venereal disease and the leprosy have no native country, if we believe all the authors who have written upon their origin. Pros|per Alpinus, derives the almost yearly plagues of Cairo from Syria, and Dr Warren flattered the people of Barbadoes, by an attempt to persuade them, that the yellow fever of the West Indies, was originally imported from Siam. This princi|ple of referring the origin of the evils of life, from ourselves to others, is universal. It disco|vered itself in paradise, and it is every where, an essential feature in the character of man.

I have asserted in the introduction to the history of this fever, that I believed it to have been gene|rated in our city; I shall now deliver my reasons for that belief.

1. The yellow fever in the West Indies and in all other countries where it is endemic, is the off|spring of vegetable putrefaction. Heat, exercise, and intemperance in drinking, (says Dr Lind) dis|posePage  148 to this fever in hot climates, but they do not produce it, without the concurrence of a remote cause. This remote cause exists at all times, in some spots of the Islands, but in other parts of even the same islands, where there are no marsh exhalations, the disease is unknown. I shall not waste a moment in enquiring into the truth of Dr Warren's account of the origin of this fever. It is fully refuted by Dr Hillary, and it is treated as chimerical by Dr Lind. They have very limited ideas of the history of this fever who suppose it to be peculiar to the East or West Indies. It was generated in Cadiz after a hot and dry summer in 1764, and in Pensacola in 1765*. The tertian fever of Minorca, when it attacked Englishmen put on the usual symptoms of the yellow fever†. In short, this disease, ap|pears according to Dr Lind, in all the southern parts of Europe, after hot, and dry weather‡.

2. The same causes (under like circumstances) must always produce the same effects. There is nothing in the air of the West Indies above other hot countries, which disposes it to produce a yel|low fever. Similar degrees of heat, acting upon Page  149 dead and moist vegetable matters, are capable of producing it, together with all its various modifi|cations, in every part of the world. In support of this opinion, I shall transcribe part of a letter from Dr Miller, of the Delaware state.

To the above information it may be added, that the dysentery which prevailed during the late au|tumn in several of the villages of Pennsylvania, was attended with a malignity and mortality, un|known before in any part of the state. I need not pause to remark that this dysentery arose from putrid exhalation, and that it is like the bilious colic, only a modification of one original genus of bilious fever.

Page  151 But further, a malignant fever resembling that which was epidemic in our city, prevailed during the autumn in many parts of the United States, viz. at Lynn in Massachusetts, at Weatherfield and Coventry in Connecticut, at New Galloway in the state of New York, on Walkill and on Pensocken creeks in New Jersey, at Harrisburgh, and Hum|melstown in Pennsylvania, in Caroline country in Maryland, on the South branch of the Potowmac in Hardie county, also in Lynchburgh and in Alexandria in Virginia, and in several counties in North Carolina. In none of these places was there a suspicion of the disease being imported from abroad, or conveyed by an intercourse with the city of Philadelphia.

It is no objection to the inference which follows from these facts, that the common remitting fever was not known during the above period in the neighbourhood of this city, and in many other parts of the state, where it had usually appeared in the autumnal months. There is a certain combination of moisture with heat, which is essential to the production of the remote cause of a bilious fever. Where the heat is so intense, or of such long du|ration as wholly to dissipate moisture, or when the rains are so great as totally to overflow the Page  152 marshy ground, or to wash away putrid masses of matter, no fever can be produced.

Dr Dazilles, in his treatise upon the diseases of the Negroes in the West Indies, informs us, that the RAINY season is the most healthy at Cayenne, owing to the neighbouring morasses being DEEPLY overflowed—whereas at St Domingo, a DRY sea|son is most productive of diseases; owing to its favouring those degrees of moisture which pro|duce morbid exhalations. These facts will explain the reason why, in certain seasons, places which are naturally healthy in our country, become sickly, while those places which are naturally sickly, escape the prevailing epidemic. Previously to the dissipation of the moisture from the putrid masses of vegetable matters in our streets, and in the neighbourhood of the city, there were (as several practitioners can testify) many cases of mild remit|tents, but they all disappeared about the first week in September.

It is worthy of notice, that the yellow fever pre|vailed in Virginia in the year 1741, and in Charles|ton in South Carolina in the year 1699, in both which years, it prevailed in Philadelphia. Its pre|valence in Charleston is taken notice of in a Page  153 letter dated November 18th, O. S. 1699, from Isaac Norris to one of his correspondents. The letter says, that "150 persons had died in Charles|ton in a few days," that "the survivors fled into the country," and that "the town was thinned to a very few people." Is it not probable, from the prevalence of this fever twice in two places in the same years, that it was produced (as last year) by a general constitution of air, co-operating with miasmata, which favoured its generation in differ|ent parts of the continent? But again, such was the state of the air in the summer of 1793, that it predisposed other animals to diseases, besides the human species. In some parts of New Jersey, a disorder prevailed with great mortality among the horses, and in Virginia among the cows, during the last autumn. The urine in both was yellow.—Large abscesses appeared in different parts of the body in the latter animals, which when opened, discharged a yellow serous fluid. From the colour of these discharges, and of the urine, the disease got the name of the yellow water.

3. I have before remarked that a quantity of damaged coffee, was exposed at a time (July the 24th) and in a situation (on a wharf, and in a dock) which favoured its putrefac|tion, and exhalation. Its smell was highly pu|trid Page  154 and offensive, insomuch that the inhabitants of the houses in Water and Front Streets, who were near it, were obliged in the hottest weather to exclude it, by shutting their doors and windows. Even persons, who only walked-along those streets, complained of an intolerable foetor, which upon enquiring, was constantly traced to the putrid cof|fee. It should not surprise us, that this seed, so inoffensive in its natural state, should produce, af|ter its putrefaction a violent fever. The records of medicine furnish instances of similar fevers be|ing produced, by the putrefaction of many other vegetable substances. Fourteen men out of six|teen, perished by a malignant fever, a few years ago, at the island of Tortola, from the effluvia ge|nerated by some putrefied potatoes, which were taken out of the hold of a Liverpool vessel. "The effluvia (says Dr Zimmerman) from a little heap of flax, has been known to occasion a malig|nant fever, which proved fatal to the family, in which it first began, and afterwards spread its Con|tagion through a whole country." Dr Rodgers in his treatise upon the diseases of Cork, mentions a malignant fever which swept away a great num|ber of the students of Wadham College in Ox|ford, "The singularity of the case (adds the Doc|tor) engaged all the gentlemen of the faculty, in a serious inquiry into the causes of so remarkable Page  155 an effect, and all agreed that the contagious infec|tion arose from the putrefaction of a vast quantity of cabbages thrown into a heap out of the several gardens near the College." Lancissi relates, that one end of the city of Rome was nearly desolated by the effluvia of some rotted hemp, which lay in the neighbourhood of the city. The same author remarks, that "fevers often prevail at Constanti|nople, which owe their origin to the hemp which is brought from Cairo, and which is put wet into the public granaries, and suffered to ferment du|ring the summer. It is afterwards sold, and the seeds of those diseases are afterwards spread among the people." Many other facts might be adduced of radishes, turnips, garlic, and sundry other vegetables, generating by putrefaction, fe|vers, similar to those which have been mentioned.

4. The rapid progress of the fever from Water-street, and the courses through which it travelled into other parts of the city, afford a strong evi|dence that it was at first propagated chiefly by ex|halation from the putrid coffee. It is remarkable that it passed first through those alleys, and streets which were in the course of the winds that blew across the dock and wharf where the coffee lay, and that persons were affected at a much greater distance from Water-street by that means, than Page  156 was afterwards known by means of the contagion which was generated by infected persons.

5. Many persons who had worked, or even vi|sited in the neighbourhood of the exhalation from the coffee, early in the month of August, were indisposed afterwards with sickness, puking, and yellow sweats, long before the air of Water-street was so much impregnated with the contagion, as to produce such effects; and several patients whom I attended in the yellow fever declared to me, or to their friends, that their indispositions began ex|actly at the time they inhaled the offensive effluvia of the coffee.

6. The first cases of the yellow fever have been clearly traced to the sailors of the vessel who were first exposed to the effluvia of the coffee. Their sickness commenced with the day on which the coffee began to emit its putrid smell. The disease spread with the encrease of the poisonous exhala|tion. A journeyman of Mr Peter Brown's, who worked near the corner of Race and Water-streets, caught the disease on the 27th of July. Elizabeth Hill, the wife of a fisherman was infected by only sailing near the pestilential wharf, about the first of August, and died at Kensington on the 14th of the same month. Many other names might be Page  157 mentioned of persons who sickened during the last week in July or the first week in August, who ascribed their illnesses to the smell of the coffee. From three of those persons who came under my notice, the disease was evidently propagated by contagion: from one of them, to nearly a whole family, and from another to a girl of eight years old, who was led by curiosity to examine the yel|low colour which it was said had appeared in the face of the infected person, after death.

7. It has been remarked that this fever did not spread in the country, when carried there by per|sons who were infected, and who afterwards died with it. This I conceive was occasioned, in part by the contagion being deprived of the aid of mi|asmata from the putrid matter which first produced it in our city, and in part, by its being diluted, and thereby weakened by the pure air of the coun|try. During four times in which it prevailed in Charleston, in no one instance, according to Dr Lining, was it propagated in any other part of the state.

8. It is very remarkable that in the histories of the disorder which have been preserved in this country, it has six times appeared about the first Page  158 or middle of August, and declined, or ceased about the middle of October—viz. in 1732, 1739, 1745, and 1748 in Charleston; in 1791 in New-York, and in 1793 in Philadelphia. This fre|quent occurrence of the yellow fever at the usual period of our common bilious remittents, cannot be ascribed to accidental coincidence, but must be resolved in most cases into the combination of more active miasmata with the predisposition of a tropi|cal season. In speaking of a tropical season, I include that kind of weather in which rains and heats are alternated with each other, as well as that, which is uniformly warm.

9. Several circumstances attended the late epi|demic, which do not occur in the West-India yel|low fever. It affected children as well as adults in common with our annual bilious fevers. In the West Indies Dr Hume tells us it never attack|ed any person under puberty. It had, moreover, many peculiar symptoms (as I have already shewn) which are not to be met with in any of the histo|ries of the West-India yellow fever.

10. Why should it surprise us to see a yellow fever generated amongst us? It is only a higher grade of a fever which prevails every year in Page  159 our city, from vegetable putrefaction. It con|forms in the difference of its degrees of violence, and danger to season, as well as climate, and in this respect it is upon a footing with the small-pox, the measles, the fore-throat, and several other dis|eases. There are few years pass, in which a ple|thoric habit, and more active but limited mias|mata, do not produce Sporadic Cases of true yel|low fever in Philadelphia. It is very common in South and North Carolina and in Virginia, and there are facts which prove, that not only strangers, but native individuals, and in one instance, a whole family, have been carried off by it in the state of Maryland. It proved fatal to one hundred per|sons in the city of New-York in the year of 1791, where it was evidently generated by putrid exha|lation. The yellow colour of the skin, has unfor|tunately too often been considered as the charac|teristic mark of this fever, otherwise many other instances of its prevalence might be discovered, I have no doubt in every part of the United States. I wish with Dr Mosely, the term yellow, could be abolished from the titles of this fever, for this co|lour is not only frequently absent, but sometimes occurs in the mildest bilious remittents. Dr Hal|ler in his pathology, describes an epidemic of this kind in Swisserland, in which this colour generally attended, and I have once seen it almost universal Page  160 in a common bilious fever which prevailed in the American army in the year 1776.

If any thing could surprise me after reading the report of the College of Physicians that our late fever was imported, in spite of every possible evi|dence to the contrary, it would be the opinion which was delivered publicly by some leading members of the College, that no fever produced by vegetable putrefaction and exhalation, had ever been contagious. It is scarcely possible to open a practical book upon medicine, without meeting with facts which establish a contrary opinion. The fevers generated by putrid cabbage, men|tioned by Dr Rodgers, and by putrid flax men|tioned by Dr Zimmerman, were both contagious. Dr Lind ascribes the yellow fever every where to marsh or putrid vegetable exhalations; and this fever, we know, spreads by contagion. Dr Lind, Jun. establishes the contagious nature of the marsh fever which prevailed in Bengal in the year 1762. I shall transcribe his words upon this subject. "Although marsh miasmata (says he) first bring on the disease, yet contagion presently spreads it, and renders it more epidemic. Thus the Drake Indiaman continued free from the disorder for two weeks together, when she had no commu|nication with other ships; whereas as soon as the Page  161 disorder was brought on board, many were seized with it within a few days in such a manner as to leave no room to entertain the least doubt con|cerning its pestilential nature*."

Dr Clark mentions a contagious malignant fever from marsh miasmata, which prevailed at Prince's Island in the year 1771, and which after|wards infected the crew of the Grenville India|man†. The contagious pestilential fever in France, so accurately described by Riverius, was produced by an exhalation from putrid vegeta|bles, particularly hemp and flax‡. Even inter|mittents, the most frequent and the most nume|rous offspring of marsh exhalation, are contagi|ous. Of this there are many proofs in practical authors. Bianchi describes an intermittent which was highly contagious at Wolfenbuttle in the year 1666§. Dr Clark mentions a number of cases in which this mild species of fever was propagated by contagion. Dr Cleghorn has established the contagious nature of intermittents by many facts. After mentioning numerous instances of their ha|ving Page  162 spread in this way, he says, "These tertian• have as good a right to be called contagious as the measles, small-pox, or any other disease*." The United States, in common with other coun|tries, have in many places exhibited proofs of the contagious nature of fevers, produced by putrid vegetable exhalations. The yellow fever which the citizens of New York wisely admit to have been generated in their city from vegetable putre|faction in the year 1791, spread by contagion†. The bilious fever which prevailed in Philadelphia in the year 1778, was evidently contagious; so were the bilious fevers which prevailed during the last autumn in Weathersfield, Harrisburgh, and on the south branch of the Potowmac. I hope I shall be excused by the physicians of other states (if this publication should fall into their hands) for having employed a single page in combating an error which is so obvious to common observa|tion. My only design in exposing it, is to prevent a repetition of its fatal influence in the only city in the world in which it has ever been believed or propagated.

Page  163 I am far however from denying that this disease has not sometimes been imported into our coun|try. From the authority of Dr Lind, it appears that this has once been the case in Philadelphia. In this respect it is upon a footing with the plague, which is both an imported and a generated dis|ease, in the cities of the East. I am disposed how|ever to believe that the instances of the yellow fe|ver being imported are very few, compared with those of its being generated in our country. What makes this opinion probable is, that neither Great Britain nor Ireland have ever, to my knowledge, been infected by this fever, notwithstanding their long and frequent commercial intercourse with the West India islands. The summers in each of those countries, though seldom hot enough to generate a contagious yellow or bilious fever, are notwith|standing warm enough to favour the propagation of an imported contagion of that disorder. The jail fever which has more than once been introdu|ced into our city in crowded ships from Holland, I suspect has been sometimes mistaken for the yel|low fever of the West Indies. But I have ano|ther reason for discrediting some of the accounts of the importation of this fever, which have been handed down to us by former generations, and that is, the manner in which the College of Phy|sicians decided upon the question of the origin of Page  164 the disease now under consideration. The go|vernor of the state requested in his letter to them, to know whether it was imported; if it were, from what place, at what time, and in what man|ner. The report of the College of Physicians takes no notice of either of those questions. In vain did Dr Foulke call upon the college to be more definite in their answer to the governor's letter. They had faithfully sought for the infor|mation required, but to no purpose. The cha|racter of their departed brother Dr Hutchinson, for capacity and vigilance in his office, as inspec|tor of sickly vessels, was urged without effect as an argument against the probability of the disease being imported. Public report had derived it from several different islands; had chased it from ship to ship, and from shore to shore; and finally conveyed it at different times into the city, al|ternately by dead and living bodies; and from these tales, all of which when investigated, were proved to be without foundation, the College of Physicians composed their letter. It would seem from this conduct of the College as if medi|cal superstition had changed its names, and that in accounting for the origin of pestilential fevers, ce|lestial, planetary, and demoniacal influence, has only yielded to the term—importation.

Page  165 Let not the reader reject the opinion I have de|livered, because it is opposed by so great a majo|rity of the physicians of Philadelphia. A single physician supported an opinion of the existence of the plague at Messina in the year 1743, in oppo|sition to all the physicians (33 in number) of that city. They denied the disease in question to exist, because it was not accompanied by glandular swel|lings. Time shewed that they were all mistaken, and the plague, which might probably have been checked at its first appearance by their united ef|forts, was by means of their ignorance, introdu|ced with great mortality into every part of the city. This disposition of physicians to limit the symptoms of several other diseases, cannot be suf|ficiently lamented. The frequent absence of a yellow colour in our late epidemic, led to mistakes which cost the city of Philadelphia several hun|dred lives.

The report of the College of Physicians has served to confirm me in an opinion, that the plagues which occasionally desolated most of the countries in Europe in former centuries, and which were always said to be of foreign extraction, were in most instances of domestic origin. Between the years 1006 and 1680, and plague was epidemic 52 times all over Europe. It prevailed 14 times in Page  166 14th century. The state of Europe in this long period, is well known. Idleness, a deficiency of vegetable aliment, a camp life from the frequency of wars, famine, an uncultivated and marshy soil, small cabins, and the want of cleanliness in dress, diet, and furniture, all concurred to generate pes|tilential diseases. The plagues which prevailed in London every year from 1593 to 1611, and from 1636 to 1649, I suspect were generated in that city. The diminution of plagues in Europe, more especially in London, appears to have been produced by the great change in the diet and man|ners of the people; also by the more commodious and airy forms of the houses of the poor, among whom the plague always makes its first appear|ance. It is true, these plagues were said by au|thors to have been imported either directly or in|directly from the Levant; but the proofs of such importation were in most cases as vague and defi|cient, as they were of the West India origin of our late epidemic. The pestilential fevers which have been mentioned, have been described by au|thors, by the generic name of the plague; but some of them appear to have originated from pu|trid vegetable exhalations, and to have resembled in most of their symptoms, the West India and North American yellow fever.

Page  167 I am aware that the opinion and facts which I have stated upon the origin of the late epidemic, are not popular with our citizens, but I did not dare to conceal them; for I am persuaded a know|ledge and belief of them, involve in their conse|quences, the lives of millions that are yet unborn.

Commerce can no more be endangered than Re|ligion, by the publication of philosophical truth. On the contrary it must suffer most by the adop|tion of the traditional error which I have endea|voured to refute, for while the cause of a malig|nant fever is obvious to the senses, it will be easy to guard against it; but while it is believed that the disease may be imported, and no body know, from what place, at what time, and in what man|ner, we shall not only be careless in the midst of filth and danger, but our city will always hold its character for health by a timid and precarious te|nure. I am the more disposed to expect forgive|ness from my fellow citizens for this attempt to serve them, by the recollection of the sudden change in the health of our city which followed the arching the offensive dock between Front and Third streets in the year 1782. By advising that measure (in which I stood nearly alone) I incurred the censure of several valuable citizens. The bills of mortality however soon shewed that the mea|sure Page  168 was right, and I have since seen with great pleasure the extraordinary healthiness of our city, ascribed by indifferent people, to that, among other causes.

The climate of our country can no more suffer than the commerce of our city, by this investiga|tion; for it fixes the late fever, and all the other malignant fevers of the United States, upon putrid vegetable exhalation. Without the matrix of putrid vegetable matters, there can no more be a bilious or yellow fever generated amongst us, than there can be vegetation without earth—water or air. To ascribe our late disease therefore to the exclusive influence of the atmosphere, is a reflec|tion upon our climate which is equally unphiloso|phical and unjust.

Let it only be clearly proved, and boldly assert|ed, that a bilious yellow fever has been, and may be generated in our country, under the circum|stances before mentioned, and the return of it, as also of common bilious and intermitting fevers may every where be prevented by a due attention to the cleanliness of the wharfs and suburbs, as well as the streets of our cities, and towns; by draining and cultivating marshy grounds in their neighbourhood, and in the neighbourhood of Page  169 farm houses,—and where the last cannot be done, by sheltering them from the current of vegetable exhalations, by means of a body of trees that are of speedy growth. In this manner, malignant and deadly fevers have been banished from most of the cities in Europe.

I have hinted in the course of this history, at the resemblance which the yellow fever bears to the plague. Before I dismiss this part of my sub|ject, I shall briefly enumerate the circumstances, and symptoms, which belong to them in common; and afterwards mention those which are peculiar to each of them. The utility of this digression will, I hope appear hereafter, when I come to deli|ver the history of the cure of the yellow fever.—The principles which suggested and directed it, will apply alike to both diseases.

The circumstances and symptoms in which the plague, and the yellow fever (as it lately appeared in our city) resemble each other, are as follow:

In being accompanied and encreased by warm weather.

In affecting those people most generally who fol|low occupations which expose them to be much Page  170 heated. The bakers were great sufferers by the plagues at Aleppo, described by Dr P. Russel.

In affecting persons who are suddenly debili|tated by fear or grief.

In affecting all ages; also the poor more than the rich; men more than women; and persons of robust, more than those of weakly habits.

In attacking with, and without premonitory symptoms.

In being excited by intemperance, and labour.

In being accompanied by a full, tense, depressed, regular, or an intermitting pulse.

In being accompanied by hemorrhagies. These are less frequent in the plague than in the yellow fever.—Abortions are alike common in both diseases.

The following symptoms of our late yellow fever occur likewise in the plague.

Inflammation of the brain.

Page  171 Inflammation, mortifications, and carbuncles in the alimentary canal and stomach.

Costiveness or diarrhoea. Copious sweats in the beginning of the disease which afford relief.—A discharge of a blackish liquor from the stomach by vomiting, in the close of the disease.

A moist white tongue, in its beginning, and a dry black tongue in its last stage.

Absence of heat and thirst in some cases.

Convulsions, syncope, great depression of spirits, exquisite pain, so as to excite screamings in the sick. Delirium and a temporary loss of memory after recovery.

A red or a brilliant eye, and great venereal ex|citability in the convalescent state of the disease.

Buboes, and an exclusive affection of the lym|phatic glands.

Maculae, or red spots resembling flea bites, wa|tery vesicles, or blisters which end in mortifica|tions, petechiae, anthrax, and carbuncles.

Page  172 Sizy, dense, or dissolved blood.

The plague appears in the forms of quotidian, tertian, and quartan fevers. It has different grades, also different durations, from one day to two, three and four weeks. It is most fatal at its first appearance. Convulsive twitchings of the tendons are less common in the plague, than in the nervous fever. It chases away, or unites with all other febrile diseases.

I have before remarked, that during the pre|valence of the plague, some foreigners escape the contagion.

The contagion of the plague infects the atmos|phere of a whole city, and is propagated without contact with the sick. Many people discover marks of the presence of this contagion in their bodies, who are in apparent good health; a dis|position to sweat is very common in such persons. The disease is sometimes propagated by contact by means of this sweat, when it affects the hands.

Persons infected with the contagion of the plague, communicate it before they are sensible of their being affected by it. The contagion is excited at different times, from the moment it is Page  173 received into the body, until the 16th day after|wards.

Persons who have had the plague, are capable of re-infection.

Brutes, as cats and dogs are affected in some instances, with symptoms of the plague, particu|larly buboes.

Persons confined in Seraglios in Eastern coun|tries, and in Monasteries in Catholic countries, also grave diggers, very often escape the plague.

The bodies of persons who die of the plague become stiff in some instances immediately after death. Tears likewise often appear on their cheeks.

Cold weather checks the plague, but not so uniformly as it does the yellow fever.

The diseases which succeed the plague, appear with more or less of its symptoms.

It will appear hereafter that the cure of the yellow fever, accorded in several particulars, with that of the plague.

Page  174 The circumstances and symptoms in which the plague differs from the yellow fever are as follow:

A vomiting is less common in the plague, than in the yellow fever. Bile is less frequently dis|charged, and the stools are less foetid, and offensive.

There are small horny swellings upon the breast and limbs in the plague which did not occur in the yellow fever. They are called tokens.

The contagion of the plague does not infect as so great a distance, as the contagion of the yel|low fever.

It affects more universally, than the yellow fe|ver, and (with a few exceptions) it is more mor|tal when left to itself.

It sometimes prevails in cold weather. It pre|vails likewise in a greater variety of states of the atmosphere.

The body is of its usual, or of a greenish co|lour after death.

The plague is of animal origin. It is derived in some instances from dead animal matters. The Page  175 plagues which laid waste the Roman Empire in the reign of Justinian, are ascribed by Mr Gib|bon, to swarms of putrifying locusts. But the most frequent source of the plague is from human miasmata, rendered pestilential, by famine, grief, the want of cleanliness, and by a number of per|sons crouded together in small rooms, or houses.

The yellow fever has been confounded with the jail or hospital fever. I shall briefly enume|rate the circumstances and symptoms in which they agree and disagree.

The first are as follow:

The jail-fever affects persons who are debilita|ted by grief, fear, or intemperance.

The pulse is sometimes intermitting in this fe|ver. This is taken notice of by Dr Ferriar.

There are marks of congestion in the brain, without any signs of inflammation in it after death. There are likewise in this fever great depression of spirits, sighing, delirium, palsy, and a debilita|ted state of the memory after recovery. This occurs more frequently, and in a greater degree, after the jail, than after the yellow fever.

Page  176 The eye is sometimes red, and sometimes dull in this fever. There is frequently an absence of thirst.

There is in the jail fever in its worst state, a suppression or great ••at in the urine.

Buboes, petechiae, pain along the spermatic cord, a swelling of one testicle, ulcers in the throat, and abscesses in different parts of the body, have all occurred occasionally in this fever.

The circumstances and symptoms in which the jail fever differs from the yellow fever, are as fol|low:

It affects persons who have been previously weakened by other diseases, or who are of weakly habits.

The pulse is seldom full or tense, but generally weak and quick.

The tongue soon loses its whiteness and mois|ture, and assumes when dry, a dark colour.

The stomach is seldom disordered. The bowels are either in their natural state, or a diarrhoea at|tends. Page  177 The stools are seldom bilious, or preter|naturally foetid.

There are great twitchings in the tendons, and tremors in the tongue, and limbs.

Intermissions and remissions of the fever are sel|dom, or scarcely perceptible.

It prevails alike in the winter, spring, and au|tumn. It is moderated, or checked by warm weather, provided patients are placed in situations in which they can breathe a sufficient quantity of fresh air.

It is less contagious and mortal than the yellow fever.

It is derived from human miasmata produced under inferior degrees of all those circumstances, which favour the generation of the plague. It is, to the plague in its degree, what the common bilious, is, to the yellow fever.

There is a camp fever described by some au|thors, which is derived from a mixture of marsh and human miasmata. Its symptoms are com|pounded Page  178 of those which belong to the bilious, and jail fevers.

I shall not attempt to distinguish the yellow, from the common bilious fever. They are only different grades of the same disease. The follow|ing, appears to be the natural order of a scale of such fevers as are derived from marsh miasmata.

1. The yellow fever.

2. The common bilious remitting fever.

3. The intermitting fever.

4. The febricula of authors, or what are called "inward fevers" in the southern states. Differ|ent degrees of force in the remote cause, in con|junction with a difference in the sensible qualities of the air, frequently produce all those grades of bilious or marsh fever in different seasons, and sometimes, in the same season. The encrease, or abstraction of accidental stimuli, likewise often change these different states of bilious fever into each other. Thus, what are called inward fevers have often been excited by means of a ride, or a long walk, into an intermittent; an intermittent Page  179 has been changed by the premature use of the bark into a remitting fever, and a common remit|tent, has, by improper regimen or violent exer|cise, been excited into a yellow fever. The dan|ger in each case, is determined by the force of the miasmata, and the state of the air.

In contemplating the immense proportion of human misery, which is produced by pestilential diseases, we are naturally led to inquire whether their approaches are not indicated by some un|usual signs in the operations of nature. What is called instinct in many animals, has repeatedly taught them to foresee, and to avoid many natu|ral evils; and if reason has not taught man to do the same, it is probably because its exercises have not been directed to those subjects.

I have endeavoured to discover whether any thing uncommon occurred in the operations of na|ture in the atmosphere, or in the animal and ve|getable kingdoms in the course of the winter and summer, which preceded our late epidemic. The result of my inquiries is as follows.

The winter of 1793 was unusually moderate. It was supposed this had an influence upon the weather which favoured the generation and pro|pagation Page  180 of the disease. I should have been dis|posed to admit this opinion, had moderate winters in Pennsylvania been uniformly succeeded by sick|ly autumns. Livy records that a pestilential fever in Rome was preceded by an unusually cold win|ter*.

The wild pidgeons were common during the winter of 1793 in many parts of Pennsylvania. But they have occasionally appeared in great stocks in our state in former winters, without ha|ving been the harbingers of a sickly autumn.

Dr P. Russel says, that uncommon and violent diseases generally preceded the plague at Aleppo. Dr Sydenham informs us, that acute inflammatory fevers were the forerunners of the plague in Lon|don in 1665. I suspect that uncommon circum|stances attending certain diseases, either as to their violence or time of appearance, will be found to suggest a prelude to a sickly autumn in all coun|tries. The scarlatina anginosa I have remarked was attended with an uncommon degree of inflam|matory diathesis, in the month of July. Dr Por|ter informed me that he had been called to seve|ral cases of dysentery, attended with symptoms of Page  181 great malignity, in the neighbourhood of Frank|fort, in the months of July and August. Dr Sen|ter informed me in a letter dated the 26th of No|vember, 1793, that "during the last two summer months, fevers and fluxes were more obstinate than he had ever known them, at Newport in Rhode Island." My pupil Mr Nathaniel Potter, in a letter from Caroline county, in Maryland, dated November 1st, 1793, gave me the follow|ing information. "On my arrival at this place, on the first of August, I was informed by gentle|men of the faculty, that the dysentery had pre|vailed from the first of June to the fifteenth of July, with considerable mortality. From obser|vations and communications from different peo|ple in this county, I did not hesitate to predict a sickly autumn; for it is an invariable maxim here, both among physicians and farmers, that if the wheat be damaged by rust or blast, a contagi|ous dysentery is soon to follow; and the sooner in the summer the dysentery appears, the more violent and mortal will be the diseases of the autumn."

These communications, though short and few, will be useful if they serve to lead physicians to observe and record hereafter the diseases which precede universal and mortal epidemics.

Page  182 There can be no doubt of a warm summer, whether it be wet or dry, having often preceded malignant autumnal fevers. Mr Norris in a let|ter to one of his friends, dated the 24th of Au|gust, O. S. says that "the summer of 1699 was the hottest he had ever felt, and that several had died in the harvest fields with the violence of the heat." It appears from another of Mr Norris's letters, dated the 12th of August, O. S. that the yellow fever made its first appearance in that month. The yellow fevers of 1762 and 1793, were both preceded by warm summers.

I have one more remark to mention upon this subject, which was communicated to me by a gen|tleman who had resided occasionally in southern and tropical countries. He informed me that he had observed in the month of July, several weeks before the yellow fever became general, a pecu|liar and universal allowness of complexion in the faces of the citizens of Philadelphia, such as he had observed to precede the prevalence of malig|nant bilious fevers in hot climates. Dr Dick in|formed me that he had observed the same appear|ance in the faces of people in Alexandria, accom|panied in some cases by a yellowness in the eyes, during the last summer, and some time before vio|lent Page  183 bilious fevers became epidemic upon the banks of the Potowmac.

With these observations I take leave of the his|tory of our late epidemic fever. A few of its symptoms which have been omitted in the history, will be included in the method of cure; for they were discovered or produced by the remedies which were used for that purpose.

Page  [unnumbered]

☞ The following Page begins an account of the states of the thermometer and weather, from the first of January to the first of August, and of the states of the barometer, thermometer, winds, and weather, from the first of August to the ninth of November, 1793. The times of ob|servation for the first three months are at 7 in the morning, and 2 in the afternoon; for the next five months they are at 6 in the morning, and 3 in the afternoon. From the first of Octo|ber to the ninth of November, they are as in the first three months.

Page  185

January, 1793.	February, 1793.
Therm.	Weather.	Therm.	Weather.
D	7h	2h		7h	2h
1	27	30	Cloudy.	9	26	Fair, hazey.
2	30	41	Fair, cloudy.	25	34	Rain, ditto.
3	30	33	Cloudy, rain.	33	37	Cloudy, fair.
4	38	41	Rain, cloudy.	25	46	Cloudy, fair.
5	35	42	Fair, cloudy.	36	44	Cloudy, ditto.
6	33	47	Cloudy, fair.	35	46	Cloudy, rain.
7	33	51	Fair, fair,	36	40	Cloudy, fair.
8	32	49	Fair, ditto.	28	44	Cloudy, ditto.
9	33	48	Hazey, fair.	42	50	Rain, fair.
10	38	51	Fair, ditto.	38	40	Cloudy, fair.
11	35	48	Fair, clouds.	19	27	Fair, cloudy.
12	31	42	Fair, ditto.	20	28	Snow, cloudy.
13	28	4•	Fair, do.	22	31	Cloudy, snow.
14	25	27	Hail, snow, sleet.	27	39	Cloudy, fair.
15	32	37	Clouds, mist,	18	40	Fair, ditto.
16	37	39	Rain, ditto.	29	42	Cloudy, ditto.
17	37	45	Rain, snow, fair.	44	48	Rain, ditto.
18	32	52	Fair, ditto.	39	49	Cloudy, fair.
19	37	48	Fair, do	31	41	Cloudy, rain.
20	33	47	Hazey, cloudy.	52	53	Rain, fair.
21	36	47	Cloudy, fair.	37	49	Fair, ditto.
22	27	32	Fair, ditto.	29	34	Fair, do.
23	22	37	Fair, do.	22	34	Snow, cloudy.
24	30	39	Cloudy, do.	54	59	Rain, cloudy.
25	30	41	Fair, hazey.	34	35	Cloudy, ditto.
26	31	—	Fair.	35	43	Rain, mist.
27	23	38	Fair, cloudy, snow.	43	43	Rain, cloudy.
28	35	45	Cloudy, fair.	14	26	Fair, ditto.
29	29	37	Fair, ditto.
30	22	23	Snow, hail.
31	25	32	Cloudy, fair.

Page  186

March, 1793.	April, 1793.
Therm.	Weather.	Therm.	Weather.
D	7h	2h		7h	2h
1	20	•8	Fair, ditto.	45	70	Cloudy, fair.
2	31	51	Hazey, cloudy.	47	71	Fair, ditto.
3	48	63	Rain, fair.	56	80	Fair, do.
4	43	61	Hazey, ditto.	51	72	Cloudy, fair.
5	51	52	Rain, fair.	53	61	Cloudy, rain.
6	32	50	Fair, ditto.	60	76	Misty, fair.
7	36	62	Fair, do. clouds.	51	65	Fair, do.
8	54	60	Cloudy, rain.	46	74	Fair, do.
9	26	41	Fair, ditto.	55	71	Fair, cloudy.
10	29	51	Fair, do.	50	56	Fair, do.
11	43	55	Rain, do.	37	63	Fair, do.
12	40	43	Cloudy, do.	54	62	Cloudy, rain, fair.
13	38	39	Cloudy, fair.	49	62	Fair, do.
14	26	44	Fair, do.	50	70	Fair, do.
15	32	59	Fair, do.	45	55	Rain, cloudy.
16	52	62	Cloudy, fair.	46	62	Cloudy, fair.
17	51	72	Cloudy, fair.	48	67	Fair, clouds, fair.
18	58	69	Hazey, cloudy.	52	66	Cloudy, fair.
19	53	59	Fair, do.	52	75	Fair, do.
20	42	61	Fair, do.	52	49	Rain, cloudy.
21	41	43	Rain, cloudy.	44	47	Cloudy, ditto.
22	31	47	Fair, do.	43	46	Rain, cloudy.
23	35	57	Fair, do.	42	63	Fair, do.
24	37	50	Fair, do.	44	68	Fair, do.
25	35	59	Fair, do.	45	65	Cloudy, cloudy.
26	47	54	Cloudy, rain.	53	57	Cloudy, rain.
27	43	51	Fair, cloudy.	47	46	Rain, do.
28	33	45	Fair, clouds, fair.	44	54	Rain, cloudy.
29	34	57	Fair, do.	40	59	Fair, do.
30	41	58	Cloudy, fair.	40	65	Fair, do.
31	42	61	Cloudy, fair.

Page  187

May, 1793.	June, 1793.
Therm.	Weather.	Therm.	Weather.
D.	7h	2h		7h	2h
1	45	69	Foggy, cloudy.	53	61	Rain, showery.
2	52	73	Fog, clouds, fair.	54	64	Clouds, showers.
3	60	63	Rain, do.	55	62	Cloudy, rain, fair,
4	60	80	Fair, do.	54	60	Rain, do. cloudy.
5	55	56	Cloudy, do.	58	72	Cloudy, fair, rain.
6	47	58	Cloudy, fair.	—	71	Cloudy, rain,
7	50	68	Cloudy, fair.	68	78	Fair, do.
8	59	78	Cloudy, fair.	65	—	Fair, do.
9	61	79	Foggy, fair.	70	88	Fog, fair.
10	65	71	Rain, hazey.	74	90	Fair, do.
11	55	75	Cloudy, fair.	76	90	Fair, do.
12	61	76	Cloudy, rain.	75	88	Fair, showers.
13	57	78	Fair, do.	74	81	Cloudy, rain.
14	59	83	Fair, cloudy.	63	77	Fair, do.
15	60	71	Fair, do.	63	82	Fair, hazey.
16	50	69	Fair, do.	67	85	Fair, do.
17	48	74	Fair, do.	74	89	Fair, showers.
18	61	81	Cloudy, fair.	73	88	Fair, do.
19	65	85	Fair, rain.	77	91	Fair, do.
20	65	87	Fair, do.	79	88	Fair, rain, fair.
21	68	86	Fair, do. clouds.	75	85	Cloudy, rain.
22	72	80	Clouds, gusts.	58	78	Cloudy, fair,
23	94	79	Cloudy, fair.	58	78	Fair, do.
24	58	75	Fair, do.	60	79	Fair, do.
25	52	70	Fair, cloudy.	67	74	Cloudy, rain.
26	61	66	Rain, do.	66	69	Cloudy, rain.
27	68	84	Cloudy, fair.	68	80	Cloudy, fair.
28	70	68	Fair, clouds, rain.	71	85	Cloudy, fair.
29	57	62	Cloudy, rain, clouds.	77	88	Cloudy, do.
30	54	57	Cloudy, rain.	74	90	Fair, do.
31	54	60	Clouds, do.

Page  188JULY, 1793.

	Barometer.	Therm.	Wind.	Weather.
Days.	6 A. M.	3 P. M.	6 A. M.	6 P. M.	6 A. M.	3 P. M.
1	30 0	29 9	77	88	W	W	fair.
2	29 8	29 7	77	81	W		fair, showers.
3	29 9	30 0	74	80	E	E	cloudy,
4	30 1	30 0	70	83	E	SW	cloudy, fair, rain.
5	30 0	29 9	76	90	NW	SW	fair, do.
6	29 9	29 9	78	91	SW	SW	cloudy, thunder.
7	29 9	30 0	73	88	NE	NW	fair, clouds.
8	30 1	30 1	72	85	E	E	cloudy, fair.
9	30 0	29 8	73	81	S	SW	cloudy, do.
10	30 0	30 0	70	84	W	NW	fair, do.
11	30 0	30 0	74	88	NW	NW	fair, clouds.
12	30 1	30 2	70	84	N	N	fair, do.
13	30 1	30 0	68	83	NW	NW	fair, do.
14	30 0	30 0	65	80	N	Calm	fair, hazey.
15	30 0	29 9	66	75	SW	SW	cloudy, do.
16	29 8	29 7	70	83	W	W	rain, fair.
17	29 8	29 9	68	81	NW	NW	fair, do.
18	30 0	30 0	66	86	W	SW	fair, do.
19	29 9	29 9	75	85	SW	W	fair, cloudy, rain.
20	30 0	30 0	72	87	W	NW	fair, do. shower.
21	30 1	30 1	70	86	NW	NW	fair, do.
22	30 0	30 0	72	87	SW	SW	fair, do.
23	30 0	30 0	73	91	SW	SW	fair, cloudy.
24	29 9	29 9	75	89	Calm	W	cloudy, fair.
25	30 1	30 1	71	83	NW	NNW	fair, do.
26	30 2	30 2	63	82	N	NE	fair, do.
27	30 2	30 1	64	81	S clam	S	fair, cloudy.
28	30 1	30 0	72	85	Calm	NNE	cloudy, fair.
29	30 1	30 1	74	85	SSE	NE	cloudy, do. rain.
30	30 1	30 0	73	86	S	SW	cloudy, fair.
31	29 9	29 8	76	80	SSW	SW	cloudy, rain, fair.

Page  189AUGUST, 1793.

	Barometer.	Therm.	Wind.	Weather.
	6 A. M.	3 P. M.	6 A. M.	3 P. M.	6 A. M.	3 P. M.	6 A. M.	3 P. M.
1	29 95	30 0	65	77	WNW	NW	cloudy,	fair,
2	30 1	30 1	63	81	NW	SW	fair,	fair,
3	30 6	29 95	62	82	N	NNE	fair,	fair,
4	29 97	30 0	65	87	S	SW	fair,	fair,
5	30 5	30 1	73	90	SSW	SW	fair,	fair,
6	30 2	30 0	77	87	SW	W	cloudy,	fair,
7	30 12	30 1	68	83	NW	W	fair,	fair,
8	30 1	29 95	69	86	SSE	SSE	fair,	rain,
9	29 8	29 75	75	85	SSW	SW	cloudy, fair,
10	29 9	29 9	67	82	W	SW	fair,	fair,
11	30 0	30 0	70	84	SW	WSW	cloudy,	cloudy,
12	30 0	30 0	70	87	W	W	fair,	fair,
13	30 5	30 0	71	89	SW	W	fair,	fair,
14	30 0	29 95	75	82	SW	SW	fair,	rain,
15	30 0	30 1	72	75	NNE	NE	fair,	cloudy,
16	30 1	30 1	70	83	NNE	NE	fair,	fair,
17	30 1	30 0	71	86	SW	SW	fair,	fair,
18	30 1	30 1	73	89	calm	SW	fair,	fair,
19	30 1	30 0	72	82	N	N	fair,	cloudy,
20	30 1	30 12	69	82	NNE	NNE	fair,	fair,
21	30 15	30 25	62	83	N	NNE	fair,	fair,
22	30 3	30 35	63	86	NE	SE	fair,	fair,
23	30 25	30 15	63	85	calm	S	fair,	fair,
24	30 1	30 1	73	81	calm	calm	cloudy,	rain,
25	30 1	30 1	71	66	NE	NE	rain,	gr. rain
26	30 15	30 2	59	69	NE	NE	cloudy,	cloudy,
27	30 2	30 2	65	73	NE	NE	cloudy,	cloudy,
28	30 2	30 15	67	80	S	calm	cloudy,	clearin.
29	30 16	30 15	72	86	calm	SW	cloudy,	fair,
30	30 1	30 1	74	87	calm	SW	fair,	fair,
31	30 0	30 0	74	84	SW	NW	rain,	fair,

Page  190SEPTEMBER, 1793.

	Barometer.	Therm.	Wind.	Weather.
	6 A. M.	3 P. M.	6 A. M.	3 P. M.	6 A. M.	3 P. M.	6 A. M.	3 P. M.
1	30 0	29 30	71	86	calm	SW	fog,	fair,
2	29 75	29 8	73	86	SW	SW	fair,	fair,
3	80 0		60		NW	N	fair,	fair,
4	30 15	30 15	55	75	W	W	fair,	fair,
5	30 15	30 1	62	80	SE	S	fair,	cloudy,
6	29 97	29 95	70	89	WSW	W	fair,	cloudy,
7	30 0	30 0	65	77	WNW	NW	fair,	fair,
8	30 1	30 1	64	70	calm	calm	cloudy,	cloudy,
9	30 0	30 0	66	80	SE	NW	rain,	fair,
10	30 0	30 0	64	72	N	NNE	fair,	cloudy,
11	30 1	30 0	62	72	NNE	N	cloudy,	fair,
12	29 96	29 9	58	76	NW	NNW	fair,	fair,
13	29 95	30 0	57	72	NW	N	fair,	fair,
14	30 0	30 5	58	79	NW	NW	fair,	fair,
15	30 0	29 97	65	80	N	S	fair,	fair,
16	29 9	29	70	84	S	SW	cloudy,	fair,
17	29 8	29 85	66	67	N	N	cloudy,	cloudy,
18	30 3		44		N		fair,
19	30 4	30 35	45	70	calm	SW	fair,	fair,
20	30 3	30 15	54	69	calm	SE	hazey,	hazey,
21	30 0	29 0	59	78	calm		cloudy,	fair,
22	30 0	30 0	63	83	calm		cloudy,	fair,
23	30 1	30 1	62	81	calm	SE	cloudy,	cloudy,
24	30 〈◊〉	30 2	65	70	NE	ENE	cloudy,	fair,
25	30 15	30 0	61	68	NE	NE	cloudy,	cloudy,
26	29 8	29 7	58	79	N	N	cloudy,	fair,
27	29 7		64		NW	NW	cloudy,	fair,
28	30 5	30 15	54	73	NW	NW	fair,	fair,
29	30 3	30 3	56	74	NE	ENE	cloudy,	fair,
30	30 35	30 3	57	75	calm	SW	foggy,	fair.

Page  191OCTOBER, 1793.

	Barometer.	Therm.	Winds.	Weather.
	7 A. M.	2 P. M.	7 A. M.	2 P. M.	7 A. M.	2 P. M.	7 A. M.	2 P. M.
1	30 15	30 5	64	80	SW	SW	cloudy,	fair.
2	29 9	30 5	70	73	W	NNW	cloudy,	fair,
3	30 2	30 15	50	72	W	SW	fair,	fair,
4	29 75	29 7	59	72	SW	W	cloudy,	cloudy,
5	30 0	30 1	58	66	N	N	fair,	fair,
6	30 3	30 3	43	66	NE	W	fair,	fair,
7	30 45		46		calm		fair,
8	30 6	30 6	53	68	N	N	fair,	fair,
9	30 5	30 4	53	70	NW	NW	fair,	fair,
10	30 2	30 2	49	74	E	NW	fair,	fair,
11	30 0	29 85	51	74	W	W	fair,	fair,
12	26 6	29 55	58	64	SW	NW	rain,	rain,
13	29 85	29 9	49	69	NW	NW	fair,	fair,
14	30 5	30 0	52	76	SW	SW	calm,	fair,
15	29 75	29 8	56	54	SW	N	fair,	rain,
16	30 0	30 •	•7	•3	NNW	N	fair,	fair,
17	30 1	30 1	37	60	NE	NE	fair,	fair,
18	30 1	30 1	41	62	NW	NW	fair,	fair,
19	30 0	29 9	51	66	N	N	cloudy,	fair,
20	30 0	30 0	44	54	NW	N	fair,	fair,
21	30 0	30 2	49	59	N	NW	fair,	fair,
22	29 6	29 5	51	65	NW	NW	fair,	fair,
23	29 8	29 8	47	60	W	W	fair,	fair,
24	30 3	30 4	36	59	W	NW	fair,	fair,
25	30 4	30 3	46	71	S	S	cloudy,	do.h-w.
26	30 2	30 2	60	72	calm	SW	cloudy.	cloudy,
27	30 3	30 3	44	44	NNE	NNE	cloudy,	cloudy,
28	30 2	30 1	34	37	N	N	cloudy,	cloudy,
29	29 85	29 85	28	44	NNW	NW	fair,	fair,
30	30 1	30 1	28	49	calm	SW	hazey,	hazey,
31	30 15	30 2	42	45	calm	NNE	cloudy,	rain,

Page  192NOVEMBER, 1793.

	Barometer.	Therm.	Winds.	Weather.
	7 A. M.	2 P. M.	7 A. M.	2 P. M.	7 A. M.	2 P. M.	7 A. M.	2 P. M.
1	30 1	30 1	40	41	NNE	NE	rain,	cloudy,
2	30 3	30 25	32	49	NNE	NE	fair,	fair,
3	30 1	30 0	43	56	calm	SW	cloudy,	cloudy,
4	29 8	29 9	55	67	SW	SW	cloudy,	fair,
5	30 15	30 1	50	64	NE	NE	rain,	rain,
6	29 8	29 65	63	67	S	S	cloudy,	cloudy,
7	29 8	29 8	44	64	calm	SW	fair,	fair,
8	29 8	29 85	43	56	SSW	SW	fair,	fair,
9	29 9	29 95	42	64	SW	SW	fair,	fair,

Page  193

Of the Method of Cure.

IN the introduction to the history of the fever, I mentioned the remedies which I used with success, in several cases which occurred in the beginning of August. I had seen, and re|corded in my note book, the efficacy of gentle purges in the yellow fever of 1762; but finding them unsuccessful after the 20th of August, and observing the disease to assume uncommon symp|toms of great indirect debility, I laid them aside, and had recourse to a gentle vomit of ipecacuanha on the first day of the fever, and to the usual re|medies for exciting the action of the sanguiferous system. I gave bark in all its usual forms of in|fusion, powder, and tincture. I joined wine, brandy, and aromatics with it. I applied blisters to the limbs, neck, and head. Finding them all ineffectual, I attempted to rouse the system by wrapping the whole body, agreeably to Dr Page  194 Hume's practice, in blankets dipped in warm vi|negar. To these remedies I added one more: I rubbed the right side with mercurial ointment, with a view of exciting the action of the vessels in the whole system, through the medium of the li|ver, which I then supposed to be principally, tho' symptomatically, affected by the disease. None of these remedies appeared to be of any service; for although three out of thirteen recovered of those to whom they were applied, yet I have reason to believe that they would have recovered much sooner had the cure been trusted to nature. Per|plexed and distressed by my want of success in the treatment of this fever, I waited upon Dr Stephens, an eminent and respectable physician from St Croix, who happened then to be in our city, and asked for such advice and information upon the subject of the disease, as his extensive practice in the West Indies would naturally sug|gest. He politely informed me that he had long ago laid aside evacuations of all kinds in the yel|low fever; that they had been found to be hurt|ful, and that the disease yielded more readily to bark, wine, and above all, to the use of the cold bath. He advised the bark to be given in large quantities by way of glyster, as well as in the usual way; and he informed me of the manner in which the cold bath should be used, so as to de|rive Page  195 the greatest benefit from it. This mode of treating the yellow fever appeared to be reason|able. I had used bark in the manner he recom|mended it in several cases of sporadic yellow fever with success in former years. I had moreover the authority of several other physicians of repu|tation in its favour. Dr Cleghorn tells us, that "he sometimes gave the bark when the bowels were full of vicious humours. These humours (he says) are produced by the fault of the circu|lation. The bark by bracing the solids, enables them to throw off the excrementitious fluids, by the proper emunctories*."

I began the use of each of Dr Stevens's reme|dies the next day after my interview with him, with great confidence of their success. I prescri|bed bark in large quantities; in one case I ordered it to be injected into the bowels every four hours. I directed buckets full of cold water to be thrown frequently upon my patients. The bark was offensive to the stomach, or rejected by it in every case in which I prescribed it. The cold bath was grateful, and produced relief in several cases by inducing a moisture on the skin. For a while I had hopes of benefit to my Page  196 patients from the use of these remedies, but in a few days, I was distressed to find they were not more effectual than those I had previously used. Three out of four of my patients died to whom the cold bath was administered in addition to the tonic remedies before mentioned.

Baffled in every attempt to stop the ravages of this fever, I anticipated all the numerous and complicated distresses in our city, which pestilential diseases have so often produced in other coun|tries. The fever had a malignity, and an obstinacy which I had never before observed in any disease, and it spread with a rapidity and mortality, far beyond what it did in the year 1762. Heaven alone bore witness to the anguish of my soul in this awful situation. But I did not abandon a hope that the disease might yet be cured. I had long believed that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provi|ded a remedy. Under the impression of this be|lief, I applied myself with fresh ardour to the in|vestigation of the disease before me. I ransacked my library, and pored over every book that treated of the yellow fever. The result of my researches for a while was fruitless. The accounts of the symptoms and cure of the disease by the Page  197 authors I consulted, were contradictory, and none of them appeared altogether applicable to the pre|vailing epidemic. Before I desisted from the in|quiry to which I had devoted myself, I recollected that I had among some old papers, a manuscript account of the yellow fever as it prevailed in Vir|ginia in the year 1741, which had been put into my hands by Dr Franklin, a short time before his death. I had read it formerly, and made extracts from it into my lectures upon that disorder. I now read it a second time. I paused upon every sentence; even words in some places arrested and fixed my attention. In reading the history of the method of cure, I was much struck with the fol|lowing passages.

"It must be remarked, that this evacuation (meaning by purges) is more necessary in this, than in most other fevers. The abdominal viscera are the parts principally affected in this disease, but by this timely evacuation, their feculent cor|ruptible contents are discharged, before they cor|rupt and produce any ill effects, and their various emunctories, and secerning vessels are set open, so as to allow a free discharge of their contents, and consequently a security to the parts them|selves, during the course of the disease. By this evacuation the very minera of the disease, pro|ceeding Page  198 from the putrid miasma fermenting with the salivary, bilious, and other inquiline humours of the body, is sometimes eradicated by timely emptying the abdominal viscera on which it first fixes, after which a gentle sweat does as it were nip it in its bud. Where the primae viae, but especially the stomach, is loaded with an offensive matter, or contracted, and convulsed with the ir|ritation of its stimulus, there is no procuring a laudable sweat, till that is removed; after which a necessary quantity of sweat breaks out of its own accord, these parts promoting it when by an ab|sterging medicine, they are eased of the burden or stimulus which oppresses them."

"All these acute putrid fevers, ever require some evacuation to bring them to a perfect crisis, and solution, and that even by stools, which must be promoted by art, where nature does not do the business herself. On this account an ill-timed scrupulousness about the weakness of the body, is of bad consequence in these urging circumstances; for it is that which seems chiefly to make evacua|tions necessary, which nature ever attempts, after the humours are fit to be expelled, but is not able to accomplish for the most part in this disease; and I can affirm, that I have given a purge in this case, when the pulse has been so low, that it could hardlyPage  199 be felt, and the debility extreme, yet both one, and the other have been restored by it."

"This evacuation, must be procured by leni|tive chologoque purges."

Here I paused. A new train of ideas suddenly broke in upon my mind. I believed the weak and low pulse which I had observed in this fever, to be the effect of debility of the indirect kind, but the unsuccessful issue of purging, and even of a spontaneous diarrhoea, in a patient of Dr Hutchin|son's had led me not only to doubt of, but to dread its effects. My fears from this evacuation were confirmed, by the communications I had re|ceived from Dr Stevens. I had been accustomed to raising a weak and low pulse in pneumony and apoplexy, by means of blood-letting, but I had attended less to the effects of purging in produ|cing this change in the pulse. Dr Mitchell in a moment dissipated my ignorance and fears upon this subject. I adopted his theory, and practice, and resolved to follow them. It remained now only to fix upon a suitable purge to answer the purpose of discharging the contents of the bowels. I have before described the state of the bile in the gall-bladder, and duodenum in an extract from the history of a dissection made by Dr Page  200 Mitchell. I suspected that my want of success in discharging this bile, in several of the cases in which I attempted the cure by purging, was owing to the feebleness of my purges. I had been in the habit of occasionally purging with calomel in bilious and inflammatory fevers, and had re|commended the practice the year before in my lectures, not only from my own experience, but upon the authority of Dr Clark. I had more|over, other precedents for its use in the practice of Sir John Pringle, Dr Cleghorn, and Dr Balfour, in diseases of the same class with the yellow fever. But these were not all my vouchers for the safety, and efficacy of calomel. In my attendance upon the military hospitals during the late war, I had seen it given combined with jalap in the bilious fever by Dr Thomas Young, a senior surgeon in the hospitals. His usual dose, was ten grains of each of them. This was given once or twice a day, until it procured large evacuations from the bowels. For a while I remonstrated with the Doctor against this purge, as being dispropor|tioned to the violence and danger of the fever; but I was soon satisfied that it was as safe as cre|mor tartar, or glauber's salts. It was adopted by several of the surgeons of the hospital, and was universally known, and sometimes prescribed, by the simple name of ten and ten. This mode of Page  201 giving calomel occurred to me in preference to any other. The jalap appeared to be a necessary addition to it, in order to quicken its passage through the bowels; for calomel is slow in its operation, more especially when it is given in large doses. I resolved after mature deliberation, to prescribe this purge. Finding ten grains of jalap insufficient to carry the calomel through the bow|els, in the rapid manner I wished, I added fifteen grains of the former, to ten of the latter; but even this dose was slow, and uncertain in its ope|ration. I then issued three doses, each consisting of fifteen grains of jalap, and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder, not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwith|standing some of them were advanced several days in the disorder. Mr Richard Spain, a block-ma|ker, in Third-street, took eighty grains of calomel, and rather more of rhubarb and jalap mixed with it, on the two last days of August, and on the first day of September. He had passed twelve hours, before I began to give him this medicine, without a pulse, and with a cold sweat on all his limbs. His relations had given him over, and one of his neighbours complained to me, of my neglecting Page  202 to advise them to make immediate preparations for his funeral. But in this situation, I did not despair of his recovery. Dr Mitchell's account of the effects of purging in raising the pulse, ex|citing a hope that he might be saved provided his bowels could be opened. I now committed the exhibition of the purging medicine to Mr Stall, one of my pupils, who mixed it, and gave it with his own hand three or four times a day. At length, it operated and produced two copious, foetid stools. His pulse rose immediately afterwards, and a universal moisture on his skin, succeeded the cold sweat on his limbs. In a few days he was out of danger, and he now lives in good health as the first fruits of the efficacy of mercu|rial purges in the yellow fever.

After such a pledge of the safety and success of my new medicine, I gave it afterwards with con|fidence. I communicated the prescription to such of the practitioners as I met in the streets. Some of them I found had been in the use of calomel for several days, but as they had given it in small and single doses only, and had followed it by large doses of bark, wine, and laudanum, they had done little or no good with it. I imparted the prescription to the College of Physicians, on the third of September, and endeavoured to remove Page  203 the fears of my fellow citizens, by assuring them that the disease was no longer incurable. Mr Lewis, the lawyer, Dr M'llvaine, Mrs Bethel, her two sons, and a servant maid, and Mr Peter Baynton's whole family, (nine in number) were some of the first trophies of this new remedy. The credit it acquired, brought me an immense accession of business. It still continued to be al|most uniformly effectual in all those which I was able to attend, either in person, or by my pupils. Dr Griffitts, Dr Say, Dr Pennington, and my former pupils who had settled in the city, viz. Dr Leib, Dr Porter, Dr Annan, Dr Woodhouse, and Dr Mease, were among the first physicians who adopted it. I can never forget the transport with which Dr Pennington ran across the street, to inform me, a few days after he began to give strong purges, that the disease, yielded to them in every case. But I did not rely upon purging alone, to cure the disease. The theory of its proximate cause, which I had adopted, led me to use other remedies, to abstract excess of stimulus from the system. These were blood-letting, cool air, cold drinks, low diet, and applications of cold water to the body. I had bled Mrs Bradford, Mrs Leaming, and one of Mrs Palmer's sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first Page  204 week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had moreover, heard of a man who had been bled on the first day of the disorder, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type, and in|stead of tending to a crisis on the third, to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experi|ence such sublime joy as I now felt in contemplat|ing the success of my remedies. It repaid me for all the toils and studies of my life. The con|quest of this formidable disease, was not the effect of accident, nor of the application of a single re|medy; but, it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind, when I add a short extract from my note book, dated the 10th of September. "Thank God! Out of one hundred patients, whom I have visited, or prescribed for, this day, I have lost none."

Being unable to comply with the numerous demands which were made upon me for the purg|ing Page  205 powders, notwithstanding I had requested my sister, and two other persons to assist my pupils in putting them up; and finding myself unable to attend all the persons who sent for me, I furnished the apothecaries with the recipe for the mercurial purges, together with a copy of the following di|rections, for giving them, and for the treatment of the disorder.

"As soon as you are affected, (whether by night or day) with a pain in the head, or back, sick|ness at stomach, chills or fever; more especially, if those symptoms be accompanied by a redness, or faint yellowness in the eyes, take one of the pow|ders in a little sugar and water, every six hours, until they produce four or five large evacuations from the bowels—drink plentifully of water gruel, or barley water, or chicken water, or any other mild drink that is agreeable, to assist the opera|tion of the physic. It will be proper to lie in bed while the medicine is operating; by which means a plentiful sweat will be more easily brought on. After the bowels are thoroughly cleansed, if the pulse be full or tense, eight or ten ounces of blood should be taken from the arm, and more, if the tension or fulness of the pulse should continue. Balm tea, toast and water, lemonade, tamarind water, weak camomile tea, or barley water should Page  206 be drank during this state of the disorder—and the bowels should be kept constantly open, either by another powder, or by small doses of cremor tartar, or cooling salts, or by common opening glysters; but if the pulse should become weak and low after the bowels are cleansed, infusions of camomile and snake-root in water, elixir of vi|triol, and laudanum; also wine and water, or wine, punch, and porter should be given, and the bark either in infusion in water or in substance, may be administered in the intermission of the fe|ver. Blisters may likewise be applied to the sides, neck, or head in this state of the disorder, and the lower limbs may be wrapped up in flannels wetted in hot vinegar or water. The food should consist of gruel, sago, panada, tapioca, tea, coffee, weak chocolate, wine whey, chicken broth, and the white meats, according to the weak or active state of the system. The fruits of the season may be eaten with advantage at all times. Fresh air should be admitted into the room in all cases, and cool air when the pulse is full and tense. The floor should be sprinkled now and then with vine|gar, and the discharges from the body be re|moved as speedily as possible."

"The best preventives of the disorder, are a temperate diet, consisting chiefly of vegetables, Page  207 great moderation in the exercises of body and mind, warm cloathing, cleanliness, and a gently open state of the bowels."

Hitherto there had been great harmony among the physicians of the city, although there was a diversity of sentiment as to the nature and cure of the prevailing fever. But this diversity of sen|timent and practice, was daily lessening, and would probably have ceased altogether in a few days, had not the following publication subscribed A. K. and said to be written by Dr Adam Kuhn, made its appearance on the 11th of September, in the General Advertiser, from which it was copied into all the papers of the city.

To obviate the effects of this letter upon the minds of the citizens, I published the next day an account of the ill success which had attended the use of the remedies recommended by Dr Kuhn, in my practice, and of the happy effects of mercurial purges and bleeding. This publication was con|cluded with the following remarks.

Page  213 The above address to the citizens, produced the following letter from Dr Kuhn to the Mayor of the city.

"FROM the 23d of August, the day on which I saw the first patient in the yellow fever, to the the third of September, when I was my|self confined with a remittent fever, I visited sixty persons ill of various complaints. The greater part were indisposed with remittent and inter|mittent fevers, which always prevail among us at this season of the year, which all yielded readily to our mode of treating those diseases, except in one gentleman, who had been many years an invalid. Seven only of this num|ber Page  214 had the yellow fever; three of them were patients of other gentlemen of the Faculty. Of these seven, I was called to four, in the early stage of the disease. Three of them are now well; the other was in the fourth day of the disease, when I became unwell myself. He had then no unfavourable symptoms; but died on the eighth day from the time he was seized."

A day or two afterwards, the following letter appeared in all the newspapers from Mr Hamilton, the Secretary of the Treasury of United States, to the College of Physicians.

This letter was followed by a letter from Dr Stephens to Dr Redman, the president of the College of Physicians, which was published in the Federal Gazette of the 16th of September.

An essay upon the theory of this disease at this juncture, would have been as ill-timed as a dis|course upon tactics would be to an army in the height of a battle; but Dr Stevens's publication made it necessary for me to appeal to the reason of my brethren upon the theory of the disease. I did it in a few words in the following address to the College of Physicians.

During this controversy with the opinions and practice of Dr Kuhn and Dr Stevens, I published in the Federal Gazette, the following letter to the College of Physicians; also some additions to the directions I had published with the mercurial purges.

Having mentioned the conditional use of bark, wine, and laudanum, in my first publication, and finding them not only useless, but hurtful, I pub|lished the following address to the citizens of Phi|ladelphia, on the 16th of September. In this address I repeated my advice to live upon a milk and vegetable diet.

I shall mention hereafter the substitutes I used for the tonic remedies which I had thus publicly decried.

On the 20th of September the following pub|lication appeared in the Federal Gazette, sub|scribed by Dr Currie.

To this, I published the following answer the next day.

Besides the publications I have mentioned, Dr Wistar addressed a history of an attack he had of the fever, to the physicians of Philadelphia, in the General Advertiser of the 26th of Septem|ber. He began it by observing, that "he be|lieved many persons had been supposed to have been cured of the disease, who had never had it," and he concluded without deciding upon any of the remedies which were the subjects of con|troversy. He added a strong testimony from his Page  236 own experience of the efficacy of cool air in abating the excessive action of the arterial system.

I pass over many anonymous essays upon the fever, which appeared in the newspapers; also several, from medical gentlemen who beheld the disease at a distance. They all tended more or less to distract the public mind, and to lessen the confidence of the citizens in the simple, and pow|erful remedies which I had recommended.

In support of the efficacy of these remedies, Dr Porter, Dr Annan, and Dr Mease, gave very de|cided testimonies in the public papers. I shall insert as an epitome of them all, the following let|ter from Dr Porter.

The safety of the new remedies (as they were sometimes called) was finally admitted by their greatest enemies, but their efficacy was supposed to be confined only to common remittents, to the influenza, or to pleurisies, and other inflammatory fevers; for those diseases were believed to be con|stantly present in the city; and the certificates which were published of large families having been cured of the yellow fever by the new reme|dies, Page  238 were discredited, or treated with contempt, because the patients had recovered without a yel|low colour in their faces.

To refute this error, as well as to shew that I was not singular in my opinions respecting blood-letting, purges, and opium, I published the fol|lowing extracts from Dr Mosely, in the Federal Gazette of the 11th of October.

In justice to Dr Currie, I take great pleasure in inserting the following short address to the citi|zens, in which the retracts the opinion he had given to the public in the Federal Gazette of the the 20th of September.

The conclusion of the above address was unfor|tunately erroneous. The dispute between the physicians turned upon more interesting points than the name of the disease, as must be very ob|vious from the perusal of the preceding pages.

I have suppressed a letter to Dr John Rodgers of New York, dated the third of October, con|taining a short history of the treatment of the dis|ease, only because it will be detailed more fully in this work. That publication was intended as an answer to many letters which I received from practitioners in the country, requesting an account of my mode of treating the disorder. I have like|wise suppressed a second letter to Dr Rodgers, containing some extracts from Dr Sydenham, which were intended to establish the exclusive in|fluence of powerful epidemics over inferior febrile diseases. This subject has been discussed in a more ample manner in the history of the fever.

Page  243 From the different publications which I have inserted, it appears that there were two modes of practice pursued; the one dictated by an opinion that the disease was highly putrid, and the other, that it was of a highly inflammatory nature. But besides these there were two other modes of treat|ing the disease, the one by moderate purging with calomel only, and moderate bleeding, on the first or second day of the fever, and afterwards by the copious use of bark, wine, laudanum, and aro|matic tonics. This practice was supported by an opinion, that the fever was inflammatory in its first, and putrid in its second stage; the other mode referred to, was peculiar to the French physicians, several of whom had arrived in the city from the West Indies just before the disorder made its appearance. Their remedies were va|rious. Some of them prescribed nitre, cremor tartar, camphor, centaury tea, the warm bath, glysters, and moderate bleeding, while a few, used lenient purges, and large quantities of tama|rind water, and other diluting drinks. The dis|sentions of the American physicians threw a great number of patients into the hands of these French physicians. They were moreover supposed to be better acquainted with the disease than the physi|cians of the city, most of whom it was well known had never seen it before.

Page  244 I shall hereafter inquire into the relative success of each of the four modes of practice which have been mentioned.

Having delivered a general account of the re|medies which I used in this disorder, I shall now proceed to make a few remarks upon each of them. I shall afterwards mention the effects of the remedies used by other physicians.

OF PURGING.

I HAVE already mentioned my rea|sons for promoting this evacuation, and the medi|cine I preferred for that purpose. It had many advantages over any other purge. It was de|tergent to the bile and mucus which lined the bowels. It probably acted in a peculiar manner upon the biliary ducts, and it was rapid in its ope|ration. One dose was sometimes sufficient to open the bowels; but from two to six doses were often necessary for that purpose; more especially as part of them was frequently rejected by the stomach. I did not observe any inconvenience from the vomiting which was excited by the jalap. Page  245 It was always without that straining which is pro|duced by emetics; and it served to discharge bile when it was lodged in the stomach. I did not rest the discharge of the contents of the bowels on the issue of one cleansing on the first day. There is in all bilious fevers, a reproduction of morbid bile as fast as it is discharged. I therefore gave a purge every day while the fever continued. I used castor oil, salts, cremor tartar, and rhubarb (after the mercurial purges had performed their office) according to the inclinations of my pati|ents, in all those cases where the bowels were ea|sily moved; but where this was not the case, I gave a single dose of calomel and jalap every day. Strong as this purge may be supposed to be, it was often ineffectual; more especially after the 20th of September, when the bowels became more obstinately constipated. To supply the place of the jalap, I now added gamboge to the calo|mel. Two grains and an half of each made into a pill, were given to an adult every six hours until they procured four or five stools. I had other de|signs in giving a purge every day besides discharging the re-accumulated bile. I had observed the fever to fall with its principal force upon such parts of the body as had been previously weakened by any former disease. By creating an artificial weak part in the bowels, I diverted the force of the fe|ver Page  246 to them, and thereby saved the liver and brain from fatal or dangerous congestions. The prac|tice was further justified by the beneficial effects of a plentiful spontaneous diarrhoea in the begin|ning of the disorder*; by hemorrhagies from the bowels, when they occurred from no other parts of the body, and by the difficulty or impractica|bility of reducing the system by means of plen|tiful sweats. The purges seldom answered the in|tentions for which they were given, unless they produced four or five stools a day. As the fever shewed no regard to day or night in the hours of its exacerbations, it became necessary to observe the same disregard to time in the exhibition of purges; I therefore prescribed them in the even|ing at all times when the patient had passed a day without two or three plentiful stools. When purges were rejected, or slow in their operation, I always directed opening glysters to be given Page  247 every two hours. The effects of purging were as follow:

1. It raised the pulse when low, and reduced it when it was preternaturally tense or full.

2. It revived and strengthened the patient. This was evident in many cases, in the facility with which patients who had staggered to a close-stool, walked back again to their beds, after a co|pious evacuation. Dr Sydenham takes notice of a similar encrease of strength after a plentiful sweat in the plague. They both acted by ab|stracting excess of stimulus, and thereby removing indirect debility.

3. It abated the paroxism of the fever. Hence arose the advantage of giving a purge in some cases in the evening, when an attack of the fever was expected in the course of the night.

4. It frequently produced sweats when given on the first or second day of the fever, after the most powerful sudorifics had been taken to no purpose.

5. It sometimes checked that vomiting which oc|curs in the beginning of the disorder; and it al|ways assisted in preventing the more alarming occur|rence of that symptom, about the 4th or 5th day.

Page  248 6. It removed obstructions in the lymphatic sys|tem. I ascribe it wholly to the action of mer|cury, that in no instance did any of the glandular swellings, which I formerly mentioned, terminate in a suppuration.

7. By discharging the bile through the bowels as soon and as fast as it was secreted, it prevented in most cases a yellowness of the skin.

However salutary the mercurial purge was, ob|jections were made to it by many of our physi|cians; and prejudices, equally weak and ill-found|ed, were excited against it. I shall enumerate and answer those objections.

1. It was said to be of too drastic a nature. It was compared to arsenic; and it was called a dose for a horse. This objection was without founda|tion. Hundreds who took it declared they had never taken so mild a purge. I met with but one case in which it produced bloody stools; but I saw the same effect from a dose of salts. It some|times, it is true, operated from twenty to thirty times in the course of twenty-four hours; but I heard of an equal number of stools in two cases from salts and cremor tartar. It is not an easy thing to affect life, or even subsequent health, by Page  249 copious or frequent purging. Dr Kirkland mentions a remarkable case of a gentleman who was cured of a rheumatism by a purge, which gave him between 40 and 50 stools. This patient had been previously affected by his disorder 16 or 18 weeks*. Dr Mosely not only proves the safe|ty, but establishes the efficacy of numerous and copious stools in the yellow fever. Dr Say pro|bably owes his life to three-and-twenty stools pro|cured by a dose of calomel and gamboge, taken by my advice. Dr Redman was purged until he fainted, by a dose of the same medicine. This venerable gentleman, in whom 70 years had not abated the ardour of humanity, nor produced ob|stinacy of opinion, came forward from his retire|ment, and boldly adopted the remedies of purg|ing and bleeding, with success in several families, before he was attacked by the disease. His reco|very was as rapid, as the medicine he had used was active in its operation. Besides taking the above purge, he lost twenty ounces of blood by two bleedings†.

Page  250 But who can suppose that a dozen or twenty stools in a day could endanger life, that has seen a diarrhoea continue for several months, attended with fifteen or twenty stools every day, without making even a material breach in the constitution? Hence Dr Hillary has justly remarked, that it rarely or never happens that the purging in this disease, though violent, takes the patient off, but the fever and inflammation of the bowels*. Dr Clark in like manner remarks, that evacuations do not destroy life in the dysentery, but the fever with the emaciation or mortification which attend and follow the disease†.

Page  251 2. A second objection to this mercurial purge was, that it excited a salivation, and sometimes loosened the teeth. I met with but two cases in which there was a loss of teeth from the use of this medicine, and in both, the teeth were previ|ously loose or decayed. The salivation was a tri|fling evil, compared with the benefit which was derived from it. I lost only one patient in whom it occurred. I was taught by this accidental ef|fect of mercury, to administer it with other views, than merely to cleanse the bowels, and with a success which added much to my confidence in the power of medicine over this disease. I shall men|tion those views under another head.

3. It was said that the mercurial purge, exco|riated the rectum, and produced the symptoms of pain and inflammation in that part, which were formerly mentioned.

To refute this charge, it will be sufficient to remark that the bile produces the same excori|ation and pain in the rectum in the bilious and yellow fever, where no mercury has been given to discharge it. In the bilious remitting fever which prevailed in Philadelphia in 1780, we find the bile which was discharged by "gentle doses of salts, and cream of tartar, or the butternut pill, was so Page  252 acrid as to excoriate the rectum, and so offensive as to occasion in some cases, sickness and faintness both in the patients, and in their attendants*."

Dr Hume says further upon this subject, that the rectum was so much excoriated by the natural discharge of bile in the yellow fever, as to render it impossible to introduce a glyster pipe into it.

4. It was objected to this purge, that it in|flamed, and lacerated the stomach and bowels. In support of this calumny, the inflamed and morti|fied appearances which those viscera exhibited upon dissection in a patient who died at the hos|pital at Bush-hill, were spoken of with horror in some parts of the city. To refute this objection, it will only be necessary to review the account formerly given of the state of the stomach and bowels after death from the yellow fever, in cases in which no mercury had been given. I have before taken notice that Sir John Pringle, and Dr Cleghorn, had prescribed mercurial purges with success in the dysentery, a disease in which the bowels are affected with more irritation and inflammation than in the yellow fever. Dr Clark Page  253 informs us that he had adopted this practice. I shall insert the eulogium of this excellent physi|cian, upon the use of mercury in the dysentery in his own words. "For several years past, when the dysentery has resisted the common mode of practice, I have administered mercury with the greatest success; and am thoroughly persuaded that it is possessed of powers to remove inflamma|tion, and ulceration of the intestines, which are the chief causes of death, in this distemper*."

5. It was urged against this powerful and effi|cacious medicine, that it was prescribed indiscri|minately in all cases; and that it did harm in all weak habits. To this I answer, that there was no person so weak by constitution, or a previous disease, as to be injured by a single dose of this medicine. Mrs Meredith the wife of the Trea|surer of the United States, a lady of uncommon delicacy of constitution, took two doses of the powder in the course of twelve hours, not only without any inconvenience, but with an evident increase of strength soon afterwards. Many simi|lar cases might be mentioned. Even children took two or three doses of it with perfect safety. This will not surprise those physicians who have Page  254 been in the practice of giving from ten to twenty grains of mercury, with an equal quantity of jalap, as a worm purge, and from fifty to an hun|dred grains of calomel in the course of four or five days, in the internal dropsy of the brain. But I am happy in being able to add further, that many women took it in every stage of pregnancy without suffering the least inconvenience from it. Out of a great number of pregnant women whom I attended in this fever, I did not lose one to whom I gave this medicine, nor did any of them suffer an abortion. One of them had twice mis|carried in the course of the two or three last years of her life. She bore a healthy child three months after her recovery from the yellow fever.

No one has ever objected to the indiscriminate mode of preparing the body for the small-pox by purging medicines. The uniform inflammatory diathesis of that disease, justifies the practice, in a certain degree in all habits. The yellow fever admits of a sameness of cure much more than the small-pox, for it is more uniformly and more highly inflammatory. An observation of Dr Sydenham, upon epidemics applies in its utmost extent to our late fever. "Now it must be observed (says this most acute Physician) that some epidemic diseases, in some years are uniformly and constantly the Page  255 same*." However diversified our fever was in some of its symptoms, it was in all cases accompa|nied by more or less inflammatory diathesis, and by a morbid state of the alimentary canal.

Much has been said of the bad effects of this purge from its having been put up carelessly by the apothecaries, or from its having been taken contrary to the printed directions, by many peo|ple. If it did harm in any one case (which I do not believe) from the former of the above causes, the fault is not mine. Twenty men employed con|stantly in putting up this medicine, would not have been sufficient to have complied with all the de|mands which were made of me for it. Hundreds who were in health, called or sent for it as well as the sick, in order to have it in readiness in case they should be surprised by the disorder in the night, or at a distance from a physician.

In all the cases, in which this purge was sup|posed to have been hurtful, when given on the first or second day of the disorder, I believe it was because it was not followed by repeated doses of the same, or of some other purge; or because it was not aided by blood-letting. I am led to make Page  256 this assertion, not only from the authority of Dr Sydenham, who often mentions the good effects of bleeding in moderating or checking a diarrhoea, but by having heard no complaints of patients being purged to death by this medicine, after blood-letting was universally adopted by all the physicians in the city.

It was remarkable that the demand for this purging powder continued to encrease under all opposition, and that the sale of it by the apothe|caries was greatest towards the close of the disease. I shall hereafter say, that this was not the case with the West India remedies.

It is possible that this purge sometimes proved hurtful when it was given after the 5th day of the disorder, but it was seldom given for the first time after the third day, and when it was, the pa|tient was generally in such a situation that nothing did him either good or harm.

I derived great pleasure from hearing after the fever had left the city, that calomel had been given with success as a purge in bilious fevers in other parts of the Union besides Philadelphia. Dr Lawrence informed me that he had cured many patients by it, of the yellow fever which prevailed Page  257 in New York in the year 1791, and the New York papers have told us that several practitioners had been in the habit of giving it in the autumnal fevers, with great success in the Western parts of that state. They had probably learned the use of it from Dr Young, who formerly practised in that part of the United States, and who lost no opportunity of making its praises public, wherever he went.

My pupil Mr Potter gave calomel and jalap in large doses, with great success in the bilious fever of Caroline county in Maryland, before he knew that I had adopted that purge in the cure of our epidemic. He had heard the history of its origin and use from me, some months before, in a con|versation upon bilious fevers in my shop.

I have only to add to my account of that purg|ing medicine, that under an expectation, that the yellow fever would mingle some of its bilious symp|toms, with the common inflammatory fevers of the winter, and first spring months, I gave that purge in the form of pills in every case of inflam|matory fever to which I was called. The fatal issue of several fevers in the city, during the win|ter, in which this precaution had been neglected, satisfied me that my practice was proper and useful.

Page  258 It is to be lamented that all new remedies are forced to pass through a fiery ordeal. Opium and bark were long the objects of terror and invective in the schools of medicine. They were administer|ed only by physicians for many years, and that too with all the solemnity of a religious ceremony. This superstition with respect to those medicines, has at last passed away. It will I hope soon be succeeded by a time, when the prejudices against ten and ten, or ten and fifteen, will sleep with the vulgar fears which were formerly entertained of the bark pro|ducing diseases and death, years after it had been taken, by "lying in the bones."

OF BLOOD-LETTING.

THE theory of this fever which led me to administer purges, determined me to use blood-letting, as soon as it should be indicated. I am disposed to believe, that I was tardy in the use of this remedy, and I shall long regret the loss of three patients, who might probably have been saved by it. I cannot blame myself for not having used it earlier, for the immense number of patients which poured in upon me, in the first week of Sep|tember, Page  259 prevented my attending so much to each of them, as was necessary to determine upon the pro|priety of this evacuation. I was in the situation of a surgeon in a battle, who runs to every call, and only stays long enough with each soldier, to stop the bleeding of his wound, while the encrease of the wounded, and the unexpected length of the battle, leave his original patients to suffer from the want of more suitable dressings. The reasons which de|termined me to bleed were,

1. The state of the pulse, which became more tense, in proportion as the weather became cool.

2. The appearance of a moist, and white tongue on the first day of the disorder; a certain sign of an inflammatory fever!

3. The frequency of hemorrhagies from every part of the body, and the perfect relief given in some cases, by them.

4. The symptoms of congestion in the brain re|sembling those which occur in the first stage of hy|drocephalus internus, a disease in which I had late|ly used bleeding with success.

Page  260 5. The character of the diseases which had pre|ceded the yellow fever. They were all more or less inflammatory. Even the scarlatina anginosa had partaken so much of that diathesis, as to re|quire one bleeding to subdue it.

6. The warm and dry weather which had like|wise preceded the fever. Dr Sydenham attributes a highly inflammatory state of the small-pox, to a previously hot and dry summer; and I have since observed that Dr Hillary, takes notice of inflam|matory fevers having frequently succeeded hot and dry weather in Barbadoes*. He informs us fur|ther, that the yellow fever is always most acute and inflammatory, after a very hot season†.

7. The authority of Dr Mosely had great weight with me in advising the loss of blood, more especi|ally as his ideas of the highly inflammatory nature of the fever, accorded so perfectly with my own.

8. I was induced to prescribe blood-letting by recollecting its good effects in Mrs Plalmer's son, whom I bled on the 20th of August; and who ap|peared to have been recovered by it.

Page  261 Having begun to bleed, I was encouraged to continue it by the appearance of the blood, and by the obvious and very great relief my patients de|rived from it.

The following is a short account of the appear|ances of the blood drawn from a vein in this dis|order.

1. It was in the greatest number of cases, dense, and of a scarlet colour, without any separation into crassamentum and serum.

2. There was in many cases a separation of the blood into crassamentum and yellow serum.

3. There were a few cases in which this separa|tion took place, and the serum was of a natural colour.

4. There were many cases in which the blood was as sizy as in pneumony and rheumatism.

5. The blood was in some instances covered above with a blue pellicle of sizy lymph, while the part which lay in the bottom of the bowl was dissolved. The lymph was in two cases mixed with green streaks.

Page  262 6. It was in a few instances of a dark colour, and as fluid as molasses. I saw this kind of blood in a man who walked about his house during the whole of his sickness, and who finally recovered. Both this, and the 5th kind of blood which has been mentioned, occurred chiefly where bleeding had been omitted altogether, or used too sparingly in the beginning of the disorder.

7. In some patients, the blood, in the course of the disease, exhibited nearly all the appearances which have been mentioned. They were varied by the time in which the blood was drawn, and by the nature and force of the remedies which had been used in the disorder.

The effects of blood-letting upon the system were as follow:

1. It raised the pulse when depressed, and quick|ened it, when it was preternaturally slow, or subject to intermissions.

2. It reduced its force and frequency.

3. It checked in many cases, the vomiting which occurred in the beginning of the disorder, and thereby enabled the stomach to retain the purging Page  263 medicine. It likewise assisted the purge in pre|venting the dangerous or fatal vomiting which came on about the 5th day.

4. It lessened the difficulty of opening the bowels. Upon this account, in my publication of the 12th of September, I advised bleeding to be used before, as well as after taking the mercu|rial purge. Dr Woodhouse informed me that he had several times seen patients call for the close stool while the blood was flowing from the vein.

5. It removed delirium, coma, and obstinate wakefulness. It also prevented or checked he|morrhagies; hence perhaps another reason why not a single instance of abortion occurred in such of my female patients as were pregnant.

6. It disposed in some cases to a gentle perspi|ration.

7. It lessened the sensible debility of the system, hence patients frequently rose from their beds, and walked across their rooms in a few hours after the operation had been performed.

8. The redness of the eyes frequently disap|peared in a few hours after bleeding. Mr Coxe Page  264 observed a dilated pupil to contract to its natural size, within a few minutes after he had bound up the arm of his patient. I remarked in the former part of this work, that blindness in many instances attended or followed this fever. Only two such cases occurred among my patients. In one of them it was of short continuance, and in the other it was probably occasioned by the want of suffi|cient bleeding. In every case of blindness that came to my knowledge, bleeding had been omit|ted, or used only in a very moderate degree.

9. It eased pain. Thousands can testify this effect of blood-letting. Many of my patients whom I bled with my own hand, acknowledged to me while the blood was flowing, that they were better; and some of them declared, that all their pains had left them, before I had completely bound up their arms.

10. But blood-letting had in many cases an effect, the opposite of easing pain. It frequently encreased it in every part of the body, more espe|cially in the head. It appeared to be the effect of the system rising suddenly from a state of indirect debility, and of an encreased action of the blood-vessels which took place in consequence of it. I have frequently seen complaints of the breast, and Page  265 of the head, made worse by a single bleeding, and from the same cause. It was in some cases an unfortunate event in the yellow fever, for it pre|vented the blood-letting being repeated, by ex|citing, or strengthening the prejudices of patients and physicians against it. In some instances, the patients grew worse after a second, and in one, after a third bleeding. This was the case in Miss Redman. Her pains encreased after three bleed|ings, but yielded to the fourth. Her father Dr. Redman concurred in this seemingly absurd prac|tice. It was at this time, my old master reminded me of Dr Sydenham's remark, that moderate bleeding did harm in the plague, where copious bleeding was indicated, and that in the cure of that disorder, we should leave nature wholly to herself, or take the cure altogether out of her hands. The truth of this observation was very obvious. By taking away as much blood as re|stored the blood-vessels to a morbid degree of action, without reducing this action afterwards, pain, congestion, and inflammation, were fre|quently encreased, all of which were prevented, or occurred in a less degree, when the system rose gradually from the state of depression which had been induced by indirect debility. Under the in|fluence of the facts and reasonings which have been mentioned, I bore the same testimony in Page  266 acute cases, against what was called moderate bleeding, that I did against bark, wine and lauda|num in this fever.

11. Blood-letting when used early on the first day, frequently strangled the disease in its birth, and generally rendered it more light, and the con|valescence more speedy and perfect. I am not sure that it ever shortened the duration of the fever where it was not used within a few hours of the time of its attack. Under every mode of treatment, it seemed disposed after it was completely formed to run its course. I was so satisfied of this peculi|arity in the fever, that I ventured in some cases to predict the day on which it would terminate, not|withstanding I took the cure entirely out of the hands of nature. I did not lose a patient on the third, whom I bled on the first, or second day of the disorder.

12. In those cases which ended fatally, blood-letting restored, or preserved the use of reason, rendered death easy, and retarded the putre|faction of the body after death.

I shall now mention some of the circumstances which directed and regulated the use of this remedy.

Page  267 1. Where bleeding had been omitted, for three days, in acute cases it was seldom useful. Where purging had been used, it was sometimes successful. I recovered two patients who had taken the mercurial purges, whom I bled for the first time on the 7th day. One of them was the daughter of Mr James Cresson, the other was a journeyman ship-carpenter at Kensington. In those cases where bleeding had been used on the first day, it was both safe and useful to repeat it every day afterwards, during the continuance of the fever.

2. I preferred bleeding in the exacerbation of the fever. The remedy here was applied when the dis|ease was in its greatest force. A single paroxism, was like a sudden squall to the system, and unless abated by bleeding, or purging, produced univer|sal disorganization. I preferred the former to the latter remedy in cases of great danger, be|cause it was more speedy, and more certain in its operation.

3. I bled in several instances in the remis|sion of the fever, where the pulse was tense or chorded. It lessened the violence of the succeed|ing paroxism.

Page  268 4. I bled in all those cases in which the pulse was preternaturally slow, provided it was tense. Mr Benj. W. Morris, Mr Thomas Wharton Jun. and Mr Wm. Sansom, all owe their lives probably to their having been bled in the above state of the pulse. I was led to use bleeding in this state of the pulse, not only by the theory of the disease which I had adopted, but by the success which had often attended this remedy, in a slow and depress|ed state of the pulse in apoplexy and pneumony. I had, moreover, the authority of Dr Mosely in its favour, in the yellow fever, and of Dr Sydenham, in his account of a new fever, which appeared in the year 1685. The words of the latter physician are so apposite to the cases which have been men|tioned, that I hope I shall be excused for insert|ing them in this place. "All the symptoms of weakness (says our author) proceed from nature's being in a manner oppressed, and overcome by the first attack of the disease, so as not to be able to raise regular symptoms adequate to the violence of the fever. I remember to have met with a remark|able instance of this several years ago, in a young man I then attended; for though he seemed in a manner expiring, yet the outward parts felt so cool, that I could not persuade the attendants he had a fever, which could not disengage, and shew itself clearly, because the vessels were so full as to ob|struct Page  269 the motion of the blood. However, I said, that they would soon find the fever rise high enough upon bleeding him. Accordingly after taking away a large quantity of blood, as vio|lent a fever appeared as ever I met with, and did not go off till bleeding had been used three or four times*."

5. I bled in those cases in which the fever ap|peared in a tertian form, provided the pulse was full and tense. I well recollect the surprise with which Mr Van Berkel heard this prescription from me, at a time when he was able to walk and ride out on the intermediate days of a tertian fever. The event which followed this prescription, shew|ed that it was not disproportioned to the violence of his disease, for it soon put on such acute and inflammatory symptoms as to require six subse|quent bleedings to subdue it.

6. I bled in those cases where patients were able to walk about, provided the pulse was the same as has been mentioned under the 4th head. I was determined as to the propriety of bleeding in these two supposed mild forms of the fever, by having observed each of them when left to themselves frequently to terminate in death.

Page  270 7. I paid no regard to the dissolved state of the blood, when it appeared on the first or second day of the disorder, but repeated the bleedings after|wards in every case, where the pulse continued to indicate it. It was common to see sizy blood suc|ceed that which was dissolved. This occurred in Mr Josiah Coates, and Mr Samuel Powel. Had I believed that this dissolved state of the blood arose from its putrefaction, I should have laid aside my lancet as soon as I saw it; but I had long ago part|ed with all ideas of putrefaction in bilious fevers. The refutation of this doctrine, was the object of one of my papers in the Medical Society of Edin|burgh, in the year 1767. The dissolved appear|ance of the blood, I suppose to be the effect of a certain action of the blood-vessels upon it. It oc|curs in fevers in which no putrid, or foreign mat|ter has been introduced into the system. The ty|phoid pneumony described by Dr Huxham in his epidemics, and well known in the southern states of America, in the spring of the year, has never been ascribed to any other remote cause, than the sensible qualities of the air.

8. The presence of petechiae did not deter me from repeating blood-letting, where the pulse re|tained its fulness or tension. I prescribed it with success in the cases of Dr Mease, and of Mrs Geb|ler, Page  271 in Dock-street, in each of whom petechiae had appeared. Bleeding was equally effectual in the case of the Rev. Mr Keating at a time when his arms were spotted with that species of eruptions which I have compared to moscheto-bites. I had precedents in Dr De Haen*, and Dr Sydenham† in favour of this practice. So far from viewing these eruptions as signs of putrefaction, I consider|ed them as marks of the highest possible inflamma|tory diathesis. They disappeared in each of the above cases after bleeding.

9. In determining the quantity of blood to be drawn, I was governed by the state of the pulse, and by the temperature of the weather. In the beginning of September, I found one or two mo|derate bleedings sufficient to subdue the fever; but in proportion as the system rose by the dimi|nution of the stimulus of heat, and the fever put on more visible signs of inflammatory diathesis, more frequent bleedings became necessary. I bled many patients twice, and a few three times a day. I preferred frequent and small, to large bleedings, in the beginning of September; but towards the height and close of the epidemic, I Page  272 saw no inconvenience from the loss of a pint, and even twenty ounces of blood at a time. I drew from many persons seventy and eighty ounces in five days; and from a few, a much larger quan|tity. Mr Gribble, cedar-cooper, in Front-street, lost by ten bleedings an hundred ounces of blood; Mr George, a carter in Ninth-street, lost about the same quantity by five bleedings; and Mr Peter Mierken, one hundred and fourteen ounces in five days. In the last of the above persons the quan|tity taken was determined by weight. Mr Toy, blacksmith near Dock-street, was eight times bled in the course of seven days. The quantity taken from him was about an hundred ounces. The blood in all these cases was dense, and in the last very sizy. They were all attended in the month of October, and chiefly by my pupil Mr Fisher; and they are all this day living and healthy in|stances of the efficacy of copious blood-letting, and of the intrepidity and judgment of their young physician. Children, and even old people, bore the loss of much more blood in this fever, than in common inflammatory fevers. I took above thirty ounces, in five bleedings, from a daughter of Mr Robert Bridges, who was then in the 9th year of her age. Even great debility, whether natural or brought on by previous diseases, did not in those few cases in which it yielded to the fever, deprive Page  273 it of the uniformity of its inflammatory character. The following letter from my friend Dr Griffitts, written soon after his recovery from a third attack of the fever, and just before he went into the country for the re-establishment of his health, will furnish a striking illustration of the truth of the above observation.

I have compared a paroxism of this fever to a sudden squall; but the disease in its whole course was like a tedious equinoctial gale, acting upon a ship at sea; its destructive force was only to be op|posed Page  274 by handing every sail, and leaving the sys|tem to float, as it were, under bare poles. Such was the fragility (if I may be allowed the expres|sion) of the blood-vessels, that it was necessary to unload them of their contents, in order to prevent the system sinking, from hemorrhagies, or from effusions in the viscera, particularly the brain.

9. Such was the indomitable nature of the pulse in some patients, that it did not lose its force after numerous and copious bleedings. In all such cases, I considered the diminution of its frequency, and the absence of a vomiting, as signals to lay aside the lancet. The continuance of this preter|natural force in the pulse, appeared to be owing to the contagion which was universally diffused in the air, acting upon the arterial system in the same manner that it did in persons who were in apparent good health.

Thus have I mentioned the principal circum|stances which were connected with blood-letting, in the cure of the yellow fever. I shall now con|sider the objections that were made to it at the time, and since the prevalence of the fever.

It was said that the bleeding was unnecessarily copious; and that many had been destroyed by it. Page  275 To this I answer, that I did not lose a single pati|ent whom I bled seven times, or more, in this fe|ver. As a further proof that I did not draw an ounce of blood too much, it will only be necessary to add, that hemorrhagies frequently occurred af|ter a third, a fourth, and in one instance (in the only son of Mr William Hall) after a sixth bleed|ing had been used; and further, that not a single death occurred from natural hemorrhagies in the first stage of the disorder. A woman who had been bled by my advice, awoke the night follow|ing in a bath of her blood; which had flowed from the orifice in her arm. The next day she was free from pain and fever. There were many recoveries in the city from similar accidents. There were likewise some recoveries from copious na|tural hemorrhagies in the more advanced stages of the disorder, particularly when they occurred from the stomach and bowels. I left a servant maid of Mrs Morris's, in Walnut-street, who had dis|charged at least four pounds of blood from her stomach, without a pulse, and with scarcely a symptom that encouraged a hope of her life; but the next day I had the pleasure of finding her out of danger.

It is remarkable that fainting was much less common after bleeding in this fever, than in com|mon Page  276 inflammatory fevers. This circumstance was observed by Dr Griffitts, as well as myself. It has since been confirmed to me by three of the principal bleeders in the city, who performed the operation upwards of four thousand times. It oc|curred chiefly in those cases where it was used for the first time on the third or fourth day of the dis|ease. A swelling of the legs, moreover, so com|mon after plentiful bleeding in pneumony and rheumatism, rarely succeeded the use of this reme|dy in the yellow fever.

2. Many of the indispositions, and much of the subsequent weakness of persons who had been cured by copious blood-letting, have been ascribed to it. This is so far from being true, that the re|verse of it has occurred in many cases. Mr Mier|ken worked in his sugar-house in good health, nine days after his last bleeding; and Mr Gribble, and Mr George seem by their appearance to have derived fresh vigour from their evacuations. I could mention the names of many people who think their constitutions have been improved by the use of those remedies; and I know several per|sons in whom they have carried off habitual com|plaints. Mr Richard Wells attributes his relief from a chronic rheumatism to the copious bleed|ing and purging which were used to cure him of Page  277 the yellow fever; and Mr William Young, the bookseller, was relieved of a chronic pain in his side, by means of the same remedies.

3. It was said, that blood-letting was prescribed indiscriminately in all cases, without any regard to age, constitution, or the force of the disease. This is not true as far as it relates to my practice. In my prescriptions for patients whom I was un|able to visit, I advised them, when they were inca|pable of judging of the state of the pulse, to be guided in the use of bleeding, by the degrees of pain they felt, particularly in the head; and I sel|dom advised it for the first time, after the second, or third day of the disorder.

In pneumonies which affect whole neighbour|hoods in the spring of the year, bleeding is the universal remedy. Why should it not be equally so, in a fever which is of a more uniform inflam|matory nature, and which tends more rapidly to effusions, in parts of the body, much more vital than the lungs?

I have before remarked, that the debility which occurs in the yellow fever, is of the indirect kind. The debility in the plague is of the same nature. It has long been known that direct debility is to Page  278 be removed by the gradual application of stimuli, but it has been less observed, that the excess of stimulus in the system is best removed in a gradual manner, and that too, in proportion to the de|grees of indirect debility, which exist in the sys|tem.

This principle in the animal economy has been acknowledged by the practice of occasionally stop|ping the discharge of water from a canula in tap|ping, and of blood from a vein, in order to pre|vent fainting.

Child-birth, induces fainting, and sometimes death, only by the sudden abstraction of the sti|mulus of distention and pain.

In all those cases where purging or bleeding have produced death in the yellow fever or plague, when they have been used on the first or second day of those disorders, I suspect that it was oc|casioned by the quantity of the stimulus abstracted, being disproportioned to the degrees of indirect debility. The following facts will I hope throw light upon this subject.

1. Dr Hodges informs us, that "although blood could not be drawn in the plague, even in Page  279 the smallest quantity without danger, yet an hun|dred times the quantity of fluids, was discharged in pus from buboes without inconvenience*."

2. Pareus, after condemning bleeding in the plague, immediately adds an account of a patient, who was saved by an hemorrhage from the nose which continued two days†."

3. I have before remarked that bleeding proved fatal in three cases in the yellow fever in the month of August; but at that time, I saw one, and heard of another case, in which death seemed to have been prevented by a bleeding at the nose. Perhaps the uniform good effects which were ob|served to follow a spontaneous hemorrhage from an orifice in the arm, arose wholly from the gra|dual manner in which the stimulus of the blood was in this way abstracted from the body. Dr Williams relates a case of the recovery of a gen|tleman from the yellow fever by means of small hemorrhagies which continued three days from wounds in his shoulders made by being cupped. He likewise mentions several other recoveries by hemorrhagies from the nose, after "a vomit|ing Page  280 of black humours, and a hiccup had taken place*:"

4. There is a disease in North Carolina known among the common people by the name of the "pleurisy in the head." It occurs in the winter after a sickly autumn, and seems to be an evane|scent symptom of a bilious remitting fever. The cure of it has been attempted by bleeding, in the common way, but generally without success. It has however, yielded to this remedy in another form, that is, to the discharge of a few ounces of blood obtained by thrusting a piece of quill up the nose.

5. Riverius describes a pestilential fever which prevailed at Montpelier in the year 1623, which carried off one half of all who were affected by it†. After many unsuccessful attempts to cure it, this judicious physician prescribed the loss of two or three ounces of blood. The pulse rose with this small evacuation. Three or four hours after|wards, he drew six ounces of blood from his pa|tients, and with the same good effect. The next Page  281 day, he gave a purge, which he says rescued his patients from the grave. All whom he treated in this manner recovered. The whole history of this epidemic is highly interesting, from its agree|ing with our late epidemic in so many of its symp|toms, more especially as they appeared in the dif|ferent states of the pulse.

An old and intelligent citizen of Philadelphia, who remembers the yellow fever of 1741, says that when it first made its appearance, bleeding was attended with fatal consequences. It was laid aside afterwards, and the disease prevailed with great mortality, until it was checked by the cold weather. Had blood been drawn in the manner mentioned by Riverius, or had it been drawn in the usual way, after the abstraction of the stimulus of heat by the cool weather, the disease might probably have been subdued, and the remedy of blood letting, thereby have recovered its cha|racter.

Dr Hodges has another remark in his account of the plague in London in the year 1665, which is still more to our purpose than the one which I have quoted from it upon this subject. He says that "bleeding as a preventive of the plague was only safe and useful, when the blood was drawn Page  282 by a small orifice, and a small quantity taken at different times*."

I have remarked in the history of the yellow fever of last autumn, that it was often cured on the first or second day by a copious sweat. The Rev. Mr Ustick was one among many whom I could mention, who were saved from a violent attack of the fever, by this evacuation. It would be absurd to suppose that the contagion which produced the disease, was discharged in this man|ner from the body. The sweat seemed to cure the fever, only by lessening the quantity of the fluids, and thus gradually removing the indirect debility of the system. The profuse sweats which sometimes cure the plague, as well as the disease which is brought on by the bite of poisonous snakes, seem to act in the same way.

The system under the impression of the conta|gion of a malignant fever, resembles a man strug|gling beneath a load of two hundred weight, who is able to lift only one hundred and seventy-five. In order to assist him it will be to no pur|pose to attempt to infuse additional vigour into his muscles by the use of a whip or of strong Page  283 drink. Every exertion will serve only to waste his strength. In this situation (supposing it impos|sible to divide the weight which confines him to the ground) let the pockets of this man be emp|tied of their contents, and let him be stripped of so much of his clothing, as to reduce his weight five and twenty or thirty pounds. In this situa|tion he will rise from the ground; but if the weights be abstracted suddenly, while he is in an act of exertion he will rise with a spring that will endanger a second fall, and probably produce a temporary convulsion in his system. By abstract|ing the weights from his body more gradually, he will rise by degrees from the ground, and the sys|tem will accommodate itself in such a manner to the diminution of its pressure, as to resume its erect form, without the least deviation from the natural order of its appearance and motions.

It has been said that the stimulating remedies of bark, wine, and the cold bath, were proper in our late epidemic in August, and in the beginning of September, but that they were improper after|wards. If my theory be just, they were more improper in August and the beginning of Septem|ber, than they were after the disease put on the outward and common signs of inflammatory dia|thesis. The reason why a few strong purges cured Page  284 the disease at its first appearance was, because they abstracted in a gradual manner some of the immense portion of stimulus under which the ar|terial system laboured, and thus gradually relieved it from its low degrees of indirect debility. Bleed|ing was fatal in these cases, only because it re|moved this indirect debility in too sudden a man|ner.

The principle of the gradual abstraction, as well as of the gradual application of stimuli to the bo|dy, in all the diseases of indirect debility on the one hand, and of direct, on the other, opens a wide field for the improvement of medicine. Perhaps all the discoveries of future ages will consist more in a new application of established principles, and in new modes of exhibiting old medicines, than in the discovery of new theories, or of new arti|cles of the Materia Medica.

The reasons which induced me to prescribe purging and bleeding, in so liberal a manner, na|turally led me to recommend COOL and FRESH AIR to my patients. The good effects of it were ob|vious in almost every case in which it was applied. It was equally proper whether the arterial system was depressed, or whether it discovered in the pulse, a high degree of morbid excitement. Dr Page  285 Griffiths furnished a remarkable instance of the influence of cool air upon the fever. Upon my visiting him on the morning of the eighth of Oc|tober, I found his pulse so full and tense, as to in|dicate bleeding, but after sitting a few minutes by his bed-side, I perceived that the windows of his room had been shut in the night by his nurse, on account of the coldness of the night air. I desired that they might be opened. In ten minutes af|terwards, the Doctor's pulse became so much slower and weaker, that I advised the postpone|ment of the bleeding, and recommended a purge instead of it. The bleeding notwithstanding be|came necessary, and was used with great advantage in the afternoon of the same day.

The cool air was improper only in those cases where a chilliness attended the disease.

For the same reason that I advised cool air, I directed my patients to use cold DRINKS. They consisted of lemonade, tamarind, jelly, and raw apple water, toast and water, and of weak balm, and camomile tea. The subacid drinks were pre|ferred in most cases, as being not only most agree|able to the taste, but because they tended to cor|rect by mixture, the acrid quality of the bile. All these drinks were taken in the early stage of the Page  286 disorder. Towards the close of it, I permitted the use of porter and water, weak punch, and when the stomach would bear it, weak wine-whey.

I forbad all cordial and stimulating food in the active state of the arterial system. The less my patients ate, of even the mildest vegetable food, the sooner they recovered. Weak coffee, which (as I have formerly remarked) was almost univer|sally agreeable, and weak tea were always inoffen|sive. As the action of the pulse diminished, I in|dulged my patients with weak chocolate; also with milk, to which roasted apples, or minced peaches, and (where they were not to be had,) bread, or Indian mush were added.

Towards the crisis, I advised the drinking of weak chicken, veal, or mutton broth, and after the crisis had taken place, I permitted mild animal food to be eaten in a small quantity, and to be increased according to the waste of the excita|bility of the system. This strict abstinence which I imposed upon my patients did not escape ob|loquy, but the benefits they derived from it, and the ill effects which arose in many cases from a contrary regimen, satisfied me that it was proper in every case in which it was prescribed.

Page  287 COLD WATER was a most agreeable and power|ful remedy in this disorder. I directed it to be applied by means of napkins to the head, and to be injected into the bowels by way of glyster. It gave the same ease to both, when in pain, which opium gives to pain from other causes. I like|wise advised the washing of the face and hands, and sometimes the feet with cold water, and always with advantage. It was by suffering the body to lie for some time in a bed of cold water, that the inhabitants of the island of Massuah cured the most violent bilious fevers*. When applied in this way, it gradually abstracts the heat from the body, and thereby lessens the action of the system. It differs as much in its effects upon the body from the cold bath, as rest in a cold room, differs from exercise in the cold and open air.

I was first led to the practice of the partial ap|plication of cold water to the body, in fevers of too much force in the arterial system, by observ|ing its good effects in active hemorrhagies, and by recollecting the effects of a partial application of warm water to the feet, in fevers of an opposite character. Cold water when applied to the feet as certainly reduces the pulse in force and fre|quency, Page  288 as warm water applied in the same way, produces contrary effects upon it. In an experi|ment which was made at my request by one of my pupils, by placing his feet in cold pump water for a few minutes, the pulse was reduced 24 strokes in a minute, and became so weak as hardly to be perceptible.

In the use of the remedies which were necessary to overcome the inflammatory action of the sys|tem, I was obliged to reduce it below its natural point of excitement. In the present imperfect state of our knowledge in medicine, perhaps no disease of too much action, can be cured without it.

I have said in another place, that I was early obliged to desist from the use of wine, bark, and laudanum in the first stage of this disorder. I found them as offensive to the stomach, and nearly as hurt|ful in its second stage, as I had found them in its first. In this situation new resources in the ma|teria medica were opened to me. I had observed a favourable issue of the fever in every case, in which a spontaneous discharge took place from the salivary glands. I had observed further, that all such of my patients (one excepted) as were sa|livated by the mercurial purges recovered in a few Page  289 days. This, early suggested an idea to me that the calomel might be applied to other purposes, than the discharging of bile from the bowels. I ascribed its salutary effects when it salivated in the first stage of the disorder, to the excitement of in|flammation and effusion in the throat, diverting them from more vital parts of the body. In the the second stage of the disorder, I was led to pre|scribe it as a stimulant, and with a view of obtain|ing this operation from it, I aimed at exciting a salivation as speedily as possible in all cases. Two precedents encouraged me to make trial of this remedy.

In the month of October 1789, I attended a gen|tleman in a bilious fever, which ended in many of the symptoms of a typhus mitior. In the lowest state of his fever, he complained of a pain his right side, for which I ordered half an ounce of mercu|rial ointment to be rubbed on the part affected. The next day, he complained of a sore mouth, and in the course of four and twenty hours, he was in a moderate salivation. From this time his pulse became full and slow, and his skin moist. His sleep and appetite suddenly returned, and in a day or two he was out of danger. The second precedent for a salivation in a fever, which occurred to me was in Dr Haller's short account of the works of Page  290 Dr Cramer*, and which I had a year before copied into my note book. The practice was moreover, justified in point of safety, as well as the probability of success, by the accounts which Dr Clark has lately given of the effects of a saliva|tion in the dysentery†. I began by prescribing the the calomel in small doses, at short intervals, and afterwards I directed large quantities of the oint|ment to be rubbed upon the limbs. The effects of it in every case in which it affected the mouth, were salutary. Dr Woodhouse improved upon my me|thod of exciting the salivation, by rubbing the gums with calomel, in the manner directed by Mr Clare. It was more speedy in its operation in this way than in any other, and equally effectual. Several per|sons appeared to be benefited by the mercury in|troduced into the system in the form of an ointment, where it did not produce a salivation. Among these, were the Rev. Dr Blackwell, and Mr John Davis.

Since the above account was written of the good effects 〈◊〉 mercurial salivation in this fever, I have had great satisfaction in discovering that it was pre|scribed with equal, and even greater success, by Dr Wade in Bengal, in the year 1791, and by Mr Chisholm in the island of Granada, in the cure of Page  291 bilious yellow fevers*. Dr Wade did not lose one, and Mr Chisholm lost only one, out of forty eight prtients in whom the mercury affected the salivary glands. The latter gave 150 grains of colomel, and applied the strongest mercurial ointment below the groin of each side, in some cases. He adds further, that not a single instance of a relapse oc|curred, where the disease was cured by salivation.

After the reduction of the system, blisters were applied with great advantage to every part of the body. They did most service when they were ap|plied to the crown of the head. I did not see a single case, in which a mortification followed the sore, which was created by a blister.

Brandy and water, or porter and water, when agreeable to the stomach, with now and then a cup of chicken broth, were the drinks I prescribed to assist in restoring the tone of the system.

In some cases I directed the limbs to be wrapped in flannels dipped in warm spirits, and cataplasms of bruised garlic to be applied to the feet. But my principal dependence, next to the use of mer|curial medicines, for exciting a healthy action in the arterial system, was upon mild and gently sti|mulating Page  292 food. This consisted of rich broths, the flesh of poultry, oysters, thick gruel, mush and milk, and chocolate. I directed my patients to eat or drink a portion of some of the above ar|ticles of diet every hour or two during the day, and in cases of great debility, I advised their being waked for the same purpose two or three times in the night. The appetite frequently craved more savoury articles of food, such as beef-stakes, and sausages; but they were permitted with great caution, and never 'till the system had been pre|pared for them by a less stimulating diet.

There were several symptoms which were very distressing in this disorder, and which required a specific treatment.

For the vomiting, with a burning sensation in the stomach, which came on about the 5th day, I found no remedy equal to a table spoonful of sweet milk taken every hour, or to small draughts of milk and water. I was led to prescribe this simple medicine, from having heard from a West India practitioner, and afterwards read in Dr Hume's account of the yellow fever, encomiums upon the milk of the cocoa-nut for this trouble|some symptom. Where sweet milk failed of giving relief, I prescribed small doses of sweet oil, and in some cases a mixture of equal parts of milk, sweet Page  293 oil and molasses. They were all intended to di|lute, or blunt the acrimony of the humors which were either effused, or generated in the stomach. Where they all failed of checking the vomiting, I prescribed weak camomile tea, or porter, or cy|der and water, with advantage. In some of my pa|tients, the stomach rejected all the mixtures, and liquors which have been mentioned. In such cases, I directed the stomach to be left to itself for a few hours, after which it sometimes received and re|tained the drinks that it had before rejected, pro|vided they were administered in a small quantity at a time.

The vomiting was sometimes stopped by a blister applied to the external region of the stomach.

A mixture of liquid laudanum and sweet oil, applied to the same place, gave relief where the stomach, was affected by pain only, without a vomiting.

I have formerly mentioned that a distressing pain often seized the lower part of the bowels. I was early taught that laudanum was not a pro|per remedy for it. It yielded in almost every case, to two or three emolient glysters, or to the loss of a few ounces of blood.

Page  294 The convalescence from this fever was in ge|neral rapid, but in some cases it was very slow. I was more than usually struck by the great re|semblance which the system in the convalescence from this fever, bore to the state of the body and mind in old age. It appeared, 1. in the great weakness of the body, more especially of the limbs. 2. In uncommon depression of mind, and in a great aptitude to shed tears. 3. In the ab|sence or short continuance of sleep. 4. In the frequent occurrence of appetite, and in some cases in its inordinate degrees. And 5. In the loss of the hair of the head, or in its being suddenly changed in some cases to a grey colour.

Pure air, gentle exercise, and agreeable socie|ty, r••oved the debility both of body and mind of this premature, and temporary old age. I met with a few cases, in which the yellow colour continued for several weeks after the patient's re|covery from all the other symptoms of the fever. It was removed most speedily and effectually by two or three moderate doses of calomel and rhu|barb.

A feeble and irregular intermittent, was very troublesome in some people, after an acute attack of the fever. It yielded gradually to camomile or snake-root tea, and country air.

Page  295 In a publication dated the 16th of September, I recommended a diet of milk and vegetables, and cooling purges to be taken once or twice a week, to the citizens of Philadelphia. This advice was the result of the theory of the disease I had adopt|ed, and of the successful practice which had arisen from it. In my intercourse with my fellow citi|zens, I advised this regimen to be regulated by the degrees of fatigue and contagion to which they were exposed. I likewise advised moderate blood-letting to all such persons as were of a ple|thoric habit. To men whose minds were influ|enced by the publications in favour of bark and wine, and who were unable at that time to grasp the extent and force of the contagion of this ter|rible fever, the idea of dieting, purging, or bleed|ing the inhabitants of a whole village or city, ap|peared to be extravagant and absurd: but I had many precedents, besides the authority of reason, in favour of the advice. Dr Mitchell recommend|ed moderate bleeding with success, as a preventive of the yellow fever in Virginia, in the year 1741. A military surgeon belonging to the French troops at Hispaniola, assured Dr Foulke that he had for many years bled the recruits from France, as soon as they arrived, and thereby secured them from a seasoning by the yellow fever. The less mortality of this disorder in the French and Spa|nish, Page  296 than in the English Islands, has been justly attributed to the natives of France and Spain car|rying with them to the West Indies more tempe|rate habits, in the use of wine and animal food, than the natives of Great Britain. I had more|over, the analogy of the regimen made use of to prepare the body for the small-pox and plague, in favour of this advice. Dr Haller has given extracts from the histories of two plagues, in which the action of the contagion was prevented, or mitigated, by bleeding*. Dr Hodges con|firms the utility of the same practice. The bene|fits of low diet, as a preventive of the plague, were established by many authors, long before they received the testimony of the benevolent Mr Howard in their favour. Socrates in Athens, and Justinian in Constantinople, were preserved by means of their abstemious modes of living, from the plagues which occasionally ravaged those ci|ties. By means of the low diet, gentle physic, and occasional bleedings, which I thus publicly recom|mended, the disease was prevented in many in|stances, or rendered mild where it was taken. But my efforts to prevent the disease in my fel|low-citizens, did not end here. I advised them, not only in the public papers, but in my inter|course Page  297 with them, to avoid heat, cold, labour, and every thing else that could excite the conta|gion (which I knew to be present in all their bo|dies) into action. I forgot upon this occasion the usual laws which regulate the intercourse of man with man in the streets, and upon the public roads, in my excursions into the neighbourhood of the city. I cautioned many persons whom I saw walking or riding in an unsafe manner, of the danger to which they exposed themselves; and thereby I hope prevented an attack of the disor|der in many people. If in a single instance I un|happily excited an emotion of terror in a fellow-citizen, by this conduct, I thus publicly ask his pardon. There should be no ceremony in cal|ling to a man to avoid a precipice; or in pulling him out of a fire.

It was from a conviction of the utility of low diet, gentle evacuations, and of carefully shunning all the exciting causes which I have mentioned, that I concealed in no instance from my patients, the name of their disorder. This plainness, which was blamed by weak people, produced strict obe|dience to my directions, and thereby limited the propagation of the fever in many families, or rendered it when taken, as mild as inoculation does the small-pox. The opposite conduct of se|veral Page  298 physicians, by preventing the above precau|tions, encreased the mortality of the disease; and in some instances contributed to the extinction of whole families. Such have been, and ever will be, the effects of ignorance and fraud in the pro|fession of medicine.

I proceed now to make a few remarks upon the remedies recommended by Doctors Kuhn and Stevens, and by the French physicians.

Had the whole materia medica been ransacked, there could not have been found any three medi|cines more opposite to the disorder than bark, wine, and laudanum. In every case in which I pre|scribed bark, it was offensive to the stomach. In several tertians which attended the convalescence from a common attack of the fever, I found it al|ways unsuccessful, and once hurtful. Mr Wil|ling took it for several weeks without effect. About half a pint of a weak decoction of the bark produced in Mr Samuel Meredith, a parox|ism of the fever, so violent as to require the loss of ten ounces of blood to moderate it. Dr An|nan informed me that he was forced to bleed one of his patients twice, after having given him a small quantity of bark, to hasten his convalescence. If in any case it was inoffensive, or did service, I Page  299 suspect it must have acted upon the bowels as a purge. Dr Sydenham says the bark cured inter|mittents by this evacuation*; and Mr Bruce says it operated in the same way, when it cured the bi|lious fevers at Massuah.

Wine was nearly as disagreeable as the bark to the stomach, and equally hurtful. I tried it in every form, and of every quality, but without suc|cess. It was either rejected by the stomach, or produced in it a burning sensation. I should sus|pect that I had been mistaken in my complaints against wine, had I not since met with an account in Skenkius of its having destroyed all who took it in the famous Hungarian fever, which prevailed with great mortality over nearly every country in Europe, about the middle of the 16th century†. Dr Wade declares wine to be "ill adapted to the fevers of Bengal, where the treatment has been proper in other respects."

Laudanum has been called by Dr Mosely "a fatal medicine" in the yellow fever. In one of Page  300 my patients who took only fifteen drops of it, without my advice, to ease a pain in his bowels, it produced a delirium, and death in a few hours. I was much gratified in discovering that my prac|tice, with respect to the use of opium in this fe|ver, accorded with Dr Wade's in the fever of Bengal. He tells us that "it was mischievous in almost every instance, even in combination with antimonials."

The spices were hurtful in the first stage of the fever, and when sufficient evacuations had been used, they were seldom necessary in its second.

The elixir of vitriol was in general, offensive to the stomach.

The cold bath was useful in those cases where its sedative prevailed over its stimulating effects. But this could not often happen, from the sud|denness and force with which the water was thrown upon the body. In two cases in which I prescribed it, it produced a gentle sweat, but it did not save life. In a third it removed a deliri|um, and reduced the pulse for a few minutes, in frequency and force, but this patient died. The recommendation of it indiscriminately in all cases was extremely improper. In that chilliness and Page  301 tendency to fainting upon the least motion, which attended the disorder in some patients, it was an unsafe remedy. I heard of a woman who was seized with delirium immediately after using it, from which she never recovered; and of a man who died a few minutes after he came out of a bathing tub. Had this remedy been the exclu|sive antidote to the yellow fever, the mortality of the disease would have been but little checked by it. Thousands must have perished from the want of means to procure tubs, and of a suitable number of attendants to apply the water, and to lift the patient in and out of bed. The reason of our citizens ran before the learning of the friends of this remedy, and long before it was abandoned by the physicians; it was rejected as useless, or not attempted, because impracticable, by the good sense of the city. It is to be lamented that the remedy of cold water has suffered in its cha|racter by the manner in which it was advised. In fevers of too much action, it reduces the morbid excitement of the blood-vessels, provided it be applied without force, and for a considerable time to the body. It is in the jail fever, and in the second stage of the yellow fever only, in which its stimulant and tonic powers are proper. Dr Jackson establishes this mode of using it, by in|forming Page  302 us, that when it did service, it "gave vi|gour and tone" to the system*.

The third mode of practice which I mentioned in this fever consisted of a union of the evacuating, and tonic remedies. The physicians who adopted this mode, gave calomel by itself in small doses on the first, or second day of the fever, bled once or twice in a sparing manner, and gave the bark, wine, and laudanum in large quantities upon the first appearance of a remission. After they began the use of these remedies, purging was omitted, or if the bowels were moved, it was only by means of gentle glysters. This practice I shall say hereafter was not much more successful than that which was recommended by Dr Kuhn and Dr Stevens. It resembled throwing water and oil at the same time upon a fire, in order to ex|tinguish it.

The French remedies were nitre, and cremor tartar in small doses, centaury tea, camphor, and several other warm medicines; subacid drinks taken in large quantities, the warm bath, and moderate bleeding.

Page  303 After what has been said, it must be obvious to the reader, that the nitre and cremor tartar in small doses, could do no good, and that camphor and all cordial medicines must have done harm. The diluting subacid drinks which the French physicians gave in large quantities were useful in diluting and blunting the acrimony of the bile, and to this remedy assisted by occasional bleeding, I ascribe most of the cures which were performed by those physicians.

Those few persons in whom the warm bath pro|duced copious and universal sweats recovered, but in nearly all the cases which came under my no|tice, it did harm.

I come now to inquire into the comparative success of the four different modes of practice which have been mentioned.

I have already said that ten out of thirteen pati|ents whom I treated with bark, wine, and lauda|num, and that three out of four, in whom I added the cold bath to those remedies, died. Dr Pen|nington informed me, that he had lost all the pa|tients, (six in number) to whom he had given the above medicines. Dr Johnson assured me with great concern, about two weeks before he died, Page  304 that he had not recovered a single patient by them. Whole families were swept off, where these me|dicines were used. But further, most of those persons who caught the fever in the city, and sick|ened in the country, or in the neighbouring towns, and who were treated with tonic remedies, died. There was not a single cure performed by them in New York, where they were used with every possible advantage. But why do I multiply proofs of their deadly effects? The clamours of hundreds whose relations had perished by them, and the fears of others, compelled those physicians who had been most attached to them, to lay them aside, or to prepare the way for them (as it was called) by purging and bleeding. The bathing tub soon shared a worse fate than bark, wine, and lauda|num, and long before the disease disappeared, it was discarded by all the physicians in the city.

In answer to these facts, we have been told that Mr Hamilton, and his family recovered by the use of Dr Stevens's remedies. I shall not say of those cures, what some gentlemen of the faculty who had seen but little of the disease, and who had for|gotten that a powerful epidemic banishes, or unites with all other diseases, have said of my cures, viz. that they were not of the yellow fever. It was impossible for Mr Hamilton to have had a fever Page  305 at that time of any other kind. The neighbour|hood in which he lived, was healthy, and he had been daily exposed at his office in Chesnut-street, to the contagion of the prevailing epidemic. The disease in this case was either very light, or Mr Hamilton owes more to the strength of his consti|tution, and the goodness of heaven, than most of the people who recovered from the disorder. That it was light in all the branches of Mr Hamilton's family who were infected by him, I infer from this being the case in every similar instance in which the disease spread in the country.

"Success (says Dr Sydenham) is not a sufficient proof of the excellency of a method of cure in acute diseases, since some are recovered by the im|prudent procedure of old women; but it is fur|ther required, that the distemper should be easily cured, and yield conformably to its own nature*," and again, speaking of the cure of the new fever of 1685, this incomparable physician observes, "If it be objected, that this fever frequently yields to a quite contrary method to that which I have laid down, I answer, that the cure of a disease by a method which is attended with success only now and then in a few instances, differs extremely from Page  306 that practical method, the efficacy whereof appears both from its recovering greater numbers, and all the practical phenomena happening in the cure*."

After what has been said of Mr Hamilton's cure, it will not be expected that I should say any thing of the three patients mentioned in Dr Kuhn's letter to the mayor who recovered under the use of Dr Stevens's remedies. The fourth patient mentioned by Dr Kuhn, whom he left on the 4th day of the disease with "no unfavourable symp|toms" was Dr Hutchinson. I visited him the day after Dr Kuhn left him, and found him sitting in a chair near the head of his bed, with all his clothes on, as if he had been in his usual health. A short examination of his case, satisfied me that he was in extreme danger. His face was suffused with blood. He had a full pulse, and an hemor|rhage from his gums, which last symptom I was told came on the day before. I pressed him to take a strong mercurial purge, but he refused it. From that moment I despaired of his recovery. He died three days afterwards.

The reader will naturally pause after reviewing these remarks upon the above cures, and ask, Page  307 whether it was consistent with the rules of just and safe reasoning in medicine, to deduce a general and uniform method of treating this disorder, from the favourable issue of only four or five cases, and whether it was candid, to condemn in the most un|qualified manner, a contrary mode of practice, after repeated public, and private declarations, that it had at that time, cured several hundred people.

Far be it from me to deny that indirect debility may not be overcome by such stimuli as are more powerful than those which occasion it. This has sometimes been demonstrated by the efficacy of bark, wine, and laudanum, in the confluent and petechial small-pox; but even this state of that dis|order, yields more easily to blood-letting, or to plentiful evacuations from the stomach and bowels on the first or second day of the eruptive fever. This I have often proved, by giving a large dose of tartar emetic, and calomel, as soon as I was sa|tisfied from circumstances, that my patient was in|fected with the small-pox. But the indirect debi|lity of the yellow fever appears to be much greater than that which occurs in the small-pox, and hence it more uniformly resisted the most power|ful tonic remedies.

Page  308 I have publicly asserted, that the remedies which I adopted, and of which I have given a history, cured a greater proportion than ninety-nine out of an hundred of all who applied to me on the first day of the disorder before the 15th day of September. I regret that it is not in my power to furnish a list of them, for a majority of them were poor people, whose names are still unknown to me. I was not singular in this successful prac|tice in the first appearance of the disorder. Dr Penington assured me on his death bed, that he had not lost one, out of forty-eight patients whom he had treated agreeably to the principles and practice I had recommended. Dr Griffitts tri|umphed over the disease in every part of the city, by the use of what were called the new remedies. My former pupils spread by their success, the re|putation of purging, and bleeding, wherever they were called. Unhappily the pleasure we derived from this success in the treatment of the disorder, was of short duration. Many circumstances con|tributed to lessen it, and to revive the mortality of the fever. I shall briefly enumerate them.

1. The distraction produced in the public mind, by the recommendation of remedies, the opposites in every respect of purging and bleeding.

Page  309 2. The opinion which had been published by several physicians, and inculcated by others, that we had other fevers in the city besides the yellow fever. This produced a delay in many people in sending for a physician, or in taking medicines for two or three days, from a belief that they had nothing but a cold, or a common fever. Some people were so much deceived by this opinion, that they refused to send for physicians lest they should be infected by them, with the yellow fever. In most of the cases in which these delays took place, the disease proved mortal.

To obviate a suspicion, that I have lave laid more stress upon the fatal influence of this error than is just, I shall here insert an extract of a letter I have lately been favoured with from Mr John Connelly one of the city committee, who fre|quently left his brethren in the City Hall, and spent many hours in visiting and prescribing for the sick. "The publications (says he) of some physicians that there were but few persons infected with the yellow fever, and that many were ill with colds and common remitting and fall fevers, proved fa|tal to almost every family which was credulous enough to believe them. That opinion 〈◊〉 its hundreds, if not its thousands, many of whom did not send for a physician until they were in the last Page  310 stage of the disorder, and beyond the power of medicine."

3. The interference of the friends of the sti|mulating system, in dissuading patients from sub|mitting to sufficient evacuations.

4. The deceptions which were practised by some patients upon their physicians in their re|ports of the quantity of blood they had lost, or of the quality, and number of their evacuations by stool.

5. The impracticability of procuring bleeders as soon as bleeding was prescribed. Life in this disease, as in the apoplexy, frequently turned upon that operation being performed within an hour. It was often delayed from the want of a bleeder, one or two days.

6. The inability of physicians, from the num|ber of their patients, and from frequent indisposi|tion, to visit the sick, at such times, as was neces|sary to watch the changes in their disorder.

7. The great accumulation, and concentration of the contagion in sick rooms from the continu|ance of the disease in the city, whereby the system Page  311 was exposed to a constant stimulus, and the effect of evacuations was thus defeated.

8. The want of skill or fidelity in nurses to ad|minister the medicines properly, to persuade pa|tients to drink frequently; also to supply them with food or cordial drinks when required in the night.

9. The great degrees of indirect debility in|duced in the systems of many of the people who were affected by the disorder, from fatigue in at|tending their relations or friends.

10. The universal depression of mind, amounting in some instances to despair, which affected many people. What medicine could act upon a patient who awoke in the night, and saw through the broken and faint light of a candle, no human creature, but a black nurse, perhaps asleep in a distant corner of the room; and who heard no noise, but that of a herse conveying, perhaps a neighbour or a friend, to the grave? The state of mind under which many were affected by the dis|ease, is so well described by the Rev. Dr Smith in the case of his wife, in a letter I received from him in my sick room, two days after her death, that I hope I shall be execused for inserting an Page  312 extract from it. It forms a part of the history of the disease. The letter was written in answer to a short note of condolence which I sent to the Doctor immediately after hearing of Mrs Smith's death. After some pathetic expressions of grief, he adds, "The scene of her funeral, and some preceding circumstances, can never depart from my mind. On our return from a visit to our daughter, whom we had been striving to console on the death of Mrs Keppele, who was long fa|miliar, and dear to both, my dear wife passing the burying ground gate, led me into the ground, view|ed the graves of her two children, called the old grave digger, marked a spot for herself as close as possible to them and the grave of Dr Phineas Bond, whose memory she adored. Then by the side of the spot she had chosen, we found room and chose mine, pledging ourselves to each other, and directing the grave digger that this should be the order of our interment. We returned to our house. Night approached. I hoped my dear wife had gone to rest as she had chosen since her return from nursing her daughter, to sleep in a chamber by herself, through fear of infecting her grand-child and me. But it seems she closed not her eyes; sitting with them fixed through her chamber window on Mrs Keppele's house, 'till about midnight she saw her herse, and followed it Page  313 with her eyes as far as it could be seen. Two days afterwards Mrs Rodgers, her next only sur|viving intimate friend, was carried past her win|dow, and by no persuasion could I draw her from thence, nor stop her sympathetic foreboding tears, so long as her eyes could follow the funeral, which was through two squares, from Fourth to Second street, where the herse disappeared." The Doc|tor proceeds in describing the distress of his wife. But pointed as his expressions are, they do not convey the gloomy state of her mind with so much force as she has done it herself in two letters to her niece Mrs Cadwallader, who was then in the country. The one was dated the 9th, the other the 11th of October. I shall insert a few extracts from each of them. "October 9th; It is not possible for me to pass the streets without walking in a line with the dead. Passing infected houses, and looking into open graves. This has been the case for many weeks. "I don't know what to write, my head is gone, and my heart is torn to pieces." "I intreat you to have no fears on my account. I am in the hands of a just and mer|ciful God, and his will be done."

October 11th: "Don't wonder that I am so low to day. My heart is sunk down within me." Page  314 The next day this excellent woman sickened, and died on the 19th of the same month.

If in a person possessed naturally of uncommon equanimity, and fortitude, the distresses of our city, produced such dejection of spirits, what must have been their effect upon hundreds, who were not endowed with those rare and extraordinary quali|ties of mind? Death in this, as well as in many other cases in which medicine had done its du|ty, appeared to be the inevitable consequence of the total abstraction of the energy of the mind in restoring the natural motions of life.

Under all the circumstances which have been mentioned, which opposed the system of depletion in the cure of this fever, it was still far more suc|cessful than any other mode of cure that had been pursued before in the United States or in the West Indies.

Three out of four died of the disorder in Ja|maica, under the care of Dr Hume.

Dr Blane considers it as one of the "most mortal" of diseases, and Dr Jackson places a more successful mode of treating it, among the Page  315 subjects which will admit of "innovation" in medicine.

After the 15th of September my success was much limited, compared with what it had been before that time. But at no period of the disease did I lose more than one in twenty of those whom I saw on the first day, and attended regularly through every stage of the fever; provided they had not been previously worn down by attending the sick.

The following statement which will admit of being corrected, if it be inaccurate, will I hope, establish the truth of the above assertions.

About one half of the families whom I have at|tended for many years, left the city. Of those who remained, many were affected by the disor|der. Out of the whole of them, after I had adopted my second mode of practice, I lost only five heads of families, and about a dozen servants and children. In no instance did I lose both heads of the same family. My success in these cases was owing to two causes; 1st, To the credit my for|mer patients gave to my public declaration, that we had only one fever in the city; hence they ap|plied Page  316 on the first day, and sometimes on the first hour of their indisposition; and 2dly, To the nu|merous pledges many of them had seen of the safety and efficacy of copious blood-letting by my advice, in other diseases: hence my prescription of that necessary remedy, was always obeyed in its utmost extent. Of the few adults whom I lost, among my former patients, two of them were old people; two took laudanum without my know|ledge; and one refused to take medicine of any kind; all the rest had been worn down by previ|ous fatigue.

I have before said that a great number of the blacks were my patients. Of these not one died under my care. This uniform success among those people, was not owing altogether to the mildness of the disease, for I shall say presently, that a great proportion of a given number died under other modes of practice.

In speaking of the comparative effects of purg|ing and bleeding, it may not be amiss to repeat, that not one pregnant woman to whom I pre|scribed them died, or suffered abortion. Where the tonic remedies were used, abortion or death, and in many instances both, were nearly universal.

Page  317 Many whole families, consisting of five, six, and in three instances, of nine members, were recover|ed by plentiful purging and bleeding. I could swell this work by publishing a list of those fami|lies; but I take more pleasure in adding, that I was not singular in my success in the use of the above remedies. They were prescribed with great advantage by many of the physicians of the city, who had for a while given tonic medicines without effect. I shall not mention the names of any of the physicians who totally renounced those medicines, lest I should give offence by not men|tioning them all. Many large families were cured by some of them, after they adopted and pre|scribed copious purging and blood-letting. One of them cured ten in the family of Mr Robert Haydock, by means of those remedies. In one of that family the disease came on with a vomit|ing of black bile.

But the use of the new remedies was not di|rected finally by the physicians alone. The cler|gy, the apothecaries, many private citizens, seve|ral intelligent women, and two black men, prescrib|ed them with great success. Nay more, many per|sons prescribed them to themselves; and as I shall say hereafter, with a success that was unequalled by any of the regular or irregular practitioners in the city.

Page  318 It was owing to the almost universal use of purging and bleeding, that the mortality of the disease diminished in proportion as the number of persons who were affected by it, encreased about the middle of October. It was scarcely double of what it was in the middle of September, and yet six times the number of persons were probably at that time confined by it.

The success of copious purging and bleeding was not confined to the city of Philadelphia. Se|veral persons who caught the disease in town, and sickened in the country, were cured by them.

Could a comparison be made of the number of patients who died of our late fever, after having been plentifully bled and purged, with those who died of the yellow fever in the years 1699, 1741, 1747, and 1762, I am persuaded that the propor|tion would be very small in the year 1793, com|pared with the former years*. Including all who died under every mode of treatment, I suspect the Page  319 mortality to be less in proportion to the popula|tion of the city, and the number of persons who were affected, than it was in any of the other years that have been mentioned.

Not less than 6000 of the inhabitants of Phila|delphia probably owe their lives to purging and bleeding, during the late autumn.

I proceed with reluctance to inquire into the comparative success of the French practice. It would not be difficult to decide upon it from ma|ny facts that came under my notice in the city; but I shall rest its merit wholly upon the returns of the number of deaths at Bush-hill. This hospi|tal, after the 22d of September, was put under the care of a French physician, who was assisted by one of the physicians of the city. The hospital was in a pleasant and airy situation; it was provided with all the necessaries and comforts for sick peo|ple that humanity could invent, or liberality sup|ply. The attendants were devoted to their duty; and cleanliness and order pervaded every room in the house. The reputation of this hospital, and of the French physician, drew patients to it in the early stage of the disorder. Of this I have been assured in a letter from Dr Annan, who was ap|pointed to examine and give orders of admission Page  320 into the hospital, to such of the poor of the di|strict of Southwark, as could not be taken care of in their own houses. Mr Olden has likewise in|formed me, that most of the patients who were sent to the hospital by the city committee (of which he was a member) were in the first stage of the fever. With all these advantages, the deaths between the 22d of September and the 6th of November, amounted to 448 out of 807 pati|ents who were admitted into the hospital within that time. Three fourths of all the blacks (near|ly 20) who were patients in this hospital died. A list of the medicines prescribed there may be seen in the minutes of the proceedings of the city committee. Calomel and jalap are not among them. Moderate bleeding and purging with Glauber salts, I have been informed, were used in some cases by the physicians of this hospital. The proportion of deaths to the recoveries, as it appears in the minutes of the committee from whence the above report is taken, is truly melan|choly! I hurry from it therefore to a part of this work, to which I have looked with pleasure, ever since I sat down to compose it.

I have said that the clergy, the apothecaries, and many other persons who were uninstructed in the principles of medicine, prescribed purging, and Page  321 bleeding with great success in this disorder. Ne|cessity gave rise to this undisciplined sect of practi|tioners, for they came forward to supply the places of the regular bred physicians who were sick or dead. I shall mention the names of a few of those persons who distinguished themselves as volunteers in this new work of humanity. The late Rev. Mr Fleming one of the ministers of the Catholic church, carried the purging powders in his pocket, and gave them to his poor parishioners with great success. He even became the advocate of the new remedies. In a conversation I had with him on the 22d of September, he informed me, that he had advised four of our physicians whom he met a day or two before, "to renounce the pride of science, and to adopt the new mode of practice, for that he had witnessed its good effects in many cases." Mr John Keihmle, a German apothecary, has assured me that out of 314 patients whom he visited, and 187 for whom he prescribed from the reports of their friends, he lost only 47 (which is nearly but one in eleven) and that he treated them all agreeably to the method which I had recom|mended. The Rev. Mr Schmidt one of the mi|nisters of the Lutheran church, was cured by him. I have before mentioned an instance of the judg|ment of Mr Connelly, and of his zeal in visiting and prescribing for the sick. His remedies were Page  322 bleeding and purging. He moreover, bore a con|stant and useful testimony against bark, wine, lau|danum, and the warm bath*. Mrs Paxton in Carter's alley, and Mrs Evans the wife of Mr John Evans in Second-street, were indefatigable; the one in distributing mercurial purges composed by herself, and the other in urging the necessity of copious bleeding and purging among her friends and neighbours, as the only safe remedies for the fever. These worthy women were the means of saving many lives†. Absalom Jones, and Richard Allen, two black men, spent all the intervals of Page  323 time, in which they were not employed in burying the dead, in visiting the poor who were sick, and in bleeding and purging them, agreeably to the directions which had been printed in all the news papers. Their success was unparalleled by what is called regular practice. This encomium upon the practice of the blacks, will not surprise the reader when I add, that they had no fear of putrefaction in the fluids, nor of the calumnies of a body of fellow citizens in the republic of medi|cine, to deter them from plentiful purging and bleeding. They had besides no more patients, than they were able to visit two or three times a day. But great as their success was, it was exceeded by those persons who in despair of pro|curing medical aid of any kind, purged and bled themselves. This palm of superior success, will not be withheld from those people, when I explain the causes of it. It was owing to their early use of the proper remedies, and to their being guided in the repetition of them, by the continuance of a tense pulse, or of pain and fever. A day, an af|ternoon, Page  324 and even an hour, were not lost by these people in waiting for the visit of a Physician who was often detained from them, by sickness, or by new and unexpected engagements, by which means the precious moment for using the remedies, with effect, passed irrevocably away. I have stated these facts from faithful inquiries, and numerous observations. I could mention the names, and families of many persons who thus cured them|selves. One person only shall be mentioned, who has shewn by her conduct what reason is capable of doing when it is forced to act for itself. Mrs Long, a widow, after having been twice unsuc|cessful in her attempts to procure a physician, un|dertook at last to cure herself. She took several of the mercurial purges, agreeably to the printed directions, and had herself bled seven times in the course of five or six days. The indication for re|peating the bleeding, was the continuance of the pain in her head. Her recovery was rapid, and complete. The history of it was communicated to me by herself, with great gratitude, in my own house, during my second confinement with the fever. To these accounts of persons who cured themselves in the city, I could add many others, of citizens who sickened in the country, and who cured themselves by plentiful bleeding and pur|ging, without the attendance of a physician.

Page  325 From a short review of these facts, reason, and humanity awake from their long repose in medi|cine, and unite in proclaiming, that it is time to take the cure of pestilential fevers out of the hands of physicians, and to place it in the hands of the people. Let not the reader startle at this propo|sition. I shall give the following reasons for it.

1. In consequence of these pestilential fevers affecting a great number of people at one time, it has always been, and always will be impossible, for them all to have the benefit of medical aid, more especially as the proportion of physicians to the number of sick, is generally diminished upon these occasions, by desertion, sickness and death.

2. The safety of committing to the people the cure of pestilential fevers, particularly the yel|low fever and the plague, is established by the simplicity and uniformity of their proximate cause, and of their remedies. However diversified they may be in their symptoms, the system in both dis|eases is always under a state of indirect debility, and in all cases requires the abstraction of stimu|lus in a greater or less degree, or in a sudden or gradual manner. There can never be any danger of the people injuring themselves by mistaking any other disease for a yellow fever, or a plague, Page  326 for no other febrile disorder can prevail with them. It was probably to prevent this mistake, that the Benevolent Father of mankind, who has permitted no evil to exist which does not carry its antidote along with it, originally imposed that law upon all great and mortal epidemics.

3. The history of the yellow fever in the West Indies, proves the advantage of trusting patients to their own judgment. Dr Lind has remarked, that a greater proportion of sailors who had no physicians, recovered from that fever, than of those who had the best medical assistance. The fresh air of the deck of a ship, a purge of salt water, and the free use of cold water, probably triumphed here over the cordial juleps of phy|sicians.

4. By committing the cure of this and other pestilential diseases to the people, all those cir|cumstances which prevented the universal success of purging, and bleeding in our late epidemic, will have no operation. The fever will be mild in most cases, for all will prepare themselves to receive it by a vegetable diet, and by moderate evacuations. The remedies will be used the mo|ment the disease is felt, or even seen, and the con|tagion generated by it, will be feeble and propa|gated Page  327 only to a small distance from such patients. There will then be no disputes among physicians about the nature of the disease to distract the pub|lic mind, for they will seldom be consulted in it. None will suffer from chronic debility induced by previous fatigue, in attending the sick, nor from the want of nurses, for few will be so ill as to re|quire them, and there will be no "foreboding" fears of death or despair of recovery, to invite an attack of the disease, or to ensure its mortality.

The small-pox was once as fatal as the yellow fever and the plague. At present, it yields as universally to a vegetable diet, and evacuations, in the hands of apothecaries, the clergy, and even of the good women, as it does in the hands of Doctors of physic.

They have narrow conceptions, not only of the divine goodness, but of the gradual progress of human knowledge, who suppose that all pestilen|tial diseases shall not, like the small-pox, sooner or later cease to be the scourge and terror of man|kind.

For a long while air, water and even the light of the sun, were dealt out by physicians to their pa|tients with a sparing hand. They possessed for se|veral centuries the same monopoly of many artificial Page  328 remedies. But a new order of things is rising in medicine as well as in government. Air, water, and light are taken without the advice of a physi|cian, and bark and laudanum are now prescribed every where by nurses, and mistresses of families, with safety and advantage. Human reason cannot be stationary upon these subjects. The time must, and will come, when in addition to the above reme|dies, the general use of calomel, jalap, and the lancet, shall be considered among the most essen|tial articles of the knowledge, and rights of man.

It is no more necessary, that a patient should be ignorant of the medicine he takes to be cured by it, than that the business of government should be conducted with secrecy in order to ensure obedi|ence to just laws. Much less is it necessary that the means of life should be prescribed in a dead language, or dictated with the solemn pomp of a necromancer. The effects of imposture in every thing are like the artificial health produced by the use of ardent spirits. Its vigour is temporary, and is always followed by misery and death.

The belief that the yellow fever and the plague are necessarily mortal, is as much the effect of a superstitious torpor in the understanding, as the ancient belief, that the epilepsy was a supernatural disease, and that it was an offence against heaven Page  329 to attempt to cure it. It is partly from the influ|ence of this torpor in the minds of some people, that the numerous cures of the yellow fever per|formed by a few simple remedies, were said to be of other diseases. It is necessary, for the con|viction of such persons, that patients should always die of that, and other dangerous disorders, to prove that they have been affected by them.

The repairs which our world is undergoing, as far as they relate to the melioration of the condi|tion of man, will be incomplete, until pestilential fevers cease to be numbered among the widest outlets of human life.

There are many things which are now familiar to women and children which were known a cen|tury ago only to a few men who lived in closets, and were distinguished by the name of philoso|phers.

We teach an hundred things in our schools less useful, and many things more difficult, than the knowledge that would be necessary to cure a yel|low fever or the plague.

In my attempts to teach the citizens of Phila|delphia by my different publications, the method Page  330 of curing themselves of our late fever, I observed no difficulty in their apprehending every thing that was addressed to them, except what related to the different states of the pulse. All the know|ledge that is necessary to discover when blood-letting is proper, might be taught to a boy or girl of twelve years old in a few hours. I taught it in less time to several persons during the pre|valence of our late epidemic.

I should as soon believe that ratafia was intend|ed by the Author of Nature, to be the only drink of man, instead of water, as believe that the knowledge of what relates to the health and lives of a whole city, or nation, should be con|fined to one, and that a small or a privileged order of men.—But what have physicians, what have universities, or medical societies done after the labours, and studies of many centuries towards lessening the mortality of pestilential fevers? They have either copied, or contradicted each other in all their publications. Plagues and ma|lignant fevers, are still leagued with war and fa|mine, in their ravages upon human life.

Botallus in France, and Dr Sydenham in Eng|land, it is true, long ago used the proper remedies for those disorders with universal success; but Page  331 they were unable to introduce them into general practice. The reason is obvious: They recom|mended them in their writings only to physicians. At the expence of an immense load of obloquy, I have addressed my publications to the people. The appeal though hazardous, in the present state of general knowledge in medicine, has suc|ceeded. The citizens of Philadelphia are deliver|ed from their fears of copious evacuations, of cold air, and cold water, and above all, of a sore mouth from mercury, in the cure of the yellow fever; and the pride and formalities of medicine, as far as they relate to this disease, are now as completely discarded in our city, as the deceptions of witchcraft were, above a century ago.

To prevent the propagation and mortality of this fever, it will be necessary when it makes its appearance in a city or country, to publish an ac|count of those symptoms which I have called the precursors of the disease, and to exhort the peo|ple as soon they feel those symptoms, to have immediate recourse to the remedies of purging or bleeding. The danger of delay in using one, or both those remedies, should be inculcated in the strongest terms, for the disease, like Time, has a lock on its forehead, but is bald behind. The bite of a rattle-snake is seldom fatal, because the Page  332 medicines which cure it, are applied, or taken, as soon as the poison comes in contact with the blood. There is less danger to be apprehended from the contagion of the yellow fever in the system than from the poison of the snake, provided the reme|dies for it, are administered within a few hours after it is excited into action.

Let persons who are subject to chronic pains, or diseases of any kind, be advised not to be deceiv|ed by them. Every pain at such a time, is the beginning of the disease; for the contagion I have said, always acts first on debilitated parts of the body. From an ignorance of this law of epide|mics many persons by delaying their applications for help, perished with our late fever.

Let nature be trusted in no case whatever, to cure this disease; and let no attack of it, however light, be treated with neglect. Death as cer|tainly performs his work, when he steals on the system in the form of a mild intermittent, as he does, when he comes on with the symptoms of apoplexy, or a black vomiting.

Cleanliness in houses and dress, cannot be too often inculcated during the prevalence of a yellow fever.

Page  333 Lastly, Let those who are in health be directed to prepare their bodies by means of a low diet, for the reception of the disease in the manner that has been formerly mentioned; and let pleasure, and even labour, where it exposes men to the heat of the sun, or of a culinary fire, be every where sus|pended. Thus, while the system is prepared to bend like the willow, the contagion of the fever will pass over it, without doing any harm.

Let it not be supposed, that I mean, that the history which I have given of the method of cure of our late epidemic, should be applied in all its parts, to the yellow fevers which may appear hereafter in the United States, or which exist at all times in the West India islands. Season and climate vary this, as well as all other diseases. Bark and wine, so fatal in our late, may be pro|per in a future yellow fever. But without the fear of being refuted, I will notwithstanding assert, that the proper remedies for this fever at all times, and in all places in its first stage, must be evacuations. The only inquiry, when the disease makes its appearance, should be, from what part of the body these evacuations should be procured; the order which should be pursued in obtaining them, and the quantity of each of the matters to Page  334 be discharged, which should be withdrawn at a time.

Thus far did I venture from my theory of the disease, and from the authorities of Dr Hillary and and Dr Mosely, to decide in favour of evacua|tions in the yellow fever in hot climates; but Dr Wade, and Mr Chisholm again support me by their practice in the fevers of the East and West Indies. They both gave strong mercurial pur|ges, and bled in some cases. Dr Wade confirm|ed by his practice, the advantage, of gradually abstracting stimulus from the system. He never drew blood even in the most inflammatory cases, until he had first discharged the contents of the bowels. The Doctor has further established the efficacy of a vegetable diet, and of water as a drink, as the best means of preventing the disor|der in a hot climate.

The manner in which the contagion of the plague acts upon the system, is so much like that which has been described in the yellow fever, and the accounts of the efficacy of low diet in pre|paring the body for its reception, and of copious bleeding, cold air and cold water, in curing it, are so similar, that all the directions which relate Page  335 to preventing, mitigating, or curing the yellow fever, may be applied to it. The fluids in the plague shew a greater tendency to the skin, than they do, in the yellow fever. Perhaps upon this account, the early use of powerful sudorifics may be more proper in the former, than in the latter disorder. From the influ|ence of early purging, and bleeding in pro|moting sweat in the yellow fever; there can be little doubt, but the efforts of nature to unload the system in the plague through the channel of the pores, might be accelerated by the early use of the same remedies. One thing with respect to the plague is certain; that its cure depends upon the abstraction of stimulus, either by means of plentiful sweats, or of purulent matter from ex|ternal sores. Perhaps the efficacy of these re|medies depends wholly upon their diminishing the indirect debility of the system in a gradual manner. If this be the case, those natural dis|charges might be easily and effectually imitated by small and repeated bleedings.

To correspond in quantity with the discharge from the skin, blood-letting in the plague should be copious. A profuse sweat continued for twen|ty four hours, cannot fail of wasting many pounds of the fluids of the body. This was the duration Page  336 of the critical sweats in the famous plague which was known by the name of the English sweating sickness, and which made its appearance in the army of Henry VII. in Milford-Haven in Wales, and spread from thence through every part of the kingdom.

The principles which lead to the prevention and cure of the yellow fever and the plague, apply with equal force to the mitigation of the measles, and to the prevention or mitigation of the scarlatina anginosa, the dysentery, and the jail or hospital fe|ver. I have remarked in a former publication*, that a previous vegetable diet lessened the violence and danger of the measles. Dr Sims taught me seve|ral years ago, to prevent or mitigate the scarlatina anginosa, by means of gentle purges after children are infected by it†. Purges of salts have in many instances preserved whole families and neighbour|hoods from the dysentery where they have been exposed to the contagion. During the late Ame|rican war, an emetic seldom failed of preventing an attack of the hospital fever, when given in its forming state‡. I have had no experience of the Page  337 effects of previous evacuations in abating the vio|lence, or preventing the mortality of the malig|nant sore throat, but I can have no doubt of their efficacy from the sameness of the state of the sys|tem in that disorder, as in other malignant fevers. The debility induced in it, is of the indirect kind, and the supposed symptoms of putrefaction, are nothing but the disguised effects of a sudden and violent pressure of an inflammatory stimulus upon the arterial system.

With these observations I close the history of the rise, progress, symptoms, and treatment of the bilious remitting yellow fever which lately ap|peared in Philadelphia. My principal aim has been to revive, and apply to it, the principles, and practice of Dr. Sydenham, and however coldly those principles, and that practice may be received by some physicians of the present day, I am satis|fied that experience in all ages, and in all coun|tries will vouch for their truth and utility.

Page  339

NARRATIVES of escapes from great dangers of shipwreck, war, captivity, and famine, have always formed an interesting part of the history of the body, and mind of man. But there are deliverances from equal dangers, which have hitherto passed unnoticed; I mean, from pestilential fevers. I shall briefly describe the state of my body and mind, during my intercourse with the sick in our late epidemic. The account will throw additional light upon the disorder, and pro|bably illustrate some of the laws of the animal economy. It will moreover serve to furnish a lesson to all who may be placed in similar circum|stances, to commit their lives without fear, to the protection of that BEING who is able to save to the uttermost, not only from future, but from pre|sent evil.

Some time before the fever made its appearance, my wife and children went into the state of New-Jersey where they had long been in the habit of spending the summer months. My family about Page  340 the 25th of August, consisted of my mother, a sis|ter who was on a visit to me, a black servant man, and a mulatto boy. I had five pupils, viz. Warner Washington, and Edward Fisher, of Virginia, John Alston of South Carolina, and John Red|man Coxe (grandson to Dr Redman) and John Stall both of this city. They all crouded around me upon the sudden encrease of business, and with one heart devoted themselves to my service, and to the cause of humanity.

The credit which the new mode of treating the disease acquired in all parts of the city, produced an immense influx of patients to me from all quar|ters. My pupils were constantly employed; at first in putting up purging powders, but after a while 〈◊〉 in bleeding and visiting the sick.

Between the eighth and the 15th of September I visited and prescribed for, between an hundred and an hundred and twenty patients a day. Several of my pupils visited a fourth or fifth part of that number. For a while we refused no calls. In the short intervals of business which I spent at my meals, my house was filled with patients, chiefly the poor, waiting for advice. For many weeks I seldom ate without prescribing for numbers as I sat at my table. To assist me at these hours, as Page  341 well as in the night, Mr Stall, Mr Fisher and Mr Coxe accepted of rooms in my house, and became members of my family. Their labours now had no remission.

Immediately after I adopted the antiphlogistic mode of treating the disorder, I altered my man|ner of living. I left off drinking wine and malt liquors. The good effects of the disuse of these liquors, helped to confirm me in the theory I had adopted of the disease. A troublesome head-ach, which I had occasionally felt, and which excited a constant apprehension that I was taking the fe|ver, now suddenly left me. I likewise at this time left off eating solid animal food, and lived wholly, but sparingly, upon weak broth, pota|toes, raisins, coffee, and bread and butter.

From my great intercourse with the sick, my body became highly impregnated with the conta|gion. My eyes were yellow, and sometimes a yellowness was perceptible in my face. My pulse was preternaturally quick, and I had profuse sweats every night. These sweats were so offen|sive as to oblige me to draw the bed-cloths close to my neck to defend myself from their smell. They lost their foetor entirely upon my leaving Page  342 off the use of broth, and living intirely upon milk and vegetables. But my nights were ren|dered disagreeable, not only by these sweats, but by the want of my usual sleep, produced in part by the frequent knocking at my door, and in part by anxiety of mind, and the stimulus of the con|tagion upon my system. I lay down in conformi|ty to habit only, for my bed ceased to afford me rest or refreshment. When it was evening, I wished for morning; and when it was morning, the prospect of the labours of the day, caused me to wish for the return of evening. The degrees of my anxiety may be easily conceived, when I add, that I had at one time upwards of thirty heads of families under my care: among these were Mr Josiah Coates, the father of eight, and Mr Benjamin Scull, and Mr John Morrell, each fathers of ten children. They were all in immi|nent danger; but it pleased God to make me the instrument of saving each of their lives. I rose at 6 o'clock, and generally found a number of persons waiting for advice in my shop or parlour. Hitherto the success of my practice gave a tone to my mind, which imparted preternatural vigour to my body. It was meat and drink to me to ful|fil the duties I owed to my fellow citizens in this time of great and universal distress. From a hope Page  343 that I might escape the disease, by avoiding every thing that could excite the contagion in my body into action, I carefully avoided the heat of the sun, and the coldness of the evening air. I like|wise avoided yielding to every thing that should raise or depress my passions. But at such a time, the events which influence the state of the body and mind are no more under our command, than the winds or weather. On the evening of the 14th of September, after eight o'clock, I visited the son of Mrs Berriman, near the Swedes' church, who had sent for me early in the morn|ing. I found him very ill. He had been bled in the forenoon by my advice, but his pulse indicat|ed a second bleeding. It would have been diffi|cult to procure a bleeder at that late hour. I therefore bled him myself. From hanging over his breath and blood for ten minutes, and after|wards riding home in the night air, debilitated as I was by the labours of the day, I found myself much indisposed the ensuing night. I rose not|withstanding at my usual hour. At 8 o'clock I lost ten ounces of blood, and immediately after|wards got into my chair, and visited between for|ty and fifty patients before dinner. At the house of one of them, I was forced to lie down a few minutes. In the course of this morning's labours, my mind was suddenly thrown off its pivots, by Page  344 the last look, and the pathetic cries of a friend for help, who was dying under the care of a French physician. I came home about two o'clock, and was seized immediately afterwards with a chilly fit and a high fever. I took a dose of the mercurial medicine, and went to bed. In the evening I took a second purging powder, and lost ten ounces more of blood. The next morning I bathed my face, hands, and feet in cold water for some time. I drank plentifully during the day and night of weak hyson tea, and of water, in which currant jelly had been dissolved. At eight o'clock I was so well as to admit persons who came for ad|vice into my room, and to receive reports from my pupils of the state of as many of my patients as they were able to visit; for unfortunately they were not able to visit them all (with their own) in due time; by which means several died. The next day I came down stairs, and prescribed in my parlour for not less than an hundred people. On the 19th of the same month, I resumed my la|bours, but in great weakness. It was with diffi|culty that I ascended a pair of stairs, by the help of a banister. A slow fever, attended with irre|gular chills, and a troublesome cough, hung con|stantly upon me. The fever discovered itself in the heat of my hands, which my patients often told me were warmer than their own. The con|tagion Page  345 now began to affect me in small and infect|ed rooms, in the most sensible manner. On the morning of the 4th of October I suddenly sunk down in a sick room upon a bed, with a giddiness in my head. It continued for a few minutes, and was succeeded by a fever which confined me to my house the remaining part of the day.

Every moment in the intervals of my visits to the sick, was employed in prescribing in my own house for the poor, or in sending answers to mes|sages from my patients; time was now too pre|cious to be spent in counting the number of per|sons who called upon me for advice. From cir|cumstances, I believe it was frequently 150, and seldom less than 50 in a day, for five or six weeks. The evening did not bring with it the least relax|ation from my labours. I received letters every day from the country, and from distant parts of the Union, containing inquiries into the mode of treating the disorder, and after the health and lives of persons who had remained in the city. The business of every evening was to answer these letters, also to write to my family. These em|ployments by affording a fresh current to my thoughts, kept me from dwelling on the gloomy scenes of the day. After these duties were per|formed, I copied into my note book all the obser|vations Page  346 I had collected during the day, and which I had marked with a pencil in my pocket book in sick rooms, or in my carriage. To these constant labours of body and mind were added distresses, from a variety of causes. Having found myself unable to comply with the numerous applications that were made to me, I was obliged to refuse many, every day. My sister counted forty seven in one forenoon before 11 o'clock. Many of them left my door with tears, but they did not feel more distress than I did, from refusing to fol|low them. Sympathy when it vents itself in acts of humanity, affords pleasure, and contributes to health, but the reflux of pity, like anger, gives pain, and disorders the body. In riding through the streets, I was often forced to resist the entreaties of parents imploring a visit to their children, or of children to their parents. I recollect, and even yet, I recollect with pain, that I tore myself at one time from five persons in Moravian-alley who at|tempted to stop me; by suddenly whipping my horse, and driving my chair as speedily as possible beyond the reach of their cries.

The solicitude of the friends of the sick for help, may further be conceived of, when I add, that the most extravagant compensations were sometimes offered for medical services, and in one Page  347 instance, for only a single visit. I had no merit in refusing these offers, and I have introduced an ac|count of them, only to inform such physicians as may hereafter be thrown into a similar situation, that I was favoured with an exemption from the fear of death, in proportion as I subdued every selfish feeling, and laboured exclusively for the be|nefit of others. In every instance in which I was forced to refuse these pathetic and earnest appli|cations, my distress was heightened by the fear, that the persons whom I was unable to visit, would fall into improper hands, and perish by the use of bark, wine, and laudanum.

But I had other afflictions besides the distress which arose from the abortive sympathy which I have described. On the 11th of September, my ingenious pupil Mr Washington, fell a victim to his humanity. He had taken lodgings in the coun|try, where he sickened with the disorder. Having been almost uniformly successful in curing others, he made light of his fever, and concealed the knowledge of his danger from me, until the day before he died. On the 18th of September Mr Stall sickened in my house. A delirium attended his fever from the first hour it affected him. He refused, and even resisted force when used to com|pel him to take medicine. He died on the 23d Page  348 of September*. Scarcely had I recovered from the shock of the death of this amiable youth, when I was called to weep for a third pupil, Mr Alston, who died in my neighbourhood, the next day. He had worn himself down before his sickness, by uncom|mon exertions in visiting, bleeding, and even sit|ting up with sick people. At this time Mr Fisher was ill in my house. On the 26th of the month at 12 o'clock Mr Coxe my only assistant was seized with the fever, and went to his grand father's. Page  349 I followed him with a look, which I feared would be the last, in my house. At two o'clock my sister who had complained for several days, yielded to the disorder, and retired to her bed. My mother followed her, much indisposed, early in the evening. My black servant man had been confined with the fever for several days, and had on that day for the first time quitted his bed. My little mulatto boy of eleven years old, was the only person in my fa|mily who was able to afford me the least assistance. At 8 o'clock in the evening, I finished the business of the day. A solemn stillness at that time per|vaded the streets. In vain did I strive to forget my melancholy situation by answering letters, and by putting up medicines to be distributed next day among my patients. My faithful black man crept to my door, and at my request sat down by the fire, but he added by his silence and dullness, to the gloom which suddenly overpowered every faculty of my mind.

On the first day of October at two o'clock in the afternoon, my sister died. I got into my carriage within an hour after she expired, and spent the af|ternoon in visiting patients. According as a sense of duty, or as grief has predominated in my mind, I have approved, and disapproved of this act, ever since. She had borne a share in my labours. She Page  350 had been my nurse in sickness, and my casuist in my choice of duties. My whole heart reposed itself in her friendship. Upon being invited to a friend's house in the country, when the disease made its appearance in the city, she declined ac|cepting the invitation, and gave as a reason for so doing, that I might probably require her ser|vices in case of my taking the disorder, and that if she were sure of dying, she would remain with me, provided that by her death, she could save my life. From this time I declined in health and strength. All motion became painful to me. My appetite began to fail. My night sweats conti|nued. My short and imperfect sleep, was disturbed by distressing, or frightful dreams. The scenes of them were derived altogether from sick rooms, and grave yards. I concealed my sorrows as much as possible from my patients, but when alone, the retrospect of what was past, and the prospect of what was before me, the termination of which was invisible, often filled my soul with the most poignant anguish. I wept frequently when retired from the public eye, but I did not weep over the lost members of my family alone. I be|held or heard every day of the deaths of citizens useful in public, or amiable in private life. It was my misfortune to lose as patients, the Rev. Mr Fleming and Mr Graesel, both exhausted by their Page  351 labours of piety and love among the poor, before they sickened with the disorder. I saw the last struggles of departing life in Mr Powel, and de|plored in his death, an upright and faithful servant of the public, as well as a sincere and affectionate friend. Often did I mourn over persons who had by the most unparalleled exertions, saved their friends and families from the grave, at the expence of their own lives. Many of these martyrs to humanity, were in humble stations. Among the members of my profession with whom I had been most intimately connected, I had daily cause of grief and distress. I saw the great and expanded mind of Dr Penington, shattered by delirium, just before he died. He was to me dear and beloved, like a younger brother. He was moreover a Joab in the contest with the disease. Philadelphia must long deplore the premature death of this ex|cellent physician. Had he lived a few years lon|ger, he would have filled an immense space in the republic of medicine*. It was my affliction to see my friend Dr John Morris breathe his last, and Page  352 to hear the first effusions of the most pathetic grief from his mother, as she bursted from the room in which he died. But I had distress from the sick|ness, as well as the deaths of my brethren in physic. My worthy friends Dr Griffitts. Dr Say, and Dr Mease, were suspended by a thread over the grave, nearly at the same time. Heaven in mercy to me, as well as in kindness to the public, and their friends, preserved their lives. Had they died, the measure of my sorrows would have been com|plete.

I have said before, that I early left off drinking wine; but I used it in another way. I carried a little wine in a vial in my pocket, and when I felt myself fainty, after coming out of a sick room, or after a long ride, I kept about a spoonful of it in my mouth for half a minute, or longer, without swallowing it. So weak and excitable was my system, that this small quantity of wine refreshed and invigorated me as much as half a pint would have done at any other time. The only diffe|rence was, that the vigour I derived from the wine in the former, was of shorter duration than when taken in the latter way.

For the first two weeks after I visited patients in the yellow fever, I carried a rag wetted with Page  353 vinegar, and smelled it occasionally in sick rooms: but after I saw and felt the signs of the universal presence of the contagion in my system, I laid aside this, and all other precautions. I rested my|self on the bed-side of my patients, and I drank milk, or eat fruit in their sick rooms. Besides be|ing saturated with the contagion, I had another security against being infected by my patients, and that was, I went into scarcely a house which was more infected than my own. Most of the people who called upon me for advice, left a por|tion of contagion behind them. Four persons died next door to me on the east; three a few doors above me on the west; and five in a small frame house on the opposite side of the street, to|wards the south. On the north side, and about 150 feet from my house, the fever prevailed with great malignity in the family of Mr James Cres|son. But this was not all. Many of the poor people who called upon me for advice, were bled by my pupils in my shop, and in the yard, which was between it, and the street. From the want of a sufficient number of bowls to receive their blood, it was sometimes suffered to flow and pu|trify upon the ground. From all these sources, streams of contagion were constantly poured into my house, and conveyed into my body by the air, and in my aliment. Thus charged with the fuel Page  354 of death, I was frequently disposed to say with Job, and almost without a figure, to "corrup|tion, thou art my father; and to the worm, thou art my mother and my sister."

The deaths of my pupils and sister have often been urged as objections to my mode of treating the fever. Had the same degrees of labour and fatigue which preceded the attack of the yellow fever in each of them, preceded an attack of a common pleurisy, I think it probable that some, or perhaps all of them, would have died with it. But when the influence of the concentrated con|tagion which filled my house, was added to that of constant fatigue upon their bodies, what reme|dies could be expected to save their lives? Un|der the above circumstances, I consider the reco|very of the other branches of my family from the fever (and none of them escaped it) with emo|tions, such as I should feel, had we all been revived from apparent death, by the exertions of a hu|mane society.

In getting hastily out of my carriage about the 22d of September, I wounded one of my fingers with a small nail. As my hands were constantly exposed to the contagion of the fever in feeling pulses, I had this wound carefully wrapped up, Page  355 from an apprehension that the contagion when received directly into the blood, might more cer|tainly excite the fever, than when received in the ordinary way. In the hurry of business, the rag dropped off my finger without my noticing it. The wound inflamed, but healed notwithstanding in a few days, and I found no inconvenience from it.

The issue of this accident was highly satisfacto|ry to me, as it established the analogy between the small-pox and yellow fever, and confirmed me in the propriety of preparing the body for the re|ception of the latter, by the same regimen, as for the former disorder.

For upwards of six weeks I did not taste ani|mal food, nor fermented liquors of any kind. The quantity of aliment which I took inclusive of drinks, during this time, was frequently not more than one or two pounds in a day. Yet upon this diet, I possessed for a while uncommon activity of body. This influence of abstinence upon bodily exertion, has been happily illustrated by Dr Jackson in his directions for preserving the the health of soldiers in hot climates. He tells us, that he walked an hundred miles in three days in Jamaica, during which time he breakfasted on tea, supped on bread and sallad, and drank nothing Page  356 but lemonade or water. He adds further, that he walked from Edinburgh to London in eleven days and an half, and that he travelled with the most ease when he only breakfasted and supped, and drank nothing but water. The fatigue of riding on horseback, is prevented or lessened by abstinence from solid food. Even the horse suffers least from a quick and and long journey, when he is fed sparingly with hay. These facts add weight to the arguments formerly adduced, in favour of a vegetable diet in preventing or mitigating the action of the contagion of malig|nant fevers upon the system. In both cases the abstraction of stimulus, removes the body fur|ther from the reach of indirect debility.

Food supports life as much by its stimulus, as by affording nourishment to the body. Where an artificial stimulus acts upon the system, the natural stimulus of food ceases to be necessary. Under the influence of this principle, I encreased, or diminished my food with the signs I discover|ed of the encrease, or diminution of the contagion in my body. Until the 15th of September I drank weak coffee, but after that time, I drank nothing but milk, or milk and water in the inter|vals of my meals. I was so satisfied of the efficacy of this mode of living, that I believed life Page  357 might have been preserved, and a fever prevented, for many days with a much greater accumulation of the contagion in my system, by means of a total abstinence from food. Poison is a relative term, and an excess in quantity, or a derangement in place, is necessary to its producing deleterious effects. The contagion of the yellow fever pro|duced sickness and death, only from the excess of its quantity, or from its force being encreased by the addition of those other stimuli which I have elsewhere called exciting causes.

In addition to low diet, as a preventive of the disorder, I obviated costiveness by taking occa|sionally a calomel pill, or by chewing rhubarb.

I had read, and taught in my lectures, that fasting encreases acuteness in the sense of touch. My low living had that effect in a certain degree upon my fingers. I had a quickness in my per|ception, of the state of the pulse in the yellow fever, that I had never experienced before in any other disorder. My abstemious diet, assisted perhaps by the state of my feelings, had like|wise an influence upon my mind. Its operations were performed with an ease, and a celerity, which rendered my numerous, and complicated duties, much less burdensome, than they would Page  358 probably have been under other circumstances of diet, or a less agitated state of my passions.

My perception of the lapse of time was new to me. It was uncommonly slow. The ordinary business and pursuits of men appeared to me in a light that was equally new. The herse and the grave mingled themselves with every view I took of human affairs. Under these impressions I re|collect being as much struck with observing a number of men employed in digging the of cellar a large house, as I should have been at any other time, in seeing preparations for building a palace upon a cake of ice. I recollect further, being struck with surprise about the 1st of October, in seeing a man busily employed in laying in wood for the approaching winter. I should as soon have thought of making provision for a dinner on the first day of the year 1800.

In the account of my distresses, I have passed over the slanders which were propagated against me by some of my brethren. I have mentioned them only for the sake of declaring in this public manner, that I most heartily forgive them; and that if I discovered at any time, an undue sense of the unkindness and cruelty of those slanders, it was not because I felt myself injured by them, but Page  359 because I was sure they would irreparably injure my fellow citizens, by lessening their confidence in the only remedies that I believed to be effectual in the reigning epidemic. One thing in my con|duct towards these gentlemen may require justifi|cation; and that is, my refusing to consult with them. A Mahometan and a Jew might as well attempt to worship the Supreme Being in the same temple, and through the medium of the same ceremonies, as two physicians of opposite principles and practice, attempt to confer about the life of the same patient. What is done in censequence of such negotiations (for they are not consultations) is the ineffectual result of neu|tralised opinions; and wherever they take place, would be considered as the effect of a criminal compact between physicians, to assess the property of their patients, by a shameful prostitution of the dictates of their consciences. Besides, I early dis|covered that it was impossible for me by any rea|sonings, to change the practice of some of my bre|thren. Humanity was therefore on the side of leaving them to themselves; for the extremity of wrong in medicine, as in morals and government, is often a less mischief, than that mixture of right and wrong which serves by palliating, to perpetu|ate evil.

Page  360 After the loss of my health, I received letters from my friends in the country, pre••••g me in the strongest terms to leave the city. Such a step had become impracticable. My aged mother was too infirm to be removed, and I could not leave her. I was moreover, part of a little circle of physi|cians, who had associated themselves in support of the new remedies. This circle would have been broken by my quitting the city. The weather varied the disease, and in the weakest state of my body, I expected to be able from the reports of my pupils, to assist my associates in detecting its changes, and in accommodating our remedies to them. Under these circumstances, it pleased God to enable me to reply to one of the letters that urged my retreat from the city, that "I had resolved to stick to my principles, my practice, and my patients, to the last extremity."

On the ninth of October, I visited a consider|able number of patients, and as the day was warm, I lessened the quantity of my clothing. Towards evening I was seized with a pain in the back, which obliged me to go to bed at eight o'clock. About twelve I awoke with a chilly fit. A violent fever with acute pains in different parts of my bo|dy, followed it. At one o'clock I called for Mr Fisher who slept in the next room. He came in|stantly, Page  361 with my affectionate black man to my re|lief. I saw my danger painted in Mr Fisher's countenance. He bled me plentifully and gave me a dose of the mercurial medicine. This was immediately rejected. He gave me a second dose, which likewise acted as an emetic, and discharged a large quantity of bile from my stomach. The remaining part of the night was passed under an apprehension that my labours were near an end. I could hardly expect to survive so violent an at|tack of the fever, broken down, as I was, by labour, sickness and grief. My wife and seven children, whom the great and distressing events that were passing in our city, had jostled out of my mind for six or seven weeks, now resumed their former place in my affections. My wife had stipulated, in consenting to remain in the country, to come to my assistance in case of my sickness; but I took measures, which, without alarming her, proved effectual in preventing it. My house was a Lazaretto, and the probability of my death, made her life doubly necessary to my family. In the morning, the medicine operated kindly, and my fever abated. In the afternoon it returned, attended with a great inclination to sleep. Mr Fisher bled me again which removed the sleepiness. The next day the fever left me, but in so weak a state, that I awoke two successive nights with a Page  362 faintness which threatened the extinction of my life. It was removed each time by taking a little aliment. My convalescence was extremely slow. I returned in a very gradual manner to my former habits of diet. The smell of animal food, the first time I saw it at my table, forced me to leave the room. During the month of November, and all the winter months I was harrassed with a cough, and a fever somewhat of the hectic kind. The early warmth of the spring, removed those complaints, and I now enjoy, through divine goodness, my usual state of health.

I should be deficient in gratitude, were I to con|clude this narrative without acknowledging my obligations to my surviving pupils Mr Fisher and Mr Coxe, for the great support and sympathy I derived from them in my labours and distresses.

I take great pleasure likewise in acknowledging my obligations to my former pupil Dr Woodhouse, who assisted me in the care of my patients, after I became so weak as not to be able to attend them with the punctuality their cases required. The disinterested exploits of these young gentlemen in the cause of humanity, and their success in the treatment of the disorder, have endeared their names to hundreds, and at the same time, afforded Page  363 a prelude of their future eminence and usefulness in their profession.

But wherewith shall I come before the great FATHER and REDEEMER of men, and what shall I render unto him for the issue of my life, from the grave?

—Here all language fails—

"Come then, expressive silence, muse his praise."