A brief history of epidemic and pestilential diseases; with the principal phenomena of the physical world, which precede and accompany them, and observations deduced from the facts stated. : In two volumes. / By Noah Webster, author of Dissertations on the English language and several other works--member of the Connecticut Academy of Arts and Sciences--of the Society for the Promotion of Agriculture, Arts and Manufactures, in the state of New-York--of the American Academy of Arts and Sciences, and corresponding member of the Historical Society in Massachusetts. ; Vol. I[-II].

SECTION XIII. Of the order, connection and progression of pestilential epidemics.

IN the early periods of the world, little notice appears to have been taken of a connection between epidemic diseases; nor have modern writers supplied this defect in the history of medicin. Hippocrates and Sydenham seem to have been aware of such a connection, and the latter author has laid broad and firm foun|dation for a complete system of truth, on the subject of epidem|ics. His observations were confined to the city of London. Had he extended his view to all parts of Europe, and general|ized his observations, he would have found a multitude of facts to justify his theory, and probably would have raised it above the reach of that obloquy and ridicule, which succeeding professors of physic, of less genius and learning, have c••••t on his occult qualities of air.

Indeed, it is surprising that medical men have not pursued the ideas suggested by these great fathers of their science. Hippo|crates led the way, unlocking the great doctrin of a constitution or state of the atmosphere, calculated to produce particular epi|demic diseases; a doctrin which Sydenham has pursued with wonderful success. Any man who reads the history of diseases, must see that certain species of them appear nearly together in time and place. The order in which they appear, may not be exactly the same at all times, and in all countries; but they oc|cur so nearly together, as evidently to prove their alliance, and their dependence on the same general causes.

All popular diseases must have, for their causes, some princi|ples as extensive as the effects. These causes most probably exist in the elements, fire, air and water; for we know of no other medium by which diseases can be communicated to whole com|munities of people▪

Bad food indeed is a fruitful source of diseases; but this must always proceed from the qualities of the elements which enter into its composition. A defect therefore in the nourishing powers of food, is a consequence of a defect or superabundance in the elements, or in their combination in animal and vegetable produc|tions. It may be considered as a disease in the animal and veg|etable kingdom, which most probably proceeds from the same causes, as epidemic distempers among mankind.

The principal epidemic distempers which invade mankind, are, catarrh or influenza, measles, whooping or chin cough, the dif|ferent species of angina, small pox, bilious fevers, petechial fe|ver, dysentery, plague. Of these, catarrh is the most decided|ly an epidemic dependent wholly on a particular state of atmos|phere. Cullen calls it "catarrh from contagion," to distinguish it from sporadic cases of the same disease; but, after careful ob|servation, during the progress of it in the United States in 1789, and again in 1790, I am confident the progress of the disease de|pends very little on a communication from person to person. It has been doubted whether it is an infectious disease; and I have some evidence to prove it not so; but certain it is, that its sud|den invasion of whole families, whole towns and even whole countries, and the rapidity of its progress over sea and land, ab|solutely preclude the supposition of its dependence on specific contagion.

The other diseases above enumerated may arise from both cau|ses—infection and a peculiar state of air. Some of them de|pend mostly on a constitution of air, fitted to produce them; others are seldom produced without a connection with diseased persons. It is however proper to observe that the small-pox, dys|entery and plague are not usually, and in strictness of language, epidemic diseases. They seldom invade whole countries. They are more properly endemic; yet this epithet is not strictly appli|cable to them; being used more properly to denote a disease which is peculiar to a particular place, whereas those diseases may invade any place on the globe. The elephantiosis is an endemic in Egypt and certain other places in warm climates; the small-pox, dysentery and plague usually appear in cities, camps, or

other unhealthy situations, without affecting neighboring places, which contain not the same local causes of disease. They might therefore, in strict propriety, be denominated temporary endemics, in opposition to epidemics which spread to all places alike; and to endemics, which constantly or usually appear in particular parts of the world.

This distinction however is not very material; and I shall therefore speak of the small-pox, dysentery and plague, as epi|demic diseases; meaning by this epithet, that they, at certain times, spread generally over a particular town or region.

The nature and kinds of contagion will be more particularly considered, in a subsequent section; the present subject, is, the order, connection, and progression observable in pestilential epi|demics.

The influence of a certain state of air in generating epidemics was observed by Hippocrates, who has described the prevalent diseases, in different seasons. In his second section on epidem|ics, he describes what he calls "Katastasis loimodes," a pesti|lential state of the air or seasons. He does not indeed in this passage mention the plague, but he speaks of those malignant dis|eases which are, in modern times, the precursors of the plague, and which are now produced by the state of weather which he describes.

This state of the seasons he represents thus, "The year was austrinus, remarkable for southerly breezes, rainy and without winds. The first part of the year dry, and autumn rainy, with southerly winds, humid and cloudy. In winter, southerly winds, moist and mild weather. About the vernal equinox, se|vere cold, but the north winds, with snow, were of no long du|ration. Spring was again calm, southerly weather—great rains continued till August—then clear hot weather—the cool Elesian winds blew but little and for short periods. A rainy autumn, with north winds."

The southerly, hot, humid air here described, whenever of long continuance in summer, proves the cause of numerous ma|lignant diseases, in the United States, as well as in Europe, al|tho not certainly productive of pestilence.

Hippocrates proceeds to mention the diseases which prevailed in this state of seasons. "Before spring, even during the cold weather, appeared many erysipelous diseases of a malignant type. Diseases of the fauces, accompanied with hourseness, ardent fe|vers, with phrenitis; ulcers in the mouth; inflammation of eyes, carbuncles, &c. These diseases spread and became epidemic and mortal." The author then proceeds to describe the erys••pelas and other diseases here named. These cases differ from the plague in Athens; and prove that the pestilence in Thasus, where he wrote, was of milder symptoms, though probably cotemporary with that epidemic in Athens.

My particular reason for reciting these passages from Hippoc|rates, is, to prove a progressiveness in a pestilential state of air, and the diseases which it produces. The diseases here mention|ed are the same, substantially, as those which precede the plague in modern times, in the countries bordering on the Mediterra|nean, and with little variation, the same with those which pre|cede the plague in all parts of the world. Erysipelous, or other eruptive diseases, catarrhous affections, or ardent fevers, are the constant precursors of the plague, wherever it appears. Hip|pocrates does not mention any fatal plague, in the state of air described; and it often happens, at this day, that the strength of the pestilential principle is arrested in its progress, and the ep|idemics are limited, in their violence, to diseases of a type less malignant than the true plague, or arising to the plague only in a few scattering cases. But whatever may be the degree of the pestilential state of the air, or at whatever point, it may be des|tined to cease, and yield to a more salubrious constitution, the class of diseases which mark its rise and progress, are always simi|lar, or the same, modified only in the violence of their symptoms, by accidental circumstances.

A careful attention to these facts, cannot fail to convince the observer of the justness of Sydenham's doctrines, in regard to constitutions of air; and the facts themselves demolish, at one stroke, all the common medical doctrines of the communication of pestilence from place to place by contagion, or fomites.

Unfortunately, the histories of ancient plagues furnish but

little light on this subject; yet the barren annals of antiquity and the middle ages, are not wholly destitute of evidence to this point. The progression of the plague in Rome, growing more general and fatal to the second and third year, is a fact re|corded by Livy, and is related in the preceding pages.

The remark of Dion Cassius, that the ashes from Vesuvius, in the great eruption of 79, produced, that year, only slight diseases, but the next year, an epidemic, has already been no|ticed. It leaves no room to question, that the destructive plague of the year 80, was preceded by epidemic disorders of a less ma|lignant type.

The middle ages furnish facts in confirmation of this doctrin. Witness the great plague in 1112, which was preceded by ery|sipelous diseases in England in 1109, and great mortality in 1111. The plague of 1242, which was preceded by great mortality in 12••0—the same fact is observable in the pestilence of 1252, 1368, 1379, 1390, 1517, 1527, 1575, 1636—and in many other instances.

This fact did not escape the notice of that accurate observer of nature, Lord Bacon, who lived at a period when the plague frequently infested England. He says, "The lesser infections of the small-pox, purple fever, agues, &c. in the preceding sum|mer, and hovering all the winter, portend a great pestilence the fol|lowing summer, for putrefaction rises not to its height at once." Works, vol. 3, p. 59.

That state of air which produces pestilential diseases, Lord Bacon denominates putrefaction; but whatever appellation we may give to the cause of pestilence, the remark is demonstrably well founded, that this "rises not to its height at once." It is progressive; producing first the "lesser infections." The plague is rarely, if ever, an original, distinct, isolated disease; but the last or most mortal form of a series of malignant distempers. The purple fever mentioned by Lord Bacon is nearly allied to the petechial fever, which is the usual precursor of pestilence in the Levant.

The universal plague of 1635, 6 and 7, was preceded by the

usual diseases, and the progress of them is distinctly traced by the learned Diemerbroeck. He remarks, chap. 3 de peste, that "the spring of 1635, was warm and moderately humid, to which succeeded a very hot, dry season, in which appeared many ma|lignant epidemics. In the first place, a severe plague broke out at Leyden, and destroyed more than 20,000 lives. At Ni|meguen, in Gueldres and other regions, a certain pestilent fe|ver spread with dreadful mortality. In autumn, the severe heat still continuing with excessive drouth, many other malignant dis|eases appeared, as small-pox, measles, diarrhea and dysentery of a very bad type; but above all, the above mentioned pestilential purple fever, called in Italy petechial, increased daily in extent and violence, until it turned into the true plague—"donec tandem in apertissimam pestem transiret."—The author goes on to remark that from November through the winter, scattering cases of plague occurred in Nimeguen. In January 1636, it increased, and in March spread and became epidemic—rose to its height in April, and continued till October. See pages 5 and 6.

This passage contains a number of important facts. First—the seasons were insalubrious. Secondly—the pestilential state of air extended to many places at the same time: In another page, the author says the pestilence spread over almost all Germany and the low countries. Thrdly—this state of air was of different de|grees of malignity or violence, in different places at the same time. Thus, the plague appeared at Leyden early in 1635, but cotemporary with this, was the appearance of the purple fever in Nimeguen and in other places; and during the summer and au|tumn, this and other epidemics continued to rage with great mor|tality, and at last, the strength of the pestilential principle increa|sing, the fever changed its form, and appeared in the true plague.

Now, the modern way of accounting for the plague in Nime|guen, would be to allege or suppose some infected goods to have conveyed the contagion from Leyden, where it first appeared; and then to suppose the infection to be carried to Leyden from the Levant.

The philosophic Diemerbroeck, who was present and observed all the circumstances, supposes nothing. He relates plain facts

just as they occurred, and admits that the plague must have ori|ginated in the country.

By considering the malignant epidemics that prevailed at that time, as connected and depending on the same general cause, we solve all the difficulties attending the origin of the plague. The petechial fever, which appeared at Nimeguen and other places, in 1635, was one of the forms in which the general contagion of the period, exhibited its effects on the human constitution. It was a part of the pestilence—it could not be conveyed from Ley|den, for it appeared in most parts of the low countries and in Ger|many, at the same time. The same general cause, an indisposi|tion in the elements to support healthy life, produced various pes|tilential diseases, according to place, season, age, habit of body and constitution, until its strength and violence arose to their height, and gradually introduced the worst form of pestilence.

The idea of Diemerbroeck, that the purple fever "turned to the plague," must give great offence to the followers of Mead and Cullen, the advocates for the doctrin of the propagation of the plague solely by specific contagion. It opposes efficaciously their whole theory, and levels it with the earth.

The fact is however indisputable. In the distressing period from 1569 to 1577, when Europe was almost depopulated by the spotted fever, physicians observed that this disease frequently turned into the plague, and the plague into the spotted fever. The same fact was often noticed by writers of the 16th and 17th cen|turies, in which the plague frequently overran Europe.—These two diseases, are therefore two distinct forms or modifications of pestilence—probably bearing an affinity to each other, like that between the distinct and confluent small-pox. This fact shows that the distinction made by medical writers, between pestis and pestilentia, the plague and other pestilential distempers, however useful in practice, is not authorized by truth and philosophy. The ancients classed all contagious epidemics together, and de|nominated them pestilence; and this distribution, in regard to their causes and origin, was doubtless most philosophical. The distri|bution made by modern physicians, seems to have arisen out of differences of symptoms, and to be best adapted to practice. At

the same time, it has probably been the occasion of the common error of considering different species or forms of pestilence, as diseases of generical difference, and proceeding wholly from dis|tinct causes, when in fact they all have one general cause in com|mon, and the varieties of their symptoms proceed from distinct lo|cal and temporary causes.

On this subject the learned Riverius, in his Praxeos Medicae, lib. 17. has many judicious remarks. He observes, "That authors, who wrote on fevers, distinguish a pestilent from a ma|lignant fever—by pestilent fever they understand the true plague; by a malignant one, the fever vulgarly called purple, or other fe|ver, which tho epidemic and contagious, is less dangerous, and in which more patients survive than perish—whereas the essence of the true plague consists in this, that it destroys more than half who are seized with it." He however considers these fevers as differing mostly in degree of malignity, and therefore treats of them under one head.

A pestilent fever this author considers as not proceeding solely from intemperate heat, or putridity; but from a malignant and poisonous quality; and whenever this quality appears in a fever, whether quotidian, hectic or putrid, he thinks it ought to be de|nominated pestilent. A pestilent fever differs from the plague as species from genus because there may be plague without fever.

This author remarks also the connection between certain epi|demics. "Many deadly diseases accompany the prevalence of pestilence—as phrenitis, anginas, pleurisies, peripneumonies, in|flamations of the liver, dysenteries and many others." He as|cribes epidemics to the state of air, as a common cause, to which he adds the usual local or particular causes, which modify its in|fluence.

Prosper Alpinus informs us that these diseases prevail also in Egypt, at certain times; but he gives no account of their order or connection. Vol. 2. p. 73.

Bellinus describes the phenomena which precede the plague, which he calls its antecedents. After mentioning food of a bad quality, impure air from exhalations, intemperate seasons, va|pours emitted during earthquakes and the like, he says, "Mox

terraemotu Achaia universa commota est, et duae tunc civitates, Bura et Helice, abruptis locorum devoratae."

Muratori, Gen. Hist. vol. 1. 7.

Other authors refer this catastrophe to the period of pestilence last mentioned, which some writers place in the year of Rome 388, and others, in 384; but all agree that it was during the approximation of a comet. This last pestilence was dreadful in the extreme, sparing no age or sex. The year after it, the earth opened and exhibited a vast chasm in the midst of Rome, into which M. Curtius precipitated himself for the salvation and prosperity of the city.

Livy, b. 7. 7.

P. Orosius and P. Diaconus, followed by Muratori, place the commencement of this plague in the year of Rome 384. Orosius says that "in the 103d and 105th Olympiad, Italy was shaken a whole year, by tremendous earthquakes. The hundred and third Olympiad, according to our common chro|nology, comprehends the years of Rome from 386 to 389, in|clusive. It is probable that in one of the shocks of this series of earthquakes, the chasm was made in Rome as already related. It will be observed that this event followed the pestilence.

The comet that appeared, during this calamity, was probably that mentioned by Aristotle, Meteorol. lib. 1. ca. 6, of which he was an eye-witness.

But I must not omit what authors relate concerning the pe|culiar character of this plague. Orosius says, it was not such a pestilence, as usually proceeded from irregular seasons, extreme drouth, sudden heat of the spring, unseasonable moisture of sum|mer and autumn, or the impure air blown from the Calabrian groves; but severe and continued, attacking all descriptions of people, and either destroying their lives, or leaving them in a weak and miserable condition.

The winter when the comet appeared Aristotle relates to have been cold; but the severity and duration of the plague cannot be accounted for on the principle of changes or irregularities in the seasons. It was one of those violent epidemics which never afflict mankind, without some essential alteration in the invisible

began to appear, six months before the arrival of the infection from Syria!

In Aleppo, the plague which appeared in 1742, was preceded by an acute fever; and after the disease abated in July, appeared diarrheas and dysentery of a malignant type, attended in many cases with petechae, and intermittents which often proved fatal. These diseases, in their acute forms, prevailed also with the plague, which in this year was not severe, nor wholly the predominant epidemic.

This continued acute fever and pleurisies, ran through the win|ter. In November appeared a few cases of the plague. Where the infection had lain dormant from July to November, the author of this account, Alexander Russell, has not informed us.

In the spring of 1743, the plague again appeared and spread in the city, and at the usual time in summer subsided, being again succeeded by other acute disorders, which by bleeding and pur|ging, were formed into tertians, double tertians and quotidians.

Here again we have the same progression in the state of the pestilence, which had been remarked by Hippocrates, Bacon and Sydenham. During the existence of this pestilential constitu|tion in Aleppo, all the ordinary diseases of the country assumed a more malignant type; or as Sydenham remarked of the dis|eases which preceded the plague of 1665, they "differed from the same diseases in other years, by new and unusual symptoms, which in short amounted to this, that they were all more violent." See vol. 1, p. 20.

The diseases changed their form with the seasons—the acute fever preceding ran into plague, and plague ran into malignant dysentery, tertians, and other acute distempers.

Similar facts are observed in America. The plague has been preceded by acute diseases, as anginas, remittents of a bad type, &c. and followed by remittents, dysentery and malignant pleurisy.

The dreadful plague at Messina in 1743, which destroyed two thirds of its inhabitants, was introduced by a malignant fever. One physician alone out of thirty-three, pronounced it the plague; the others denied it, because the disease was not attended with glandular swellings.

A similar fever preceded the severe plague at Venice in 1576, and the same uncertainty at first embarrassed the physicians and magistracy.

The terrible pestilence at Naples in 1656, was announced by the usual herald of the disease, a malignant fever. One physi|cian alone pronounced it the plague, and for his audacity was im|prisoned by the Viceroy.

The extensive pestilence which spread over all the Levant countries and islands, from 1759 to 1763, was every where pre|ceded by a similar increase of malignant diseases, and especially by the petechial fever, which appeared, at Aleppo, in the year next previous to the plague. Yet the author of this account, Patrick Russel, labors very gravely to trace the disease to Turks from Egypt and their old clothes.

The uncertainty among physicians, at the commencement of a plague, with respect to the nature of the disorder, is a strong proof of the doctrin for which I contend. Van Helmont, Diemer|broeck and others have found it necessary to lay down rules with a great degree of care and caution, to enable themselves to de|termin, whether a malignant disease is the plague or not. Van Helmont observes, p. 1138 that he could perceive no difference in the pulse, in plague and continual fevers of the malignant kind —that buboes in the groin, paroitides, &c. are not unfrequently found in fevers free from plague; and sometimes spots and car|buncles. But, says he, if many of these appearances do concur, there is no difficulty in pronouncing it the plague, especially if they appear before or early after the fever.

Diemerbroeck declares, that no one symptom determines a disease to be the plague—neither fever, buboes nor carbuncles are essential to that disease, for it often passes off without either— many of its symptoms are common to that and other distempers— the existence of the disease therefore is to be determined by a view of all the circumstances, and one criterion, he remarks, is, the prevalence of the plague in neighboring towns.

This last remark indicates that the author had observed the existence of pestilence in various places at the same time, to be a common event.

The difficulty at first in ascertaining the existence of the plague, proceeds wholly from the progression in the series of dis|eases—the malignant fevers, preceding gradually incr••asing in violence, and changing their form.

It has been the same in the United States. The first cases of the bilious plague have occured early in summer, usually in July, sometimes in June. These have not excited much alarm, for they have not usually prov•• ••fectious; and they have theref••••e been classed among the ordinary diseases of the hot season. This however has ever been a mistake; they were the less malignant forms of approaching pestilence; yet five or six weeks after their appearance, when the epidemic has showed itself in its formidable array, our citizents have hunted out some vessel from southern climates and palmed the evil on her seamen or cargo.

Van Swieten, Comment. vol. 16, 3. remarks, "that the plague has sometimes lain concealed under the mask of other dis|eases. When the plague raged at Vienna in 1713, it frequently assumed the appearance of a pleurisy, catarrh, or quinsy, but soon after, broke out buboes and carbuncles, most certain signs of the plague, accompanied with the usual symptoms."

Here we observe the usual precursors and companions of the plague and the progression of the pestilential principle.

Hippocrates has remarked the augmented violence of diseases, in particular periods. He says, "There are times when almost all the diseases that occur, are extremely malignant, and in gen|eral, fatal, so that coughs, phthisis, angina, are all equally mor|tal. He assures us, that the truth of his observations had been confirmed, in countries very different from each other, and in a variety of seasons and climates." See the passage cited in Zim|merman on physic, p. 163.

We have multiplied proofs of the justness of these remarks. During the periods which I call pestilential, the common diseases of a country, as dysentery, and intermittents, become more obstinate and mortal; and even the pleurisy and peripneumony, acquire unusual violence. And it may not be improper to re|peat an observation before made, that the malignant or epidemic pleurisy never appears, excep•• during these pestilential periods.

It precedes or follows, in winter, spring or autumn, those sum|mers alone when pestilence invades our cities. Such was the dreadful disease in America, in 1697-8—in 1761—and which has showed itself, in several towns, during the present pestilential constitution.

But a most satisfactory proof of the progressiveness in a pesti|lential state of air, and in the corresponding malignity of dis|eases, is found in the bills of mortality. Thus, before the Lon|don plague in 1625, the bill of mortality rose from 8 or 9000, the standard of health, to 11,000 in 1623, and to 12,000 in 1624. The approach of pestilence was clearly announced, two years before it appeared. And as the time of its appearance drew near, the extension or malignity of the preceding fevers was greatly augmented; for in the year of the plague, almost nineteen thousand persons died of other diseases than the plague. As the plague usually prevails from June or July to November, and other diseases are mostly merged in it, almost all the deaths by common diseases must have been in the beginning of the year, from January to June or July. Now, eighteen thousand deaths in the six months preceding the plague, or even two thirds of the number, mark a prodigious increase of mortality—the common sign of approaching pestilence.

In the pestilential period in London, from 1634 to 1636, the bill of mortality rose two years previous to the plague.

The last great plague, in 1665, was announced by unusual malignity in diseases, four years before its appearance. In 1661, according to Sydenham, began a series of epidemics, which greatly swelled the list of burials. There was however some a|batement in 1663; but in 1664, and the first five months of 1665, the mortality again increased with rapidity, till a dread|ful pestilence laid waste the city.

A similar increase of mortality is observable in the bills for Augsburg, previous to the plague in 1628, and in 1635—in Dresden, in 1632 and 3—in Philadelphia in 1793, in New-York in 1795, and in New-London in 1798.

It must however be observed, that the bills of mortality will

not, in all cases, exhibit the augmented number and malignancy of the diseases which precede pestilence; for it sometimes hap|pens that the year next preceding the plague, is very healthy, and the malignancy in the distempers, which mark the beginning of the pestilential state, does not appear till the winter or spring previous to the plague. In this case, the augmented mortality falls within the year and the same bills, as the deaths by the plague. This was the case in Augsburg in the year 1535. In such cases, there is an interval between the preceding epidemics and the plague; such as we have observed in the New-England States, between the influenza and the scarlet fever, and the lat|ter disease and the yellow fever.

Monthly bills will exhibit the progress of pestilential epidem|ics, with more accuracy.

Fernelius remarks page 161, that "infection is to be perceiv|ed in the air, when it produces fevers not pestilent, but which are at the threshhold of pestilence,"—plainly intimating that cer|tain malignant diseases precede the plague. He speaks of the fact as general and well understood.

Even in the West-Indies, the infectious yellow fever has its pre|cursors. That fever in Barbadoes, in 1738, was preceded by catarrh and suffocating cough in 1737 and spring of 1738. Yet authors pretend the disease to have been imported from Martinico!

See Warren and Short, vol. 2. 164.

The different modes in which pestilence invades mankind, seem to depend on different causes. Sometimes, the principal cause seems to be an essential alteration in the invisible properties of the elements; in which case, the diseases of a particular con|stitution, tho somewhat modified in their symptoms, are not con|trolled or arrested by the seasons. On the contrary the atmosphere continues to be pestilential, and to multiply disorders of a ma|lignant type, through every variety of seasons and of weather. Thus, we observe many instances of violent plagues in the most pleasant, and to all appearance, the most salubrious seasons. Several instances have been mentioned in the preceding history, and we have demonstration of the fact in the United States. The present pestilential state commenced with the measles and

catarrh of 1789 and 90.—The summers of 1794 and of 1797 were apparently temperate and salubrious; yet in both these summers, the plague renewed its ravages in some towns, tho with less mortality than in the sultry and unhealthy summers of 1793-95 and 98.

On the other hand, pestilence sometimes proceeds principally from excessively intemperate seasons, as in severe heat, after a cold winter. In this case, the pestilence may invade a city very suddenly and without a regular augmentation of mortality from previous diseases. But even in this case, the plague has its precur|sors, which appear at leas•• a few weeks, if not two or three months previous to its attack.

Thus the plague in Aleppo in 1742, first showed itself in the suburbs in April; but was preceded by an acute fever in March. The bilious plague in Philadelphia in 1793, according to Dr. Rush, was preceded by the influenza, scarlatina and bilious re|mittents. The same disease in 1797 appeared, in scattering ca|ses, as early as June.

In New-York, the epidemic of 1795 was preceded by an|gina trachealis with anomalous symptoms, some cases of obsti|nate dysentery, at a premature stage of summer, and by febrile complaints accompanied with bilious evacuations. At a meeting of the medical society, early in July, these facts were mentioned, as denoting an uncommon state of air, and the society came to a resolution, to make particular observations on the diseases that might occur, before their next meeting. But, in the interval, the crisis of the pestilence arrived, and removed all doubts.

See Dr. Baily on the epidemic of 1795, p. 55, and sequel.

The severe pestilence of the year 1798 doubtless owes its vio|lence to a series of most intemperate weather—most excessive heat, following a long and severely cold winter. Yet this dis|ease was preceded by premonitory signs, especially catarrhal fe|vers. Of all the disorders to which mankind are exposed, none seem to indicate a pestilential state of air, with so much certainty as catarrhal affections. They almost always precede the plague —usually accompany it, and sometimes tread close upon its heels.

In addition to the numerous authorities already cited, in proof

of the progression of pestilence, let me mention Skenkius, who, in speaking of the diseases of 1564 and 5, observes, that angi|nas, pleurisies and peripneumonies became epidemic; abortions were frequent, pains in the joints, small pox and measles "quos tanquam praecursores sequebatur epidemica lues, incredibili gras|sationis saevitia," depopula••ing towns and country, in Turkey, Egypt, France, England and Germany. Observations, p. 748.

Skenkius remarked that the plague followed the other epidem|ics, as its precursors.

The same author takes notice of a malignant angina, in 1564, which often proved fatal in a few hours, like the plague. I men|tion this, because the learned Dr. Fothergill, and tribes of mod|ern physicians who follow a celebrated name, have alledged that the angina maligna is a new disease, not known in Europe till a|bout the year 1610, altho it never was more fatal, than in England in 1517.

In 1573 prevailed dysentery, measles, and purple fever, which in 1574, says Skenkius, changed into the plague. His words are remarkable. "Dudum sane praesagiebat animus mihi, malignum hoc febrium genus, quod toto biennio Europae partem non mini|mam peragravit, velut sparsis quibusdam praeludiis, in pestem aper|tissimam transiturum. Neque me adeo mea fefellit opinio." Ob|serv. p. 761. This author foresaw the plague, by means of its precursors.

"Eodem modo variolae, morbilli, dysenteriae grossantes, sae|pissime sunt praecursores internuncii pestis." Epidemic small-pox, measles and dysentery, are very often the forerunners of the plague.

Hostices, p. 253.

It is a common remark that the reigning epidemic subdues all other diseases, or compels them to assume its character. This re|mark, as a general one, is just; and is of no small weight, in proving the connection between certain species of epidemics. In the spring of 1795, the measles prevailed in New-York, but of a mild type. In August, this disease disappeared, being com|pletely merged in the bilious fever that spread from August to November. No sooner had the fever subsided, than the measles

re-appeared, and was of a less favorable type. This is a con|tagious disease, and yet how impotent was its contagion, in the instance related, under the all-controlling influence of the season and the elements.—It disappeared in summer in defiance of the powers of specific contagion, and was reproduced in autumn, with|out its assistance.

This fact demonstrates that a general cause operated in the production of that disease; which general cause, in summer, was controlled, by the heat of the season and local causes in that city; these temporary and local causes operated during a particu|lar time, and gave a different complexion to diseases; when they gave way, at the approach of winter, the general cause again as|sumed its empire and reproduced the measles, which is a disease little affected by local causes.

But while local causes predominated, in producing bilious plague, the general cause was not altogether inefficient; no bil|ious pestilence ever becoming epidemic and infectious, but un|der the influence of a pestilential constitution.

A fact related in Fairfield's diary, relative to the small-pox in Boston in 1702, is very much in point.

This disease appeared in June and gave much alarm; but prov|ed to be of a mild type, and none died of it for several weeks. It continued to be favorable, till September, when it assumed a more formidable aspect; being attended with what the writer calls a scarlet fever. The season was excessively dry. In De|cember, the scarlet fever abated, but the small-pox continued to be very mortal, till the following spring. These facts are relat|ed by an unlettered, observing man; but they are evidence of a progressiveness in the disease. The efflorescence that accompa|nied the disease from September to December was only a partic|ular, malignant symptom or modification of the small-pox, pro|duced by season or other temporary cause.

The measles often exhibits a similar progression. This cir|cumstance explains the difficulties mentioned by medical writers. Dr. Rush mentions the circumstance of persons in 1789, who had a fever, cough and all the symptoms of measles, except a general eruption. Some had a trifling efflorescence about the

neck and breast. The same happened in 1773 and 1783. Vol. 2. 238. The fact is also mentioned in Edinburgh Medical Es|says, vol. 5. Persons thus affected have the measles, months or years afterwards. This lighter species of the measles is pro|duced by the same general cause which produces the disease in full force; but the constitution, at that time, resists the further operation of the cause. At a future time the cause will produce the disease complete.

Under the history of the diseases of 1792 and 3, I have re|lated the progress of the late scarlatina in this country. There cannot be stronger evidence of the progression of an epidemic in|fluence in the atmosphere than the history of that distemper has furnished. The violent stage of that disease, was preceded four, five, and in some places eight months, by a milder species of the disorder; and this mild form was, in some places, an epidemic. These facts entirely overwhelm all the pretended influence of in|fection, in originating the disease. They prove incontestibly that a state of air suited to the production of that disease, was not the effect of any sudden, visible change in the seasons; for the mild form of the scarlatina appeared indifferently, in any season of the year; as at New-York in August, at Hartford in May and at New-Haven in November; but that it was a progres|sive change, gradually inducing debility in the human body, or whatever else may be its predisposition to a particular disease.

Whether the scarlatina appeared, in any part of the country, without being announced by this slight form of the disease, is a question that cannot be solved, without particular information from every town. And very possibly the fact itself may have passed, in some places, unobserved. But the progressiveness of the distemper was distinctly marked in New-York, in Fairfield, in New-Haven, in Bethlem and in Hartford.

The same phenomenon was observed in the same disease, in 1786, in London. The first case appeared in March, was of a mild kind and excited no great apprehension. No other case oc|curred to the knowledge of the physician, except in the same family, till May, when another case appeared, but of a light kind. In June, the disease became epidemic and malignant.

Here we observe the progress of the pestilential principle, in England, like that which has been observed in America.

See Memoirs of the Medical Society, London, vol. 1. 388.

A remarkable fact mentioned by the great Mr. Boyle, in the fifth volume of his works, p. 724, serves to show the regular progression of that state of air which produces the plague. In 1665, three months before the plague broke out in London, a man sent for a physician, complaining of •• swelling in his groin, from which circumstance he predicted the plague which was to follow, and said he had experienced the same swelling in the former plagues, which he considered as the certain forerunner of the dis|ease. Boyle took this account from the physician himself.

This was no whim, for it is perfectly philosophical. It is a common fact, that, during the plague, in a city, persons in health experience severe pains in the glands, as in the groin and under the arms, those sensible parts which are peculiarly affected by the disease. Sorbait mentions that he felt such pains, during the plague in Vienna in 1679, and others did the same, but without any tumor. Dr. Gothwald experienced similar pains in the plague at Dantzick in 1709.

See Baddam's Memoirs, vol. 6. 12.

Boyle, vol. 6. 429, relates that one Beale knew a woman who could certainly tell when the plague was in the neighboring country, by a pain in the wounds of three sores she had, when affected by the plague in her youth. The relation is altogether credible; for we know that the state of air producing the dis|ease, occasions pains in the glands of persons in health; much more therefore would the same parts, after being rendered more sensible by plague sores, be affected with pain, during a similar state of air. The facts demonstrate that the plague is produced by a peculiar state of air, which may be perceived before the dis|ease appears; and much more, during its prevalance, by persons in health.

Another fact demonstrative of the same doctrin of a progres|sion in the pestilential principle, is, the unusual number of abor|tions, which precede the invasion of a severe plague. This fact was observed by Diemerbroeck, previous to the plague in Ni|mueguen,

in 1636, and is numbered by him among the presages of the disease. De peste page 11. Other authors have record|ed the same fact, among whom Diemerbroeck cites Alexander Benedictus, Forestus and Seunertus.

The cause assigned for this phenomenon, is, "the debility of the heart and other viscera, which renders the tender body of the foetus incapable of resisting the malignity of the pestilential poison, and which exposes the woman in a pregnant state, to continual irritation."

In confirmation of this principle, we may cite the facts, so fre|quently mentioned by writers on this subject, that the plague rarely or never spares pregnant women. This was remarked by Livy and Dionysius in Rome—by Procopius and Evagrius, in the plagues of 543 and 590, and by subsequent writers.

The fact authorizes the supposition, that a pestilential state of air induces extreme excitement or irritability, and consequently indirect debility, especially in the nervous and vascular systems. The effect of this general cause must of course be first visible in persons most susceptible of excitement—among whom are preg|nant women, which is obvious from the facility with which they receive impressions from the sight of unnatural objects. The ap|pearance of the effect of the pestilential state of the atmosphere, on such persons, previous to its fatal effects on other persons, leaves no room to question its gradual increase in strength.

Of the progressiveness of pestilential epidemics therefore we can have no doubt, nor of their connection through a common cause. The order i•• which they show themselves is not exactly the same; being varied by a multitude of subordinate causes, as seasons, weather, noxious exhalations, and sometimes perhaps by infection.

The accounts of diseases in the two or three last centuries are recorded with so little regard to just arrangement, that it is no•• easy to collect from them the exact order in time, in which the epidemics of any particular period have appeared. Sydenham however has left an admirable sample of the hi••••ory of epidem+ics in London from 1661 to 1680—a samp••e that throws im|mense light on the principles here maintained—a sample which

ought to be well studied, and which it is inexcuseable in medical writers not to imitate. Let any man observe the regularity with which certain eruptive diseases, as the measles and small-pox, appeared and subsided, according to the seasons, during the con|stitution of air fitted to produce them, until both yielded to a different constitution, and then say, whether he can question Sydenham's principles, or the existence of a general contagion, operating in the production of a particular class of diseases. Un|der a philosophical view of such facts, into what trifles will dwindle all the formidable vulgar doctrines about infection!

It must however be remarked, that the small-pox, in modern times, will not exhibit similar effects as formerly; since the art of inoculation has nearly banished the disease as an epidemic, from our cities, where alone it used to prevail to any considerable extent.

Let us then attend to the order of the epidemics which have marked the latest periods of pestilence in America; many of which are within the memory of the present generation.

A. D. 1733

influenza.

A. D. 1734

unknown.

A. D. 1735

angina maligna.

A. D. 1736

angina maligna.

A. D. 1737

severe influenza.

A. D. 1738

pestilence in Barbadoes, Charleston and Mexico, measles New-England.

A. D. 1739

pestilence in Barbadoes, Charleston and Mexico, measles New-England.

A. D. 1740

measles America.

A. D. 1741

angina, pestilence Philadelphia and Virginia.

A. D. 1742

anginas.

A. D. 1743

pestilence in New-York.

A. D. 1745

dysentery, pestilence New-York and Charleston.

A. D. 1746

pestilence at Albany and among the Mohegans.

A. D. 1747

influenza.

A. D. 1748

measles, dysentery and angina.

A. D. 1749

measles, dysentery and angina.

A. D. 1750

measles, dysentery and angina.

A. D. 1751

measles, dysentery and angina.

A. D. 1752

measles, dysentery and angina.

A. D. 1753

measles, dysentery and angina.

A. D.

1754

angina.

A. D. 1755

angina.

A. D. 1756

dysentery in some places.

A. D. 1757

influenza.

A. D. 1758

measles.

A. D. 1759

measles, dysentery, fevers.

A. D. 1760

unknown, till autumn, then

A. D. 1761

influenza and inflammatory fevers very fatal.

A. D. 1762

pestilence in Philadelphia.

A. D. 1763

pestilence among the Indians on Nantucket.

A. D. 1764

 

A. D. 1765

dysentery.

A. D. 1766

dysentery.

A. D. 1767

unknown.

A. D. 1768

unknown.

A. D. 1769

measles, angina.

A. D. 1770

angina, fevers.

A. D. 1771

catarrh, angina.

A. D. 1772

influenza and measles, angina.

A. D. 1773

angina, dysentery.

A. D. 1774

angina, dysentery.

A. D. 1775

angina and dysentery very fatal.

A. D. 1776

angina and dysentery very fatal.

A. D. 1777

angina and dysentery very fatal.

A. D. 1778

fevers, but no epidemic.

A. D. 1779

health.

A. D. 1780

health.

A. D. 1781

influenza.

A. D. 1782

influenza Europe.

A. D. 1783

measles, angina.

A. D. 1784

anginas and bilious fevers.

A. D. 1785

anginas and bilious fevers.

A. D. 1786

anginas and bilious fevers.

A. D. 1787

anginas and bilious fevers.

A. D. 1788

measles began in autumn.

A. D. 1789

measles, influenza.

A. D. 1790

measles, influenza.

A. D.

1791

pestilence began in New-York, but not severe.

A. D. 1792

angina began in New-York.

A. D. 1793

angina, plague, dysentery.

A. D. 1794

angina, plague, dysentery.

A. D. 1795

angina, plague, dysentery, measles.

A. D. 1796

angina, plague, dysentery, measles.

A. D. 1797

plague, dysentery.

A. D. 1798

plague, dysentery, typhus mitior.

A. D. 1799

plague.

Such has been the general course of epidemic diseases in Ame|rica, as far as I can obtain information. Further enquiries may render the account more accurate, and more nearly perfect.

It will be observed that the order is not quite uniform; nor is this to be expected, considering the various causes which concur in the production, and diversification of diseases. In general, measles and catarrh precede anginas, dysentery and pestilential fevers. And it is remarkable that these diseases belong to the class of inflammatory diathesis: So does the mild small-pox, which, before the practice of inoculation, was almost regularly a precursor of the plague in the cities of Europe.

In general then epidemic diseases first attack the brain and the throat, before they seize the whole nervous system and the abdo|minal viscera. It is observable also, that winter, spring and autumn, produce mostly diseases of the stenic diathesis, as measles, catarrh, and inflammatory fevers; and summer, diseases of astenic diathe|sis, as typhus fevers, dysentery of a malignant kind, and plague. Indeed the plague seems to begin and end in catarrh—that is, it begins in catarrh in winter and spring, takes the form of plague, during the hot season, and re-assumes the catarrhal and inflamma|tory form in the succeeding winter. The measles and influen|za, however, prevail at any season.

When I arrange epidemics under particular years, I speak of those diseases which extend over a whole country, or occur in ma|ny places. If we look into large cities, we shall find some of these diseases, almost every year. But my observations relate on|ly to those diseases when they become general, or occur in vari|ous parts of a country in the same year.

When I place angina, plague and dysentery against a particular year, it is not intended that these diseases were all epidemic in the same place. Thus, while in 1793 the plague was in Phila|delphia, the scarlatina began to prevail in New-York and the wes|tern part of Connecticut. For it must not be overlooked, that although measles and influenza appear nearly at the same time in all parts of the United States, yet the pestilential fevers that fol|low them first show themselves in the larger cities in the southern latitudes. Thus the measles and influenza were universal in 1789 and 90, at least this was the case with the influenza; but the bili|ous plague broke out in New-York, Philadelphia and Charleston, before it did in Boston and Newburyport. The same is observa|ble in the other hemisphere. The influenza spreads over Asia, Europe and Africa, in a few weeks, but the following pestilence first appears in Egypt or the Levant, or in Turkey, then in the northern parts of Europe. To these remarks there are few ex|ceptions.

It is also observable, that the pestilence in cities takes the form of petechial fever and plague; but in country towns, more gene|rally terminates in dysentery.

It is a popular opinion that measles and small-pox never origi|nate in the human constitution, without contagion. The palpable absurdity of such an opinion has not prevented its propagation and belief, among even well-informed men. So far is this opinion from truth, that the first cases of these diseases in every epidemic period, are always generated in the human body, without conta|gion. When the condition of the elements is fitted to produce these diseases, they appear in all parts of a country, without con|tagion, they spread rapidly, and decline when the general causes cease to operate. During this period, contagion is efficacious in propagating them, and no longer. When the condition of the elements is not fitted to produce them, if sporadic cases appear in particular habits of body, they will not always spread the diseases.* 1.1 Sydenham long ago taught this truth, in describing the changes

in the epidemics of 1670—1672. Measles and small-pox came and went with the seasons and condition of the air.

The truth is, that certain conditions of the elements tend to produce eruptive diseases, and before the practice of inoculation, the small pox was almost regularly one of that series of epidemics which I class together, as of one family, and the precursors of plague. It is nearly allied to the measles, and appears usually about the same time. I am convinced that catarrh, measles, mild small-pox and whooping cough, are but varied forms of dis|ease, occasioned by modifications of the same elemental causes.

Certain it is, they are all predominant about the same time, and as a general remark, they precede the invasion of diseases which bear the character of typhus.

I have never conversed with a physician who could not name instances of small-pox, originating without any known contagion, and generally medical gentlemen admit the disease to be generated in the constitution. This principle is unquestionably just, and ought to be known, and received as truth; for the belief that con|tagion is necessary to the existence of the disease, has produced most mischievous consequences. An instance happened in Shar|on a few years ago, in which a woman was seized with the small-pox; but as she had not been exposed to contagion, her disease was mistaken, till just before her death; and twenty or thirty persons were supposed to have taken the disease before the true nature of it was understood.

In the winter of 1797-8, occurred in Hartford two sporadic cases of measles, which could not possibly be traced to contagion. At another time, a family was infected by means of a stranger; but in neither of these cases was the disease propagated to others, who were exposed to the breath of the patients. See Dr. Cogs|well's letter, Med. Repos. vol. 2. 301. Innumerable similar in|stances may be mentioned.

In the same manner the various species of angina and the plague occur in sporadic cases under the operation of powerful local and constitutional causes, which, if not favored by the condition of the elements, will not spread and become epidemic.

Notes

• * 1.1

  This is here meant of the natural contagion of the diseases from the breath and effluvia, which is not always efficacious in spreading them. The variolous matter of small-pox is excepted; for, if good, this will generally communicate the disease at any time.