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Full text of "Medical inquiries and observations"


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MEDICAL INQUIRIES 



AND 



OBSERVATIONS. 



BY BENJAMIN RUSH, M. D. 

PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, 

AND OF CLINICAL PRACTICE, IN THE UNIVERSITY 

OF PENNSYLVANIA. 



IN FOUR VOLUMES. 
VOL. III. 



THE SECOND EDITION, 

REVISED AND ENLARGED BY THE AUTHOR. 



PHILADELPHIA, 

PUBLISHED BY J. CQNRAD 8t CO. CHESNUT-STREET, PHILADELPHIA; 
M. h J. CONRAD &. CO. BALTIMORE; RAPIN, CONRAD, &. CO. WASH- 
INGTON; SOMERVELL & CONRAD, PETERSBURG; AND BONSAL, 
CONRAD, & CO. NORFOLK. 

PRINTED BY T. ijf G. PALMER, 116, HIGH-STREET. 

1805. 



Uo.iv 
1$ m*^ 



CONTENTS OF VOLUME III 



page 
OUTLINES of a theory of fever 1 

An account of the bilious yellow fever, as it appeared 

in Philadelphia in 1793 67 

An account of the bilious yellow fever, as it appeared 

in Philadelphia in 1794 355 

An account of sporadic cases of bilious yellow fever, 

as they appeared in Philadelphia in 1795 and 1796 435 



OUTLINES 



OF A 



THEORY OF FEVER. 



V©L. III. A 



OUTLINES 



OF A 



THE OR T OF FEVER, 



AS many of the diseases which are the subjects of 
these volumes belong to the class of fevers, the fol- 
lowing remarks upon their theory are intended to 
render the principles and language I have adopted, 
in the history of their causes, symptoms, and cure, 
intelligible to the reader. 

I am aware that this theory will suffer by being 
published in a detached state from the general view 
of the proximate cause of -disease which I have 
taught in my lectures upon pathology, as well as 
from its being deprived of that support which it 
would receive from being accompanied with an ac- 
count of the remedies for fever, and the times and 



4 OUTLINES OF A 

manner of exhibiting them, all of which would have 
served to illustrate and establish the facts and rea- 
sonings which are to follow upon this difficult and 
interesting inquiry, 

I shall not attempt to give a definition of fever. 
It appears in so many different forms, that a just 
view of it can only be given in a minute detail of 
all its symptoms and states. 

In order to render the theory, which I am about 
to deliver, more simple and intelligible, it will be 
necessary to premise a few general propositions. 

I. Fevers of all kinds are preceded by general 
debility. This debility is natural or accidental. 
The former is the effect of the sanguineous tempe- 
rament, and exists at all times in manv constitu- 
tions. The latter is induced, 

1. By such preternatural or unusual stimuli, as^ 
after first elevating the excitement of the system 
above its healthy grade, and thereby wasting a part 
of its strength, or what Dr. Brown calls excitabi- 
lity, and Darwin sensorial power, afterwards re- 
duces it down to that state which I shall call debi- 
lity of action. Or, 



THEORY OF FEVER. 5 

2. It is induced by such an abstraction of natu- 
ral stimuli as to reduce the system below its healthy 
grade of excitement, and thereby to induce what 
Dr. Brown calls direct debility, but what I shall 
call debility from abstraction. This general debi- 
lity is the same, whether brought on by the former 
or the latter causes. When induced by the latter, 
the system becomes more excitable than when in- 
duced by the former causes, and hence an attack 
of fever is more frequently invited by it, than by 
that state of debility which succeeds the application 
of an undue portion of stimulating powers. To 
this there is an exception, and that is, when the re- 
mote causes of fever act with so much force and 
rapidity as suddenly to depress the system, without 
an intermediate elevation of it, and before sufficient 
time is given to expend any part of its strength or 
excitability, or to produce the debility of action. 
The system in this state, is exactly similar to that 
which arises from a sudden reduction of its healthy 
excitement, by the abstraction of stimuli. This 
debility from abstraction, moreover, is upon a foot- 
ing with the debility from action, when it is of a 
chronic nature. They botli alike expend so much 
of the quality or substance of excitability, as to 
leave the system in a state in which irritants are 
seldom able to excite the commotions of fever, and 
when they do, it is of a feeble nature, and hence 



6 OUTLINES Or A 

we observe persons who have been long exposed 
to debilitating causes of both kinds, often escape 
levers, while those who are recently debilitated, are 
affected by them, under the same circumstances of 
exposure to those causes. 

That fevers are preceded by general debility I 
infer from their causes, all of which act by reducing 
the excitement of the system, by the abstraction of 
stimuli, or by their excessive or unusual applica- 
tion. The causes which operate in the former 
way are, 

1. Cold. This is universally acknowledged to 
be a predisposing cause of fever. That it debi- 
litates, I infer, 1. From the languor which is ob- 
served in the inhabitants of cold countries, and 
from the weakness which is felt in labour or exer- 
cise in cold weather. 2. From the effects of expe- 
riments, which prove, that cold air and cold water 
lessen the force and frequency of the pulse. 

2. The debilitating passions of fear, grief, and 
despair. 

3. All excessive evacuations, whether by the 
bowels, blood-vessels, pores, or urinary passages. 



THEORY OF FEVER. 7 

4. Famine, or the abstraction of the usual quan- 
tity of nourishing food. 

The causes which predispose to fever by the ex- 
cessive or unusual application of stimuli are, 

1. Heat. Hence the greater frequency of fevers 
in warm climates, and in warm weather. 

2. Intemperance in eating and drinking. 

3. Unusual labour or exercise. 

4. Violent emotions, and stimulating passions of 
the mind. 

5. Certain causes which act by over- stretching a 
part, or the whole of the body, such as lifting 
heavy weights, external violence acting mechani- 
cally in wounding, bruising, or compressing parti- 
cular parts, extraneous substances acting by their 
bulk or gravity, burning, and the like*. The in- 
fluence of debility in predisposing to fevers is fur- 
ther evident from their attacking so often in the 
night, a time when the system is more weak than 
at any other, in the four and twenty hours. 

* Cullen's First Lines- 



8 OUTLINES OF A 

II. Debility being thus formed in the system, 
by the causes which have been enumerated, a sud* 
den accumulation of excitability takes place, where- 
by a predisposition is created to fever. The 
French writers have lately called this predisposi- 
tion " vibratility," by which they mean a liableness 
in it to be thrown into vibrations or motions, from 
pre-existing debility. It is not always necessary 
that a fever should follow this state of predisposi- 
tion. Many people pass days and weeks under it, 
without being attacked by a fever, by carefully or 
accidentally avoiding the application of additional 
stimuli or irritants to their bodies : but the space 
between this state of predisposition, when it is re- 
cent, and a fever, is a very small one ; for, inde- 
pendently of additional stimuli, the common im- 
pressions which support life sometimes become 
irritants, and readily add another link to the chain' 
of causes which induce fever, and that is, 

III. Depression of the whole system, or what 
Dr. Brown calls indirect debility. It manifests' 
itself in weakness of the limbs, inability to stand 
or walk without pain, or a sense of fatigue, a dry, 
cool, or cold skin, chilliness, a shrinking of the 
hands and face, and a weak or quick pulse. These 
symptoms characterize what I have called in my 
lectures the forming state of fever. It is not ne- 



THEORY OF FEVER. , 9 

eessary that a paroxysm of fever should follow this 
depressed state of the system, any more than the 
debility that has been described. Many people, 
by rest, or by means of gentle remedies, prevent 
its formation ; but where these are neglected, and 
the action of stimuli, whether morbid or natural, 
are continued, 

IV. Re-action is induced, and in this re-action, 
according to its greater or less force and extent, 
consist the different degrees of fever. It is of an 
irregular or a convulsive nature. In common cases, 
it is seated primarily in the blood-vessels, and par- 
ticularly in the arteries. These pervade every 
part of the body. They terminate upon its whole 
surface, in which I include the lungs and alimen- 
tary canal, as well as the skin. They are the out- 
posts of the system, in consequence of which they 
are most exposed to cold, heat, intemperance, and 
all the other external and internal, remote and ex- 
citing causes of fever, and are first roused into 
resistance by them. 

Let it not be thought, from these allusions, that 
I admit Dr. Cullen's supposed vires naturas medi- 
catrices to have the least agency in this re-action 
of the blood-vessels. I believe it to be altogether 
the effect of their elastic and muscular texture, and 

vol. in. s 



1® OUTLINES OF A 

that it is as simply mechanical as motion from im- 
pressions upon other kinds of matter. 

That the blood-vessels possess muscular fibres, 
and that their irritability or disposition to motion 
depends upon them, has been demonstrated by 
Dr. Vasschuer and Mr. John Hunter, by many 
experiments. It has since been proved by Spal- 
lanzani, in an attempt to refute it. Even Dr. 
Haller, who denies the muscularity and irritability 
of the blood-vessels, implies an assent to them in 
the following words : " There are nerves which 
descend for a long way together through the sur- 
face of the artery, and at last vanish in the cellular 
substance of the vessel, of which we have a speci- 
men in the external and internal carotids, and in 
the arch of the aorta ; and from these do not the 
arteries seem to derive a muscular and convulsive 
force very different from that of their simple elasti- 
city ? Does not it show itself plainly in fevers, 
faintings, palsies, consumptions, and passions of 
the mind*?" 

The re-action or morbid excitement of the 
arteries discovers itself in preternatural force, or 
frequency in their pulsations. In ordinary fe- 

* First Lines, sect. 32 of the chapter on arteries. 



THEORY OF FEVER. 11 

ver, it is equally diffused throughout the whole 
sanguiferous system, for the heart and arteries are 
so intimately connected, that, like the bells of the 
Jewish high-priest, when one of them is touched, 
they all vibrate in unison with each other. To 
this remark there are some exceptions. 

1. The arteries are sometimes affected with 
great morbid excitement, while the natural func- 
tions of the heart are unimpaired. This occurs in 
those states of fever in which patients are able to 
sit up, and even to walk about, as in pulmonary 
consumption, and in hectic fever from all its causes. 

2. The heart and pulmonary artery are some- 
times affected with great morbid excitement, while 
the pulsations of the arteries on the wrists are per- 
fectly natural. 

3. The morbid excitement of the arteries is 
sometimes greater on one side of the body than on 
the other. This is obvious in the difference in the 
number and force of the pulsations in the different 
arms, and in the different and opposite appearances 
of the blood drawn from their veins, under equal 
circumstances. 



1£ OUTLINES OF A 

4. The arteries in the head, lungs, and abdomi- 
nal viscera are sometimes excited in a high degree, 
while the arteries in the extremities exhibit marks 
of a feeble morbid action. Fevers attended with 
these and other deviations from their common phe- 
nomena, have been called by Dr. Alibert, altax- 
iqnes. They occur most frequently in malignant 
fevers. 

While morbid excitement thus pervades gene- 
rally or partially the sanguiferous system, depres- 
sion and debility are increased in the alimentary 
canal, and in the nervous and muscular systems. 
In the stomach, bowels, and muscles, this debility 
is occasioned by their excitement being abstracted, 
and translated to the blood-vessels. 

I shall now endeavour to illustrate the proposi- 
tions which have been delivered, by taking notice 
of the manner in which fevers are produced by 
some of its most obvious and common causes. 

Has the body been debilitated by exposure to 
the cold air ? its excitability is thereby increased, 
and heat acts upon it with an accumulated force : 
hence the frequency of catarrhs, pleurisies, and other 
inflammatory fevers in the spring, after a cold win- 
ter ; and of bilious remittents in the autumn, when 



/THEORY OF PEVER. 1.3 

warm days succeed to cold and damp nights. 
These diseases are seldom felt for the first time in 
the open air, but generally after the body has been 
exposed to cold, and afterwards to the heat of a 
warm room or a warm bed. Mild intermittents 
have frequently been observed to acquire an in- 
flammatory type in the Pennsylvania hospital, in 
the months of November and December, from the 
heat of the stove rooms acting upon bodies previ- 
ously debilitated and rendered excitable by cold 
and disease. 

Has there been an abstraction of heat by a sud- 
den shifting of the wind from the south-west to the 
north-west or north-east points of the compass, or 
by a cold night succeeding to a warm day ? a fe- 
ver is thereby frequently excited. These sources 
of fever occur every autumn in Philadelphia. The 
miasmata which exist in the body at that time in a 
harmless state, are excited into action, in a manner 
to be mentioned presently, by the debility from 
cold, aided in the latter case by the inaction of 
sleep, suddenly induced upon the system. 

Again : has the body been suddenly debilitated 
by labour or exercise ? its excitement is thereby 
diminished, but its excitability is increased in such 
a manner that a full meal, or an intemperate glass 



14 OUTLINES OF A 

of wine, if taken immediately after the fatigue is 
induced upon the body, excites a fever : hence the 
frequency of fevers in persons upon their return 
from hunting, surveying, long rides, or from a 
camp life. 

But how shall we account for the production of 
fever from the measles and smail-pox, which attack 
so uniformly, and without predisposing debility 
from any of its causes which have been enume- 
rated ? I answer, that the contagions of those dis- 
eases seldom act so as to produce fever, until the 
system is first depressed. This is obvious from 
their being preceded by languor, and all the other 
symptoms formerly mentioned, which constitute the 
forming state of fever. The miasmata which in- 
duce the plague and yellow fever, when they are not 
preceded by the usual debilitating and predisposing 
causes, generally induce the same depression of the 
system, previously to their exciting fever. Even 
wounds, and other local irritants seldom induce fe- 
ver before they have first produced the symptoms 
of depression formerly mentioned. I shall presently 
mention the exceptions to this mode of producing 
fever from contagious miasmata and local injuries, 
and show that they do not militate against the truth 
of the general proposition that has been delivered. 



THEORY OF FEVER. 15 

It may serve still further to throw light upon this 
part of our subject to take notice of the difference 
between the action of stimuli upon the body predis- 
posed by debility and excitability to fever, and 
their action upon it when there is no such predis- 
position to fever. 

In health there is a constant and just proportion 
between the degrees of excitement and excitability, 
and the force of stimuli. But this is not the case 
in a predisposition to a fever. The ratio between 
the action of stimuli and excitement, and excitabi- 
lity is destroyed ; and hence the former act upon 
the latter with a force which produces irregular ac- 
tion, or a convulsion in the arterial system. When 
the body is debilitated, and its excitability increas- 
ed, either by fear, darkness, or silence, a sudden 
noise occasions a short convulsion. We awake, 
in like manner, in a light convulsion, from the sud- 
den opening of a door, or from the sprinkling of a 
few drops of water in the face, after the excitability 
of the system has been accumulated by a night's 
sleep. In a word, it seems to be a law of the sys- 
tem, that stimulus, in an over-proportion to excita- 
bility, either produces convulsion, or goes so far 
beyond it, as to destroy motion altogether in death. 



16 OUTLINES OF A 

V. There is but one exciting cause of fever, arui 
that is stimulus. Heat, alternating with cold*, 
marsh and human miasmata, contagions and poi- 
sons of all kinds, intemperance, passions of the 
mind, bruises, burns, and the like, all act by a sti- 
mulating power only, in producing fever. This 
proposition is of great application, inasmuch as it 
cuts the sinews of the division of diseases from 
their remote causes. Thus it establishes the same- 
ness of a pleurisy, whether it be excited by heat 
succeeding cold, or by the contagions of the small- 
pox and measles, or by the miasmata of the yellow 
fever. 

To this proposition there is a seeming objection. 
Cold, sleep, immoderate evacuations, and the debi- 
litating passions of grief and fear (all of which ab- 
stract excitement) appear to induce fever without 
the interposition of a stimulus. In all these cases, 
the sudden abstraction of excitement destroys the 
equilibrium of the system, by which means the 
blood is diverted from its natural channels, and by 

* Perhaps there is no greater enemy to the life of man 
than cold. Dr. Sydenham ascribes nearly all fevers to it, 
particularly to leaving off winter clothes too soon, and to 
exposing the body to cold after it has been heated. These 
sources of fever, he adds, destroy more than the plague, 
sword, or famine**— Wattis's edition, toL I. fi, 357. 



-THEORY OF FEVER. 17 

acting with preternatural force in its new directions^ 
becomes an irritant to the blood-vessels, and thus a 
stimulating and exciting cause of fever. When it 
is induced by cold alone, it is probable so much of 
the perspirable matter may be retained as to co-ope- 
rate, by its irritating qualities, in exciting the fever. 

VI. There is but one fever. However different 
the predisposing, remote, or exciting causes of fe- 
ver may be, whether debility from abstraction or 
action, whether heat or cold succeeding to each 
other, whether marsh or human miasmata, whether 
intemperance, a fright, or a fall, still I repeat, there 
can be but one fever. I found this proposition 
upon all the supposed variety of fevers having but 
one proximate cause. Thus fire is a unit, whether 
it be produced by friction, percussion, electricity, 
fermentation, or by a piece of wood or coal in a 
state of inflammation. 

VII. All ordinary fever being seated in the 
blood-vessels, it follows, of course, that all those 
local affections we call pleurisy, angina, phrenitis, 
internal dropsy of the brain, pulmonary consump- 
tion, and inflammation of the liver, stomach, bow- 
els, and limbs, are symptoms only of an original 
and primary disease in the sanguiferous system. 
The truth of this proposition is obvious from the 

vol. in. c 



18 OUTLINES OF A 

above local affections succeeding primary fever, and 
from their alternating so frequently with each other. 
I except from this remark those cases of primary 
affections of the viscera which are produced by lo- 
cal injuries, and which, after a while, bring the 
whole sanguiferous system into sympathy. These 
cases are uncommon, amounting, probably, to not 
more than one in a hundred of all the cases of local 
affection which occur in general fever. 

In my 4th proposition I have called the action of 
the arteries irregular in fever, to distinguish it from 
that excess of action which takes place after violent 
exercise, and from that quickness which accom- 
panies fear or any other directly debilitating cause. 
The action of the arteries here is regular, and, 
when felt in the pulse, affords a very different sen- 
sation from that jerking which we feel in the pulse 
of a patient labouring under a fever. 

This irregular action is, in other words, a con- 
vulsion in the sanguiferous, but more obviously, in 
the arterial system. 

That this is the case I infer from the strict ana- 
logy between symptoms of fever, and convulsions 
in the nervous system. I shall briefly mention the 
particulars in which this analogy takes place. 



THEORY OF FEVER. 19 

1. Are convulsions in the nervous system pre- 
ceded by debility ? So is the convulsion of the 
blood-vessels in fever. 

2. Does debility induced on the whole, or on a 
part only, of the nervous system, predispose to 
general convulsions, as in tetanus ? So we observe 
debility, whether it be induced on the whole or on 
a part of the arterial system, predisposes to general 
fever. This is obvious in the fever which ensues 
alike from cold applied to every part of the body, 
or from a stream of cold air falling upon the neck, 
or from the wetting of the feet. 

3. Do tremors precede convulsions in the nerv- 
ous system ? So they do the convulsion of the 
blood-vessels in fever. 

4. Is a coldness in the extremities a precursor 
of convulsions in the nervous system ? So it is of 
fever. 

5. Do convulsions in the nervous system impart 
a jerking sensation to the fingers ? So does the 
convulsion of fever in the arteries, when felt at the 
wrists. 



OUTLINES OF A. 

6. Are convulsions in the nervous system attend- 
ed with alternate action and remission ? So is the 
convulsion of fever. 

7. Do convulsions in the nervous system return 
at regular and irregular periods ? So does fever. 

8. Do convulsions in the nervous system, under 
certain circumstances, affect the Junctions of the 
brain ? So do certain states of fever. 

9. Are there certain convulsions in the nervous 
system which affect the limbs, without affecting the 
functions of the brain, such as tetanus, and chorea 
sancti viti ? So there are certain fevers, particularly 
the common hectic, which seldom produces deli- 
rium, or even head-ach, and frequently does not 
confine a patient to his bed. 

10. Are there local convulsions in the nervous 
system, as in the hands, feet, neck, and eye-lids? 
So there are local fevers. Intermittents often ap- 
pear in the autumn with periodical heat and pains 
in the eyes, ears, jaws, and back. 

11. Are there certain grades in the convulsions 
of the nervous system, as appears in the hydrophp- 
bia, tetanus, epilepsy, hysteria, and hypochondria- 



THEORY OF FEVER. 21 

sis f So there are grades in fevers, as in the plague, 
yellow fever, small-pox, rheumatism, and common 
remitting and intermitting fevers. 

12 Are nervous convulsions most apt to occur 
in infancy ? So are fevers. 

13. Are persons once affected with nervous con- 
vulsions frequently subject to them through life? 
So are persons once affected with fever. The in- 
termitting fever often returns with successive 
springs or autumns, and, in spite of the bark, some- 
times continues for many years in all climates and 
seasons. 

14. Is the strength of the nervous system in- 
creased by convulsions ? This is so evident that it 
often requires four or five persons to confine a de- 
licate woman to her bed in a convulsive fit. In 
like manner the strength of the arterial system is 
increased in a fever. This strength is great in pro- 
portion to the weakness of every other part of the 
body. 

15. Do we observe certain nervous convulsions 
to affect some parts of the nervous system more 
than others, or, in other words, do we observe pre- 
ternatural strength or excitement to exist in one 



22 OUTLINES OF A 

part of the nervous system, while other parts of the 
same system exhibit marks of preternatural weak- 
ness or defect of excitement? We observe the 
same thing in the blood-vessels in a fever. The 
pulse at the wrist is often tense, while the force of 
the heart is very much diminished. A delirium 
often occurs in a fever from excess of excitement 
in the blood-vessels of the brain, while the pulse 
at the wrist exhibits every mark of preternatural 
weakness. 

16. Is there a rigidity of the muscles in certain 
nervous diseases, as in catalepsy ? Something like 
this solstice in convulsion occurs in that state of 
fever in which the pulse beats but sixty, or fewer 
strokes in a minute. 

17. Do convulsions go off gradually from the 
nervous system, as in tetanus, and chorea sancti 
viti ? So they do from the arterial blood-vessels in 
certain states of fever. 

18. Do convulsions go off suddenly in any cases 
from the nervous system ? The convulsion in the 
blood-vessels goes off in the same manner by a 
sweat, or by a haemorrhage, frequently in the 
course of a night, and sometimes in a single hour. 



THEORY OF FEVER. 23 

19. Does palsy in some instances succeed to con- 
vulsions in the nervous system P Something like a 
palsy occurs in fevers of great inflammatory action 
in the arteries. They are often inactive in the 
wrists, and in other parts of the body, from the im- 
mense pressure of' the remote cause of the fever 
upon them. 

From the facts and analogies which have been 
mentioned, I have been led to conclude that the 
common forms of fever are occasioned simply by 
irregular action, or convulsion in the blood-vessels. 

The history of the phenomena of fever, as deli- 
vered in the foregoing pages, resolves itself into a 
chain, consisting of the five following links. 

1. Debility from action, or the abstraction of sti- 
muli. When this debility is induced by action, it 
is sometimes preceded by elevated excitement in 
the blood-vessels, from the first impressions of sti- 
muli upon them. 

2. An increase of their excitability. 

3. Stimulating powers applied to them. 

4. Depression, And, 



24 OUTLINES OF A 

5. Irregular action or convulsion. 

The whole of the links of this chain are percep- 
tible only when the fever comes on in a gradual 
manner. But I wish the reader to remember, that 
the same remote cause is often debilitating, stimu- 
lating, and depressing, and that, in certain fevers, 
the remote cause sometimes excites convulsions in 
the blood-vessels without being preceded by pre* 
ternatural debility and excitability, and with' but 
little or no depression of the system. This has of- 
ten been observed in persons who have been sud- 
denly exposed to those marsh and human miasmata 
which produce malignant fevers. It sometimes 
takes place likewise in fevers induced by local in- 
juries. The blood vessels in these cases are, as it 
were, taken by storm, instead of regular approaches; 

I might digress here, and show that all diseases, 
whether they be seated in the arteries, muscles, 
nerves, brain, or alimentary canal, are all preceded 
by debility ; and that their essence consists in irre- 
gular action, or in the absence of the natural order 
of motion, produced or invited by predisposing de- 
bility. I might further show, that all the moral, 
as well as physical evil of the world consists in pre* 
disposing weakness, and in subsequent derangement 



THEORY OF FEVER. 25 

of action or motion ; but these collateral subjects 
are foreign to our present inquiry. 

Let us now proceed to examine how far the 
theory which has been delivered accords with the 
phenomena of fever. 

■ 

I shall divide these phenomena into two kinds. 

I. Such as are transient, and more or less com- 
mon to all fevers. These I shall call symptoms of 
fever. 

II. Such as, being more permanent and fixed, 
have given rise to certain specific names. These I 
shall call states of fever. 

I shall endeavour to explain and describe each of 
thern in the order in which they have been men- 
tioned. 

I. Lassitude is the effect of the depression of the 
whole system, which precedes fever. 

The same cause, when it acts upon the extremi- 
ties of the blood-vessels, produces coldness and 
chills. This is obvious to any person, under the 
first impression of the miasmata which bring on 

VOL. III. d 



26 OUTLINES OF A 

fevers, also under the influence of fatigue, and de- 
bilitating passions of the mind. The absence of 
chills indicates the sensibility of the external parts 
of the body to be suspended or destroyed, as well 
as their irritability ; hence when death occurs in 
the lit of an intermittent, there is no chill. A 
chilly fit, for the same reason, seldom occurs in the 
most malignant cases of fever. It is sometimes 
excited by blood-letting, only because it weakens 
those fevers to such a degree, as to carry the blood- 
vessels back to the grade of depression. Coldness 
and chills are likewise removed by blood-letting, 
only because it enables the arteries to re-act in such 
a manner as to overcome the depression that in- 
duced it. It has been remarked, that the chilly fit, 
in common fevers, seldom appears in its full force 
until the patient approaches a fire, or lies down on 
a warm bed ; for in these situations sensibility is 
restored by the stimulus of the heat acting upon 
the extremities of the blood-vessels. The first im- 
pressions of the rays of the sun, in like manner, 
often produce coldness and chills in the torpid bo- 
dies of old and weakly people. 

Tremors are the natural consequence of the ab- 
straction of that support which the muscles receive 
from the fulness and tension of the blood-vessels. 
It is from this retreat of the blood towards the vis- 



THEORY OF FEVER. 27 

©era, that the capillary arteries lose their fulness and 
tension ; hence they contract like other soft tubes 
that are emptied of their contents. This contrac- 
tion has been called a spasm, and has improperly 
been supposed to be the proximate cause of fever. 
From the explanation that has been given of its 
cause, it appears, like the coldness and chills, to be 
nothing but an accidental concomitant, or effect of 
a paroxysm of fever. 

The local pains in the head, breast, and bones in 
fever, appear to be the effects of the irregular de- 
termination of the blood to those pails, and to 
morbid action being thereby induced in them. 

The want of appetite and costiveness are the con- 
sequences of a defect of secretion of the gastric 
juice, and the abstraction of excitement or natural 
action from the stomach and bowels. 

The inability to rise out of bed, and to walk, is 
the effect of the abstraction of excitement from the 
muscles of the lower limbs. 

The dry skin or partial sweats appear to depend 
upon diminished or partial action in the vessels 
which terminate on the surface of the body. 



28 OUTLINES OP A 

The high-coloured and pale urine are occasioned 
by an excess or a -deficiency of excitement in the 
secretory vessels of the kidneys. 

The suppression of the urine seems to arise from 
what Dr. Clark calls an engorgement, or choaking 
of the vessels of the kidneys. It occurs most fre- 
quently in malignant fevers. 

Thirst is probably the effect of a preternatural 
excitement of the vessels of the fauces. It is by 
no means a uniform symptom of fever. We some- 
times observe it, in the highest degree, in the last 
stage of diseases, induced by the retreat of the last 
remains of excitement from every part of the body, 
to the throat. 

The white tongue is produced by a change in 
the secretion which takes place in that organ. Its 
yellow colour is the effect of bile ; its dryness is 
occasioned by an obstruction of secretion, or by the 
want of action in the absorbents ; and its dark and 
black colour, by a tendency to mortification. 

It will be difficult to account for the variety in 
the degrees and locality of heat in the body in a fe- 
ver, until we know more of the cause of animal 



THEORY OF FEVER. 29 

heat. From whatever cause it be derived, its ex- 
cess and deficiency, as well as all its intermediate 
degrees, are intimately connected with more or less 
excitement in the arterial system. It is not neces- 
sary that this excitement should exist only in the 
large blood-vessels. It will be sufficient for the 
purpose of creating great heat, if it occur only in 
the cutaneous vessels ; hence we find a hot skin in 
some cases of malignant fever in which there is an 
absence of pulse. 

Eruptions seem to depend upon effusions of se- 
rum, lymph, or red blood upon the skin, with or 
without inflammation, in the cutaneous vessels. 

I decline taking notice in this place of the symp- 
toms which are produced by the debility from ac- 
tion and abstraction, and by the depression of the 
system. They appear not only in the temperature 
of the body, but in all the different symptoms of fe- 
ver. It is of importance to know when they origi- 
nate from the former, and when from the latter cau- 
ses, as they sometimes require very different and 
opposite remedies to remove them. 

It remains only to explain the cause why excess 
in the force or frequency of the action of the blood- 



30 OUTLINES OP A 

vessels shouM succeed debility in a part, or in the 
whole of die body, and be connected for days and 
weeks with depression and preternatural debility in 
the nerves, brain, muscles, and alimentary canal. 
I shall attempt the explanation of this phenomenon 
by directing the attention of the reader to the ope- 
rations of nature in other parts of her works. 

1. A calm may be considered as a state of de- 
bility in the atmosphere. It predisposes to a cur- 
rent of air. But is this current proportioned to 
the loss of the equilibrium of the air? By no 
means. It is excessive in its force, and tends 
thereby to destroy the works both of nature and 
art. 

2. The passions are given to man on purpose 
to aid the slow and uncertain operations of reason. 
But is their action always proportioned to the 
causes which excite them ? An acute pneumony, 
brought on by the trifling injury done to the sys- 
tem by the fatigue and heat of an evening spent in 
a dancing assembly, is but a faint representation of 
the immense disproportion between a trifling af- 
front, and that excess of passion which seeks for 
gratification in poison, assassination, or a duel. 



THEORY OF FEVER. 31 

The same disproportion appears between cause and 
effect in public bodies. A hasty word, of no mis- 
chievous influence, has often produced convulsions, 
and even revolutions, in states and empires. 

If we return to the human body we shall find in 
it many other instances of the disproportion be- 
tween stimulus and action, besides that which takes 
place in the excitement of fever. 

3. A single castor oil nut, although rejected by 
the stomach upon its first effort in vomiting, has, in 
one instance that came within my knowledge, pro- 
duced a vomiting that continued nearly four and 
twenty hours. Here the duration of action was far 
beyond all kind of proportion to the cause which 
excited it. 

4. A grain of sand, after being washed from the 
eye, is often followed by such an inflammation or 
excess in the action of the vessels of the eye, as to 
require bleeding, purging, and blistering to remove 
it. 

Could we comprehend every part of the sublime 
and ineffable system of the divine government, I 



32 OUTLINES OF A 

am sure we should discover nothing in it but what 
tended ultimately to order. But the natural, mo- 
ral, and political world exhibit every where marks 
of disorder, and the instruments of this disorder, 
are the operations of nature. Her influence is 
most obvious in the production of diseases, and in 
her hurtful or ineffectual efforts to remove them*. 
In again glancing at this subject I wish it to be re- 
membered that those operations were not originally 
the means of injuring or seducing man, and that I 
believe a time will come when the exact relation 
between cause and effect, or, in other words, the 
dominion of order shall be restored over every ac- 
tion of his body and mind, and health and happi- 
ness again be the result of every movement of na- 
ture. 

From the view I have given of the state of the 
blood-vessels in fever, the reader will perceive the 
difference between my opinions and Dr. Brown's 
upon this subject. The doctor supposes a fever to 
consist in debility. I do not admit debility to be a 
disease, but place it wholly in morbid excitement, 



* See the Comparative View of the Diseases of the In- 
dians and of Civilized Nations. Vol. I. 



THEORY OF FEVER. &3 

invited and fixed by previous debility. He makes 
a fever to consist in a change only of a natural 
action of the blood -vessels. I maintain that it con- 
sists in a preternatural and convulsive action of the 
blood vessels. Lastly, Dr. Brown supposes excite- 
ment and excitability to be equally diffused over 
the whole body, but in unhealthy proportions to 
each other. My theory places fever in excitement 
and excitability unequally diffused, manifesting 
themselves, at the same time, in morbid actions, 
depression, and debility from abstraction, in differ- 
ent parts of the body. No new excitement from 
without is infused into the svstem bv the irritants 
which excite a fever. They only destroy its equal 
and natural distribution ; for while the arteries are 
in a plus, the muscles, stomach, and bowels are in a 
minus state of excitement, and the business of me- 
dicine is to equalize it in the cure of fever, that is, 
to abstract its excess from the blood-vessels, and 
to restore it to the other parts of the body. 

II. I come now to apply the theory w T hich I have 
delivered to the explanation and description of the 
different phenomena or states of fever. 

I have said in my sixth proposition that there is 
but one fever. Of course I do not admit of its ar- 
tificial division into genera and species. A disease 

V©*,. III. E 



34 OUTLINES OP A 

which so frequently changes its form and place, 
should never have been designated, like plants and 
animals, by unchangeable characters. The oak 
tree and the lion possess exactly the same proper- 
ties which they did nearly 6000 years ago. But 
who can say the same thing of any one disease ? 
The pulmonary consumption is sometimes trans- 
formed into head-ach, rheumatism, diarrhoea, and 
mania, in the course of two or three months, or the 
same number of weeks. The bilious fever oftea 
appears in the same person in the form of colic, dy- 
sentery, inflammation of the liver, lungs, and brain, 
in the course of five or six days. The hypochon- 
driasis and the hysteria seldom fail to exchange 
their symptoms twice in the four and twenty hours. 
Again : the oak tree has not united with any of the 
trees of d,e forest, nor has the lion imparted his 
specific qualities to any other animal. But who 
can apply similar remarks to any one disease? 
Phrenitis, gastritis, enteritis, nephritis, and rheu- 
matism all appear at the same time in the gout and 
yellow fever. Many observations of the same kind 
might be made, to show the disposition of nearly all 
other diseases to anastomose with each other. To 
describe them therefore by any fixed or specific cha- 
racters is as impracticable as to measure the dimen- 
sions of a cloud on a windy day, or to fix the 
component parts of water by weighing it in a hydro- 



THEORY OF FEVER. 35 

static balance. Much mischief has been done by 
nosological arrangements of diseases. They erect 
imaginary boundaries between things which are of 
a homogeneous nature. They degrade the human 
understanding, by substituting simple perceptions 
to its more dignified operations in judgment and 
reasoning. They gratify indolence in a physician, 
by fixing his attention upon the name of a disease, 
and thereby leading him to neglect the varying 
state of the system. They moreover lay a founda- 
tion for disputes among physicians, by diverting 
their attention from the simple, predisposing, and 
proximate, to the numerous, remote, and exciting 
causes of diseases, or to their more numerous and 
complicated effects. The whole materia medica is 
infected with the baneful consequences of the no- 
menclature of diseases, for every article in it is 
pointed only against their names, and hence the 
origin of the numerous contradictions among au- 
thors who describe the virtues and doses of the 
same medicines. By the rejection of the artificial 
arrangement of diseases, a revolution must follow 
in medicine. Observation and judgment will take 
the place of reading and memory, and prescriptions 
will be conformed to existing circum stances. The 
road to knowledge in medicine by this means will 
likewise be shortened ; so that a young man will 
be able to qualify himself to practise physic at as 



36 OUTLINES OF A 

much less experice of time and labour than for- 
merly, as a child would learn to read and write by 
the help of the Roman alphabet, instead of Chinese 
characters. 

In thus rejecting the nosologies of the schools, I 
do not wish to see them banished from the libraries 
of phy sicians. When consulted as histories of the 
effects of diseases only, they may still be useful. I 
use the term diseases, in conformity to custom, for, 
properly speaking, disease is much a unit as fever. 
It consists simply of morbid action or excitement 
in some part of the body. Its different seats and 
degrees should no more be multiplied into different 
diseases, than the numerous and different effects of 
heat and light upon our globe should be multiplied 
into a plurality of suns. 

The advocates for Dr. Cullen's system of medi- 
cine will not, I hope, be offended by these obser- 
vations. His immense stock of reputation will 
enable him to sustain the loss of his nosology with- 
out being impoverished by it. In my attempts to 
introduce a new arrangement of fevers, I shall only 
give a new direction to his efforts to improve the 
healing art. 



WHEORY OP FEVER. 37 

Were it compatible with the subject of the pre- 
sent inquiry, it would be easy to show, that the 
same difficulties and evils are to be expected from 
Dr. Darwin's division of diseases, as they affect the 
organs of sensation and motion, and as they are 
said to be exciubively related by association and 
volition, that have been deprecated from their di- 
visions and subdivisions by the nosologists. Dis- 
eases, like vices, with a few exceptions, are neces- 
sarily undisciplined and irregular. Even the ge- 
nius of Dr. Darwin has not been able to compel 
them to move within lines. 

I return from this digression to remark that mor- 
bid action in the blood-vessels, whether it consist 
in preternatural force and frequency, or preternatu- 
ral force without frequency, or frequency without 
force, constitutes fever. Excess in the force and 
frequency in the pulsations of the arteries have been 
considered as the characteristic marks of what is 
called inflammatory fever. There are, however, 
symptoms which indicate a much greater excess 
of irritating impressions upon the blood-vessels. 
These are preternatural slowness, intermissions, and 
depression in the pulse, such as occur in certain 
malignant fevers. 



38^ OUTLINES OF A 

s 

But there is a. grade of fever, which transcends 
in force that which produces inflammation. It oc- 
curs frequently in hydrophobia, dysentery, colic, 
and, baron Humboldt lately informed me, upon 
the authority of Dr. Comoto, of Vera Cruz, in 
the yellow fever of that city, when it proves fatal in 
a few hours after it attacks. In vain have physi- 
cians sought to discover, by dissections, the cause 
of fever in those cases, when followed by death, in 
the parts of the body in which it was supposed, from 
pain and other symptoms, to be principally seated. 
Those parts have frequently exhibited no marks of 
inflammation, nor of the least deviation from a 
healthy state. I have ascribed this apparent ab- 
sence of disease to the serous vessels being too 
highly excited, and thereby too much contracted, 
to admit the entrance of red blood into them. I 
wish these remarks to be remembered by the stu- 
dent of medicine. They have delivered me from 
the influence of several errors in pathology ; and 
they are capable, if properly extended and applied, 
of leading to many important deductions in the 
practice of physic. 

I shall now briefly mention the usual effects of 
fever, or morbid excitement in the blood-vessels, 
when not removed by medicine. They are, 



THEORY OF FEVER. 39 

1. Inflammation. It is produced by an effu- 
sion of red particles of blood into serous vessels, 
constituting what Dr. Boerhaave calls error loci. 
It is the second grade of fever, and, in fevers of 
great violence, does not take place until morbid 
excitement has continued for some time, or has 
been reduced by bleeding. 

2. Secretion, or an effusion from rupture, of 
the serum of the blood, constituting dropsies. 

3. Secretion of lymph or fibrin, forming a mem- 
brane which adheres to certain surfaces in the bodv. 



4. Secretion of pus, also of sloughs. 

5. An effusion by rupture, or a congestion of all 
the component parts of the blood. 

6. Gangrene from the death of the blood-vessels. 

7. Rupture of blood-vessels, producing hae- 
morrhage. 

8. Redness, phlegmon, pustules, and petechia* 
on the skin, and tubercles in the lungs, and on the 
liver and bowels. 



OUTLINES OF A 

9. Schirrus. 



10. Calcareous and other earthy matters. Both 
these take place only in the feeble and often imper- 
ceptible grades of morbid action in the blood-ves- 
sels. 

11. Death. This arises from the following 
causes. 

1. Sudden destruction of the excitability of the 
blood-vessels. 

2. A disorganization of parts immediately neces- 
sary to life. 

3. A change in the fluids, so as to render them 
destructive to what are called the vital organs. 

4. Debility, from the exhausted or suspended 
state of the excitability of the blood-vessels. 

All these effects of fever are different according 
to its grade. Dr. Blane says fevers are rarely in- 
flammatory in the West- Indies ; that is, they pass 
rapidly from simple morbid excitement to conges- 
tion, haemorrhage, gangrene^ and death. This re- 
mark is confirmed by Dr. Dalzelle, who says the 



/ 



THEORY OP FEVER. 41 

pneumony in the negroes, in the French West- In- 
dia islands, rarely appears in any other form than 
that of the notha, from the arteries in the lungs 
being too much stimulated to produce common in- 
flammation ; but such is the force of morbid excite- 
ment in hoi climates, that it sometimes passes sud- 
denly over all its intermediate effects, and discovers 
itself only in death. This appears to have taken 
place in the cases at Vera Cruz, mentioned by ba- 
ron Humboldt. 

All the different states of fever may be divided, 

I. Into such as affect the whole arterial system ; 
but with no, or very little local disease. 

II. Into such as affect the whole arterial system, 
and are accompanied at the same time with evident 
local disease. 

III. Into such as ap'pear to pass by the arterial 
system^ and to fix themselves upon other parts of 
the body. I shall call these states of fever mis- 
placed. 

I. To the first class of the states of fever belong, 

VOL. Ill, F 



42 OUTLINES OF A 

3. The malignant. It constitutes the highest 
grade of morbid diathesis. It is known by attacking 
frequently without a chilly fit, by coma, a depressed* 
slow, or intermitting pulse, and sometimes by the 
absence of pain, and with a natural temperature or 
coldness of the skin. It occurs in the plague, m 
the yellow fever, in the gout, in the small-pox and 
measles, in the hydrophobia, and after taking opium 
and other stimulating substances. Dr. Quier has 
described a pleurisy in Jamaica, in which some of 
those malignant symptoms took place. They are 
the effect of such a degree of impression as to pro- 
strate the arterial system, and to produce a defect 
of action from an excess of force. Such is this ex- 
cess of force, in some instances, in this state of fe- 
ver, that it induces general convulsions, tetanus, 
and palsy, and sometimes extinguishes life in a few 
hours, by means of apoplexy or syncope. From 
its being accompanied with these symptoms, it 
has received the name of adynamique by Dr. Ali- 
bert. The less violent degrees of stimulus in this 
state of fever produce palsy in the blood-vessels. It 
probably begins in the veins, and extends gradually 
to the arteries. It seems further to begin in the 
extremities of the arteries, and to extend by degrees 
to their origin in the heart. » This is evident in the 
total absence of pulse which sometimes takes place 
in malignant fevers, four and twenty, and even eight 



THEORY OF FEVER. 43 

and forty hours before death. But there are cases 
in which this palsy affects both the veins and arte- 
ries at the same time. It is probably from this si- 
multaneous affection of the blood-vessels, that the 
arteries are found to be nearly full of blood after 
death from malignant fevers. The depressed, and 
intermitting pulse which occurs in the beginning 
of these fevers perhaps depends upon a tendency to 
palsy in the arteries, independently of an affection of 
the heart or brain. 

This prostrate state of fever more frequently 
when left to itself terminates in petechia, buboes,, 
carbuncles, abscesses, and mortifications, according 
as serum, lymph, or red blood is effused in the vis- 
cera or external parts of the body. These morbid 
appearances have been ascribed to putrefaction, and 
the fever has received, from its supposed presence, 
the name of putrid. The existence of putrefaction 
in the blood in a fever is rendered improbable, 

1. By Dr. Seybert's experiments*, which prove 
that it does not take place in the blood in a living 
state. It occurs in the excretions of bile, fasces, 
and urine, but in this case it does not act as a fer- 
ment, but a stimulus only upon the living body. 

* Inaugural dissertation, entitled, " An Attempt to dis- 
prove the Putrefaction of the Blood in Living Animals." 



44 outlines or A 

2. By similar appearances, with those which 
have been ascribed to putrefaction, having been 
produced by lightning, by violent emotions of the 
mind, by extreme pain, and by every thing else 
which induces sudden and universal disorganiza- 
tion in the fluids and soiids of the bodv. The iol- 
lowing facts clearly prove that the symptoms which 
have been supposed to designate a putrid fever, are 
wholly the effect of mechanical action in the blood- 
vessels, and are unconnected with the introduction 
of a putrid ferment in the blood. 

Hippocrates relates the case of a certain Anti- 
phillus, in whom a putrid bilious fever (as he calls 
it) was brought on by the application of a caustic 
to a wound*. 

An acute pain in the eye, Dr. Physick informed 
me, produced the symptoms of what is called a 
putrid fever, which terminated in death in five 
days, in St. George's hospital, in the year 1789. 

Dr. Baynard relates, upon the authority of a 
colonel Bampfield, that a stag, which he had chased 
for some time, stopped at a brook of water in order 
to drink. Soon afterwards it fell and expired. The 

* Epidemics, book iv. 



THEORY OF FEVER. 45 

colonel cut its throat, and was surprised to perceive 
the blood which issued from it had a putrid and 
offensive smell*. 

Dr. Desportes takes notice that a fish, which he 
calls a sucker, affected the svbtem nearly in the 
same manner as the miasmata of the yellow fever. 
A distressing vomiting, a coldness of the extremi- 
ties, and an absence of pulse, were some of the 
symptoms produced by it, and an inflammation and 
mortification of the stomach and bowels, were dis* 
covered after death to be the effects of its violent 
operation. 

Even opium, in large doses, sometimes produces 
by its powerful stimulus the same symptoms which 
are produced by the stimulus of marsh miasmata. 
These symptoms are a slow pulse, coma, a vomit- 
ing, cold sweats, a sallow colour of the face, and a 
suppression of the discharges by the urinary pas- 
sages and bowels. 

Error is often perpetuated by words. A belief 
in the putrefaction of the blood has done great mis- 
chief in medicine. The evil is kept up, under the 
influence of new theories, by the epithet putrid, 

* Treatise on the Cold Bath, 



46 OUTLINES OF A 

which is still applied to fever in all our medical 
books. For which reason I shall reject it altoge- 
ther hereafter, and substitute in its room 

2. The gangrenous state of fever ; for what ap- 
pear to some physicians to be signs of putrefaction, 
are nothing but the issue of a violent inflammation 
left in the hands of nature, or accelerated by stimu- 
lating medicines. Thus the sun, when viewed at 
mid-day, appears to the naked eye, from the excess 
of its splendour, to be a mass of darkness, instead 
of an orb of light. 

The same explanation of what are called putrid 
symptoms in fever, is very happily delivered by 
Mr. Hunter in the following words : " It is to be 
observed (says this acute physiologist) that when 
the attack upon these organs, which are principally 
connected with life, proves fatal, that the effects of 
the inflammation upon the constitution run through 
all the stages with more rapidity than when it hap- 
pens in other parts ; so that at its very beginning, 
it has the same effect upon the constitution which 
is only produced by the second stage of inflamma- 
tion in other parts*." 

* Treatise on Inflammation, chap. I. 8* 



THEORY OF EEVER. 47 

3. The synocba> or the common inflammatory 
state of fever, attacks suddenly with chills, and is 
succeeded by a quick, frequent, and tense pulse, 
great heat, thirst, and pains in the bones, joints, 
breast, or sides. These symptoms sometimes oc- 
cur in the plague, the jail and yellow fever, and the 
small-pox ; but they are the more common charac- 
teristics of pleurisy, gout, and rheumatism. They 
now and then occur in the influenza, the measles, 
and the puerperile fever. 

4. The synochas state of fever is known by a full, 
quick, and round pulse without tension. The au- 
tumnal bilious fever and colic, also the gout, often 
appear in this form. 

5. There is a state of fever in which the pulse is 
small, but tense and quick. The patient, in this 
state of fever, is seldom confined to his bed. We 
observe it sometimes in the chronic rheumatism, 
and in pulmonary consumption. The inflammatory 
state of this grade of fever is proved from the inef- 
ficacy of the volatile tincture of guaiacum and other 
stimulants to remove it, and^ from its yielding so 
suddenly to blood-letting. I have called it the sy- 
nochula state of fever. 



48 OUTLINES OP A 

6. There is a state of fever inclining more to the 
synocha, than what is called the typhus, or low 
chronic state of fever. I have called it the syno- 
choid state of fever. 

7. The typhus state of fever is generally preceded 
by all those circumstances which debilitate the sys- 
tem, both by the action and abstraction of stimuli. 
It is known by a weak and frequent puise, a dis- 
position to sleep, a torpor of the alimentary canal, 
tremors of the hands, a dry tongue, and, in some 
instances, by a diarrhoea. These symptoms occur 
most frequently in what is called the jail, the ship, 
and the hospital fever. I heard of it in a few cases 
in the yellow fever of 1793, and all writers take 
notice of cases of the plague, which run on into a 
slow fever that continues 30 or 40 days. I have 
seen it succeed the common bilious fever, pleurisy, 
and influenza. It has been confounded with the 
malignant state of fever, or what is called the typhus 
gravior ; but it differs widely from it in being ac- 
companied by a feeble excitement in the blood- 
vessels, from a feeble stimulus, and by the usual 
signs of debility from abstraction in every other 
part of the body. 

From the accession of new stimuli, or an increase 
in the force of former ones, this typhus state of 



THEORY OF FEVER. 49 

fever sometimes assumes, on the 11th, 14th, and 
even 20th days, the symptoms of the synocha state 
of fever. It will be useful to remember this re- 
mark, not only because it establishes the unity of 
fever, but because it will justify the use of a reme- 
dy, seldom prescribed after the disease has ac- 
quired that name which associates it with stimulat- 
ing medicines. 

The common name of this state of fever, is the 
nervous fever. This name is improper ; for it in- 
vades the nervous system by pain, delirium, and 
convulsions much less than several other states of 
fever. To prevent the absurd and often fatal asso- 
ciation of ideas upon the treatment of this state of 
fever, I have called it, from its duration, the low 
chronic state of fever. I have adopted the term 
low, from Dr. Butter's account of the remitting 
fever of children, in order to distinguish it from 
states of fever to be mentioned hereafter, in which 
the patient is not confined to his bed. This new 
name of the typhus or nervous fever establishes its 
analogy with several other diseases. We have th z 
acute and the chronic rheumatism ; the acute and 
chronic pneurnony, commonly called the pleurisy 
and pulmonary consumption ; the acute and chro- 
nic inflammation of the brain, known unfortunately 
by the unrelated names of phrenitis, madness, and 

VOL. III. G 



5tJ OUTLINES OF A 

internal dropsy of the brain. Why should we he^ 
skate, in like manner, in admitting acute and chro- 
nic fever, in all those cases where no local inflam- 
mation attends ? 

8. The typhoid state of fever is composed of the 
synocha and low chronic states of fever. It is the 
slow nervous fever of Dr. Butter. The excitement 
of the biood-vessels is somewhat greater than in the 
low chronic state of fever. Perhaps the muscular 
fibres of the blood-vessels, in this state of fever, are 
affected by different degrees of stimulus and excite- 
ment. Supposing a pulse to consist of eight cords, 
I think I have frequently felt more or less of them 
tense or relaxed, according as the fever partook 
more or less of the synocha, or low chronic states 
of fever. This state of fever occurs most frequently 
in what are called the hectic and puerperal fevers, 
and in the scarlatina. 

9. The hectic state of fever differs from all the 
ether states of fever, by the want of regularity in 
its paroxysms, in which chills, fevers, and sweats 
are included ; and by the brain, nerves, muscles, 
and alimentary canal being but little impaired in 
their functions by it. It appears to be an exclusive 
disease of the blood-vessels. It occurs in the pul- 
monary consumption, in some cases of lues, of 



THEORY OF FEVER. 51 

^erophula, and of the gout, and after most of the 
states of fever which have been described. The 
force of the pulse is various, being occasionally sy- 
nochoid, typhoid, and typhus. 

10. Intermissions, or the intermitting and re- 
mitting states of fever, are common to all the states 
©f fever which have been mentioned. But they oc- 
cur most distinctly and universally in those which 
partake of the bilious diathesis. They have been 
ascribed to the reproduction of bile, to the recur- 
rence of debility, and to the influence of the hea- 
venly bodies upon the system. None of these hy- 
potheses has explained the recurrence of fever, 
where the bile has not been in fault, where debility 
is uniform, and where the paroxysms of fever do 
not accord with the revolutions of any part of the 
solar system. I have endeavoured to account for 
the recurrence of the paroxysm of fever, in com- 
mon with all other periodical diseases, by means of 
a natural or adventitious association of motions. 
Dr. Percival has glanced at this law of animal mat- 
ter; and Dr. Darwin has explained by it, in the 
most ingenious manner, many natural and morbid 
actions in the human bodv. 

m 

11. There is a state of fever in which the mor- 
bid action of the blood-vessels is so feeble as 



52 outlines or A 

scarcely to be perceptible. Like the hectic state of 
fever, it seldom affects the brain, nerves, muscles, 
or alimentary canal. It is known in the southern 
states of America by the name of inward fevers. 
The English physicians formerly described it by 
the name of febricula. 

These eleven states of fever may be considered 
as primary in their nature. All the states which 
remain to be enumerated belong to some one of 
them, or they are compounds of two, three, or 
more of them. Even these primary states of fever 
seldom appear in the simple form in which they 
have been described. They often blend their 
symptoms ; and sometimes all the states appear at 
different times in the course of a fever. This de- 
parture from a uniformity in the character of fevers 
must be sought for in the changes of the weather, 
in the casual application of fresh irritants, or in the 
operation of the remedies which have been employ- 
ed to cure them. 

To the first class of the states of fever belong the 
sweating, the fainting, the burning, and the cold 
and chilly states of fever. 

12. The sweating state of fever occurs in the 
plague, in the yellow fever, in the small-pox, the 



THEORY OF FEVER. 53 

pleurisy, the rheumatism, and in the hectic and in- 
termitting states of fever. Profuse sweats appeared 
every other day in the autumnal fever of 1795 in 
Philadelphia, without any other symptom of an in- 
termittent. The English sweating sickness was 
nothing but a symptom of the plague. The sweats 
in all these cases are the effects of morbid and ex- 
cessive action, concentrated in the capillary vessels. 

13. The fainting state of fever accompanies the 
plague, the yellow fever, the small-pox, and some 
states of pleurisy. It is the effect of great de- 
pression ; hence it occurs most frequently in the be- 
ginning of those states of fever. 

14. The burning state of fever has given rise to 
what has been called a species of fever. It is the 
causus of authors. Dr. Mosely, who rejects the 
epithet of yellow, when applied to the bilious fever, 
because it is only one of its accidental symptoms, 
very improperly distinguishes the same fever by 
another symptom, viz. the burning heat of the skin, 
and which is not more universal than the yellowness 
which attends it. 

15. The cold and chilly state of fever differs from 
a common chilly fit, by continuing four or five 
days, and to such a degree, that the patient fre- 



54 OUTLINES OF A 

quently cannot bear his arms out of the bed. The 
coldness is most obstinate in the hands and feet. 
A coolness only of the skin attends in some cases, 
which is frequently mistaken for an absence of fe- 
ver. 

Having mentioned those states of fever which 
affect the arterial system without any, or with but 
little local disease, I proceed next to enumerate 
those states of fever which belong to the 

II. Class of the order that was mentioned, in 
which there are local affections combined with ge- 
neral fever. They are, 

16. The intestinal state of fever. I have been 
anticipated in giving this epithet to fever, by Dr. 
Balfour*. It includes the cholera morbus, diar- 
rhoea, dysentery, and colic. The remitting bilious 
fever appears, in all the above forms, in the sum- 
mer months. They all belong to the febris intro- 
versa of Dr. Sydenham. The jail fever appeal's 
likewise frequently in the form of diarrhoea and 
dysentery. The dysentery is the offspring of marsh 
and human miasmata, but it is often induced in a 
weak state of the bowels, by other exciting causes. 

* Account of the Intestinal Remitting Fever of Bengal.' 



THEORY OF FEVER. 55 

The colic occasionally occurs with states of fever 
to be mentioned hereafter. 

17. The pulmonary state of fever includes the 
true and bastard pneumony in their acute forms ; 
also catarrh from cold and influenza, and the chro- 
nic form of pneumony in what is called pulmonary 
consumption. 

18. The eruptive state of fever includes the 
small-pox, measles, erysipelas, miliary fever, 
chicken-pox, and pemphigus. 

19. The anginose state of fever includes all 
those affections of the throat which are known by 
the names of cynanche inflammatoria, tonsillaris, 
parotidea, maligna, scarlatina, and trachealis. The 
cynanche trachealis is a febrile disease. The mem- 
brane which produces suffocation and death in the 
wind-pipe is the effect of inflammation. It is said 
to be formed, like other membranes which suc- 
ceed inflammation, from the coagulable lymph of 
the blood. 

20. The rheumatic state of fever is confined 
chiefly to the labouring part of mankind. The 
topical affection is seated most commonly in the 
joints and muscles, which, from being exercised 



56 OUTLINES OF A 

more than other parts of the body, become more 
debilitated, and are, in consequence thereof, excited 
into morbid and inflammatory action. 

21. The arthritic ox gouty state of fever differs 
from the rheumatic, in affecting, with the joints 
and muscles, all the nervous and lymphatic sys- 
tems, the viscera, and the skin. Its predisposing, 
exciting, and proximate causes are the same as the 
rheumatic and other states of fever. It bears the 
same ratio to rheumatism, which the yellow fever 
bears to the common bilious fever. It is a fever 
of more force than rheumatism. 

22. The cephalic y in which are included the 
phrenitic, lethargic, apoplectic, paralytic, hydroce- 
phalic, and maniacal states of fever. That mad- 
ness is originally a state of fever, I infer, 1. From its 
causes, many of which are the same as those which 
induce all the other states of fever. 2. prom its 
symptoms, particularly a full, tense, quick, and 
sometimes a slow pulse. 3. From the inflammatory 
appearances of the blood which has been drawn to 
relieve it. And, 4. From the phenomena exhibited 
by dissection in the brains of maniacs, being the 
same as are exhibited by other inflamed viscera 
after death. These are, effusions of water or blood, 
abscesses, and schirrus. The hardness in the 



THEORY OF FEVER. 57 

i 

brains of maniacs, taken notice of by several au- 
thors, is nothing but a schirrus (sui generis), in- 
duced by the neglect of sufficient evacuations in 
this state of fever. The reader will perceive by 
these observations, that I reject madness from its 
supposed primary seat in the mind or nerves. It 
is as much an original disease of the blood-vessels, 
as any other state of fever. It is to phrenitis, 
what pulmonary consumption is to pneumony. 
The derangement in the operations of the mind is 
the effect only of a chronic inflammation of the 
brain, existing without an abstraction of musoular 
excitement. 

23. The nephritic state of fever is often induced 
by calculi, but it frequently occurs in the gout, 
small-pox, and malignant states of fever. There 
is such an engorgement, or choaking of the vessels 
of the kidneys, that the secretion of the urine is 
sometimes totally obstructed, so that the bladder 
yields no water to the catheter. It is generally ac- 
companied with a full or tense pulse, great pain, 
sickness, or vomiting, high coloured urine, and a 
pain along the thigh and leg, with occasionally a 
retraction of one of the testicles. It exists some- 
times without any pain. Of this I met with seve- 
ral instances in the yellow fever of 1793. I include 
diabetes in this state of fever. 

VOL. III. H 



58 OUTLINES OF A 

24. The hydropic state of fever, in which are 
included collections of water, in the lungs, cavity 
of the thorax, cavity of the abdomen, ovaria, scro- 
tum, testicles, and lower extremities, and usually 
preceded, and generally accompanied with morbid 
action in the blood-vessels. That dropsy is a state 
of fever, I have endeavoured to prove in another 
place*. Nineteen dropsies out of twenty appear 
to be original arterial diseases, and the water, which 
lias been supposed to be their cause, is as much 
the effect of preternatural and morbid action in the 
blood-vessels, as pus, gangrene, and schirrus are of 
previous inflammation. This has been demon- 
strated, by the late Dr. Cooper, in a man who died 
of an ascites in the Pennsylvania hospital. Pus 
and blood, as well as water, were found in the ca- 
vity of the abdomen. It is no objection to this 
theory of dropsy, that we sometimes find water in 
the cavities of the body after death, without any 
marks of inflammation in the contiguous blood- 
vessels. We often find pus, both in the living 
and dead body, under the same circumstances, 
where we are sure it was not preceded by any of 
the obvious marks of inflammation. 

* On Dropsies, vol. II. 



THEORY OF FEVER. 59 

25. The hemorrhagic state of fever, in which 
are included discharges of blood from the nose, 
lungs, stomach, liver, bowels, kidneys and blad- 
der, hemorrhoidal vessels, uterus, and skin. Hae- 
morrhages have been divided into active and pas- 
sive. It would be more proper to divide them, 
like other states of general fever, into haemorrhages 
of strong and feeble morbid action. There is sel- 
dom an issue of blood from a vessel in which there 
does not exist preternatural or accumulated ex- 
citement. We observe this haemorrhage state of 
fever most frequently in malignant fevers, in pul- 
monary consumption, in pregnancy, and in that 
period of life in which the menses cease to be re- 
gular. 

26. The amenorrhagic state of fever ©ccurs 
more frequently than is suspected by physicians. 
A full and quick pulse, head-ach, thirst, and pre- 
ternatural heat often accompany a chronic obstruc- 
tion of the menses. The inefficacy, and even 
hurtful effects, of what are called emenagogue medi- 
cines, in this state of the system, without previous 
depletion, show the propriety of introducing it 
among the different states of fever. 

I have designedly omitted to take notice of 
other states of general fever accompanied with local 



60 OUTLINES OF A 

disease, because they are most frequently combined 
with some one or more of those which have been 
mentioned. They may all be seen in Dr. Cullen's 
Synopsis, with their supposed respective generic 
characters, under the class of pyrexiae, and the or- 
der of fevers. We come now in the 

III. And last place, to mention the misplaced 
states of fever. The term is not a new one in me- 
dicine. The gout is said to be misplaced, when 
it passes from the feet to the viscera. The perio- 
dical pains in the head, eyes, ears, jaws, hips, and 
back, which occur in the sickly autumnal months, 
and which impart no fulness, force, nor frequency 
to the pulse, are all misplaced fevers. There are, 
besides these, many other local morbid affections, 
which are less suspected of belonging to febrile dis- 
eases. The nature of these states of fever may ea- 
sily be understood, by recollecting one of the laws 
of sensation, that is, that certain impressions, which 
excite neither sensation nor motion in the part of 
the body to which they are applied, excite both in 
another part. Thus worms, which are not felt in 
the stomach or bowels, often produce a trouble- 
some sensation in the throat, and a stone, which is 
attended with no pain in the bladder, produces a 
troublesome itching in the glans penis. In like 
manner, the irritants which produce fever in ordi- 



tHEORY OF TEVER, 61 

nary cases pass through the blood-vessels, and con- 
vey their usual morbid effects into a remote part 
of the body which has been prepared to receive 
them by previous debility. That this is the case, 
I infer further, from fevers being called back from 
their misplaced or suffocated situations, by creating 
an artificial debility in the arteries by the abstrac- 
tion of blood. This is often done in muscular 
convulsions, and in several diseases of the brain. 

Under this class of fevers are included 

27. The chronic hepatic state of fever. The 
causes, symptoms, and remedies of the liver dis- 
ease of the East- Indies, as mentioned by Dr. Gir- 
dlestone, all prove that it is nothing but a bilious 
fever translated from the blood-vessels, and ab- 
sorbed, or suffocated, as it were, in the liver. This 
view of the chronic hepatitis is important, inasmuch 
as it leads to the liberal use of all the remedies 
which cure bilious fever. Gall stones and contu- 
sions now and then produce a hepatitis, but under 
no other circumstances do I believe it ever exists, 
but as a symptom of general or latent fever. 

28. The haemorrhoids are frequently a local dis- 
ease, but they are sometimes accompanied with 
pain, giddiness, chills, and an active pulse. When 



62 OUTLINES OF A 

these symptoms occur, it should be considered as 
a hemorrhoidal state of fever. 

29. The opthalmia, when it occurs, as it fre- 
quently does in sickly seasons, with a quick and 
tense pulse, and pains diffused over the whole 
head, may properly be called an opthalmic state of 
fever. 

30. The tooth-ach, and 

31. Ear-ach, when they arise from colds, and 
are attended with great heat, a quick and tense 
pulse, and pains in the head, are odontalgic and 
otalgic states of fever. 

32. The apthae, from the pain and fever which 
attend them, are justly entitled to the name of the 
apthous state of fever. 

S3. The symptoms of scrophula, as described 
by Dr. Hardy, in his treatise on the glandular dis- 
ease of Barbadoes, clearly prove it to be a misplaced 
state of fever. 

34. The scurvy has lately been proved by Dr. 
Claiborne, in his inaugural dissertation, published 
in the year 1797, to arise from so many of the 



THEORY OF 1EVER. 63 

causes, and to possess so many of the symptoms, 
of the low chronic and petechial states of fever, 
that I see no impropriety in considering it as a 
state of fever. 

35. The convulsive or spasmodic state of fever. 
Convulsions, it is well known, often usher in fevers, 
more especially in children. But the connection 
between spasmodic affections and fever, in adults, 
has been less attended to by physicians. The same 
causes which produced general fever and hepatitis 
in the East- Indies, in some soldiers, produced 
locked jaw in others. Several of the symptoms of 
this disease, as described by Dr. Girdlestone, such 
as coldness on the surface of the body, cold sweats 
on the hands and feet, intense thirst, a white tongue, 
incessant vomitings, and carbuncles, all belong to 
the malignant state of fever*. By means of blood- 
letting, and the other remedies for the violent state 
of bilious fever, I have seen the convulsions in this 
disease translated from the muscles to the blood- 
vessels, where they immediately produced all the 
common symptoms of fever. 

36. The hysterical and hypochondriacal states 
of fever. The former is known by a rising in the 

* Essay on the Spasmodic Affections in India, p. 53, 54, 55. 



64 OUTLINES OF A 

throat, which is for the most part erroneously as- 
cribed to worms, by pale urine, and by a disposi- 
tion to shed tears, or to laugh upon trifling occa- 
sions. The latter discovers itself by false opinions 
of the nature and danger of the disease under which 
the patient labours. Both these states of the ner- 
vous system occur frequently in the gout and in 
the malignant state of fever. It is common to say, 
in such cases, that patients have a complication of 
diseases ; but this is not true, for the hysterical and 
hypochondriacal symptoms are nothing but the ef- 
fects of one remote cause, concentrating its force 
chiefly upon the nerves and muscles. 

37. The cutaneous state of fever. Dr. Syden- 
ham calls a dysentery a " febris in tro versa.' ' 
Eruptions of the skin are often nothing but the 
reverse of this introverted fever. Thev are a fever 
translated to the skin ; hence we find them most 
common in those countries and seasons in which 
fevers are epidemic. The prickly heat, the rash, 
and the essere of authors, are all states of misplaced 
fever. " Agues, fevers, and even pleurisies (says 
Mr. Townsend, in his Journey through Spain*), are 
said often to terminate in scabies, and this frequent- 
ly gives place to them, returning, however, when 

* Vol. II. Dublin edition- p. 262. 



THEORY OF FEVER. 65 

the fever ceases. In adults it takes possession of 
the hands and arms, with the legs and thighs, co- 
vering them with a filthy crust." Small boils are 
common among the children in Philadelphia, at the 
time the cholera infantum makes its appearance. 
These children always escape the summer epidemic. 
The elephantiasis described by Dr. Hillary, in his 
account of the diseases of Barbadoes, is evidently 
a translation of an intermittent to one of the limbs. 
It is remarkable, that the leprosy and malignant fe- 
vers of all kinds have appeared and declined toge- 
ther in the same ages and countries. But further, 
petechias sometimes appear on the skin without 
fever. Cases of this kind, with and without he- 
morrhages, are taken notice of by Riverius*, Dr. 
Duncan, and many other practical writers. They 
are cotemporary or subsequent to fevers of a ma- 
lignant complexion. They occur likewise in the 
scurvy. From some of the predisposing, remote, 
and exciting causes of this disease, and from its 
symptoms and remedies, I have suspected it, like 
the petechias mentioned by Riverius, to be origi- 
nally a fever generated by human miasmata, in a 
misplaced state. The haemorrhages which some- 
times accompany the scurvy, certainly arise from a 
morbid state of the blood-vessels. The heat and 

* Praxis Medica, lib. xviii. cap. i. 
vol. in. r 



66 OUTLINES, &€. 

quick pulse of fever are probably absent, only be- 
cause the preternatural excitement of the whole 
sanguiferous system is confined to those extreme 
or cutaneous vessels which pour forth blood. In 
like manner the fever of the small-pox deserts the 
blood-vessels, as soon as a new action begins on the 
skin. Or perhaps the excitability of the larger 
blood-vessels may be so far exhausted by the long 
or forcible impression of the remote and predispos- 
ing causes of the scurvy, as to be incapable of un- 
dergoing the convulsive action of general fever. 

With this I close my inquiry into the cause of 
fever. It is imperfect from its brevity, as well as 
from other causes. I commit it to my pupils to 
be corrected and improved. 

« We think our fathers fools, so wise we grow. 
" Our wiser sons, I hojie, will think us so." 



AN ACCOUNT 



OF THE 



Bilious Remitting Tellow Fever : 



AS XT 



APPEARED IN PHILADELPHIA, 



IN THE YEAR 1793, 



AN ACCOUNT, ©c. 



BEFORE I proceed to deliver the history 
of this fever, it will be proper to give a short ac- 
count 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 disease 
there were many cases of catarrh in the city, 
brought on chiefly by the inhabitants exposing 
themselves for several hours on the damp ground, 



70 AN ACCOUNT OF THE 

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. 

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 reign- 
ing epidemic in this month. 



BILIOUS YELLOW FEVER OF 1793. 71 

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

The register of the weather shows, 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 sen 
of James Sharswood, aged seven years, had, with 
the common symptoms of this disease, 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 96? . The weather at this time 
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 typhus or chronic fever, from which the patient 



72 AN ACCOUNT OF THE 

was recovered with great difficulty. It was the 
son of Dr. Hutchins, of the island of Barbadoes. 

The weather, for the first two or three weeks in 
August, was temperate and pleasant. The cholera 
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- 
Iatina 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 
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 citizens 
of Philadelphia, as the last that fell for many weeks 
afterwards. 



BILIOUS YELLOW FEVER OF 1793. 73 

There was something in the heat and drought of 
the summer months which was uncommon, in 
their influence upon the human body. Labourers 
every where gave out (to use the country phrase) 
in harvest, and frequently too when the mercury 
in Fahrenheit's thermometer was under 84°. It 
was ascribed by the country people to the calm- 
ness 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 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 fe- 
ver of the bilious kind, which terminated (with a 
yellow skin) in death on the 7th of the same 
month. 

VOL. III. K 



74 AN ACCOUNT OF THE 

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 reco- 
very, 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 tar- 
tar, 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 a 
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 several 
days with a sick stomach, and vomiting after eat- 
ing. 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 bro- 
ther William, who was seized with all the symp- 



BILIOUS YELLOW FEVER OF 1793. 75 

toms of the same disease. On the 5th day his 
head-ach became extremely acute, and his pulse 
fell to sixty strokes in a minute. I suspected con- 
gestion to have taken place in his brain, and or- 
dered 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. Learning, the wife of Mr. Thomas Lea- 
rning. I suspected at first that she had the influ- 
enza, but in a day or two her fever put on bilious 
symptoms. She was affected with an uncommon 
disposition to faint. Her pulse was languid, but 
tense. I took a few ounces of blood from her, 
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 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 common 
bilious fever without being benefited by it. She 
recovered, however, slowly, and was yellow for 
many days afterwards. 



76 AN ACCOUNT OF THE 

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 
third 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 ex- 
cited the least apprehension of the existence of a 
malignant or yellow fever in our city ; for I had 
frequently seen sporadic cases in which the com- 
mon bilious fever of Philadelphia had put on symp- 
toms of great malignity, 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 



BILIOUS YELLOW FEVER OF 1793. 77 

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 disease. This information 
satisfied me that my apprehensions were well found- 
ed. The origin of this fever was discovered to 
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 



78 4K ACCOUNT OF THE 

Mr. Le Maigre's, where his child had been ex- 
posed 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 coifee had emitted its noxious 
effluvia, a few days before her sickness, and had 
been much incommoded by it. Her sister, Mrs. 
Learning, had visited her during her illness at her 
house, which was about two hundred yards from 
the infected wharf. Young Mr. M'Nair and Mrs. 
Palmer's two sons had spent whole days in a comp- 
ting house near where the coffee was exposed, and 
each of them had complained of having been made 
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 ori- 
gin of a fever which I knew to be attended with 
great danger and mortality, gave me great pain. I 
did not hesitate to name it the bilious remitting yeU 
low fever. I had once seen it epidemic in Phila- 
delphia, in the year 1762. Its symptoms were 
among the first impressions which diseases made 
upon my mind. I had recorded some of these 
symptoms, as well as its mortality. I shall here in- 
troduce a short account of it, from a note book 
which I kept daring my apprenticeship. 



\ 



BILIOUS YELLOW FEVER OF 1793. 79 

'* In the year 1762, in the months of August, 
" September, October, November, and December, 
" the bilious yellow fever prevailed in Philadelphia, 
41 after a very hot summer , and spread like a plague, 
14 carrying off daily, for some time, upwards of 
44 twenty persons. 

*■ The patients were generally seized with ri- 
•* gours, which were succeeded with a violent fe- 
44 ver, and pains in the head and back. The pulse 
44 was full, and sometimes irregular. The eyes 
44 were inflamed, and had a yellowish cast, and a 
m vomiting almost always attended. 

44 The 3d, 5th, and 7th days were mostly criti- 
44 cal, and the disease generally terminated on one 
44 of them, in life or death. 

" An eruption on the 3d or 7th day over the body 
" proved salutary. 

" An excessive heat and burning about the 
" region of the liver, with cold extremities, por- 
" tended death to be at hand." 

I have taken notice, in my note book, of the 
principal remedy which was prescribed in this fe- 



80 AN ACCOUNT OF THE 

ver 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 
mortal fever being in town spread in every direction, 
but it did not gain universal credit. Some of those 
physicians who had not seen patients in it denied 
that any such fever existed, and asserted (though 
its mortality was not denied) that it was nothing 
but the common annual remittent of the city. 
Many of the citizens joined the physicians in en- 
deavouring to discredit the account I had given of 
this fever, and for a while it was treated with ridi- 
cule or contempt. Indignation in some instances 
was excited against me, and one of my friends, 
whom I advised in this early stage of the disease 
to leave the city, has since told me that for that 
advice " he had hated me." 

My lot in having thus disturbed the repose of 
the public mind, upon the subject of general health, 
was not a singular one. There are many instances 
upon record, of physicians who have rendered 
themselves unpopular, and even odious to their 
fellow-citizens, by giving the first notice of the 
existence of malignant and mortal diseases. A 



BILIOUS YELLOW FEVER OF 1793. 81 

physician, who asserted that the plague was in 
Messina, in the year 1743, excited so much rage 
in the minds of his fellow -citizens against him, as 
to render it necessary for him to save his life by 
retreating to one of the churches of that city. 

In spite, however, of all opposition, the report of 
the existence of a malignant fever in the city gained 
so much ground, that the governor of the state di- 
rected Dr. Hutchinson, the inspector of sickly 
vessels, to inquire into the truth of it, and into the 
nature of the disease. 

In consequence of this order, the doctor wrote 
letters to several of the physicians in the city, re^ 
questing information relative to the fever. To his 
letter to me, dated the 24th of August, I replied 
on the same day, and mentioned not only the ex- 
istence of a malignant fever, but the streets it occu- 
pied, and my belief of its being derived from a 
quantity of coffee which had putrified on a wharf 
near Arch-street. This, and other information 
collected by the doctor, was communicated to the 
health officer, in a letter dated the 27th of August, 
in which he mentioned the parts of the city where 
the disease prevailed, and the number of persons 
who had died of it, supposed by him to be about 
40, but which subsequent inquiries proved to be 

VOL. III. L 



82 AN ACCOUNT OF THE 

more than 150. He mentioned further, in addition 
to the damaged coffee, some putrid hides, and 
other putrid animal and vegetable substances, as 
the supposed cause of the fever, and concluded by 
saying, as he had not heard of any foreigners or 
sailors being infected, nor of its being found in any 
lodging-houses, that " it was not an imported 
disease." 

In the mean while the disease continued to 
spread, and with a degree of mortality that had never 
been known from 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 checking 
the progress of the fever in the city. After some 
consideration upon the nature of the disease, a com- 
mittee was appointed to draw up some directions 
for those purposes ; and the next day the following 
w r ere presented to the college, and adopted unani- 
mously by them. They were afterwards published 
in most of the newspapers. 

Philadelphia, August 26th, 1793. 

The college of physicians having taking into con- 
sideration the malignant and contagious fever that 



BILIOUS YELLOW FEVER OF 1793. 83 

now prevails in this city, have agreed to recommend 
to their fellow-citizens the following means of pre- 
venting its progress. 

1st. That all unnecessary intercourse should be 
avoided with such persons as are infected by it. 

2d. To place a mark upon the door or window 
of such houses as have any infected persons in it, 

3d. To place the persons infected in the centre 
of large and airy rooms, in beds without curtains, 
and to pay the strictest regard to cleanliness, by fre- 
quently changing their body and bed linen, also 
by removing, as speedily as possible, all offensive 
matters from their rooms. 



4th. To provide a large and airy hospital, in the 
neighbourhood of the city, for the reception of 
such poor persons as cannot be accommodated with 
the above advantages in private houses. 

5th. To put a stop to the tolling of the bells. 

6th. To bury such persons as die of this fever 
in carriages, and in as private a manner as posaioie. 



84 AN ACCOUNT OF THE 

7th. To keep the streets and wharves of the city 
as clean as possible. As the contagion of the dis- 
ease may be taken into the body, and pass out of 
it without producing the fever, unless it be render- 
ed active by some occasional cause, the following 
means should be attended to, to prevent the conta- 
gion being excited into action in the body. 

8th. To avoid all fatigue of body and mind. 

9th. To avoid standing or sitting in the sun ; al- 
so in a current of air, or in the evening air. 

10th. To accommod?tte the dress to the wea- 
ther, and to exceed rather in warm, than in cool 
clothing. 

11th. To avoid intemperance, but to use fer- 
mented liquors, such as wine, beer, and cyder, in 
moderation. 

The college conceive fires to be very ineffectual, 
if not dangerous means of checking the progress of 
this fever. They have reason to place more de- 
pendence upon the burning of gunpowder. The 
benefits of vinegar and camphor are confined chiefly 
to infected rooms, and they cannot be used too fre* 
cjuently upon handkerchiefs, or in smelling-bottles, 



BILIOUS YELLOW FEVER OF 1793. 85 

by persons whose duty calls to visit or attend the 
sick. 

Signed by order of the college, 

WILLIAM SHIPPEN, jun. 

Vice president. 
SAMUEL P. GRIFFITTS, 

4 Secretary. 

From a conviction that the disease originated in 
the putrid exhalations from the damaged coffee, I 
published in the American Daily Advertiser, of 
August 29th, a short address to the citizens of Phi- 
ladelphia, with a view of directing the public at- 
tention to the spot where the coffee lay, and there- 
by of checking the progress of the fever as far as 
it was continued by the original cause. 

This address had no other effect than to produce 
fresh clamours against the author ; for the citizens, 
as well as most of the physicians of Philadelphia, 
had adopted a traditional opinion that the yellow 
fever could exist among us only by importation 
from the West- Indies. 

In consequence, however, of a letter from Dr. 
Foulke to the mayor of the city, in which he had 



$6 AN ACCOUNT OF THE 

decided, in a positive manner, in favour of the ge- 
neration of the fever from the putrid coffee, the 
mayor gave orders for the removal of the coffee, and 
the 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, 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, when received into the 
body, were generally excited into action in a few 
days. I met with several cases in which they acted 
so as to produce a fever on the same day in which 
they were received into the system, and I heard of 
two cases in which they excited sickness, fainting, 
and fever within one hour after the persons were 
exposed to them. I met with no instance in which 
there was a longer interval than sixteen days be. 
tween their being received into the boay and the 
production of the disease. 



BILIOUS YELLOW FEVER OF 1793. 87 

. This poison acted differently in different consti- 
tutions, according to previous habits, to the de- 
grees of predisposing debility, or to the quantity 
and concentration of the miasmata which had 
been received into the body. 

In some constitutions, the miasmata were at 
once a remote, a predisposing, and an exciting 
cause of the disease ; hence some persons were af- 
fected by them, who had not departed in any in- 
stance from their ordinary habits of living, as to 
diet, dress, and exercise. But it was more fre- 
quently brought on by those causes acting in suc- 
cession to each other. 

I shall here refer the reader to the principles laid 
down in the outlines of the theory of fever, for an 
account of the manner in which the system was 
predisposed to this disease, by the debility induced 
by the reduction of its excitement, by action and 
abstraction, and by subsequent depression. Where 
a predisposition was thus produced, the fever was 
Excited by the following causes, acting directly or 
indirectly upon die system. Where this predis- 
position did not exist, the exciting causes produced 
both the predisposition and the disease. They 
were, 



88 AN ACCOUNT OF THE 

1. Great labour, or exercises of body or mind, 
in walking, riding, watching, or the like. It was 
labour which excited the disease so universally 
among 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 trot- 
ting horse brought it on two of my patients. Per- 
haps riding on horseback, and in the sun, was the 
exciting 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 disease in consequence of their ex- 
ertions on the night of the 7th of September, in 
extinguishing the fire which consumed Mr. Dob*- 
son's printing-office, and even the less violent ex- 
ercise of working the fire engines, for the purpose 
of laying the dust in the streets, added frequently to 
the number of the sick. 

2. Heat, from every cause, but more especially 
the heat of the sun, was a very common exciting 
cause of the disease. The register of the weather 
during the latter end of August, the whole of Sep- 
tember, and the first two weeks in October will 
show how much the heat of the sun must have 
contributed to excite the disease, more especially 



BILIOUS YELLOW FEVER OF 1793. 89 

among labouring people. The heat of common 
fires likewise became a frequent cause of the acti- 
vity of the miasmata where they 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 plen- 
tiful meal, and a few extra glasses of wine seldom 
failed of exciting the fever. But where the body 
was strongly impregnated with the seeds of the dis- 
ease, even the smallest deviation from the custom 
mary stimulus of diet, in respect to quality or quan- 
tity, roused them mto action. A supper of twelve 
oysters in one, and of but three in another, of my 
patients produced the disease. Half an ounce of 
meat excited it in a lady who had lived, by my 
advice, for two weeks upon milk and vegetables, 
and even a supper of sallad, dressed after the French 
fashion, excited it in one of Dr. Mease's patients. 

4. Fear. In many people the disease was ex- 
cited by a sudden paroxysm of fear ; but I saw 
some remarkable instances where timid people es- 
caped the disease, although they were constantly 
exposed to it. Perhaps a moderate degree of fear 
served to counteract the excessive stimulus of the 
miasmata, and thereby to preserve the body in a state 

vol. in. M ' 



90 AN ACCOUNT OF THE 

of healthy equilibrium. I am certain that fear did no 
harm after the disease was formed, in those cases 
where great morbid excess of action 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-operat- 
ed with some of my remedies (to be mentioned 
hereafter) in reducing the morbid excitement of the 
arterial system. 

5. Grief. It was remarkable that the disease 
was not excited in many cases in the attendants 
upon the sick, while there w r as a hope of their re- 
covery. The grief which followed the extinction 
of hope, by death, frequently produced it within a 
day or two afterwards, and that not in one person 
only, but often in most of the near relations of the 
deceased. But the disease w r as also produced by a 
change in the state of the mind directly opposite to 
that which has been mentioned. Many persons 
that attended patients w r ho recovered, were seized 
with the disease a day or two after they were re- 
lieved from the toils and anxiety of nursing. The 
collapse of the mind from the abstraction of the sti- 
mulus of hope and desire, by their ample gratifica- 
tion, probably produced that debility, and loss of 
the equilibrium in the system, which favoured the 



BILIOUS YELLOW FEVER OF 1793. 91 

activity of the miasmata in the manner formerly 
mentioned*. 



The effects of both the states of mind which 
have been described, have been happily illustrated 
by two facts which are recorded by Dr. Jacksonf . 
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 sickly 
as soon as the French and American armies re- 
treated from before it, and the latter, immediately 
after its capitulation. 

6. Cold. Its action, in exciting the disease, 
depended upon the diminution of the necessary and 
natural heat of the body, and thereby so far de- 
stroying the equilibrium of the system, as to ena- 
ble the miasmata to produce excessive or convul- 
sive 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 after- 
wards to change his shoes and stockings. Every 
change in the weather, that was short of producing 

* Outlines of a Theory of Fever. 

t Treatise on the Fevers of Jamaica, p. 298. 



.a 



92 AN ACCOUNT OF THE 

frost, evidently increased the number of sick peo- 
ple. 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 disease. The 
same increase of the number of sick was observed 
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 w r ere 
habitually exposed to the cool air, were less liable 
to the disease than others. I ascribe it to the ha- 
bitual impression of the cool night air upon the 
bodies of the city watchmen, that but four or five 
of them, out of twenty-live, were affected by the 
disease. 

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. 

7. Sleep. A great proportion of all who were af- 
fected by this fever, were attacked in the night. 
Sleep induced what I have called debility from ab* 



BILIOtfS YELLOW FEVER OF 1793. 93 

straction, and thereby disposed the miasmata 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 pre- 
disposing, and exciting cause was often assisted by 
the want of bed-clothes, suited to the midnight or 
morning coolness of the air. 

8. 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 disease, 
and excited it. The morbid effects of these eva- 
cuations, were much aided by fear, for it was this 
passion which perverted the judgment in such a 
manner, as to lead to the excessive use of remedies, 
which, to be effectual, should only be used in mo- 
derate quantities. 

The disease appeared with different symptoms, 
and in different degrees, in different people. They 
both varied likewise with the weather. In de- 
scribing 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 



94 AN ACCOUNT OF TH£ 

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 miasmata as to induce de- 
pression, while the brilliant eye, and the unusual 
vivacity, seemed to have been produced by a less 
quantity of the miasmata acting as a cordial upon 
the system. More or less of these symptoms fre- 
quently continued for two or three days before the 
patients were confined to their beds, and in some 
people they continued during the whole time of its 
prevalence in the city, without producing the dis- 
ease. I wish these symptoms to be remembered 
by the reader. They will form the corner stone of 
a system which I hope will either eradicate the dis- 
ease altogether, or render it as safe as an intermit- 
ting 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 chili^ fit. 



BILIOUS YELLOW FEVER OF 1793. 95 

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 disease. 

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 bilious 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 some 
cases, as to resemble two balls of fire. Sometimes 
they had a most brilliant or ferocious appearance. 
The face was suffused with blood, or of a dusky 
colour, and the whole countenance was downcast 
and clouded. After the 10th of September, when 
a determination of blood to the brain became uni- 
versal, there was a preternatural dilatation of the 
pupil. Sighing attended in almost every case. 
The skin was dry, and frequently of its natural 
temperature. These were the principal symptoms 
which discovered themselves to the eye and hand 
of a physician. The answers to the first questions 
proposed upon visiting a patient, were calculated to 
produce a belief in the mind of a physician, that the 



96 AN ACCOUNT OF THE 

disease under which the patient laboured was not 
the prevailing malignant epidemic. I did not for 
many weeks meet with a dozen patients, who ac- 
knowledged that they had any other indisposition 
than a common cold, or a slight remitting or inter- 
mitting fever. I was particularly struck with this 
self-deception in many persons, who had nursed 
relations that had died with the yellow fever, 
and who had been exposed to it in neighbour- 
hoods where it had prevailed for days and even 
weeks with great mortality. I shall hereafter trace 
a part of this disposition in the sick to deceive 
themselves to the influence of certain publications, 
which appeared soon after the disease became epi- 
demic in the city. 

In the farther 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. 



BILIOUS YELLOW FEVER OF 1793. 97 

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 mention 
some general characters of the disease, and after- 
wards subdivide it into classes, according to its de- 
grees and duration. 

I. The blood-vessels were affected more or less in 
every case of this fever. I have elsewhere said, 
that a fever is occasioned by a convulsion in the 
arterial system*. When the epidemic, which we 
are now considering, came on with a full, tense, 
and quick pulse, this convulsion was veiy percep- 
tible ; but it frequently came on with a weak pulse, 
often without any preternatural frequency or quick- 
ness, and sometimes so low as not to be perceived 
without pressing the artery at the wrists. In many 
cases the pulse intermitted after the fourth, in some 

* Outlines of a Theory of Fever. 
VOL. III. N 



98 AN ACCOUNT OF THE 

after the fifth, and in others after the fourteenth 
Stroke. These intermissions occurred in several 
persons who were infected, but who were not con- 
fined by the fever. They likewise continued in 
several of my patients for many days after their 
recovery. This was the case in particular 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. Wil- 
liam Sansom , at a time when they were in the most 
imminent danger. Dr. Physick informed me, that 
in one of his patients the pulse was reduced in fre- 
quency to 30 strokes in a minute. All these dif- 
ferent states of the pulse have been taken notice of 
by authors who have described pestilential fevers*. 
They have been improperly ascribed to the absence 
of fever : I would rather suppose that they are oc- 
casioned by the stimulus of the remote cause act- 
ing upon the arteries with too much force to admit 
of their being excited into quick and convulsive 
motions. The remedy which removed it (to be 
mentioned hereafter) will render this explanation of 
its cause still more probable. Milton describes 

* Vergasca, Sorbait, and Boate in Haller's Bibliotheca 
Medidna, vol. iii. also by Dr. Stubbs in the Philosophical 
Transactions, and Riverius in his treatise de febre pestilenti. 



JILIOUS YELLOW FEVER OF 1793. 39 

a darkness from an excess of light. In like man- 
ner we observe, in this small, intermitting, and 
slow pulse, a deficiency of strength from an excess 
of force applied to it. In nearly 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 formerly in a 
sporadic case of yellow fever. It was new to all 
my pupils. One of them, Mr. Washington, gave 
it the name of the " undescribable pulse." It aided 
in determining the character of this fever before the 
common bilious remittent disappeared in the city. 
For a while, I ascribed this peculiarity in the 
pulse, more especially its slowness, to an affection 
of the brain only, and suspected that it was pro- 
duced by what I have taken the liberty elsewhere 
to call the phrenic ula, or inflammatory state of the 
internal dropsy of the brain, and which I have re* 
marked to be an occasional symptom and conse- 
quence of remitting fever*. I was the more dis- 
posed to adopt this opinion, from perceiving this 
slow, chorded, and intermitting pulse more fre- 
quendy 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 

Vol. ii. 



100 AN ACCOUNT OF THE 

eyes. For two days we discovered no change in 
them, but on the third day after we began to inspect 
them, 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 
Di\ Say it was attended by a squinting, a symp- 
tom which marks a high degree of a morbid affec- 
tion of the brain. Had this slowness or intermis- 
sion in the pulse occurred only after signs of inflam- 
mation or congestion had appeared in the brain, 
I should have supposed that it had been derived 
wholly from that cause ; but I well recollect hav- 
ing felt it several days before I could discover the 
least change in the pupil of the eye. I am forced 
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, accom- 
panied with preternatural dilatation or contraction 
of the heart. Lieutaud mentions this species of 
pulse in several places, as occurring with an undue 
enlargement of that muscle*. Dr. Ferriar de- 
scribes a case, in which a low, irregular, intermit- 
ting, and hardly perceptible pulse attended a mor- 
bid dilatation of the heartf. In a letter I received 

* Historia Anatomica Medica, vol ii. obs. 405, 418, 423, 
.5 10. 

+ Medical Histories and Reflections, p. 130. 



BILIOUS YELLOW FEVER OF 1793. 101 

from Mr. Hugh Ferguson, then a student of me- 
dicine 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 subject. 
" A case (says my young correspondent) where a 
remarkable intermission of pulse was observed, 
occurred in this city last year. A gentleman of 
the medical profession, middle aged, of a delicate 
habit of body, and who had formerly suffered 
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. Dur- 
ing 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- 



102 AN ACCOUNT OF THE 

i 

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 disease, more especially in old people. 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 gradu- 
ally succeeded by a pulse full, tense, quick, and as 
frequent as in pleurisy or rheumatism. It differed, 
however, from a pleuritic or rheumatic pulse, in 
imparting a very different sensation to the fingers. 
No two strokes seemed to be exactly alike. Its 
action was of a hobbling nature. It was at this 
time so familiar to me that I think I could have 
distinguished the disease by it without seeing the 
patient. It was remarkable that this pulse attend- 
ed the yellow fever even when it appeared in the 



BILIOUS YELLOW FEVER OF 1793. 103 

mild form of an intermittent, and in those cases 
where the patients were able to walk about or go 
abroad. It was nearly as tense in the remissions 
and intermissions of the lever 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. 

This change of the pulse, from extreme lowness 
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 remote cause, 
had induced those symptoms of depression of the 
pulse which have been mentioned. 

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

Hcemorrhages belong to the symptoms of this 
fever as they appeared in the sanguiferous system. 
They occurred in the beginning of the disease, 
chiefly from the nose and uterus. Sometimes but 
a few drops of blood distilled from the nose. - The 



104 AN ACCOUNT OF 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 a haemorrhage 
from the iungs on the first day of the fever, which 
was supposed to be a common haemoptysis. As 
the disease advanced the discharges of blood be- 
came more universal. They occurred from the 
gums, ears, stomach, bowels, and urinary passages. 
Drops of blood issued from the inner canthus of 
the left ej^e 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 haemorrhages 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 disease, I was early led to examine 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 



BILIOUS YELLOW FEVER OF 1793. 105 

right side. Many complained of a dull pain in the 
region of the liver, but very few complained, in the 
beginning of the disease, 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, 
and some appeared to die of sudden effusions of 
blood or serum in the lungs. It was an unexpected 
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 
disease. 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 
haemorrhages from the nose and ears, by the sick- 
ness or vomiting, and by an almost universal cos- 
tive 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 disease. It is 

VOL. III. O 



106 AN ACCOUNT OF THE 

difficult to determine the exact state of these viscera 
in every case of bilious and yellow fever. Inflam- 
mation certainly takes place in some cases, and in- 
ternal haemorrhages 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 
believe further, with Dr. Clark* and Dr. Balfourf , 
that death in most cases in bilious fevers is the 
effect of these morbid congestions, and wholly un- 
connected with an exhausted state of the system, 
or a supposed putrefaction in the fluids. It is true, 
the dissections of Dr. Physick and Dr. Cathrall 
(to be mentioned hereafter) discovered no morbid 
appearances in any of the viscera which have been 
mentioned, but it should be remembered, that these 
dissections were made early in the disease. Dr. 
Annan attended the dissection of a brain of a pa- 
tient who died at Bush-hill some days afterwards, 
and observed the blood-vessels to be unusually 
turgid. In those cases where congestion 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 dis- 

* Vol. i. p. 168. 

t Treatise on the Intestinal Remitting Fever, p. 125. 



BILIOUS Y1LLOW FEVER OF 1793. 107 

appeal' after the retreat of the blood from the ex- 
tremities of the vessels, in the last moments of life. 
It is no new thing for morbid excitement of the 
brain to leave either slender, or no marks of disease 
after death. This, I have said, is often the case 
where it exceeds that degree of action which pro- 
duces an effusion of red blood into serous vessels, 
or what is called inflammation*. Dr. Quin has 
given a dissection of the brain of a child that died 
with all the symptoms of hydrocephalus internus, 
and yet nothing was discovered in the brain but a 
slight turgescence of its blood-vessels. Dr. Gir- 
dlestone 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 
informs us, that the brain was in a natural state in 
every case of death from puerperile fever, notwith- 
standing it seemed to be affected in many cases 
soon after the attack of that diseasef. 

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 

* Outlines of a theory of fever. 

t Essay on the Epidemic Disease of Lying-in Women, of 
the years 1787 and 1788, p. 34. 



108 AN ACCOUNT OF THE 

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 disease, than it had been in more temperate 
weather. 

III. The stomach and bowels were affected in 
many ways in this fever. The disease seldom ap~ 
peared without nausea or vomiting. In some 
cases, they both occurred for several days or a 
week before they were accompanied by any fever. 
Sometimes a pain, known by the name of gastro- 
dynia, ushered in the disease. The stomach was 
so extremely irritable as to reject drinks of every 
kind. Sometimes green or yellow bile was rejec- 
ted on the first day of the disease 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, 



BILIOUS YELLOW FEVER OF 1793. 109 

or if it had been checked by remedies that were 
ineffectual to remove it altogether, it generally ap- 
peared, or returned, on the 4th or 5th day of the 
disease. I dreaded this symptom on those days, 
for although it was not always the forerunner of 
death, yet it generally rendered the recovery more 
difficult and tedious. In some cases the vomiting; 
was more or less constant from the beginning to 
the end of the disease, whether it terminated in 
life or death. 

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 anxi- 
ety, and tossing of the body from one part of the 
bed to another. In some cases, this painful burn- 
ing occured 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 disease. It was very distres- 



110 AN ACCOUNT OF THE 

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 tenesmus, and mu- 
cous and bloody discharges of a true dysentery. A 
diarrhoea introduced the disease in a few persons, 
but it was chiefly in those who had been previously 
indisposed with weak bowels. 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. 

IV. I come now to describe the state of the 
secretions and excretions as they appeared in dif- 
ferent stages of this fever. 

In some cases there was a constipation of the 
liver, if I may be allowed that expression, or a to- 
tal obstruction of secretion and excretion of bile, 
but more frequently a preternatural secretion and 
excretion of it took place. It was discharged, in 
most cases, from the stomach and bowels in large 
quantities, and of very different qualities and co- 
lours. 



BILIOUS YELLOW FEVER OF 1793. Ill 

1. On the first and second days of the disease 
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 w T as discharg- 
ed on the, first day. Three of these patients reco- 
vered. 4 

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 subsequent 
dissections by Dr. Physick have taught me that 
it was the result of the first stage of those morbid 
actions in the stomach, which afterwards produce 
the black vomit. Many recovered who discharged 
this coffee- coloured matter. 

3. Towards the close of this disease, there was a 
discharge of matter of a deep or pale black colour, 
from the stomach. Flakey substances frequently 
floated in the bason or chamber-pot upon the sur- 
face of this matter. It was what is called the black 
vomit. It was formerly supposed to be vitiated 
bile, but it has been proved by Dr. Stewart, and 
afterwards by Dr. Physick, to be the effect of dis- 
ease in the stomach. 



112 AN ACCOUNT OF THE 

4. There was frequently discharged from the 
stomach in the close of the disease, a large quantity 
of grumous blood, which exhibited a dark colour 
on its outside, resembling that of some of the mat- 
ters which have been described, and which I believe 
was frequently mistaken for what is commonly 
known by the name of the black vomit. Several of 
my patients did me the honour to say, I had cured 
them after that symptom of approaching dissolution 
had made its appearance ; but I am inclined to be- 
lieve, dark- coloured blood only, or the coffee-co- 
loured 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 disease. 
This I have no doubt was bile, but it had not ac- 
quired its greatest acrimony, and it was discharged 
before mortification, or even inflammation could 
have taken place in the stomach. Several 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. 

The colour, quality, and quantity of the faces 
depended very much upon the treatment of the dis- 



BILIOUS YELLOW FEVER OF 1793. 113 

ease. Where aetive 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 appear- 
ance. 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 without 
a stool, and who had been treated with tonic reme- 
dies. I gave her a purge, which in a few hours 
procured a discharge of faeces so extremely 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 liver to be 
so constipated or paralyzed by the disease, as to be 
unable to secrete or excrete bile to colour the 

VOL. III. p 



114 AN ACCOUNT OF THE 

faeces. Large round worms were frequently dis- 
charged 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 gonor- 
rhoea. I met with one case in w T hich 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 generally 
accompanied or portended great danger. I heard 
of one case in which there was a suppression of 
urine, which could not be relieved without the use 
of the catheter. 

* Wallis's edition, vol. i. p. 197. 



BILIOUS YELLOW FEVER OF 1793. 115 

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 a dis- 
section of a person who died of the yellow fever, 
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 disease. 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 disease. I saw but few instances of 
its 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 treating this fever. 

/ 

There was in some cases a preternatural secre- 
tion and excretion of mucus from the glands of 

* Rosier'* Journal for January, 1790, vol. xxxvi. p. 380. 



IIS AN ACCOUNT OF THE 

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 assumed a red 
colour, and a smooth shining appearance. It was 
not quite dry in this state. Towards the close of 
the fever, a dry black streak appeared in its middle, 
which gradually extended to every part of it. Few 
recovered after this appearance on the tongue took 
place. 

V. In the nerwus 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 miasmata 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, some- 
times fell down in the streets. Two cases of this 
kind happened near my house. One of them came 
under my notice. He was supposed by the bye- 
standers to be drunk, but his countenance and con- 



BILIOUS YELLOW FEVER OF 1793. 117 

vulsive motions soon convinced me that this was 
not the case. 

A coma was observed in some people, or an ob- 
stinate wakefulness in every stage of the disease. 
The latter symptom most frequently attended the 
convalescence. Many were affected with immobi- 
lity, 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 extended 
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 disease, 
but I think less frequently than the last stage of 
the common bilious fever. I saw but five cases of 
recovery where this symptom took place. 

There was, in some instances, a deficiency of 
sensibility, but, in others, a degree of it extending 
to every part of the body, which rendered the ap- 



113 AN ACCOUNT OF THE 

plication 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 chronic 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 
disease. 

While the muscles and nerves in many cases ex- 
hibited so many marks of preternatural weakness, 
in some they appeared to be affected with preter- 
natural excitement. Hence patients in the close of 
the disease 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 morbid 
strength occurred to such a degree, that he stood 
up before his glass and shaved himself, on the day 
on 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 



BILIOUS YELLOW FEVER OF 1793. 11$ 

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 off 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 ail other 
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. 



120 AN ACCOUNT OF THE 

I observed in several persons the operations of 
the understanding to be unimpaired, throughout 
the whole course of the fever, who retained no re- 
membrance of any thing that passed in their sick- 
ness. 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 things 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 disease, 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 in- 
stances of derangement of mind. 

The pain which attended the disease was diffe- 
rent, according to the different states of tiie system. 



BILIOUS YELLOW FEVER OF 1793. 121 

In those cases in which it sunk under the violence 
of the disease, there was little or no pain. In pro- 
portion as the system was relieved from this op- 
pression, 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 diffe- 
rent people, the seats of either dull or acute pains. 
The stomach, towards the close of the disease, 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 produced 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 disease. The stoutest men complained, and 
even groaned under 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 instrument. The sympathy of friends with 



VOL. III. 



122 AN ACCOUNT OF THE 

the distresses of the sick extended to a small part 
of their misery, when it did not include their suffer- 
ings from pain. 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 fa- 
vourable 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. i 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 disease. 

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 r~y patients, who suf- 
fered by an excessive draught of cold water, de- 
clared, just before he died, that " he could drink 



BILIOUS YELLOW FEVER OF 1793. 123 

up the Delaware." It was always an alarming 
symptom when this thirst came on in this extra- 
vagant degree in the last stage of the disease. In 
the beginning of the fever it generally abated upon 
the appearance of a moist skin. Water was pre- 
ferred 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 disease. So keen was the 
appetite for solid, and more especially for animal 
food, after the solution of the fever, that many suf- 
fered from eating aliment that was improper from 
its quality or quantity. There was a general dis- 
relish for wine, but malt liquors were frequently 
grateful to the taste. 

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 be- 
gan to recover, than are common in any other fe- 
brile disease. I met with one case in which a man, 
who was so ill as to require two bleedings, conti- 
nued to chew tobacco through every stage of his 
fever. 



124 AN ACCOUNT OF THE 

The convalescence from this disease was mark- 
ed, in some instances, by u sudden revival of the 
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 was not peculiar to this 
fever to produce this morbid excitability of the 
Venereal appetite. It was produced in a much 
higher degree by the plague which raged in Mes- 
sina in the year 1743. 

VII. The lymphatic and glandular system did 
not escape without some signs 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 extremely painful 
in one case in which no redness or inflammation 
appeared. In the others there was considerable in- 
flammation and but little pain. 



BILIOUS YELLOW FEVER OF 1793. 125 

In one of the cases of inguinal buboes, the whole 
force of the disease seemed to be collected into the 
\y mphatic system. The patient walked about, and 
had no fever nor pain in any part of his body, ex- 
cept 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 this epidemic. They occurred in the 
yellow fever of Jamaica, as described by Dr. Wil- 
liams, and always with a happy issue of the disease*. 
A similar concentration of the contagion of the 
plague in the lymphatic glands is taken notice of by 
Dr. Patrick Russel. 

VIII. The ski?i 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 appeared 
before the third, and generally about the fifth or 
seventh day of the fever. Its early appearance al- 
ways denoted great danger. It sometimes appeared 

* Essay on the Bilious or Yellow Fever, p. 35. 



126 AN ACCOUNT OF THE 

first on the neck and breast, instead of the eyes, 
In one of my patients it discovered itself first be- 
hind 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 deeper 
shades of yellow, two or three times in the course 
of the disease. The eyes seldom escaped a yellow 
tinge ; and yet I saw a number of cases in which 
the disease appeared with uncommon malignity and 
danger, without the presence of this symptom. 

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

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- 



BILIOUS YELLOW FEVER OF 1793. 127 

mach in many of my patients, without discovering 
them. 



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 moscheto 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 
disease. 

5. Petechias 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. 



128 AN ACCOUNT OF THB 

6. Several eases 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 a haemorrhage took place, which 
precipitated the deadi 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. Black well. 

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

Notwithanding this disposition to cutaneous 
eruptions in this disease, 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 of blisters to the legs. Such was the in- 
sensibility of the skin in some people, that blisters 
made no impression upon it. 

IX. The blood in this fever has been supposed to 
undergo a chan'ge from a healdiy to a putrid state. 



BILIOUS YELLOW FEVER OF 1793. 129 

and many of its symptoms which have been des- 
cribed, particularly the haemorrhages and eruptions 
on the skin, have been ascribed to this supposed 
putrefaction of the blood. It would be easy to 
multiply arguments, in addition to those mentioned 
in another place*, 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 action or pressure upon the 
blood-vessels, and hence the external and internal 
haemorrhages. The petechiae on the surface of 
the skin depend upon the same cause. They are 
nothing but effusions of serum or red blood, from 
a rupture or preternatural dilatation of the capillary 
vesselsf. The smell emitted from persons affected 
by this disease was far from being of a putrid na- 
ture ; and if this had been the case, it would not 
have proved the existence of putrefaction in the 
blood, for a putrid smell is often discharged from 
the lungs, and from the pores in sweat, which is 

* Outlines of a Theory of Fever. 

t See Wallis's edition of Sydenham, vol. i. p. 165. vol. ii. 
p. 52, 94, 98, 350; De Haen's Ratio Medendi, vol. ii. p. 
162. vol. iv. p. 172 ; Gpubii Pathologic, sect. 498 ; and Dr. 
Seybert's inaugural dissertation, entitled " An Attempt to 
Disprove the Doctrine of Putrefaction of the Blood in Living 
Animals," published in Philadelphia in 1793. 

VOL. III. R 



130 AN ACCOUNT OF THE 

wholly unconnected with a putrid, or perhaps any 
other morbid state of the blood. There are plants 
which discharge an odour 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 vegetation : nor does the early 
putrid smell of a body which perishes with this fe- 
ver prove a putrid change to have taken place in 
the blood before death. All animals which die 
suddenly, and without loss of blood, are disposed 
to a speedy putrefaction. This has long been re- 
marked in animals that have been killed after a 
chace, or by lightning. The poisonous air called 
samiely 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, putrify in a few hours after death. The 
healthy state of the body depends upon a certain 
state of arrangement in the fluids. A derangement 
of these fluids is the natural consequence of the 
violent and rapid motions, or of the undue pres- 
sure upon the solids, which have been mentioned. 
It occurs in cases of death which are induced by 
the excessive force of stimulus, whether it be from 
miasmata, or the volatile vitriolic acid which is 
supposed to constitute the destructive samiel wind, 
or from violent commotions excited in the body by 



BILIOUS YELLOW FEVER OF 1793. 131 

external 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 
water, 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 vio- 
lent motions, which induce sudden disorganization 
in their bodies. It was observed that putrefaction 
took place most speedily after death from the yel- 
low 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. 

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 chro- 
nic forms of disease to which the human body is 
subject. An epitome, both of its symptoms and 
its theory, is happily delivered by Dr. Sydenham, 
in the following words. After describing the epi- 
demic 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 parades contained in the 



132 AN ACCOUNT OF THE 

mass, that nature being in a manner oppressed, is 
rendered unable to produce regular symptoms 
that are suitable to the disease ; and almost ail the 
phenomena that happen are irregular, by reason 
of the entire subversion of the animal economy ; 
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 sys- 
tem, or 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 
natural sleep. Mr. Powell expired with a smile 
on his countenance. Dr. Grimtts 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 

* Wallis's edition, vol. i. p. 344. 



BILIOUS YELLOW FEVER OF 1793. 133 

affect the brain and nerves. I lost a patient, in the 
year 1791, with 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 disease 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 disease. I met with 
many cases of regular tertians, in which the pa- 
tients were so well on the intermediate davs 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, or who took 
the common remedies for 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 



134 AN ACCOUNT OF THE 

month after his recovery from the more acute and 
inflammatory symptoms of the disease. 

It is nothing new for a malignant fever to appear 
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 evi- 
dently derived from the same exhalation which pro- 
duced 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 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 de- 
scribed by Dr. Cleghorn, in his account of the ter- 
tian fever of Minorca. A violent exacerbation 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, 

* De Febre Pestilenti, vol. xi. p. 93. 



BILIOUS YELLOW FEVER OF 1793. 135 

in the year 1741. " If (says he) the exacerbations 
" were on equal days, they generally died in the 
" third paroxysm, or the sixth day ; but if on un- 
" equal days, they recovered on the seventh." 

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 2d, 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 7th. 

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 re- 
mitting: fever. Where death occurred on the even 
days, it seemed to be the effect of a violent parox- 
ysm of the fever, or of great vigour of constitution, 
or of the force of medicines which protracted some 
of the motions of life beyond the close of the odd 
days which have been mentioned. 



136 AN ACCOUNT OF THE 

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 disease yielded 
to the remedies which finally subdued it more 
speedily and certainly upon its first appearance in 
the city, than it did two or three weeks afterwards. 

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 mentioned 
hereafter) in the first stage of the disease. 

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. 

* Diseases of Minorca, p. 185. 



BILIOUS YELLOW FEVER OF 1793. 137 

It will I hope be more useful to divide the patients 
affected with the disease into three classes. 

The first includes those in whom the stimulus 
of the miasmata produced coma, languor, sighing, 
a disposition to syncope, and a weak or slow pulse. 

The second includes those in whom the miasmata 
acted with less force, producing great pain in the 
head, and other parts of the body ; delirium, vo- 
miting, 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 miasmata acted so feebly as not to con- 
fine them to their beds or houses. This class of 
persons affected by the yellow fever was very nu- 
merous. Many of them recovered without medi- 
cal aid, or by the use of domestic prescriptions ; 
many of them recovered in consequence of a spon- 
taneous diarrhoea, or plentiful sweats ; many were 
saved by moderate bleeding .and purging ; while 
some died, who conceived their complaints to be oc- 
casioned by a common cold, and neglected to take 
proper care of themselves, or to use the necessary 
means for dieir recovery. It is not peculiar to the 
yellow fever to produce this feeble operation up- 

VOL. III. s 



138 AN ACCOUNT OF THE 

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 Rnssel did the same from a cham- 
ber 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 introduced these 
facts chiefly with a view of preparing the reader 
to reject the opinion that we had two species of 
fever in the city at the same time ; and to show 
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 vo- 
miting. 

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 



BILIOUS YELLOW FEVER OF 1793. 13,9 

inflammatory or nervous diseases, or by a mixture 
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 5 th 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 disease. The instant I felt 
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 fevers of unequal force can 
exist long together in the same place. As this 



140 AN ACCOUNT OF THE 

axiom seems to have been forgotten by many of 
the physicians of Philadelphia, and as the ignorance 
or neglect of it led to that contrariety of opinion 
and practice, which unhappily took place in the 
treatment of the disease, 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. 

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 that, at its declension, it degenerated into 
others, as inflammations, head-ach, 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 

* Dr. Hodge's Account of the Plague in London, p. 26. 



BILIOUS YELLOW FEVER OF 1793. 141 

Salvage, in his account of the plague at Alais, in 
the province of Languedoe*. 

The small- pox, though a disease of less force 
than the plague, has often chased it from Constan- 
tinople, probably from its being in a declining 
state. 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 symptomatic pleurisy 
which sometimes accompanied a slow fever, in the 
year 1675, and which had probably been injudi- 
ciously 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 uncertain and fallacious 
wayf." It appears further, from the writings of 
this excellent physician, that where the monarchy 
of a single disease was not immediately acknow- 

* Sed hoc observatu dignum fuit, omnes alios morbos 
acutos, durante peste siiuisse, et omnes moi'bos acutos e 
pestis genere Suisse. Nosologia Methodica, vol. i. p. 416. 

t Vol. i. p. 340. 



142 AN ACCOUNT OF THE 

ledged, by a sudden retreat of all cotemporary dis- 
eases, 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 con- 
tinual fever, accompanied by a dry skin, had pre- 
vailed for some time in the city of London. Dur- 
ing 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 at- 
tended by irregular sweats before the eruption of 
the pock. The continual fever now put on a new 
symptom. It was attended by sweats in its first 
stage, exactly like those which attended the erup- 
tive fever of the small-pox*. This despotism of a 
powerful epidemic extended itself to the most 
trifling indispositions. It even blended itself, Dr. 
Sydenham tells us, with the commotions excited 
in the system by the suppression of the lochia, as 
well as with the common puerperile feverf. Dr. 
Morton has left testimonies behind him, in different 
parts of his works, which establish, in the most 
ample manner, the truth of Dr. Sydenham's ob- 

* Vol. i. p. 352. 

t Vol. ii. p. 164. See also p. 1, 109, 122,204, 212,233, 
274, 355, 358-9, and 436. 



BILIOUS YELLOW FEVER OF 1793. 143 

servations. Dr. Huxham describes the small-pox 
as blending some of its symptoms with those of a 
slow fever, at Plymouth, in the year 1729*. Dr. 
Cleghorn mentions a constitution of the air at Mi- 
norca, so highly inflammatory, " that not only ter- 
tian fevers, but even a common hurt or bruise re- 
quired more plentiful evacuations than ordinaryf ." 
Riverius informs us, in his history of a pestilential 
fever that prevailed in France, that " it united itself 
with phrenitis, angina, pleurisy, peripneumony, he- 
patitis, dysentery, and many other diseases^ ." 

• 

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 dur- 
ing the month of September. It continued to pre- 
vail, but with several peculiar symptoms. In 
many persons it was accompanied by an eruption 

* De Aere et Morb. Epidem. p. 33, 34. 

t Page 285. 

| De Febre Pe&tilenti, vol. ii. p. 95. 



144 AN ACCOUNT 07 THE 

on the skin, and a swelling of the hands and fzei, 
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 disease*." 

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 
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 symptoms 
of dysentery, pleurisy, rheumatism, colic, palsy, 
and even of the locked jaw. That these were not 
original diseases, but symptomatic affections only 

* Vol. i. 

* Paere 28. 



BILIOUS YELLOW FEVER OF 1793. 145 

of the reigning epidemic, will appear from other 
histories of bilious fevers. Dr. Balfour tells us, in 
his account of the intestinal remitting fever of Ben- 
gal*, that it often appeared with symptoms of dy- 
sentery, 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 co- 
lic, and even the palsy, to the same cause which 
produced the bilious fever in the East-Indiesf ; 
and Dr. Hunter, in his treatise upon the diseases 
of Jamaica, mentions the locked jaw as one of its 
occasional symptoms. Even the different grades 
of this fever, from the mildest intermittent to the 
most acute continual fever, have been distinctly 
traced by Lancissi to the same marsh exhalation J. 

However irrefragably these numerous facts and 
authorities establish the assertion of the prevalence 
of but one powerful epidemic at a time, the propo- 
sition will receive fresh support, from attending to 
the effects of two impressions of unequal force made 

* Page 132.' 

f Observations on the Diseases in Long Voyages to the 
East-Indies, vol. i. p. 13, 14, 48, 151. vol. ii. p. 99, 318, and 
320. 

$ Lib. ii. cap. v. 
VOL. Ill, T 



146 AN ACCOUNT OF THE 

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 together in the body ; but 
this has, I believe, seldom 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 men- 
tioned. 

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 as the yellow fever had symptoms, but to 
vindicate myself from the charge of innovation, in 
having uniformly and unequivocally asserted, after 
the first week in September, that the yellow fever 
was the only febrile disease which prevailed in the 
city. 

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 

* Hunter on the Venereal Disease, introduction, p. 3. 



BILIOUS YELLOW FEVER OF 1793. 147 

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. 

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 a union of the 
goodness oi the Supreme ^eir.g with one ot the 
greatest calamities ol human life. 






148 AN ACCOUNT OF THE 

All ages were affected by this fever, but persons 
between fourteen and forty years of age were most 
subject to it. Many old people had it, but it was 
not so fa'al to them as to robust persons in middle 
life. It aifected children of all ages. I met with 
a violent case of the disease, in a child of four 
months, and a moderate case of it, in a child of but 
ten weeks old. The latter had a deep yellow skin. 
Both these children recovered. 

The proportion of children who suffered by this 
fever may be conceived from a single fact. Seven- 
ty-five persons were buried in the grave-yard of 
the Swedish church in the months of August, Sep- 
tember, and October, twenty-four of whom were 
children. They were buried chiefly in September 
and October ; months in which children 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. 



BILIOUS YELLOW FEVER OF 1793. 149 

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 Nime- 
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 inhabitants 
of the town. Shenkius says, that the Dutch and 
Italians escaped a plague, which prevailed for two 
years in one of the towns of Switzerland ; and Dr. 
Bell, in an inaugural dissertation, 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 manners, 
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 in the American Daily Advertiser, 
from Dr. Lining's history of the yellow fever, as it 



ISO AN ACCOUNT «T THE 

had four times appeared in Charleston, in South- 
Carolina. 

" There is something very singular (says the 
doctor) in the constitution of the negroes",, which 
renders them not liable to this fever ; for though 
many of them were as much exposed as the nurses 
to the infection, yet I never knew of one instance 
of this fever among them, though they are equally 
subject with the white people to the bilious fever*.' * 

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 hi& 
paper. 



" Sir, 

" IT is with peculiar satisfaction that I 
communicate to the public, through your paper, 
that the Af rican Society, touched with the dis- 
tresses which arise from the present dangerous dis- 
order, have voluntarily undertaken to furnish nurses 
to attend the afflicted ; and that, by applying to 

* Essays and Observations, Physical and Literary, vol. xu 
page 409. 



IILI0US YELLOW FEVER OF 1793. 151 

Absalom Jones and William Gray, both 
members of that society, they may be supplied, 

MATTH. CLARKSON, 

September 6th, 1793. Mayor. 

It was not long after these worthy Africans un- 
dertook the execution of their humane offer of ser- 
vices to the sick before I was convinced I had been 
mistaken. They took the disease in common with 
the white people, and many of them died with it. 
I think I observed the greatest number 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 
fjeople. I met with no case of haemorrhage in a 
black patient. 

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

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 : 



152 AN ACCOUNT OF THE 

1st. To the great and unusual debility induced 
upon their systems by labour in attending their 
masters and mistresses, or their children. 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 inflamma- 
tion 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 im- 
pure air 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 foul 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 sup- 
ply of food and medicines. 

There did not appear to be any advantage from 
smelling vinegar, tar, camphor, or volatile salts, in 
preventing the disease. Bark and wine were 
equally ineffectual for that purpose. I was called 
to many hundred people who were infected after 



BItlOUS YELLOW FEVER OF 1793. 15<) 

using one or more of them. Nor did the white 
washing of walls secure families from the disease. 
I am disposed to believe garlic was the only sub- 
stance that was in any degree useful in preventing 
it. I met with several persons who chewed it con- 
stantly, and who were much exposed to the mias- 
mata, without being infected. All other substances 
seemed to do harm by begetting a false confidence 
in the mind, to the exclusion of more rational pre- 
servatives. I have suspected further, that such of 
them as were of a volatile nature helped to spread 
the disease by affording a vehicle for miasmata 
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 miasmata becoming more accu- 
mulated, 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. 

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 

VOL. III. u 



154 AN ACCOUNT OF THE 

predominated over the stimulus of the miasmata, 
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 am disposed to ascribe their escape to the infected 
air of the city being destroyed by a mixture with 
» the water of the Delaware. 

Many people who were infected in the city were 
attacked by the disease in the country, but they did 
not propagate it, 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 into an 
intermitting fever*. The same changes have fre- 
quently been produced in malignant fevers, by send- 
ing patients infected with them from the foul air of 
a city, into the pure air of the country. 

* Diseases of Warm Climates, p. 169. 



BILIOUS YELLOW FEVER OF 1793. 155 

Persons confined in the house of employment, 
in the hospital, and in the jail, escaped the fever. 
The airy and remote situation of those buildings 
was probably the chief means of their preservation. 
Perhaps they derived additional security from their 
simple diet, their exemption 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, escaped 
the disease. 

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 
disease. Many of them attended the markets 
every day. Two painters, who worked at their 
business during the whole time of the prevalence 
of the fever. »nd in exposed situations, escaped it. 
Out of fbrtv scavengers who were employed in 
collecting and carrying away the dirt of the streets, 
tiftrcbed by the fever and died. Very 
few grave-diggers, compared with the riumber v/ao 



156 AN ACCOUNT OF THE 

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 con- 
stantly employed in digging cellars. The fact is 
not new that grave-diggers escape malignant fevers. 
It is taken notice of by Dr. Clark. 

It was said by some physicians in the public pa- 
pers, that the neighbourhood of the grave-yards 
was more infected than other parts of the city. 
The reverse of this assertion was true in several 
cases, owing probably to the miasmata being dilut- 
ed 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 infection received on one Sunday 
producing death on the succeeding first day of the 
week. The register of the deaths shows that this 
was not the case. I am disposed to believe that 
fewer 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 



BILIOUS YELLOW FEVER OF 1793. 157 

the exciting causes of the disease. From some 
facts to be mentioned presently, it will appear pro- 
bable, that places of public worship, in consequence 
of their size, as well as of their being shut up dur- 
ing the greatest part of the week, were the freest 
from miasmata of any houses in the city. It is 
agreeable to discover in this, as well as in all other 
cases of public and private duty, that the means of 
health and moral happiness are in no one instance 
opposed to each other. 

The disease, which was at first confined to Wa- 
ter-street, soon spread through the whole city. 
After the 15 th of September, the atmosphere of 
every street in the city was charged with miasmata; 
and there were few citizens in apparent good health, 
who did not exhibit one or more of the following 
marks of their presence in their bodies. 

1. A yellowness in the eyes, and a sallow colour 
upon their 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 



158 AN ACCOUNT OF THE 

well as in the white people. I met with it in a 
woman who had had the yellow fever in 1762. 
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 preva- 
lence of a pestilential fever, in persons in health, is 
taken notice of by Riverius*. 

3. Frequent and copious discharges by the skin 
of yellow sweats. In some persons these sweats 
sometimes had an offensive smell, resembling that 
of the washings 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. 



* " Pulsus sanorum pulsibus similes admodum, pericu- 
losi.' 1 — De Fehre JPestiltnti, fu 1 14. 



BILIOUS YELLOW FEVER OF 1793. 159 

9/ A preternatural dilatation of the pupils. This 
was universal. I was much struck in observing 
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 miasmata acting on his brain, I could not de- 
termine. 

It will be thought less strange that the miasmata 
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 attending the 
markets, w^ere infected by the disease, and sick- 
ened 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 fe- 
ver, 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 miasmata 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 
alwavs dissolved. The same state of the blood 
was observed in many persons who had been ex- 



160 AN ACCOUNT OF THE 

posed to the miasmata, who discovered no other 
symptom of the disease. 

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

The smell emitted from a patient, in a clean room, 
was like that of the small-pox, but in most cases 
of a less disagreeable nature. Putrid smells in sick 
rooms were the effects of the excretions, or of some 
other filthy matters. In small rooms, crowded in 
some instances with four or five sick people, there 
w r as an effluvia that produced giddiness, sickness at 
stomach, a weakness of the limbs, faintness, and in 
some cases a diarrhoea. I met with a foetid breath 
in one patient, which was not the effect of that me- 
dicine which sometimes produces it. 

The state of the atmosphere, during the whole 
month of September, and the first two weeks in 
October, favoured the accumulation of the mias- 
mata in the city. 



BILIOUS YELLOW FEVER OF 1793. 161 

The register of the weather shows how little the 
air was agitated by winds during the above time. 
In vain were changes in the moon expected 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 disease, they produced a languor in 
the body unknown 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 twelth of September. It fell 
between Third-street and the hospital, nearly in a 
line with Pine-street. Moschetoes (the- usual at- 
tendants of a sickly autumn) were uncommonly 
numerous. Here and there a dead cat added to 
the impurity of the air of the streets. It was sup- 
posed those animals perished with hunger in the 
city, in consequence of so many houses being de- 
serted by the inhabitants who had fled into the 
country, but the observations of subsequent years 
made it more probable they were destroyed by the 
same morbid state of the atmosphere which pro- 
duced the reigning epidemic. 

VOL. III. x 



162 AN ACCOUNT OF THE 

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 de- 
ficient, 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 vigour 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 agitated 
by gentle breezes, may be, there is, I believe, no 
record of a dry, warm, and stagnating air, having 
existed for any length of time without producing 
diseases. Hippocrates, in describing a pestilential 
fever, says the year in which it prevailed was with- 
out a breeze of wind*. The same state of the at- 



* a q; 



Sine aura, usque annus fuit." — Efiid. 3. 



BILIOUS YELLOW FEVER OF 1793. 163 

mosphere, for six weeks, is mentioned in many of 
the histories of the plague which prevailed in Lon- 
don, in 1665*. Even the sea air itself becomes 
unwholesome by stagnating ; hence Dr. Clark in- 
forms us, that sailors become sickly after long 
calms in East- India voyagesf. 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 sea- 
son proves sickly r distempers appear early, and are 
dangerous J." 

Who can review this account of the universal 
diffusion of the miasmata which produced this dis- 
ease, its universal effects upon persons apparently 
in good health, and its accumulation and concentra- 
tion, in consequence of the calmness of the air, and 
believe that it was possible for a febrile disease to 
exist at that time in our city that was not derived 
firom that source ? 

The West- India writers upon the yellow fever 
have said that it is seldom taken twice, except by 

* Letter from Sir John Bernard to Dr. Floyer, p. 233. 

t Vol. i. p. 5. 

J Diseases of the Army, p. 5. of the 7th London edition. 



164 AN ACCOUNT OF THE 

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 ex- 
posed to the infection. One of them felt a con- 
stant 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 miasmata than 
persons in early or middle life. Mr. Thomas 
Shields furnished an unequivocal proof that the dis- 
ease 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 this year. Cases of re- 
infection were very common during the prevalence 
of this fever. They occurred most frequently 
where the first attack had been light. But they 
succeeded attacks that were severe in Dr. Griffitts, 
Dr. Mease, my pupil Mr. Coxe, and several others, 
whose cases came under my notice. 

I have before remarked that the miasmata some- 
times excited a fever as soon as they were taken 
into the body, but that they often lay there from 
one to sixteen days before they produced the (lis- 



BILIOUS YELLOW FEVER OF 1793. 165 

ease. How long they existed in the body after a 
recovery from the fever I could not tell, for persons 
who recovered were, in most cases, exposed to their 
action from external sources. The preternatural 
dilatation of the pupils was a certain mark of the 
continuance of some portion of them 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 miasmata 
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. 

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 1 re- 
ceived from different persons satisfied me that all 
that I shall here relate is both accurate and just. 



166 AN ACCOUNT OF THE 

A deep yellbw colour appeared in many cases 
within a few minutes after death. In some the 
skin became purple, and in others black. I heard 
Gf 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. 

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

Some putrified in a short time after their disso- 
lution, but others had no smell for twelve, eigh- 

* Experiments on Animal Electricity, p. 90. 



1ILI0US YELLOW FEVER OF 1793. 167 

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 practice 
of pitching the joints of the coffins which were used 
to bury the dead. 

The morbid appearances of the internal parts of 
Ithe body, as they appear by dissection after death 
from the yellow fever, are different in different 
countries, and in the same countries in different 
years. I consider them all as effects only of a sti- 
mulus acting upon the whole system, and deter- 
mined more or less by accidental circumstances to 
particular viscera. Perhaps the stimulus of the 
miasmata determines the fluids more violendy in 
most cases to the liver, stomach, and bowels, and 
thereby disposes them more^than other parts to 
inflammation and mortification, and to similar effu- 
sions and eruptions with those which take place on 
the skin. There can be no doubt of the miasmata 
acting upon the liver, and thereby altering the qua- 
lities of the bile. I transcribe, with great pleasure, 



168 AN ACCOUNT OF THE 

the following account of the state of the bile in a 
female slave of forty years of age, from Dr. Mit- 
chell'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 choiedochus. 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 
its ropy consistence, seemed more peculiar to a 
bilious humour." 

The same appearance of the bile was discovered 
m several other subjects dissected by Dr. Mitchell. 



BILIOl/S YELLOW FEVER Of 1793. 16& 

The liver, in the above-mentioned slave, was 
turgid 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 
lined with a thick fur or slime, which, when scrap- 
ed 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 
be distended or swelled. This peculiarity in the 
inner coat of the stomach was universal in all the 
bodies that w r ere opened, of persons who died of 
this disease. 

VOL. III. Y 



170 AN ACCOUNT OF THE 

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 India? 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 
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 inflamed 



BILIOUS YELLOW FEVER OF 1793. 171 

in all cases. The pericardium contained a viscid 
yellow serum, and in a larger quantity than com- 
mon. The urinary bladder was a little inflamed. 
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 yeliow colour. In 
some he found the stomach and duodenum inflam- 
ed. 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 fiis- 
tory 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 
stomach, and the liver and lungs were of a putrid 
colour and texture*." 

* Diseases of Warm Climates, p. 125. 



17£ £N ACCOUNT Of THE 

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 Gazette, 
during the prevalence of this epidemic, by Dr. 
Physick and Dr. Cathrall. 

" Being well assured of the great importance of 
dissections of morbid bodies in the investigation of 
the nature of diseases, we have thought it of con* 
sequence that some of those dead of the present 
prevailing malignant fever should be examined; 
and, without enlarging on our observations, it ap- 
pears at present sufficient to state the following facts. 

" 1st. That the brain in all its parts has beei* 
found in a natural condition. 

" 2d. That the viscera of the thorax are per- 
fectly sound. The blood, however, in the heart 
and veins is fluid, similar, in its consistence, to the 
blood of persons who have been hanged, or de- 
stroyed by electricity. 

" 3d. That the stomach, and beginning of the 
duodenum, are the parts that appear most diseased. 
In two persons who died of the disease on the 5th 
day, the villous membrane of the stomach, especi- 



BILIOUS YELLOW FEVER OF 1793. 173 

ally about its smaller end, was found highly in- 
flamed ; and this inflammation extended through 
the pylorus into the duodenum, some way. The 
inflammation here was exactly similar to that in- 
duced in the stomach by acrid poisons, as by arse- 
nic, which we have once had an opportunity of 
seeing in a person destroyed by it. 

" The bile in the gall-bladder was quite of its 
natural colour, though very viscid. 

" In another person, who died on the 8th day 
of the disease, several spots of extravasation were 
discovered between the membranes, particularly 
about the smaller end of the stomach, the inflam- 
mation of which had considerably abated. Pus 
was seen in the beginning of the duodenum, and 
the villous membrane at this part was thickened. 

" In two other persons, who died at a more ad- 
vanced period of the disease, the stomach appeared 
spotted in many places with extravasations, and the 
inflammation disappeared. It contained, as did 
also the intestines, a black liquor, which had been 
vomited and purged before death. This black li- 
quor appears clearly to be an altered secretion from 
the liver; for a fluid in all respects of the same 
qualities was found in the gall bladder. This li- 



174 AN ACCOUNT OF THE 

quor was so acrid, that it induced considerable in- 
flammation and swelling on the operator's hands, 
which remained some days. The villous mem- 
brane of the intestines, in these last two bodies, was 
found inflamed in several places. 

" The liver was of its natural appearance, ex- 
cepting in one of the last persons, on the surface of 
which a very few distended veins were seen : all 
the other abdominal viscera were of a healthy 
appearance. 

" The external surface of the stomach, as well as 
of the intestines, was quite free from inflammation; 
the veins being distended with blood, which ap- 
peared through the transparent peritonium, gave 
them a dark colour. 

" The stomach of those who died early in the 
disease was always contracted ; but in those who 
died at a more advanced period of it, where extra- 
vasations appeared, it was distended with air. 

" P. S. PHYSICK, 
" J. CATHRALL." 

I have before remarked, that these dissections 
were made earlv in the disease, and that Dr. An- 



BILIOUS YELLOW FEVER OF 1793. 175 

nan attended a dissection of a body at Bush-hill, 
some time afterwards, in which an unusual tumes- 
cence 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 w r ere 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, remote 
from the spot where it originated ; although, for a 
while, in every instance, it was easily traced to it. 
This set the city in motion. The streets and roads 
leading from the city were crowded 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. 
The poor were the first victims of the fever. 
From the sudden interruption of business they suf- 



176 AN ACCOUNT 02 TH£ 

feredfor a while from poverty as well as from 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 disease, after the second week in Septem- 
ber, spared no rank of citizens. Whole families 
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 physicians, 
from the desertion of some, and the sickness and 
death of others. At one time there were but three 
physicians who were able to do business out of their 
houses, and at this time there were probably not 
less than 6000 persons ill with the fever. 

During the first three or four weeks of the pre- 
valence of the disease I seldom went into a house 
the first time, without meeting the parents or chil- 
dren of the sick in tears. Many wept aloud in my 
entry, or parlour, who came to ask for advice for 



BILIOUS YELLOW FEVER OF 1793. 177 

their relations. Grief after a while descended be* 
low weeping, and I was much struck in observing 
that m at v persons submitted to the loss of relations 
and friends without shedding a tear, or manifesting 
any other of the common signs of grief. 

A cheerful 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 strangeiy 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 thii, 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 
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. 

VOL. III. z 



178 AN ACCOUNT OF THE 

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*. 

But a more serious source of the distress of the 

i 

city arose from the dissentions of the physicians, 

* In the Life of Thomas Story, a celebrated preacher 
among the friends, there is an account of the distress of the 
city, in its infant state, from the prevalence of the yellow 
fever, in the autumn of 1699, nearly like that which has 
been described. 1 shall insert the account in his own words. 
" Great was the fear that fell on all flesh. I saw no lofty or 
airy countenance, nor heard any vain jesting to move men 
to laughter* Every face gathered paleness, and many hearts 
were humbled, and countenances fallen and sunk, as such 
that waited every moment to be summoned to the bar, and 
numbered to the grave." The same author adds, that six, 
seven, and sometimes eight, died of this fever in a day, for 
several weeks, His fellow-traveller, and companion in the 
ministry, Roger Gill, discovered upon this occasion an ex- 
traordinary degree of christian philanthropy. He publicly 
offeree] himself, in one of the meetings of the society, as a 
sacrifice for the people, and prayed that " God would please 
to accept of his life for them, that a stop might be put to the 
contagion." He died of the fever a few days afterwards. 



BILIOUS YELLOW FEVER OF 1793. 179 

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 diffe- 
rent causes. There was the same contrariety in 
the practice of the physicians that there was in 
their principles. The newspapers conve} r ed ac- 
counts of both to the public, every day. The 
minds of the citizens were distracted bv 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 remedies 
of their physician. 

The science of medicine is related to every 
thing, and the philosopher as well as the christian 
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 produced 
by it, to observe its influence upon the obligations 
of morality and religion. It was remarked during 
this time, by many people, that the name of the Su- 
preme Being was seldom profaned, either in the 
streets, or in the intercourse of the citizens with 
each other. But two robberies, and those of a 
trifling nature, occurred in nearly two months, al- 



180 AN ACCOUNT OF THE 

though many hundred houses were exposed to 
plunder, every hour of the day and night. Many 
of the religious societies met two or three times 3 
week, and some of hem 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 uncommon 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 co- 
lours. 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 perseverance, 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. The United Slates wept for the distresses 
of their capital. In several of the states, and in 
rfTany 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, 



BILIOUS YELLOW FEVER OF 1793. 181 

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 ihe 
death of friends. 

The number of deaths between the 1st of August 
and the 9th of November amounted to four thou- 
sand and forty-four. I shall here insert a register of 
the number which occurred on each day, beginning 
on the 1st of August, and ending on the 9th of 
November. By comparing it widi the register of 
the weather it will show the influence of the latter 
on the disease. Several of the deaths in August 
were from other acute diseases, and a few in the 
succeeding months were from such as were of a 
chronic nature. 



August 





died. 






died. 


1 


9 


Brought 


forward 


77 


2 


8 


August 


10 


6 


3 


9 




11 


7 


4 


10 




12 


5 


5 


10 




13 


11 


6 


3 


•* 


14 


4 


7 


12 




15 


9 


3 


5 




16 


7 


9 


11 




17 


6 




77 






132 



182 



AN ACCOUNT OF THE 





died. 






died. 


Brought forward 


132 


Brought forward 


823 


18 


5 


September 


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 


September 1 


17 


October 


1 


74 


2 


18 




2 


66 


3 


11 




3 


78 


4 


23 




4 


58 


5 


20 




5 


71 


6 


24 




6 


76 


7 


18 




7 


82 


8 


42 


- 


8 


90 


9 


32 




9 


102 


10 


29 




10 


93 


11 


23 




11 


119 


12 


33 




12 


111 


13 


37 




13 


104 


14 


48 




14 


81 


15 


56 




15 


80 


16 


67 
823 




16 


70 
3122 



Bilious yellow fever of 1793. 183 







died. ! 






died. 


Brought forward 


3122 


Brought forward 


3709 


October 


17 


80 


October 


29 


17 




18 


59 




30 


16 




19 


65 




31 


21 




20 


55 


November 1 


13 




21 


59 




2 


21 




22 


82 




3 


15 


- 


23 


54 




4 


15 




24 


38 




5 


14 




25 


35 




6 


11 




26 


23 




7 


15 




27 


13 




8 


8 


\ 


28 


24 




9 


6 






3709 




Total* 


3881 



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 this fever as 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. 



* In the above accounts there is a deficiency of returns 
from several grave-yards of 163. 



184 AN ACCOUNT OF THE 

The clouds at last dropped 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 appeared first in the sudden diminution 
of the sick, for the deaths continued for a week 
afterwards to be numerous, but they were of per- 
sons 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 Philadelphia, 



" Sir, 

" I am favoured with your letter of the 12th 
instant, which I have communicated to the com- 
mittee for the relief of the poor and afflicted of this 
citv. 



BILIOUS YELLOW FEVER OF 1793. 185 

t% It is with peculiar satisfaction that I execute 
their request, by making, in their name, on behalf 
of our suffering fellow-citizens, the most grateful 
acknowledgements for the seasonable benevolence 
of the common council of the city of New-York. 
Their sympathy is balm to our wounds. 

" We acknowledge the Divine interposition, 
whereby the hearts of so many around us have 
been touched with our distress, and have united in 
our relief. 

" May the Almighty Disposer of all events be 
graciously pleased to protect your citizens from the 
dreadful calamity with which we are now visited ; 
whilst we humbly kiss the rod, and improve by 
the dispensation. 

" The part, sir, which you personally take in 
our afflictions, and which you have so pathetically 
expressed in your letter, excites in the breasts of 
the committee the warmest sensations of fraternal 
affection. 

" The refreshing rain which fell the day before 
yesterday, though light, and the cool weather which 
hath succeeded, appear to have given a check to 
the prevalence of the disorder : of this we have 

VOL, III. 2 A 



186 AN ACCOUNT OF THE 

satisfactory proofs, as well in the decrease of the 
funerals, as in the applications for removal to the 
hospital. 

" I have, at your request, this day drawn upon 
you, at sight, in favour of the president and direc- 
tors of the Bank of North America, for the sum 
of five thousand dollars, the benevolent donations 
of the common council of the city of New- York. 

" With sentiments of the greatest esteem and 
regard, 

" I am, sir, 

M Your most obedient humble servant, 

" MATTH. CLARKSON. 

" Philadelphia, Oct. 17, 1793. 

" Richard Varick, mayor 
of the city of New -York." 

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



BILIOUS YELLOW FEVER OF 1793. 187 

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 correspondents, which 
his grandson, 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 visitation, and town 
and country are now generally healthy." The 
same disease was checked by wet and cold wea- 
ther 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 Bos- 
ton to Philadelphia, on account of the fever, until 
he was assured by the doctor, that a thunder gust, 
which had cooled the air, had rendered it safe for 
him to come into the city*. Mr. Lynford Lard- 

* From a short note in the register of the interments in 
the friends' burying-ground, it appears that the fever this 
year made its first appearance in the month of June. Tfre 
.following is a copy of that note: " 12th of the 6th month 
(O. S.), 1741, a malignant yellow fever now spreads much." 
Besides that note, there is the following: " 25th of the 7th 



188 AN ACCOUNT OF THE 

ner, 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 symptoms 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 December. 
The register of the interments in the friends' bury- 
ing- 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. 

The bilious remitting fever of 1780 yielded to 
cool weather, accompanied by rain and an easterly 
wind*. 

month (O. S.) 5 1741, many who died of the above distemper 
were persons lively, and strong, and in the prime of their 
time." 

* Vol. I. 



BILIOUS YELLOW FEVER OF 1793. 189 

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 but three persons who returned to the 
city being infected with the disease ; so completely 
was its cause destroyed in the course of a few 
weeks. 

In consequence of a proclamation by the gover- 
nor, and a recommendation by the clergy of Phi- 
ladelphia, the 12th of December was observed as 

* P. 5, 55, 180, and 323. 



190 AN ACCOUNT OF THE 

a day of thanksgiving throughout the state, for the 
extinction of the disease in the city. 

It was easy to distinguish, in walking the streets, 
the persons who had returned from the couury to 
the city, from those who had rem lined in it during 
the prevalence of the fever. The former appeared 
ruddy and healthy, while the latter appeared 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 trace of the distress 
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 
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 fever. 
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 



BILIOUS YELLOW FEVER OF 1793. 191 

been suspended for some time by the measles*. 
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 inflam- 
matory diathesis in the fevers of the winter ; for I 
had been taught by Dr. Sydenham, that the dis- 
eases 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 extraordinary ; 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 yellow 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, 
which beat only fifty strokes in a minute. His 
blood was such as I had frequently observed in 
the yellow fever. Dr. Griffltts informed me that 
he attended a patient on the 9th of January, in a 
pneumony, who had a 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 

* Introduction to a Treatise on the Venereal Disease, p. 
3. of the American edition. 



192 AN ACCOUNT OF THE 

blood in an inflammatory fever, on the 18th of Fe- 
bruary, which was dissolved. Mr. Innes, 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 disease on the 16th 
of March. None of these bilious and anoma- 
lous symptoms of the inflammatory fevers of the 
winter and spring suprised me. I had been early 
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*." 

It belongs to powerful epidemics to be followed 
by similar 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. 



* Pa-e 273. 



BILIOUS YELLOW FEVER OF 1793. 193 

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 fa- 
milies, 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 in- 
stances. 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 connect 
them with a similar constitution of the air which 
produced the previous 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 as 
belonged to the poor ; and which had been neg- 
lected in the autumn, after the ceasing of the dis- 
ease. 

The modes of purifying houses, beds, ana 
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. 

VOL. III. 2 B 



194 AN ACCOUNT OF THE 

Some destroyed all their beds and clothing that 
had been infected, or threw them into the Dela- 
ware. Many white- washed their walls, and paint- 
ed the wood- work of their house. I did not con- 
ceive the seeds of the disease 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 ex- 
pose 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 miasmata in mv house and fur- 
niture, and experience showed that they were suf- 
ficient. 

It is possible a portion of the excretions of the 
sick may be retained in clothes or beds, so as to 
afford an exhalation that may in the course of a 
succeeding summer and autumn, or from accidental 
warmth at any time, create a solitary case of fever, 
but it cannot render it epidemic. A trunk full of 
clothes, the property of Mr. James Bingham, who 
died of the yellow fever in one of die West- India 
islands about 50 years ago, was opened, some 
months after they were received by his friends, by 



BILIOUS YELLOW FEVER OF 1793. 195 

a young man who lived in his brother's family. 
This young man took the disease, and died ; but 
without infecting any of the family ; nor did the 
disease spread afterwards in the city. The father 
of Mr. Joseph Paschall was infected with the yel- 
low fever of 1741, by the smell of a foul bed in 
passing through Norris's Alley, in the latter end of 
December, after the disease had left the city. He 
died on the 25th of the month, but without reviv- 
ing the fever in the city, or even infecting his fa- 
mily. 

The matter which produced the fever in both 
these cases, hac^ nothing specific in it. It acted in 
the same manner that the exhalation from any 
other putrid matters would have done in a highly 
concentrated state. 

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 does not spread by contagion. " 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 dis- 
ease prevails in those parts. Clothes of these un- 
fortunate people have been repeatedly brought home 



196 AN ACCOUNT OF THE 

to their friends, without any accident happening to 
them." 

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 fever; 
but I must beg leave to detain him a little longer 
from that part of the work, while I resume the sub- 
ject of the origin of the fever. It is an interesting 
question, as it involves in it the means of prevent- 
ing the return of the disease, and thereby of saving 
tine lives of thousands of our citizens. 

Soon after the fever left the city^, the governor 
of the state addressed a letter to the college of phy- 
sicians, requesting to know their opinion of its ori- 
gin ; if imported, from what place, at what time, 
and in what manner. The design of this inquiry 
was to procure such information as was proper to 
lay before the legislature, in order to improve the 
laws for preventing the importation or generation 
of infectious diseases, or to enact new ones, if ne- 
cessary for that purpose. To the governor's letter 
the college of physicians sent the following answer : 



BILIOUS YELLOW FEVIR OF 1793. 197 



*.( 



Sir, 



" IT has not been from a want of respect to 
yourself, nor from inattention to the subject, that 
your letter of the 30th ult. was not sooner answer- 
ed ; but the importance of the questions proposed 
has made it necessary for us to devote a consider, 
able portion of time and attention to the subject, in 
order to arrive at a safe and just conclusion. 

" No instance has ever occurred of the disease 
called the yellow fever having been generated in 
this city, or in any other parts of the United States, 
as far as we know ; but there have been frequent 
instances of its having been imported, not only into 
this, but into other parts of North- America, and 
prevailing there for a certain period of time ; and 
from the rise, progress, and nature of the malig- 
nant fever, which began to prevail here about the 
beginning of last August, and extended itself gra- 
dually over a great part of the city, we are of opi- 
nion that this disease was imported into Philadel- 
phia, by some of the vessels which arrived in the 
port after the middle of July. This opinion we 



198 AN ACCOUNT OF THE 

are further confirmed in by various accounts we 
have received from unquestionable authorities. 

" Signed, by order of the college of physicians, 

4 * JOHN REDMAN, President. 

" November 26tb, 1793. 

" To the governor of Pennsylvania." 

Dr. Redman, the president of the college, Dr. 
Foulke, and Dr. Leib, dissented from the report 
contained in this letter. I have been necessarily 
led to continue it in the present edition of this work, 
not only because all the other members of that body 
still retain their belief of the importation of the fe- 
ver, but as a reason for republishing the facts and 
arguments in support of its domestic origin. 

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- 



BILIOUS YELLOW FEVER OF 1793. 199 

spring of vegetable putrefaction. Heat, exercise, 
and intemperance in drinking (says Dr. Lind) dis- 
pose 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 even 
of the same islands, where there are no marsh ex- 
halations, the disease is unknown. I shall not waste 
a moment in inquiring into the truth of Dr. War- 
ren's account of the origin of this fever. It is fully 
refuted by Dr. Hillary, and it is treated as chimeri- 
cal 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 admit- 
ted to have been 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 feverf . In short, this disease appears, ac- 
cording to Dr. Lind, in all the southern parts of 
Europe, after hot and dry weather J. 

2. The same causes (under like circumstances) 
must always produce the same effects. There is 

* Lind on the Diseases of Hot climates, p. 36 apd 124. 

t Cleghorn, p. 176. 

j Diseases of Hot Climates, p. 123. 



200 AN ACCOUNT OF THE 

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 
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, formerly of the Delaware state, and now 
of New- York. 

" Dover, Nov. 5, 1793. 
" Dear Sir, 

" SINCE the middle of last July we have 
had a bilious colic epidemic in this neighbourhood, 
which exhibits phenomena very singular in this 
climate ; and, so far as I am informed, unprece- 
dented in the medical records, or popular traditions 
of this country. To avoid unnecessary details it 
will suffice at present to observe, that the disease, 
on this occasion, has assumed, not only all the 
essential characters, but likewise all the violence, 
obstinacy, and malignity described by the East 
and West-Indian practitioners. If any difference 
can be observed it seems here to manifest higher 
degrees of stubbornness and malignity than we 
usually meet in the histories of tropical writers. 
In the course of the disease, not only extreme con- 



BILIOUS YELLOW FEVER OF 1793. 20l 

stipation, frequent vomiting, and the most excru- 
ciating pains of the bowels and limbs, harass the 
unhappy patient ; but to these succeed paralysis, 
convulsions, &x. and almost always uncommon 
muscular debility, oppression of the praecordia, 
&c. are the consequence of a severe attack. Bile 
discharged in enormous quantities constantly as- 
sumes the most corrupted and acrimonious appear- 
ances, commonly aeruginous in a very high degree, 
and sometimes quite atrabilious. 

" The inference I mean to draw from the phe- 
nomena of this disease, as it appears in this neigh- 
bourhood, and which I presume will also apply to 
your epidemic, is this, that from the uncommon 
protraction and intenseness of our summer and 
autumnal heats, but principally from the unusual 
drought, we have had, since the middle of July, 
a near approach to a tropical season, and that of 
consequence we ought not to be surprised if tropi- 
cal diseases, even of the most malignant nature, are 
engendered amongst us." 

To the above information it may be added, that 
the dysentery which prevailed during the autumn 
of 1793, 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 

VOL. III. 2 c 



202 AN ACCOUNT OF THE 

pause to remark that this dysentery arose from pu- 
trid exhalation, and that it is, like the bilious colic, 
only a modification of bilious fever. 

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 Pen- 
socken creeks in New-Jersey, at Harrisburgh and 
Hummelstown in Pennsylvania, in Caroline county 
in Maryland, on the south branch of the Potowmac 
in Hardie county, also in Lynchburgh and in Alex- 
andria in Virginia, and in several counties in North- 
Carolina. In none of these places was there a sus- 
picion of the disease being imported from abroad, 
or conveyed by an intercourse with the city of Phi- 
ladelphia. 

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 combina- 
tion of moisture with heat, which is essential to the 
production of die remote cause of a bilious fever. 



BILIOUS YELLOW FEVER OF 1793. 203 

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 
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 produce 
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 dissi- 
pation of the moisture from the putrid masses of 
vegetable matters in our streets, and in the neigh- 
bourhood of the city, there were (as several prac- 
tioners can testify) many cases of mild remittents, 
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 



204 AN ACCOUNT OF THE 

which years it prevailed in Philadelphia. Its pre- 
valence in Charleston is taken notice of in a letter, 
dated November 18m, O. S. 1699, from Isaac 
Norris to one of his correspondents. The letter 
says, that " 150 persons had died in Charleston 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 in 1793) by 
a general constitution of air, co-operating with 
miasmata, which favoured its generation in diffe- 
rent 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 
disease prevailed with great mortality among the 
horses, and in Virginia among the cows, during 
the 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) 



BILIOUS YELLOW FEVER OF 1793. 20£ 

which favoured its putrefaction and exhalation. 
Its smell was highly putrid 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 into- 
lerable foetor, which, upon inquiring, was con- 
stantly traced to the putrid coffee. It should not 
surprise us, that this seed, so inoffensive in its na- 
tural state, should produce, after its putrefaction, a 
violent fever. The records of medicine (to be 
mentioned hereafter) furnish instances of similar 
fevers being produced, by the putrefaction of many 
other vegetable substances. 

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 evidence 
that it was at first propagated by exhalation from 
the putrid coffee. It was observed 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 had been thrown 
in a state of putrefaction. 

5. Many persons who had worked, or even vi- 
sited, in the neighbourhood of the exhalation from 



206 AN ACCOUNT OF THE 

the coffee, early in the month of August, were In- 
disposed afterwards with sickness, puking, and 
yellow sweats, long before the air of Water- street 
was so much impregnated with the exhalation, as 
to produce such effects ; and several patients, whom 
I attended in the yellow fever, declared to me, or 
to their friends, that their indipositions 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 increase 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 1st of 
August, and died at Kensington on the 14th of the 
same month. Many other names might be men- 
tioned of persons who sickened during the last 
week in July or the first week in August, who 
ascribed their illnesses to the smell of tha coffee. 



BILIOUS YELLOW FEVER OF 1793. 207 

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. 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. In the histories of the disease which have 
been preserved in this country, it has six times 
appeared about the first 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 Philadel- 
phia. This frequent occurrence of the yellow fever 
at the usual period of our common bilious remit- 
tents, cannot be ascribed to accidental coincidence, 
but must be resolved, in most cases, into the com- 
bination of more active miasmata with the predis- 
position of a tropical 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 this epidemic, 
which do not occur in the West- India yellow fever. 
It affected children as well as adults, in common 
with our annual bilious fevers. In the West- In- 



20& AN ACCOUNT OF THE 

dies, Dr. Hume tells us, it never attacked any per- 
son under puberty. It had, moreover, many pe- 
culiar symptoms (as I have already shown) which 
are not to be met with in any of the histories of the 
We st- 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 our 
city, from vegetable putrefaction. It conforms, 
in the difference of its degrees of violence and dan- 
ger, to season as well as climate, and in this respect 
it is upon a footing with the small-pox, the measles, 
the sore-throat, and several other diseases. There 
are few years pass, in which a plethoric habit, and 
more active but limited miasmata, do not produce 
sporadic cases of true yellow 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 persons in the city of New- York 
in the year of 1 791 , where it was evidently generated 
by putrid exhalation. The yellow colour of the 
skin has unfortunately too often been considered 
as the characteristic mark of this fever, otherwise 
many other instances of its prevalence might be 



BILIOUS YELLOW FEVER OF 1793. 209 

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 colour is not only frequently absent, 
but sometimes occurs in the mildest bilious remit- 
tents. Dr. Hailer, in his pathology, describes an 
epidemic of this kind in Switzerland, in which this 
colour generally attended, and I have once seen it 
almost universal in a common bilious fever, which 
prevailed in the American army, in the year 1776. 

I cannot help taking notice, in this place, of an 
omission in the answer to the governor's letter, by 
the college of physicians. The governor requested 
to know whether it was imported ; if it were, from 
what place ', at what rime, and in what manner. In 
the answer of the college of physicians to the go- 
vernor's letter no notice was taken of any of those 
questions. In vain did Dr. Foulke call upon the 
college to be more definite in their answer to them. 
They had faithfully sought for the information re- 
quired, but to no purpose. The character of their 
departed brother, Dr. Hutchinson, for capacity 
and vigilance in his office, as inspector of sickly 
vessels, was urged without effect as an argument 
against the probability of the disease being import- 
ed. Public report had derived it from several dif- 
ferent islands ; had chased it from ship to ship, and 

VOL. III. 2 D 



210 AN ACCOUNT OF THE 

from shore to shore ; and finally conveyed it at 
different times into the city, alternately 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 medical superstition had changed 
its names, and that, in accounting for the origin of 
pestilential fevers, celestial, planetary, and demonia- 
cal influence had only yielded to the term importa- 
tion* 

Let not the reader reject the opinion I have de- 
livered because it is opposed by so great a majority 
of the physicians of Philadelphia. A single physi- 
cian supported an opinion of the existence of the 
plague at Messina, in the year 1743, in opposition 
to all the physicians (33 in number) of that city. 
They denied the disease in question to exist, be- 
cause it was not accompanied by glandular swel- 
lings. Time showed 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, introduced 
with great mortality into every part of the city. 
This disposition of physicians to limit the symp- 
toms of several other diseases, cannot be sufficiently 
lamented. The frequent absence of a yellow 



BILIOUS YELLOW FEVER OF 1793^ 211 

colour, in this epidemic, led to mistakes which cost 
the city of Philadelphia several hundred lives. 

The letter of the college of physicians has served 
to confirm me in an opinion, that the plagues which 
occasionally desolated most of the countries of 
Europe, in former centuries, and which were al- 
ways said to be of foreign extraction, were of do- 
mestic origin. Between the years 1006 and 1680, 
the plague was epidemic fifty-two times all over 
Europe. It prevailed fourteen times in the 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 pestilential 
diseases. The plagues which prevailed in London, 
every year from 1593 to 1611, and from 1636 to 
1649, I believe 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 manners 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 appearance. It is true, these 
plagues were said by authors to have been im- 
ported, either directly or indirectly, from the Le- 



212 AN ACCOUNT $S?C. 

vant ; but the proofs of such importation were as 
vague and' deficient as they were of the West- 
India origin of our epidemic. The pestilential 
fevers which have been mentioned, have been de- 
scribed by authors by the generic name of the 
plague, but they appear to have originated from 
putrid vegetable exhalations, and to have resem- 
bled, in most of their symptoms, the West- India 
and North- American yellow fever. 

I shall resume this interesting subject in another 
place, in which I shall mention a number of addi- 
tional facts, not only in support of the domestic 
origin of the bilious yellow fever, but of its not 
spreading by contagion, and of course of its being 
impossible to import it. I shall at the same time 
enumerate all its different sources, and point out 
the means of destroying or removing them, and 
thus of exterminating the disease from our coun- 
try. 

With these observations I conclude the history 
of the epidemic fever of the year 1793. A few of 
its sj^mptoms, which have been omitted in this his- 
tory, will be included in the method of cure, for 
they were discovered or produced by the remedies 
which were given for that purpose. 



/ 



§CT The following page begins an account of the 
states of the thermometer and weather, from the 
1st of January to the 1st of August, and of the 
states of the barometer, thermometer, winds, 
and weather, from the 1st of August to the 9th 
of November, 1793. The times of observation, 
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 1st of October to the 
9th of November, they are as in the first three 
months. 



• J- 



AN ACCOUNT, fcfc. 215 

January, 1793. February, 1793. 



Therm. 
D.!7h 2h 



127 

2j30 

3130 

4138 

535 

633 

7J38 

8;32 

9|33 

1038 

1135 

1231 

13|28 

1425 

15.32 

16 ! 37 

17137 

18J32 

19'37 

2033 

2ll36 

22J27 

23122 



24 
25 
26 
27 
28 
29 
30 
31 



30 
30 
31 
23 
35 
29 
22 
25 



Weather. 



Therm. 

7h 2h 



30 Cloudy. 

41 Fair, cloudy. 

33 Cloudy, rain. 

41 Rain, cloudy. 

42 Fair, cloudy. 

47 Cloudy, fair. 
5 1 Fair, fair. 
49 Fair, ditto. 

48 Hazy, fair. 

51 Fair, ditto. 
48 Fair, clouds. 
42 Fair, ditto. 
42 Fair, ditto. 

27 Hail, snow, sleet. 

37 Clouds, mist. 
39 Rain, ditto. 

45 Rain, snow, fair. 

52 Fair, ditto. 
48 Fair, ditto. 
47 Hazy, cloudy. 
47 Cloudy, fair. 
32 Fair, ditto. 

3 7 Fair, ditto. 
39Cloudv, ditto. 
41 Fair, hazy. 
— Fair. 

38 Fair, cloudy, snow, 
45 Cloudy, fair. 

3 7 Fair, ditto. 
23 Snow, hail. 
32 Cloudy, fair. 



Weather. 



9 26 Fair, hazy. 
25 34 Rain, ditto. 
33 37 Cloudy, fair. 
25 46 Cloudy, fair. 
36 44 Cloudy, ditto. 

35 46 Cloudy, rain. 

36 40 Cloudy, fair, 

28 44 Cloudy, ditto. 
42 50 Rain, fair. 

38 40 Cloudy, fair. 
1927 Fair, cloudy. 
20 28 Snow, cloudy. 
22 31 Cloudy, snow. 
27 39 Cloudy, fair. 
18 40 Fair, ditto. 

29 42 Cloudy, ditto. 
44 48 Rain, ditto. 
39 49 Cloudy, fair. 
3 141 Cloudy, rain. 
52 53 Rain, fair. 
3749 Fair, ditto. 
29 34 Fair, ditto. 
2234|Snow, cloudy. 
54j59JRain, cloudy. 

Cloudy, ditto. 
Rain, mist. 
Rain, cloudy. 



34 35 
35)43 
43 ! 43 
14 



26 Fair, ditto. 



216 



AN ACCOUNT OF THE 



March, 1793. 



April, 1793. 



Th rm. 

D.f7h|2h 



Weather. 



Therm 
7\,1 2h 



1:20 
2J31 
348 



4 

5 
6 
7 
8 



43 
51 
32 
36 
54 
926 
10129 
lli43 
12i40 



13 



1426 



15 
16 
17 

18 
19 

20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 



38 



32 
52 
51 
58 
53 
42 
41 
31 
35 
37 
35 
47 
43 
33 
34 
41 
42 



38jFair, ditto. 
5l|Hazy, cloudy. 
63 Rain, fair. 
61 Hazy, ditto. 

Rain, fair. 

Fair, ditto. 

Fair, ditto, clouds, 

Cloudv, rain. 

Fair, ditto. 

Fair, ditto. 

Rain, ditto. 

Cloudv, ditto. 

Cloudy, fair. 

Fair, ditto. 

Fair, ditto. 

Cloudv, fair. 



52 
50 
62 
60 
41 
51 
55 
43 
39 
44 
59 
62 
72 
69 
59 
61 
43 
47 Fair, ditto. 



Weather, 



57 

50 
59 
54 
51 
45 
57 
58 
61 



Cloudy, fair. 
Hazy, cloudy. 
Fair, ditto. 
Fair, ditto. 
Rain, cloudy. 



Fair, ditto. 
Fair, ditto. 
Fair, ditto. 
Cloudy, rain. 
Fair, cloudy. 
Fair, clouds, fair. 
Fair, ditto. 
Cloudy, fair. 
Cloudy, fair. 



45 70, Cloudy, fair. 

47 71 Fair, ditto. 
56 80jFair, ditto. 

51 72iCioudy, fair. 
53|6lCioudy, rain. 
60'76,Misty, fair. 
51;65'Fair, ditto. 
46|74Fair, ditto. 
55;7lFair, cloudy. 
50|56'Fair, ditto. 
37J63JFair, ditto. 
5462Cloudy, rain, fair. 
49J62 Fair, ditto. 

50 70 Fair, ditto. 

45 55 Rain, cloudy. 

46 62 Cloudy, fair. 

48 67 Fair, clouds, fair. 

52 66 Cloudy, fair. 
52 75 Fair, ditto. 

52 49 Rain, cloudy. 
44 47 Cloudy, ditto. 

43 46 Rain, cloudy. 
42 63 Fair, ditto. 

44 68 Fair, ditto. 

45 65 Cloudy, ditto. 

53 57 Cloudy, rain. 

47 46 Rain, ditto. 
44 54 Rain, cloudy. 
40 59 Fair, ditto. 
40 65 Fair, ditto. 



J 



BILIOUS YELLOW FEVER OF 1793. 217 



May, 1793. 



June, 1793. 



The rm. j 
D. 7k 2h 



YVeaiher. 



45 

2J52 
3160 
4l60 
5 55 



6 

7 



The m. 
7 . 2ii 



47 

50 

8J59 

9:61 

1065 
ll'55 
1261 
13:57 
14'59 
1560 
16J50 
1748 
18 61 
1965 



20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 



65 
68 
72 
94 
58 
52 
61 
68 
70 
57 
54 
54 



69) Foggy, cloudy. 
Fog, clouds, fair. 
Rain, ditto. 
Fair, ditto. 
Cloudy, ditto. 
Cloudy, fair. 
Cloudy, fair. 
Cloudy, fair. 
Foggy, fair. 
Rain, hazy. 
Cloudy, fair. 
Cloudy, rain. 
Fair, ditto. 
Fair, cloudy. 
Fair, ditto. 
Fair, ditto. 
Fair, ditto. 
Cloudy, fair. 



73 
63 

80 
56 
58 
68 
78 
79 
71 
75 
76 
78 
83 
71 
69 
74 
81 
85 
87 
86 
80 
79 
75 

66 
84 
68 
62 
57 
60 



it 4 air, rain. 



53 
54 
55 
54 
58 

68 
65 

70 



Wealiier. 



72 
71 
78 

88 



Fair, ditto. 
Fair, ditto, clouds. 
Clouds, gusts. 
Cloudv, fair. 
Fair, ditto. 
Fair, cloudy. 
Rain, ditto. 
Cloudv, fair. 
Fair, clouds, rain. 
Cloudy, rain, clouds. 

Cloudv, rain. 
Clouds, ditto. 



74 90 

7690 

75|88 

7481 

6377 

63 82 

6785 

7489 

73'88 

77J91 

7988 

75,85 

58(78 

58 

60 

67 

66 

68 

71 

77 

74 



61 Rain, showery. 
64 Clouds, showers. 

62 Cloudy, rain, fair. 
60 Rain, do. cloudy. 

Cloudy, fair, rain. 
Cloudy, rain. 
Fair, ditto. 
Fair, ditto. 
Foq:, fair. 
Fair, ditto. 
Fair, ditto. 
Fair, showers. 
Cloudy, rain. 
Fair, ditto. 
Fair, hazy. 
Fair, ditto. 
Fair, showers. 
Fair, ditto. 
Fair, ditto. 
Fair, rain, fair. 
Cloudy, rain. 
Cloudy, fair. 
Fair, ditto. 
Fair, ditto. 
Cloudy, rain, 
Cloudy, rain. 
Cloudy, fair. 
Cloudy, fair. 
Cloudy, ditto. 
Fair, ditto. 



78 
79 
74 
69 
80 
85 
88 
90 



VOL. III. 



2 E 



218 



AN ACCOUNT OF THE 



JULY, 1793. 



Barom. 



a 
Q 

I 
2 
3 
4 
5 
6 
7 
3 
9 

10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
ol 



< 

30 
29 8 

29 9 
o0 1 

30 
29 9 

29 9 
o0 1 

30 
30 
30 
oO 1 
o0 1 
30 
30 
29 8 

29 8 

30 

29 9 
o0 

30 1 
30 
30 
29 9 
30 
30 
30 
30 
o0 
30 
29 



1 
2 
2 
1 
1 
1 
9 



CO 

29 9 

29 7 

30 
30 0. 
29 9 

29 9 

30 
30 1 

29 8 

30 
30 
30 

30 
30 
29 9 
29 7 

29 9 

30 

29 9 

30 
30 1 
30 
30 

29 9 

30 1 
30 2 
30 1 
SO 
30 1 
30 
29 8 



Tfr 


ler. 


• 


• 


• 

< 


• 

ft 


<o 


CO 


77 


88 


77 


81 


74 


80 


70 


83 


76 


90 


78 


91 


73 


88 


72 


85 


73 


81 


70 


84 


74 


88 


70 


84 


68 


83 


65 


80 


66 


75 


70 


83 


68 


81 


66 


86 


75 


85 


72 


87 


70 


86 


72 


87 


73 


91 


75 


89 


71 


83 


63 


82 


64 


81 


72 


85 


74 


85 


73 


86 


76 


80 



Winds. 



S 



< 



w 

w 

E 
E 

NW 
SW 

NE 

E 

S 

w 

NW 

N 

NW 

N 
SW 

w 

NW 
W 
SW 
W 

NW 

SW 

SW 

Calm 

NW 

N 

S calm 

Calm. 

SSE 

S 

SSW 



& 

CO 

w 

E 

SW 
SW 
SW 

NW 

E 

SW 

NW 

NW 

N 

NW 

Calm 

SW 

W 

NW 

SW 

W 

NW 

NW 

SW 

SW 

w 

NNW 

NE 

S 

NNE 

NE 

SW 

SW 



Weather. 



rain. 



fair. 

fair, showers. 

cloudy. 

cloudy, fair, 

fair, ditto. 

cloudy, thunder. 

fair, clouds. 

cloudy, fair. 

cloudy, ditto. 

fair, ditto. 

fair, clouds. 

fair, ditto. 

fair, ditto. 

fair, hazy. 

cloudy, ditto. 

rain, fair. 

fair, ditto. 

fair, ditto. 

fair, cloudy, rain. 

fair, ditto, shower. 

fair, ditto. 

fair, ditto. 

fair, cloudy. 

cloudy, fair. 

fair, ditto. 

fair, ditto. 

fair, cloudy. 

cloudy, fair. 

cloudy, ditto, rain. 

cloudy, fair. 

cloudy, rain, fair. 



BILIOUS YELLOW FEVER OF 1793. 219 



AUGUST, 1793. 





Barom. 


Ther.i Winds. 


Weather. 






• 


• 


• 


• 


• 


g 


OS 


< &4 


• 

< 


• 


• 

< 


• 


• 

< 


• 

a. 


Q 


O eo 


<© 


CO 


o 


CO 


VD 


CO 


1 


29 95 30 


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 


65 


87 


S 


SW 


fair, 


fair, 


5 


30 5 30 1 


73 


90 


ssw 


sw 


fair, 


fair, 


6 


30 2 30 


77 


87 


sw 


w 


cloudy, 


fair, 


7 


30 12 30 1 


58 


83 


NW 


w 


fair, 


fair, 


8 


30 I 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 30 


70 


84 


sw 


wsw 


cloudy, 


cloudy, 


12 


30 30 


70 


87 


w 


w 


fair, 


fair, 


13 


30 5 30 


71 


89 


sw 


w 


fair, 


fair, 


14 


30 29 95 


75 


82 


sw 


sw 


fair, 


rain, 


15 


30 30 1 


72 


75 


NNE 


NE 


fair, 


cloudy, 


16 


30 1 30 1 


70 


83 


NNE 

sw 


NE 


fair, 


fair, 


17 


30 1 30 


71 


86 


SW 


fair, 


fair, 


18 


30 1 30 1 


73 


89 


calm 


sw 


fair, 


fair, 


19 


30 1 30 


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, 


cleann. 


29 


30 16 30 15 


72 


86 


calm 


SW 


cloudy, 


fair, 


30 


30 1 30 1 


74 


87 


calm 


SW 


fair, 


fair, 


31 


30 30 


74 


84 


sw 


NW 


rain, 


fair. 



220 



AN ACCOUNT OF THE 



SEPTEMBER, 1793. 





Ban 


3 1U. 




Th 


cr. 1 Winds. 


We 


ather. 


• 


• 




• 




• 


• 

8 


• 


i 


• 


• 


S3 


• 

<5 




• 




• 

< 


« 


• 

< 


• 


• 

< 


• 
0, 


p 


O 




co 




<o 


co 


<o 


CO 


<£) 


CO 


1 


30 





29 


30 


71 


86 


calm 


SW 


fog, 


fair, 


2 


29 


75 


29 


8 


73 


86 


SW 


SW 


fair, 


fair, 




30 









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 


9o 


70 


89 


VVSW 


w 


fair, 


cloudy, 


7 


30 





30 





65 


77 


WNW 


NW 


fair, 


fair, 


8 


30 


1 


30 


1 


64 


70 


calm 


calm 


cloudy, 


cloudy, 


g 


30 





30 





66 


80 


SE 


NW 


rain, 


fair, 


10 


30 





30 





64 


72 


N 


NNE 


fair, 


cloudy, 


11 


30 


1 


30 





62 


72 


NNE 


N 


cloudy, 


fair, 


12 


29 


96 


29 


9 


58 


76 


NW 


NNW 


fair, 


fair, 


13 


29 


95 


30 





57 


72 


NW 


N 


fair, 


fair, 


14 


30 





30 


5 


58 


79 


NW 


N V> 


fair, 


fair, 


15 


30 





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 


hazy, 


hazy, 


21 


30 





29 





59 


78 


calm 




cioudy, 


fair, 


22 


30 





30 





63 


83 


calm 




cloudy, 


fair, 


23 


30 


1 


30 


1 


62 


8 


calm 


SE 


cloudy, 


cloudy, 


24 


30 


2 


30 


2 


65 


70 


NE 


ENE 


cloudy, 


fair, 


25 


30 


15 


SO 





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 




57 


75 


calm 


SW 


ioggy* 


fair. 



BILIOUS YELLOW FEVER OF 1793. 221 



OCTOBER, 1793. 





Barom. 




Ther. 


Winds. 


Weather. I 




£ 


g 




8 


3 


S 


S 


• 


8 


c/5 

as 


< 


cC 




-<* 


Ph" 


< 


• 
P* 


< 


& 


-j 

Q 


b- 


c< 




b- 


CM 


b- 


CM 


b- 


c* 


1 


30 


15 30 


5 


64 


80 


SW 


SW 


cloudy, 


fair, 


2 


29 


9 30 


5 


70 


72 


w 


NNW 


cloudy, 


fair, 


o 
O 


30 


2 30 


15 


50 


72 


w 


SW 


fair, 


fair, 


4 


29 


75 29 


7 


59 


72 


sw 


w 


cloudy, 


cloudy, 


5 


30 


30 


1 


58 


66 


N 


N 


iair, 


fair, 


6 


30 


3 30 


o 
O 


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 


29 


85 


51 


74 


W 


W 


fair, 


fair, 


12 


29 


6 29 


55 


58 


64 


SW 


NW 


rain, 


rain, 


13 


29 


85 29 


9 


49 


69 


NW 


NW 


fair, 


fair, 


14 


30 


5 30 





52 


76 


SW 


SW 


calm, 


fair, 


15 


29 


75 29 


8 


56 


54 


sw 


N 


fair, 


rain, 


16 


30 


30 





37 


53 


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 


29 


9 


51 


66 


N 


N 


cloudy, 


fair, 


20 


30 


30 





44 


54 


NW 


N 


fair, 


fair, 


21 


30 


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 


n 
O 


46 


71 


s 


S 


cloudy, 


do. h-w. 


26 


30 


2 30 


2 


60 


72 


calm 


SW 


cloudy, 


cloudy, 


27 


30 


3 30 


O 


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 


hazy, 


hazy, 


31 


30 


15 30 


2 


42 


45 


calm 


NNE 


cloudy, 


rain. 



--jaw—- 



AN ACCOUNT OF THE 



NOVEMBER, 1793. 







Barom. 


Ther. 




Winds. 


Weather. 


w 


S 


<< 




• 


a 


& 


* 




< 




• • 


< 




< 


• 


1 

o 


30 
30 


1 30 1 
3 30 25 


40 41 

32 49 


XNE 

NNE 


NE 
NE 


rain, 
fair, 


cloudy, 

fair, 


o 

o 

4 


30 
29 


1 30 
8 29 9 


43 56 
55 67 


calm 
SW 


SW 
SW 


cloudy, 
cloudy, 


cloudy, 
fair, 


5 


30 


15 30 1 


50 64 


NE 


NE 


rain, 


rain, 


6 
7 


29 
29 


8 29 65 
8 29 8 


63 67 

44 64 


S 
calm 


S 
SW 


cloudy, 
fair, 


cloudy, 
fair, 


1 


29 


8 29 85 


43 56 


SSW 


SW 


fair, 


fair, 


9 


29 


9 29 95 


42 64 


SW 


SW^ 


fair, 


fair, 



BILIOUS YELLOW FEVER OF 1793. 223 



OF THE METHOD OF CURE. 



IN the introduction to the history of the fe- 
ver, I mentioned the remedies which I used with 
success, in several cases which occurred in the 
beginning of August. I had seen, and recorded 
in my note book, the efficacy of gentle purges in 
the yellow fever of 1762 ; but finding them unsuc- 
cessful after the 20th of August, and observing the 
disease to assume uncommon symptoms of great 
prostration of strength, 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. 



224 AN ACCOUNT OF THE 

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, though 
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 worthy 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 prac- 
tice in the West- Indies would naturally suggest. 
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~ 



BILIOUS YELLOW FEVER OF 1793. 225 

rive the greatest benefit from it. This mode of 
treating the yellow fever appeared to be reasonable. 
I had used bark, in the manner he recommended 
it, in several cases of sporadic yellow fever, with 
success, in former years. I had, moreover, the 
authority of several other physicians of reputation 
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 circulation. 
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 pre- 
scribed bark in large quantities : in one case I or- 
dered 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 seve- 
ral cases, by inducing a moisture on the skin. For 
a while I had hopes of benefit to my patients from 



VOL. III. 2 F 



* Page 223. 



'& 



226 AN ACCOUNT OF THE 

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 com- 
plicated 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 provid- 
ed 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 authors 



BILIOUS YELLOW FEVER OF 1793. 227 

I consulted were contradictory, and none of them 
appeared altogether applicable to the prevailing 
epidemic. Before I desisted from the inquiry 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 Virginia 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 disease. 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 following pas- 
sages. 

" 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- 



228 AN ACCOUNT OF THE 

ceeding from the putrid miasmata 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 y that it could 



BILIOUS YELLOW FEVER OF 1793. 229 

hardly 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 from a depressed state of the 
system, but the unsuccessful issue of purging, and 
even of a spontaneous diarrhoea, in a patient of Dr. 
Hutchinson, 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 at- 
tended less to the effects of purging in producing 
this change in the pulse. Dr. Mitchell in a mo- 
ment 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 be- 
fore described the state of the bile in the. gall-blad- 
der and duodenum, in an extract from the history 



23$ AN ACCOUNT OF THE 

of a dissection made by Dr. 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 the feebleness of my 
purges. I had been in the habit of occasionally 
purging with calomel in bilious and inflammatory 
fevers, and had recommended the practice the year 
before in my lectures, not only from my own ex- 
perience, but upon the authority of Dr. Clark. I 
had, moreover, 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 at- 
tendance 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 se- 
nior 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 



BILIOUS YELLOW FEVER OF 1793. 231 

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 operation. 
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 eifects 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, notwithstanding some of them 
were advanced several days in the disease. Mr. 
Richard Spain, a block-maker, 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 to advise them to make im- 



232 AN ACCOUNT OF THE 

mediate 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 rais- 
ing the pulse, exciting 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 pro- 
duced 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 soon af- 
terwards appeared in the streets in good health, as 
the first fruits of the efficacy of mercurial 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 Sep- 
tember, and endeavoured to remove the fears of my 



BILIOUS YELLOW FEVER OF 1793. 23$ 

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 con- 
tinued to be almost 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. Wood- 
house, and Dr. Mease, were among the first phy- 
sicians who adopted it. I can never forget the 
transport with which Dr. Pennington ran across 
Third-street to inform me, a few days after he be- 
gan 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 
it which I had adopted led me to use other reme- 
dies 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. Learning, 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 week in September, 
in two of my patients who had been bled without 

VOL. III. 2 G 



234 AN ACCOUNT OF THE 

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 dis- 
ease, who died in twelve hours afterwards. These 
cases produced caution, but they did not deter me 
from bleedine as soon as I found the disease to 
change its type, and instead of tending to a crisis 
on the third, to protract itself to a later day. I be- 
gan 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 experience such sublime joy 
as I now felt in contemplating the success of my 
remedies. It repaid me for all the toils and stu- 
dies of my life. The conquest of this formidable 
disease was not the effect of accident, nor of the 
application of a single remedy ; but it was the tri- 
umph 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 prescrib- 
ed for this day, I have lost none." 

Being unable to comply with the numerous de- 
mands which were made upon me for the purging 
powders, notwithstanding I had requested my sis- 
ter, and two other persons to assist my pupils in 



BILIOUS YELLOW FEVER OF 1793. 235 

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 printed directions for giving 
them, and for the treatment of the disease. 

Hitherto there had been great harmony among 
the physicians of the city, although there was a di- 
versity of sentiment as to the nature and cure of 
the prevailing fever. But this diversity of senti- 
ment and practice was daily lessening, and would 
probably have ceased altogether in a few days, had 
it not been prevented by two publications, the one 
by Dr. Kuhn, and the other by Dr. Stevens, in 
which they recommended bark, wine, and other 
cordials, and the cold bath, as the proper remedies 
for the disease. The latter dissuaded from the 
use of evacuations of all kinds. This method of 
cure was supported by a letter from Alexander 
Hamilton, Esq. then secretary of the treasury 
of the United States, to the college of physicians, 
in which he ascribed his recovery from the fever 
to the use of those remedies, administered bv the 
hand of Dr. Stevens. The respectable charac- 
ters of those two physicians procured an immediate 
adoption of the mode of practice recommended by 
them, by most of the physicians of the city, and a 
general confidence in it by all classes of citizens 



236 AN ACCOUNT OF THE 

Had I consulted my interest, or regarded the cer- 
tain consequences of opposing the use of remedies 
rendered suddenly popular by the names that were 
connected with them, I should silently have pur- 
sued my own plans of cure, with my old patients 
who still confided in them ; but I felt, at this sea- 
son of universal distress, my professional obliga- 
tions to all the citizens of Philadelphia to be su- 
perior to private and personal considerations, and 
therefore determined at every hazard to do every 
thing in my power to save their lives. Under the 
influence of this disposition, I addressed a letter to 
the college of physicians, in which I stated my ob- 
jections to Dr. Kuhn and Dr. Stevens's remedies, 
and defended those I had recommended. I like- 
wise defended them in the public papers against 
the attacks that were made upon them by several 
of the. physicians of the city, and occasionally ad- 
dressed such advice to the citizens as experience 
had suggested to be useful to prevent the disease, 
particularly low diet, gentle doses of laxative phy- 
sic, avoiding its exciting causes, and prompt 
applications for medical aid. In none of the re- 
commendations of my remedies did I claim the 
credit of their discovery. On the contrary, I con- 
stantly endeavoured to enforce their adoption, by 
mentioning precedents in favour of their efficacy, 
from the highest authorities in medicine. This 



BILIOUS YELLOW FEVER OF 1793. 237 

controversy with my brethren, with whom I had 
long lived in friendly intercourse, carried on amidst 
the most distressing labours, was extremely pain- 
ful to me, and was submitted to only to prevent 
the greater evil of the depopulation of our city by 
the use of remedies which had been prescribed by 
myself, as well as others, not only without effect, 
but with evident injury to the sick. The repeated 
and numerous instances of their inefficacy, in some 
of the most opulent families in the city, and the 
almost uniform success of the depleting remedies, 
happily restored the public mind, after a while, 
from its distracted state, and procured submission 
to the latter from nearly all the persons who were af- 
fected by the fever. 

Besides the two modes of practice which have 
been described, there were two others : the one 
consisted of 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 aromatic tonics. This 
practice was supported by an opinion, that the fe- 
ver 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 disease made its appearance. Their re- 



238 AN ACCOUNT OF THE 

medies were various. 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 
tamarind water, and other diluting drinks. The 
dissentions of the American physicians threw a 
great number of patients into the hands of these 
French physicians. They were moreover suppos- 
ed to be better acquainted with the disease than 
the physicians of the city, most of whom, it was 
well known, had never seen it before. 

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 reme- 
dies which I used in this disease, I shall now pro- 
ceed to make a few remarks upon each of them. 
I shall afterwards mention the effects of the reme- 
dies used by other physicians. 



BILIOUS YELLOW FEVER OF 1793. 239 



OF PURGING. 



I HAVE already mentioned my reasons for 
promoting this evacuation, and the medicine I pre- 
ferred for that purpose. It had many advantages 
over any other purge. It was detergent 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 operation. One dose was 
sometimes sufficient to open the bowels ; but from 
two to six doses were often necessary for that pur- 
pose; more especially as part of them was fre- 
quently rejected by the stomach. I did not ob- 
serve any inconvenience from the vomiting which 
was excited by the jalap. It was always without 
that straining which was produced by emetics ; and 
it served to discharge bile when it was lodged in 
the stomach. Nor did I 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 dis- 
charged. I therefore gave a purge every day while 



240 AN ACCOUNT OF THE 

the fever continued. I used castor oil, salts, cre- 
mor tartar, and rhubarb (after the mercurial purges 
had performed their office), according to the incli- 
nations of my patients, in all those cases where the 
bowels were easily 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 sup- 
posed to be, it was often ineffectual ; more especi- 
ally 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 
calomel. Two grains and a half of each, made in- 
to a pill, were given to an adult every six hours, 
until they procured four or five stools. I had other 
designs in giving a purge every day, besides dis- 
charging 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 
fever 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 disease* ; by haemorrhages from the 



* In some short manuscript notes upon Dr. Mitchell's 
account of the yellow fever in Virginia, in the year 1741, 



BILIOUS YELLOW FEVER OF 1793. 241 

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 plenti- 
ful 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 
showed 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 
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 

made by the late Dr. Kearsley, sen. of this city, he remarks, 
that in the yellow fever which prevailed in the same year in 
Philadelphia, " some recovered by an early discharge of black 
matter by stool." This gentleman, Dr. Redman informed 
me, introduced purging with glauber's salts in the yellow 
fever in our city. He was preceptor to Dr. Redman in me- 
dicine. 

VOL. III. 2 H 



242 AN ACCOUNT OF THE 

which patients who had staggered to a close-stool, 
walked back again to their beds after a copious 
evacuation. Dr. Sydenham takes notice of a simi- 
lar increase of strength after a plentiful sweat in the 
plague. They both acted by abstracting excess of 
stimulus, and thereby removing the depression of 
the system. 

3. It abated the paroxysm of the fever. Hence 
arose the advantage of giving a purge in some cases 
in the evening, when an attack of the fever was ex- 
pected 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 
occurs in the beginning of the disease, and it al- 
ways assisted in preventing the more alarming oc- 
currence of that symptom about the 4th or 5th 
day. 

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. 



BILIOUS YELLOW FEVER OF 1793. 243 

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 physicians; 
and prejudices, equally weak and ill-founded, 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 h?,d 
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 aifect life, or even subsequent, health, by 
copious or frequent purging. Dr. Kirkland men- 
tions 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 disease 16 or 18 



$44 AN ACCOUNT OF THE 

weeks*. Dr. Mosely not only proves the safety, 
but establishes the efficacy of numerous and co- 
pious stools in the yellow fever. Dr. Say proba- 
bly 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 close 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 bleedingst- 

• Treatise on the Inflammatory Rheumatism, vol. i. p. 407. 

f Dr. Redman was not the only instance furnished by the 
disease, in which reason got the better of the habits of old 
age, and of the formalities of medicine. About the time 
the fever declined, I received a letter from Dr. Shippen, 
sen. (then above 82 years of age), dated Oxford Furnace, 
New-Jersey, October 13th, 1793, in which, after approving 
in polite terms of my mode of practice, he adds, " Desperate 
diseases require desperate remedies. I would only propose 
isome small addition to your present method. Suppose you 
should substitute, in the room of the jalap, six grains of 



BILIOUS YELLOW FEVER OF 1793. 245 

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 and mortification which attend and 
follow the diseasef. 

2. A second objection to this mercurial purge 
was, that it excited a salivation, and sometimes 

gamboge, to be mixed with ten or fifteen grains of calomel ; 
and after a dose or two, as occasion may require, you should 
bleed your patients almost to death, at least to fainting ; and 
then direct a plentiful supply of mallows tea, with fresh le- 
mon juice, and sugar and barley water, together with the 
most simple, mild^ and nutricious food." The doctor con- 
cludes his letter by recommending to my perusal Dr. Do- 
ver's account of nearly a whole ship's crew having been 
cured of a yellow fever, on the coast of South-America, by 
being bled until they fainted. 

* Diseases of Barbadoes, p. 212. 

t Diseases in Voyages to Hot Climates, vol. ii. p. 322. 



246 AN ACCOUNT OF THE 

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 previously 
loose or decayed. The salivation was a trifling- 
evil, compared with the benefit which was derived 
from it. I lost only one patient in whom it occur- 
red. I was taught, by this accidental effect of 
mercury, to administer it with other views than 
merely to cleanse the bowels, and with a success 
which added much to my confidence m the power 
of medicine over this disease. I shall mention 
those views under another head. 

3. It was said that the mercurial purge excori- 
ated 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 yel- 
low fever, where no mercury has- been given to dis- 
charge 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, w r as so 
acrid as to excoriate the rectum, and so offensive 



BILIOUS YELLOW FEVER OF 1793. 247 

as to occasion j 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 inflamed 
and lacerated the stomach and bowels. In support 
of this calumny, the inflamed and mortified appear- 
ances, which those viscera exhibited upon dissection 
in a patient who died at the hospital at Bush-hill, 
were spoken of with horror in some parts of the 
city. To refute this objection it will only be ne- 
cessary 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. C leghorn 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 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 

* Vol. i. 



248 AN ACCOUNT OF THE 

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 
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 a hundred 

Vol. ii. p. 342. 



BILIOUS YELLOW FEVER OF 1793. 249 

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 with- 
out suffering the least inconvenience from it. Out 
of a great number of pregnant women whom I at- 
tended 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 miscarried 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 dis- 
eases, in some years, are uniformly and constantly 
the same*." However diversified our fever was 

Vol. i. p. 9. 
VOL. III. 2 I 



250 AN ACCOUNT OF THE 

in some of its symptoms, it was in all cases accom- 
panied 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 disease 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 disease, I believe it was be- 
cause 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 
this assertion, not only from the authority of Dr. 
Sydenham, who often mentions the good effects 



BILIOUS YELLOW FEVER OF 1793. 251 

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 remarked that the demand for this purg- 
ing powder continued to increase under all oppo- 
sition, and that the sale of it by the apothecaries 
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 on the fifth day of the 
disease, but it was seldom given for the first time 
after the third day, and when it was, the patient 
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 
in New- York, in the year 1791, and the New- 
York papers have told us that several practitioners 



252 AN ACCOUNT OF THE 

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. 

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 inflammatory 
fever to which I was called. The fatal issue of 
several fevers in the city, during the winter, in 
which this precaution had been neglected, con- 
vinced me that my practice was proper and useful. 

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 adminis- 
tered only by physicians for many years, and that 
too with all the solemnity of a religious ceremony. 
This error, with respect to those medicines, has at 
last passed away. It will, I hope, soon be suc- 
ceeded by a time when the prejudices against ten 



BILIOUS YELLOW FEVER OF 1793. 253 

and ten, or ten and fifteen, will sleep with the vul- 
gar fears which were formerly entertained of the 
bark producing diseases and death, years after it 
had been taken, by " lying in the bones.' y 



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 sav- 
ed 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, prevented my attending so much to each 
of them, as was necessary to determine upon the 
propriety 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 



254 AN ACCOUNT OF THE 

the bleeding of his wound, while the increase 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 determined 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 disease, a certain sign of an 
inflammatory fever. 

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

4. The symptoms of congestion in the brain, 
resembling those which occur in the first stage of 
hydrocephalus internus, a disease in which I had 
lately used bleeding with success. 

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- 
nuire bleeding to subdue it. 



BILIOUS YELLOW FEVER OF 1793. 255 

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 seasonf . 

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. Palmer's son, 
whom I bled on the 20th of August, and who ap- 
peared to have been recovered by it. 

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. 

* Diseases of Barbadoes, p. 16, 43, 46, 48, 52, 122. 
f Page 147. 



256 AN ACCOUNT OF THE 

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

1. It was, in the greatest number of cases, with- 
out any separation into crassamentum and serum, 
and of a scarlet colour, 

2. There was in many cases a separation of the 
blood into crassamentum andyel/ow 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 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. 

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. 



BILIOUS YELLOW FEVER OF 1793. 257 

Both this, and the fifth kind of blood which has 
been mentioned, occurred chiefly where bleeding 
had been omitted altogether, or used too sparingly 
in the beginning of the disease. 

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 disease. 

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 sub- 
ject to intermissions. 

2. It reduced its force and frequency. 

3. It checked in many cases the vomiting which 
occurred in the beginning of the disease, and there- 
by enabled the stomach to retain the purging me- 
dicine. It likewise assisted the purge in prevent- 
ing the dangerous or fatal vomiting which came on 
about the fifth day. 

VOL. III. 2 K 



258 AN ACCOUNT OF THE 

4. It lessened the difficulty of opening the bow- 
els. Upon this account, in one of my addresses to 
the ci izens of Philadelphia, 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 hae- 
morrhages ; 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 sys- 
tem ; 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 
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 



BILIOUS YELLOW FEVER OF 1793. 259 

attended or followed this fever. But 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 sufficient 
bleeding. In every case of blindness that came to 
my knowledge bleeding had been omitted, 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 bet- 
ter ; 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 
increased 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 great 
depression, and of an increased action of the blood- 
vessels which took place in consequence of it. I 
had frequently seen complaints of the breast, and 
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 excit- 



260 AN ACCOUNT OF THE 

ing 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 increased 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 preceptor in me- 
dicine 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 disease, we should leave nature 
wholly to herself, or take the cure altogether out of 
her hands. The truth of this remark 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 frequently 
increased, all of which were prevented, or occur- 
red in a less degree, when the system rose gradu- 
ally from the state of depression which had been 
induced by the great force of the disease. Under 
the influence of the facts and reasonings which 
have been mentioned I bore the same testimony in 
acute cases, against what was called moderate bleed- 
ing that I did against bark, wine, and laudanum in 
this fever. 



BILIOUS YELLOW FEVER OF 1793. 261 

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 fe- 
ver where it was not used within a few hours of 
the time of its attack. Under every mode of treat- 
ment it seemed disposed, after it was completely 
formed, to run its course. I was so satisfied of 
this peculiarity in the fever, that I ventured in 
some cases to predict the day on which it would 
terminate, notwithstanding 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 disease. 

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

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

1. Where bleeding had been omitted for three 
days, in acute cases, it was seldom useful. Where 
purging had been used, it was sometimes success- 



262 AN ACCOUNT OF THE 

ful. I recovered two patients who had taken the 
mercurial purges, whom I bled for the first time on 
the seventh 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 af- 
terwards, during the continuance of the fever. 

2. I preferred bleeding in the exacerbation of 
the fever. The remedy here w r as applied when the 
disease was in its greatest force. A single parox- 
ysm was like a sudden squall to the system, and, 
unless abated by bleeding or purging, often pro^ 
duced universal disorganization. I preferred the 
former to the latter remedy in cases of great dan- 
ger, because it was more speedy, and more certain 
in its operation. 

3. I bled in several instances in the remission of 
the fever, where the pulse was tense and corded. 
It lessened the violence of the succeedingparoxysm. 

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 



BILIOUS YELLOW FEVER OF 1793. 263 

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 depressed 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 mentioned, that I hope I shall be 
excused for inserting them in this place. " All 
the symptoms of weakness (says our author) pro- 
ceed 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 ade- 
quate to the violence of the fever. I remember to 
have met with a remarkable 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 dis- 
engage, and show itself clearly, because the vessels 
were so full as to obstruct the motion of the blood. 
However, I said, that they would soon find the fever 
rise high enough upon bleeding him. According- 
ly, after taking away a large quantity of blood, as 
violent a fever appeared as ever I met with, and 



264 AN ACCOUNT OF THE 

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 showed 
that it was not disproportioned to the violence of 
his disease, for it soon put on such acute and inflam- 
matory symptoms as to require six subsequent 
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 fourth 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. 

7. I paid no regard to the dissolved state of the 
blood, when it appeared on the first or second day 
of the disease, but repeated the bleedings after- 

* Vol. ii. p. 351. 



BILIOUS YELLOW FEVER OF 1793. 265 

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 
parted with ail 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, 1 suppose to be the effect of a 
certain action of the blood-vessels upon it. It oc- 
curs in fevers which depend upon the sensible qua- 
lities of the air, and in which no putrid or foreign 
matter has been introduced into the system. 

8. The presence of petechias 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, in Dock- street, in each of whom petechia? 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 

VOL. III. 2 L 



266 AN ACCOUNT OF THE 

precedents in Dr. De Haen* and Dr. Sydenhamf , 
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 to- 
wards the height and close of the epidemic, I 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 quantity. 
Mr. Gribble, cedar-cooper, in Front-street, lost by 



* Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172. 
f Vol. i. p. 210, and 264. 



BILIOUS YELLOW FEVER OF 1793. 267 

ten bleedings a 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 a 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 were all, years afterwards, living and 
healthy instances 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 na- 
tural or brought on by previous diseases, did not, 
in those few cases in which it yielded to the fever, 
deprive it of the uniformity of its inflammatory 
character. The following letter from Dr. Gi iffitts, 
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 



268 AN ACCOUNT OF THE 

furnish a striking illustration of the truth of the 
above observation. 

" I cannot leave town without a parting adieu 
to my kind friend, and sincere prayers for his pre- 
servation. 

" I am sorry to find that the use of the lancet 
is still so much dreaded by too many of our phy- 
sicians ; and, while lamenting the death of a valua- 
ble friend this morning, I was told that he was bled 
but once during his disease. Now if my poor 
frame, reduced by previous sickness, great anxiety, 
and fatigue, and a very low diet, could bear seven 
bleedings in five days, besides purging, and no 
diet but toast and water, what shall we say of phy- 
sicians who bleed but once ? 

" October 19 tb, 1793. » 

I have compared a paroxysm 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 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 



BILIOUS YELLOW FEVER OF 1793. 269 

unload them of their contents, in order to prevent 
the system sinking from haemorrhages, 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 miasmata, which were universally diffused in 
the air, acting upon the arterial system in the same 
manner that it did in persons who were in appa- 
rent 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. 
To this I answer, that I did not lose a single pa- 
tient 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 



270 AN ACCOUNT OF THE 

to add, that haemorrhages frequently occurred af- 
ter a third, a fourth, and in one instance (in the 
only son of Mr. William Hall) alter a sixth bleed- 
ing had been used ; and further, that not a single 
death occurred from natural haemorrhages in the 
first stage of the disease. A woman, who had 
been bled by my advice, awoke the night following 
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 re- 
coveries in the city from similar accidents. There 
were likewise some recoveries from copious na- 
tural haemorrhages in the more advanced stages of 
the disease, 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 was remarked that fainting was much less 
common after bleeding in this fever than in com- 
mon 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 



BILIOUS YELLOW FEVER OF 1793. 271 

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 seemed, by their appearance, to 
have derived fresh vigour from their evacuations. 
I could mention the names of many people who 
assured me their constitutions had been improved 
by the use of those remedies ; and I know several 
persons in whom they have carried off habitual 
complaints. Mr. Richard Wells attributed his 
relief from a chronic rheumatism to the copious 
bleeding and purging which were used to cure 
him of the yellow fever ; and Mr. William Young, 
the bookseller, was relieved of a chronic pain in 
his side, by means of the same remedies. 



272 AN ACCOUNT OF THE 

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 unable 
to visit, I advised them, when they were incapable 
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 seldom advised 
it for theirs* time, after the second or third day 
of the disease. 

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 beginning of the yellow fever, arises 
from a depressed state of the system. The debility 
in the plague is of the same nature. It has long 
been known that debility from the sudden abstrac- 
tion of stimuli is to be removed by the gradual 
application of stimuli, but it has been less observed, 
that the excess of stimulus in the system is best 



BILIOITS YELLOW FEVER OF 1793. 273 

removed in a gradual manner, and that too in pro- 
portion to the degrees of depression, which exist 
in the system. 

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 prevent 
fainting. 

Child-birth induces fainting, and sometimes 
death, only by the sudden abstraction of the stimu- 
lus 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 diseases, I suspect that it was occasioned by 
the quantity of the stimulus abstracted being dis- 
proportioned to the degrees of depression in the 
system* The following facts will I hope throw 
light upon this subject. 

r 

1. Dr. Hodges informs us, that " although 
blood could not be drawn in the plague, even in 
the smallest quantity without danger, yet a hun- 

VOL. III. 2 M 



274 AN ACCOUNT OF THE 

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 a haemorrhage from the nose, 
which continued two daysf. 

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 haemorrhage 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 
haemorrhages, which continued three days, from 
wounds in his shoulders made by being cupped. 
He likewise mentions several other recoveries by 
haemorrhages from the nose, after " a vomit- 

* Pa^e 114. 

t Skenkius, lib. vi. p. 881. 



BILIOUS YELLOW FEVER OF 1793. 275 

ing 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 evanes- 
cent 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 Montpellier, in the year 1623, which 
carried off one half of all who were affected by 
itf . 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 
day he gave a purge, which, he says, rescued his 

* Essay on the Bilious or Yellow Fever of Jamaica, p. 40. 
t De Ftbre Pestilenti, vol. ii. p. 145, 146, and 147. 



276 AN ACCOUNT OF THE 

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 character. 

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 u bleeding, as a preventive of the plague, was 
only safe and useful when the blood was drawn by 



BILIOUS YELLOW FEVER OF 1793. 277 

a small orifice, and a small quantity taken at dif- 
ferent times*." 

I have remarked, in the history of this fever, 
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 miasmata which produced the disease 
were discharged in this manner from the body. 
The sweat seemed to cure the fever only by 
lessening the quantity of the fluids, and thus gra- 
dually removing the depression 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, in certain states of malignant fever, 
resembles a man struggling beneath a load of two 
hundred weight, who is able to lift but one hun- 
dred and seventy-five. In order to assist him it 
will be to no purpose to attempt to infuse addi- 
tional vigour into his muscles by the use of a whip 
or of strong drink. Every exertion will serve only 



* Page 209. 



278 AN ACCOUNT OF THE 

to waste his strength. In this situation (supposing 
it impossible to divide the weight which confines 
him to the ground) let the pockets of this man be 
emptied 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 
the disease at its first appearance, was, because 



BILIOUS YELLOW FEVER OF 1793. 279 

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 and weakening degrees of depression. 
Bleeding was fatal in these cases, probably because 
it removed this depression in too sudden a manner. 

The principle of the gradual abstraction, as well 
as of the gradual application of stimuli to the body, 
opens a wide field for the improvement of medicine. 
Perhaps all the discoveries of future ages will con- 
sist more in a new application of established prin- 
ciples, and in new modes of exhibiting old medi- 
cines, than in the discovery of new theories, or of 
new articles 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. 
Griffitts furnished a remarkable instance of the 
influence of cool air upon the fever. Upon my 
visiting him, on the morning of the 8th of Oc- 
tober, I found his pulse so full and tense as to in- 



280 AN ACCOUNT OF THE 

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 slow- 
er and weaker that I advised the postponement of 
the bleeding, and recommended a purge instead of 
it. The bleeding notwithstanding became neces- 
sary, and was used with great advantage in the af- 
ternoon of the same day. 

The cool air w T as 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 com- 
pose the stomach. All these drinks were taken in 
the early stage of the disease. 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. 



BILIOUS YELLOW FEVER OF 1793. 281 

I forbade 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 excitability of the 
system. This strict abstinence which I imposed 
upon my patients did not escape obloquy ; but the 
benefits they derived from it, and the ill effects 
which arose in many cases from a contrary regi- 
men, satisfied me that it was proper in every case 
in which it was prescribed. 

Cold water was a most agreeable and powerful 
remedy in this disease. 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 

VOL. III. 2 N 



282 AN ACCOUNT OF THE 

same ease to both, when in pain, which opium 
gives to pain from other causes. I likewise ad- 
vised the washing of the face and hands, and some- 
times 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 inhabi- 
tants of the island of Massuah cured the most vio- 
lent 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 haemorrhages, 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 frequency, 
as warm water, applied in the same way, produces 
contrary effects upon it. In an experiment 
which was made at my request, by one of my 
pupils, by placing his feet in cold pump water for 

* Bruce's Travels. 



BILIOUS YELLOW FEVER OF 1793. 283 

a few minutes, the pulse was reduced 24 strokes 
in a minute, and became so small as hardly to be 
perceptible. 

But this effect of cold water, in reducing the 
frequency of the pulse, is not uniform. In weak 
and irritable habits, it increases its frequency. This 
has been fully proved by a number of experiments, 
made by my former pupil, Dr. Stock, of Bristol, 
in England, and published in his " Medical Col- 
lections of the Effects of Cold, as a Remedy in cer- 
tain Diseases*.' ' 

In the use of the remedies which were necessary 
to overcome the inflammatory action of the system, 
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. 

Besides the remedies which have been men- 
tioned, I was led to employ another of great effi- 
cacy. I had observed a favourable issue of the 
fever, in every case in which a spontaneous dis- 
charge took place from the salivary glands. I had 
observed further, that all such of my patients (one 

* Page 185. 



284 AN ACCOUNT OF THE 

excepted) as were salivated by the mercurial purges 
recovered in a few 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 disease, to the 
excitement of inflammation and effusion in the 
throat, diverting them from more vital parts of the 
body. In the second stage of the disease, I was 
led to prescribe it as a stimulant, and, with a view 
of obtaining this operation from it, I aimed at ex- 
citing 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, 1 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 in his 
right side, for which I ordered half an ounce of 
mercurial ointment to be rubbed on the part af- 
fected. 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 



BILIOUS YELLOW FEVER OF 1793. 285 

to me, was in Dr. Haller's short account of the 
works of Dr. Cramer*. The practice was more- 
over justified, in point of safety, as well as the pro- 
bability of success, by the accounts which Dr. 
Clarjt has lately given of the effects of a salivation 
in the dysentery! . I began by prescribing the 
calomel in small doses, at short intervals, and after- 
wards I directed large quantities of the ointment 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. Seve- 
ral persons appeared to be benefited by the mer- 
cury introduced 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. 

Soon after the above account was written of the 
good effects of a mercurial salivation in this fever, 
I had great satisfaction in discovering that it had 

* Bibliotheca Medicinx Practice, vol. iii. p. 491. 

t Diseases of Long Voyages to Hot Climates, vol. ii. p. 
334. 



286 AN ACCOUNT OF THE 

been prescribed with equal, and even greater suc- 
cess, by Dr. Wade in Bengal, in the year 1791, 
and by Dr. Chisholm in the island of Granada, in 
the cure of bilious yellow fevers*. Dr. Wade did 
not lose one, and Dr. Chisholm lost only one out of 
forty- eight patients in whom the mercury affected 
the salivary glands. The latter gave 150 grains of 
calomel, and applied the strongest mercurial oint- 
ment below the groin of each side, in some cases. 
He adds further, that not a single instance of a re- 
lapse occurred, where the disease was cured by sali* 
vation, 

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. 

* Medical Commentaries, vol. xviii. p. 209, 288. 



BILIOUS YELLOW FEVER OF 1793. 287 

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, wns upon mild and gently sti- 
mulating 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 articles 
of diet every hour or two during the day, and in cases 
of great debility, from an exhausted state of the 
system, I advised their being waked for the same 
purpose two or three times in the night. The ap- 
petite 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 prepared for them by a less 
stimulating diet. 

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

For the vomiting, with a burning sensation in 
the stomach, which came on about the fifth day, 
I found no remedy equal to a table spoonful of 
sweet milk, taken every hour, or to small draughts 



288 AN ACCOUNT OF THE 

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 giv- 
ing relief, I prescribed small doses of sweet oil, and 
m some cases a mixture of equal parts of milk, 
sweet oil, and molasses. They were all intended 
to dilute or blunt the acrimony of the humours, 
which were either effused or generated in the sto- 
mach. Where they all failed of checking the vo- 
miting, I prescribed weak camomile tea, or porter, 
or cyder and water, with advantage. In some of 
my patients 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 
retained 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 blis- 
ter 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 



BILIOUS YELLOW FEVER OF 1793. 289 

stomach was affected by pain only, without a vo- 
miting. 

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 proper 
remedy for it. It yielded in almost every case to 
two or three emollient glysters, or to the loss of a 
few ounces of blood. 

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 fre- 
quent 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 society 
removed the debility both of body and mind of this 
premature and temporary old age. I met with a 

VOL. III. 2 o 



290 AN ACCOUNT OF THE 

few cases, in which the yellow colour continued 
for several weeks after the patient's recovery from 
all the other symptoms of the fever. It was re- 
moved most speedily and effectually by two or 
three moderate doses of calomel and rhubarb. 

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. 

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 foul air to which they 
were exposed. I likewise advised moderate blood- 
letting to all such persons as were of a plethoric 
habit. To men whose minds were influenced by 
the publications in favour of bark and wine, and 
who were unable at that time to grasp the extent 
and force of the remote cause of this terrible fever, 
the idea of dieting, purging, or bleeding the inha- 
bitants of a whole village or city appeared to be 



BILIOUS YELLOW FEVER OF 1793. 291 

extravagant and absurd : but I had not only the 
analogy of the regimen made use of to prepare the 
body for the small-pox, but many precedents in fa- 
vour of the advice. Dr. Haller has given extracts 
from the histories of two plagues, in which the 
action of the miasmata was prevented or mitigated 
by bleeding*. Dr. Hodges confirms the utility of 
the same practice. The benefits 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. So- 
crates in Athens, and Justinian in Constantinople, 
were preserved, by means of their abstemious modes 
of living, from the plagues which occasionally ra- 
vaged those cities. By means of the low diet, 
gentle physic, and occasional bleedings, which I 
thus publicly recommended, the disease was pre- 
vented in many instances, or rendered mild where 
it was taken. But my efforts to prevent the disease 
in my fellow- citizens did not end here. I advised 
them, not only in the public papers, but in my in- 
tercourse with them, to avoid heat, cold, labour, 
and every thing else that could excite the miasmata 
(which I knew to be present in all their bodies) 
into action. I forgot, upon this occasion, the usual 
laws which regulate the intercourse of man with 

* Bibliotheca Medicine Practice, vol. ii. p. 93. and 38f. 



292 AN ACCOUNT OF THE 

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 disease in many people. 

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 disease. This plainness, which 
was blamed by weak people, produced strict obe- 
dience to my directions, and thereby restrained the 
progress of the fever in many families, or rendered 
it, when taken, as mild as inoculation does the 
small-pox. The opposite conduct of several phy- 
sicians, by preventing the above precautions, in- 
creased the mortality of the disease, and, in some 
instances, contributed to the extinction of whole 
families. 

I proceed now to make a few remarks upon the 
remedies recommended by Doctors Kuhn and Ste- 
vens, and by the French physicians. The former 
were bark, wine, laudanum, spices, the elixir of 
vitriol, and the cold bath. 



BILIOUS YELLOW FEVER OF 1793. 295 

In every case in which I prescribed bark, it was 
offensive to the stomach. In several tertians which 
attended the convalescence from a common attack 
of the fever, I found it always unsuccessful, and 
once hurtful. Mr. Willing took it for several 
weeks without effect. About half a pint of a weak 
decoction of the bark produced, in Mr. Samuel 
Meredith, a paroxysm of the fever, so violent as to 
require the loss of ten ounces of blood to moderate 
it. Dr. Annan 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 conva- 
lescence. 

It was not in this epidemic only that the bark 
was hurtful. Baron Humboldt informed me, that 
Dr. Comoto had assured him, it hastened death in 
every case in which it was given in the yellow fever 
of Vera Cruz. If, in any instance, it was inoffen- 
sive, or did service, in our fever, I suspect it must 
have acted upon the bowels as a purge. Dr. Sy- 
denham says the bark cured intermittents by this 
evacuation* ; and Mr. Brucq says it operated in 
the same way, when it cured the bilious fevers at 
Massuah. 



* V. 



Vol. i. p. 440, 



294 , AN ACCOUNT OF THE 

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 my 
patients, who took only fifteen drops of it, without 
my advice, to ease a pain in his bowels, it pro- 
duced 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 fever, 
accorded with Dr. Wade's in the fever of Ben- 
gal. He tells us, " that it was mischievous in 



* Omnes qui vim potione non abstinuerunt, interiere, 
adeo ut summa spes salvationis in vim abstinentia collocata 
videreter. Lib. vi. p. 847. 



BILIOUS YELLOW FEVER OF 1793. 295 

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 sudden- 
ness 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 delirium, 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 im- 
proper. In that chilliness and tendency to fainting 
upon the least motion, which attended the disease 
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 re- 
medy been the exclusive antidote to the yellow 



296 AN ACCOUNT OF THE 

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 
character 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 se- 
cond stage of the yellow fever only, in which its 
stimulant and tonic powers are proper. Dr. Jack- 
son establishes this mode of using it, by informing 
us, that when it did service, it " gave vigour and 
tone" to the system*. 

A mode of practice which I formerly 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 

* Fevers of Jamaica. 



BILIOUS YELLOW FEVER OF 1793. 297 

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 extinguish 
it. 

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

After what has been said it must 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 physic 
cians gave in large quantities, were useful in dilut- 
ing and blunting the acrimony of the bile, and to 
this remedy, assisted by occasional bleeding, I as- 

VOL. Ill, 2 p 



298 AN ACCOUNT OF THE i 

cribe most of the cures which were performed by 
those physicians. 

Those few persons in whom the ivann bath pro- 
duced copious and universal sweats recovered, but, 
in nearly all the cases which came under my notice, 
it did harm. 

■ 

I come now to inquire into the comparative suc- 
cess of all the different modes of practice which 
have been mentioned. 

I have already said that ten out of thirteen pa- 
tients 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, 
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 received the seeds of the fever in the 
city, and sickened in the country, or in the neigh- 
bouring towns, and who were treated with tonic 
remedies, died. There was not a single cure per- 



BILIOUS YELLOW FEVER OF 1793. 299 

formed by them in New- York, where they were 
used in several sporadic cases 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 pre- 
pare the way for them (as it was called) by purging 
and bleeding. The bathing tub soon shared a 
worse fate than bark, wine, and laudanum, and, 
long before the disease disappeared, it was discard- 
ed by all the physicians in the city. 

In answer to these facts we are told, that 
Mr. Hamilton and his family were cured by Dr. 
Stevens's remedies, and that Dr. Kuhn had admi- 
nistered them with success in several instances. 

Upon these cures I shall insert the following 
judicious remarks from Dr. Sydenham. " Suc- 
cess (says the doctor) is not a sufficient proof of the 
excellency of a method of cure in acute diseases, 
since some are recovered by the imprudent proce- 
dure of old women ; but it is further required, that 
the distemper should be easily cured, and yield 
conformably to its own nature*." And again, speak- 

* Vol. ii. p. 254. 



300 AN ACCOUNT OF THE 

ing of the cure of the new fever of 1685, this in- 
comparable 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 bv a method which is 
attended with success only ?iow and then, in a few 
instances, differs extremely from that practical me- 
thod, the efficacy whereof appears both from its 
recovering greater numbers, and all the practical 
phenomena happening in the cure*." 

Far be it from me to deny that the depression 
of the system 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 con- 
fluent and petechial small- pox ; but even this state 
of that disease 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 satisfied from circumstances, that my patient 
was infected with the small-pox. But the depres- 
sion produced by the yellow fever appears to be 
much greater than that which occurs in the small. 

* Vol. ii. p, 3o4, 



BILIOUS YELLOW FEVER OF 1793. 301 

pox, and hence it more uniformly resisted the most 
powerful tonic remedies. 

In one of my publications during the prevalence 
of the fever I asserted, that the remedies of which 
I have given a history cured a greater proportion 
than ninety-nine out of a hundred, of all who ap- 
plied to me on the first day of the disease, before 
the 15th day of September. I regret that it is not 
in my power to furnish a list of them, for a majo- 
rity of them were poor people, whose names are 
still unknown to me. I was not singular in this 
successful practice in the first appearance of the 
disease. Dr. Pennington assured me on his death 
bed, that he had not lost one, out of forty-eight pa- 
tients whom he had treated agreeably to the princi- 
ples and practice I had recommended. Dr. Grif- 
fitts triumphed over die disease in every part of the 
city, by the use of what were called the new reme- 
dies. My former pupils spread, by their success, 
the reputation of purging and bleeding, wherever 
they were called. Unhappily the pleasure we de- 
rived from this success in the treatment of the dis- 
ease, was of short duration. Many circumstances 
contributed to lessen it, and to revive the mortality 
of die fever. I shall briefly enumerate them. 



302 AN ACCOUNT OF THE 

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

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 no- 
thing but a cold, or a common fever. Some peo- 
ple 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 dela3 r stook place, 
the disease proved mortal. 

To obviate a suspicion that I have laid more 
stress upon the fatal influence of this error than is 
just, I shall here insert an extract of a letter I re- 
ceived from Mr. John Connelly, one of the city 
committee, who frequently 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 



BILIOUS YELLOW FEVER OF 1793. 303 

and fall fevers, proved fatal to almost every family 
which was credulous enough to believe them. 
That opinion slew its hundreds, if not its thousands, 
many of whom did not send for a physician until 
they were in the last stage of the disorder, and be- 
yond the power of medicine." 

3. The interference of the friends of the stimu- 
lating system, in dissuading patients from submit- 
ting 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 number 
of their patients, and from frequent indisposition, 
to visit the sick, at such times as was necessary to 
watch the changes in their disease. 



\ 



304 AN ACCOUNT OF THE 

7. The great accumulation and concentration of 
the miasmata in sick rooms, from the continuance 
of the disease in the city, whereby the system was 
exposed to a constant stimulus, and the effect of 
the 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 debility induced in the 
systems of many of the people who were affected 
by the disease, from fatigue in attending their rel* 
tions or friends. 

10. The universal depression of mind, amount, 
ing 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 hearse conveying, perhaps, a neigh- 
bour or a friend to the grave ? The state of mind 
under which many were affected by the disease, is 
so well described by the Rev. Dr. Smith, in the 



/ BILIOUS YELLOW FEVER OF 1793. 305 

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 excused for inserting an extract from it. 
It forms a part of the history of the disease. The 
letter was written in answer to a short note of con- 
dolence 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 familiar and dear to- both, my dear 
wife, passing the burying- ground gate, led me into 
the ground, viewed the graves of her two children, 
called the old grave-digger, marked a spot for her- 
self 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 return- 
ed 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 in- 
fecting her grandchild and me. But it seems she 
closed not her eyes ; sitting with them fixed through 

VOL. III. 2 o^ 



306 AN ACCOUNT OF THE 

her chamber window on Mrs. Keppele's house, 
till about midnight she saw her hearse, and fol- 
lowed it with her eyes as far as it could be seen. 
Two days afterwards Mrs. Rodgers, her next only 
surviving 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 hearse 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 1 1th 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 merciful God, and his will be done." 



BILIOUS YELLOW FEVER OF 1793. 307 

October 11th. " Don't wonder that I am so low 
to-day. My heart is sunk down within me." 

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 en- 
dowed with those rare and extraordinary qualities 
of mind ! Death in this, as well as in many other 
cases in which medicine had done its duty, ap- 
peared 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 disease in Jamaica, 
under the care of Dr. Hume. 



308 AN ACCOUNT OF THE 

Dr. Blane considers it as one of the " most mor- 
tal" of diseases, and Dr. Jackson places a more 
successful mode of treating it among the 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 disease. 
Out of the whole of them, after I had adopted my 
second mode of practice, I lost but 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 former patients 



BILIOUS YELLOW FEVER OF 1793. 309 

gave to my public declaration, that we had only 
one fever in the city : hence they applied on the 
first day, and sometimes on the first hour of their 
indisposition ; and 2dly, To the numerous pledges 
many of them had seen of the safety and efficacy of 
copious blood-letting, by my advice, in other dis- 
eases : hence my prescription of that necessary re- 
medy 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 knowledge, and one refused 
to take medicine of any kind ; all the rest had been 
worn down by previous 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 mild- 
ness 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 prescribed 
them, died, or suffered abortion. Where the tonic 
remedies were used, abortion or death, and, in 
many instances, both, were nearly universal. 



310 AN ACCOUNT OF THE 

Many whole families, consisting of five, six, and, 
\n three instances, of nine members, were reco- 
vered 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 medi- 
cines, lest I should give offence by not mentioning 
them all. Many large families were cured by 
some of them, after they adopted and prescribed 
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 vomiting of black bile. 

But the use of the new remedies was not di- 
rected finally by the physicians alone. The clergy, 
the apothecaries, many private citizens, several in- 
telligent women, and two black men, prescribed 
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. 



BILIOUS YELLOW FEVER OF 1793. 311 

It was owing to the almost universal use of 
purging and bleeding, that the mortality of the dis- 
ease diminished, in proportion as the number of 
persons who were affected by it increased, 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 were infected in town, and 
sickened in the country, were cured by them. 

Could a comparison be made of the number of 
patients who died of the yellow fever in 1793, after 
having been plentifully bled and purged, with those 
who died of the same disease in the years 1699, 
1741, 1747, and 1762, I am persuaded that the 
proportion would be very small in the j-ear 1793, 
compared with the former years*. Including all 
who died under every mode of treatment, I sus- 

* It appears £*>m one of Mr. Norm's letters, dated the 
9th of November, O. S. that there died 220 persons, in the 
year io99, with the yellow fever. Between 80 and 90 of 
chem, he says, belonged to the society of friends. The city, 
at this time, probably, did not contain more than 2 or 3000 
people, many of whom, it is probable, fled from the disease. 



312 AN ACCOUNT OF THE 

pect the mortality to be less, in proportion to the 
population 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 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 tVue 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 disease. Of this I have bten 
assured in a letter from Dr. Annan, who was ap- 
pointed to examine and give orders of admission 



BILIOUS YELLOW FEVER OF 1793. 313 

into the hospital, to such of the poor of the di- 
strict of South wark, as could not be taken care of 
in their own houses. Mr. Oiden 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 6 th of 
November, amounted to 448 out of 807 patients 
who were admitted into the hospital within that 
time. Three fourths of all the blacks (nearly 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's salts, 1 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 melancholy ! I hasten from it there- 
fore to a part of this work, to which 1 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 un instructed in the 
principles of medicine, prescribed purging and 
bleeding with great success in this disease. Ne- 

vol. in. 2 R 



314 AN ACCOUNT Off THE 

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 but 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 
bleeding and purging. He, moreover, bore a con- 



BILIOUS YELLOW FEVER OF 1793. 315 

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 livesf. Absalom Jones and Richard 

* In the letter before quoted, from Mr. Connelly, he ex- 
presses his opinion of those four medicines in the following 
Words : u Laudanum, bark, and wine have put a period to 
the existence of some, where the fever has been apparently 
broken, and the patients in a fair way pf recovery ; a single 
dose of laudanum has hurried them suddenly into eternity. 
I have visited a few patients where the hot bath was used, 
and am convinced that it only tended to weaken and relax 
the system, without producing any good effect." 

f The yellow fever prevailed at the Caraccos, in South- 
America, in October, 1793, with great mortality, more espe- 
cially among the Spanish troops. Nearly all died who 
were attended by physicians. Recourse was finally had to 
the old women, who were successful in almost every case to 
which they were called. Their remedies were a liquor 
called narencado (a species of lemonade) and a tea made of 
a root called Jistula. With these drinks they drenched their 
patients for the first two or three days. They induced plen- 
tiful sweats, and, probably, after blunting, discharged the 



316 AN ACCOUNT OF THE 

Allen, two black men, spent all the intervals of 
time, in which they w T ere 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 
newbpapers. 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 putre- 
faction in the fluids, nor of the calumnies of a body 
of iellow- citizens in the republic of medicine to de- 
ter 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 procuring me- 
dical 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 reme- 
dies, 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 afternoon, and even an 
hour, were not lost by these people in waiting for 
the visit of a physician, who was often detained 

bile from the bowels. I received this information from an 
American gentleman, who had been cured, by one of those 
Amazons in medicine, in the above way. 



BILIOUS YELLOW FEVER OF 1793. 317 

from them by sickness, or by new and unexpected 
engagements, by which means the precious mo- 
ment for using the remedies with effect passed irre- 
vocably away. I have stated these facts from faith- 
ful inquiries, and numerous observations. I could 
mention the names and families of many persons 
who thus cured themselves. One person only 
shall be mentioned, who has shown by her conduct 
what reason is capable of doing when it is forced 
to act for itself. Mrs. Long, a widow, after hav- 
ing been twice unsuccessful in her attempts to pro- 
cure a physician, undertook 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 indi- 
cation for repeating the bleeding was the continu- 
ance of the pain in her head. Her recovery was 
rapid and complete. The history of it was com- 
municated 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 
purging, without the attendance of a physician. 

From a short review of these facts, reason and 
humanity awake from their long repose in medi- 



318 AN ACCOUNT OF THE 

cine, and unite in proclaiming, that it is time to 
take the cure of pestilential epidemics out of the 
hands of physicians, and to place it in the hands of 
the people. Let not the reader starde at this pro- 
position. I shall give the following reasons for it. 

1. In consequence of these diseases 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 causes, and of 
their remedies. However diversified they may be 
in their symptoms, the system, in both diseases, is 
generally under a state of undue excitement or 
great depression, and in most cases requires the 
abstraction of stimulus in a greater or less degree, 
or in a sudden or gradual manner. There can 
never be any danger of the people injuring them- 
selves by mistaking any other disease for an epide- 
mic yellow fever or plague, for no other febrile dis- 
ease can prevail with them. It was probably to pre- 



BILIOUS YELLOW FEVER OF 1793. 319 

vent this mistake, that the Benevolent Father of 
mankind, who has permitted no evil to exist which j 
does not carry its antidote along with it, originally 
imposed that law upon all great and mortal epi- 
demics. 

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 physicians. 

4. By committing the cure of this and other pes- 
tilential epidemics to the people, all those circum- 
stances which prevented the universal success of 
purging and bleeding, in this disease, will 
have no operation. The fever will be mild in 
most cases, for all will prepare themselves to re- 
ceive 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 its 
violence and danger will thereby be obviated. 
There will then be no disputes among physicians, 
about the nature of the disease, to distract the pub- 



320 AN ACCOUNT OF THE 

lie 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. It has since yielded as 
universally to a vegetable diet and evacuations, in 
the hands of apothecaries, the clergy, and even of 
the good women, as it did in the hands of doc- 
tors of physic. 

They have narrow conceptions, not only of the 
Divine goodness, but of the gradual progress of 
human knowledge, who suppose that all pestilential 
diseases shall not, like the small-pox, sooner or later 
cease to be the scourge and terror of mankind. 

For a long while, air, water, and even the light 
of the sun, were dealt out by physicians to their 
patients with a sparing hand. They possessed, for 
several centuries, the same monopoly of many ar- 
tificial remedies. But a new order of things is 
rising in medicine. Air, water, and light are 
taken without the advice of a physician, and bark 



BILIOUS YELLOW FEVER OF 1793. 321 

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 remedies, the 
general use of calomel, jalap, and the lancet, shall 
be considered among the most essential 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 insure obedi- 
ence to just laws. Much less is it necessary that 
the means of life should be perscribed 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 
to attempt to cure it. It is partly from the influ- 
ence of this torpor in the minds of some people, 

VOL. III. 2 s 



322 AN ACCOUNT OF THE 

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 diseases, to prove 
that they have been affected by them. 

The repairs which our world is destined to un- 
dergo 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 a 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 
of curing themselves of yellow fever, I observed 
no difficulty in their apprehending every thing 
that was addressed to them, except what related 



BILIOUS YELLOW FEVER OF 1793. 323 

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 prevalence 
of the epidemic. 

I would as soon believe that ratafia was intended 
by the Author of Nature to be the only drink of 
man, instead of water, as believe that the know- 
ledge of what relates to the health and lives of a 
whole city, or nation, should be confined 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 stu- 
dies of many centuries, towards lessening the mor- 
tality of pestilential fevers ? They have either 
copied or contradicted each other, in all their pub- 
lications. Plagues and malignant fevers are still 
leagued with war and famine, in their ravages upon 
human life. 

To prevent the formation and mortality of this 
fever, it will be necessary, when it makes its appear- 
ance in a city or country, to publish an account of 
those symptoms which I have called the precursors 
of the disease, and to exhort the people, as soon 
as they feel those symptoms, to have immediate 



324 AN ACCOUNT OF THE 

recourse to the remedies of purging or bleeding. 
The danger of delay in using one, or both these 
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 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 yellow fever 
than from the poison of the snake, provided the 
remedies 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 it always acts first on 
debilitated parts of the body. From an ignorance 
of this law of epidemics many persons, by delaying 
their applications for help, perished with our fever. 

Let nature be trusted into 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. 



BILIOUS YELLOW FEVER OF 1793. 325 

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

Let it not be supposed, that I mean that the 
history which I have given of the method of cure 
of this 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 this, may be proper in a 
future yellow fever. But in the climate of the 
United States, I believe it will seldom appear with 
such symptoms of prostration and weakness, as not 
to require, in its first stage, evacuations of some 
kind. 

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 be dis- 
charged, 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 
Dr. Mosely, to decide in favour of evacuations in 



326 AN ACCOUNT OF THE 

the yellow fever; but Dr. Wade, and Mr. Chis- 
holm again support me by their practice in the fe- 
vers of the East and West- Indies. They both 
gave strong mercurial purges, and bled in some 
cases. Dr. Wade confirmed, 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 dis- 
charged 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 disease in a hot climate. 

The manner in which the miasmata that pro- 
duce the plague act 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 preparing the body for its reception, and of co- 
pious bleeding, cold air, and cold water, in curing 
it, are so similar, that all the directions which re- 
late to preventing, mitigating, or curing the yellow 
fever may be applied to it. The fluids in the 
plague show a greater tendency to the skin, than 
they do in the yellow fever. Perhaps, upon this 
account, the early use of powerful sudor ifics may 
be more proper in the former than in the latter 
disease. From the influence of early purging and 
bleeding in promoting sweats in the yellow fever, 



BILIOUS YELLOW FEVER OF 1793. 327 

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 de- 
pends upon the abstraction of stimulus, either by 
means of plentiful sweats, or of purulent matter 
from external sores. Perhaps the efficacy of these 
remedies depends wholly upon their elevating the 
system from its prostrated state in a gradual man- 
ner. If this be the case, those natural discharges 
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, when in- 
dicated, should be copious. A profuse sweat, con- 
tinued for twenty-four hours, cannot fail of wasting 
many pounds of the fluids of the body. This was 
the duration of the critical sweats in the famous 
plague which was known by the name of the Eng- 
lish sweating sickness, and which made its appear- 
ance in the army of Henry VII. in Milford- Ha- 
ven 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 



328 AN ACCOUNT OF THE 

with equal force to the mitigation of the measles, 
and to the prevention or mitigation of the scarlatina 
anginosa, the dysentery, and the inflammatory jail 
fever. I have remarked elsewhere*, that a previous 
vegetable diet lessened the violence and danger of 
the measles. Dr. Sims taught me, many years 
ago, to prevent or mitigate the scarlatina anginosa, 
by means of gentle purges, after children are infect- 
by itf. Purges of salts have in many instances 
preserved whole families and neighbourhoods from 
the dysentery, where they have been exposed to its 
remote cause. During the late American war, an 
emetic seldom failed of preventing an attack of the 
hospital fever, when given in its forming statef. I 
have had no experience of the effects of previous 
evacuations in abating the violence, or preventing 
the mortality of the malignant sore throat, but I 
can have no doubt of their efficacy, from the same- 
ness of the state of the system in that disease, as in 
other malignant fevers. The debility induced in it 
is from depression, 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. 

* Vol. ii. 

f Medical Memoirs, vol. r. 

$ Vol. i. 



BILIOUS YELLOW FEVER OF 1793. 329 

With these observations I close the history of 
the rise, progress, symptoms, and treatment of the 
bilious remitting yellow fever, which appeared in 
Philadelphia in the year 1793. 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 con- 
vinced that experience, in all ages and in all coun- 
tries, will vouch for their truth and utility. 



VOL. III. 2 T 



330 AN ACCOUNT OF THE 



A NARRATIVE 



OF THE 



STATE OF THE BODY AND MIND 

OF THE AUTHOR, 

DURING THE PREVALENCE OF THE FEVER. 

NARRATIVES of escapes from great 
dangers of shipwreck, war, captivity, and famine 
have always formed an interesting part of the his- 
tory of the body and mind of man. But there are 
deliverances from equal dangers which have hi- 
therto 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 the epidemic of 1793. The account will throw ad- 
ditional light upon the disease, and probably illus- 
strate some of the laws of the animal economy. It 
will, moreover, serve to furnish a lesson to all who 
may be placed in similar circumstances to commit 
their lives, without fear, to the protection of that 
Being, who is able to save to the uttermost, uot 
only from future, but from present evil. 



fclLIOUS YELLOW FEVER OF 1793. 331 

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 
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 Redman 
Coxe (grandson to Dr. Redman) and John Stall, 
both of this city. They all crowded around me 
upon the sudden increase 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, only in bleeding and visiting the sick. 

Between the 8th and the 15th of September 
I visited and prescribed for between a hundred 
and a 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 



332 AN ACCOUNT OF THE 

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 
well as in the night, Mr. Stall, Mr. Fisher, and 
Mr. Coxe accepted of rooms in my house, and be- 
came members of my family. Their labours now 
had no remission. 

Immediately after I adopted the antiphlogistic 
mode of treating the disease, 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, potatoes, 
raisins, coffee, and bread and butter. 

From my constant exposure to the sources of 
the disease, my body became highly impregnated 
with miasmata. My eyes were yellow, and some- 
times a yellowness was perceptible in my face. 
My pulse was preternaturally quick, and I had pro- 
fuse sweats every night. These sweats were so 



' 1 

BILIOUS YELLOW FEVER OF 1793. 333 

offensive, as to oblige me to draw the bed-clothes 
close to my neck, to defend myself from their 
smell. They lost their foetor entirely, upon my 
leaving off the use of broth, and living entirely up- 
on 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 mias- 
mata upon my system. I went to bed in confor- 
mity to habit only, for it 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, at which I often shud- 
dered, caused me to wish for the return of evening. 
The degrees of my anxiety may be easily con- 
ceived 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 Morell, 
both fathers of ten children. They were all in im- 
minent danger ; but it pleased God to make me 
the instrument of saving each of their lives. I rose 
at six 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 fulfil 



334 AN ACCOUNT OF THE 

the duties I owed to my fellow-citizens, in this 
time of great and universal distress. From a hope 
that I might escape the disease, by avoiding every- 
thing that could excite it into action, I carefully 
avoided the heat of the sun, and the coldness of the 
evening air. I likewise 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 wbds or weather. On the 
evening of the 14th of September, after eight 
o'clock, I visited the son of Mrs. Berriman, near 
the Swedes's church, who had sent for me early in 
the morning. I found him very ill. He had been 
bled in the forenoon, by my advice, but his pulse 
indicated a second bleeding. It would have been 
difficult to procure a bleeder at that late hour. I 
therefore bled him myself. Heated by this act, 
and debilitated by the labours of the day, I rode 
home in the evening air. During the ensuing 
night I was much indisposed. I rose, notwith- 
standing, at my usual hour. At eight o'clock I 
lost ten ounces of blood, and immediately after- 
Wards got into my chair, and visited between forty 
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 the last 



BILIOUS YELLOW FEVER OF 1793. 335 

look, and the pathetic cries, of a friend for help, 
who was dying under the care of a French physi- 
cian. I came home about two o'clock, and was 
seized, immediately afterwards, with a chilly fit 
and a hieh 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 advice 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 a hundred people. On the 19th of the 
same month, I resumed my labours, but in great 
weakness. It was with difficulty that I ascended 
a pair of stairs, by the help of a banister. A slow 
fever, attended with irregular chills, and a trouble- 
some cough, hung constantly upon me. The fe- 
ver discovered itself in the heat of my hands, which 
my patients often told me were warmer than their 
own. The breath and exhalations from the sick 



a 



36 AN ACCOUNT OF THE 



now began to affect me, in small and infected 
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 giddi- 
ness 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 relaxa- 
tion from my labours. I received letters every 
day from the country, and from distant parts of the 
union, containing inquiries into the mode of treat- 
ing the disease, and after the health and lives of 
persons who had remained in the city. The busi- 
ness of every evening was to answer these letters, 
also to write to my family. These employments, 
by affording a fresh current to my thoughts, kept 
me from dwelling on the gloomy scenes of the 
day. After these duties were performed, I copied 
into my note book all the observations I had col- 



BILIOUS YELLOW FEVER OF 1793. 337 

kcted 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 
eleven o'clock. Many of them left my door with, 
tears, but they did not feel more distress than I did 
from refusing to follow 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 intreaties of parents imploring a visit 
to their children, or of children to their parents. 
I recollect, and even yet with pain, that I tore my- 
self at one time from five persons in Moravian- 
alley, who attempted to stop me, by suddenly 
whipping my horse, and driving my chair as spee- 
dily 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 
instance, for only a single visit. I had no merit in 

VOL. III. 2 u 



338 AN ACCOUNT OF THE 

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 disease. 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 of 



BILIOUS YELLOW FEVER OF 1793. 339 

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 
uncommon exertions in visiting, bleeding, and even 
sitting 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- 

* This accomplished youth had made great attainments 
in his profession. He possessed, with an uncommon genius 
for science, talents for music, painting, and poetry. The 
following copy of an unfinished letter to his father (who 
had left the city) was found among his papers after his 
death. It shows that the qualities of his heart were equal 
to those of his head. 

" Philadelphia, September 15, 1793. 

M MY DEAR FATHER, 

" I TAKE every moment I have to spare to write to 
you, which is not many ; but you must excuse me, as I am 
doing good to my fellow-creatures. At this time, every 
moment I spend in idleness might probably cost a life. The 
sickness increases every day, but most of those who die, die 
for want of good attendance. We cure all we are called to 
on the first day, who are well attended, but so many doctors 
are sick, the poor creatures are glad to get a doctor's ser- 
vant." 



340 AN ACCOUNT OF THE 

father's. I followed him with a look, which I fear- 
ed would be the last in my house. At two o'clock 
my sister, who had complained for several days, 
yielded to the disease, 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 clays, and had on that 
day, for the first time, quitted his bed. My little 
mulatto boy, of eleven years old, was the only per. 
son in my family who was able to afford me the 
least assistance. At eight o'clock in the evening 
I finished the business of the day. A solemn still- 
ness at that time pervaded the streets. In vain did 
I strive to forget my melancholy situation by an- 
swering letters, and by putting up medicines, to be 
distributed next day among my patients. My faith- 
ful 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 over- 
powered 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 



BILIOUS YELLOW FEVER OF 1793. 341 

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 services 
in case of my taking the disease, 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 poig- 
nant anguish. I wept frequently when retired 
from the public eye, but I did not weep over the 
lost members of my family alone. I beheld or 
heard every day of the deaths of citizens, useful in 
public, or amiable in private life. It was my mis- 
fortune to lose as patients the Rev. Mr. Fleming 
and Mr. Graesel, both exhausted by their labours 



342 AN ACCOUNT OF THE 

of piety and love among the poor, before they sick- 
ened with the disease. I saw the last struggles of 
departing life in Mr. Powel, and deplored, 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 fami- 
lies 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. Pen- 
nington, 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 excellent physician. 
Had he lived a few years longer, he would have 
filled an immense space in the republic of medi- 
cine*. It was my affliction to see my friend Dr. 
John Morris breathe his last, and to hear the first 

* Before he finished his studies in medicine, he published 
a volume of ingenious and patriotic " Chemical and Eco- 
nomical Essays, designed to illustrate the connection be- 
tween the theory and practice of chemistry, and the appli- 
cation of that science to some of the arts and manufactures 
of the United States of America." 



BILIOUS YELLOW FEVER OF 1793. 343 

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 sickness, 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 complete. 

I have said before, that I early left off drinking 
wine ; but I used it in another way. I carried a 
little of it 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 table 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 difference 
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 
vinegar, and smelled it occasionally in sick rooms : 



344 AN ACCOUNT OF THE 

but after I saw and felt the signs of the universal 
presence of miasmata in my system, I laid aside 
this and all other precautions. I rested myself on 
the bed-side of my patients, and I drank milk or 
eat fruit in their sick rooms. Besides being satu- 
rated with miasmata, I had another security against 
being infected in sick rooms, and that was, I went 
into scarcely a house which was more infected than 
my own. 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 putrify upon the ground. 
From this source, streams of miasmata were con- 
stantly poured into my house, and conveyed into 
my body by the air, during every hour of the day 
and night. 

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 com- 
mon pleurisy, I think it probable that some, or per- 
haps all of them, would have died with it. But 
when the influence of the concentrated miasmata 
which fdled my house was added to that of constant 



BILIOtTS YELLOW FEVER OF 1793. 345 

fatigue upon their bodies, what remedies could be 
expected to save their lives ? Under the above 
circumstances, I consider the recovery of the other 
branches of my family from the fever (and none of 
them escaped it) with emotions, such as I should 
feel had we all been revived from apparent death 
by the exertions of a humane society. 

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 
health of soldiers in hot climates* He tells us, 
that he walked a hundred miles in three days, in 
Jamaica, during which time he breakfasted on tea, 
supped on bread and sallad, and drank nothing but 
lemonade or water. He adds further, that he 
walked from Edinburgh to London in eleven days 
and a 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 

VOL. III. 2 x 



346 an account or THE 

a quick 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 miasmata 
of malignant fevers upon the system. In both 
cases the abstraction of stimulus removes the body 
further from the reach of undue excitement and 
morbid depression. 

Food supports life as much by its stimulus, as 
by affording nourishment to the body. Where 
an artificial stimulus acts upon the system the na- 
tural stimulus of food ceases to be necessary. Un- 
der the influence of this principle, I increased or 
diminished my food with the signs I discovered 
of the increase or diminution of the seeds of the 
disease 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 might 
have been preserved, and a fever prevented, for 
many days, with a much greater accumulation of 
miasmata in my system, by means of a total absti- 
nence 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 miasmata of the yellow fever produced sick- 



BILIOUS YELLOW FEVER OF 1795. 347 

ness and death only from the excess of tiieir quan- 
tity, or from their force being increased by the ad- 
dition of those other stimuli which I have elsewhere 
called exciting causes. 

In addition to low diet, as a preventive of the 
disease, I obviated costiveness by taking occasion- 
ally a calomel pill, or by chewing rhubarb. 

I had read and taught, in my lectures, that fast- 
ing increases 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 disease. My abstemious diet, assisted per- 
haps by the state of my feelings, had likewise an 
influence upon my mind. Its operations were per- 
formed with an ease and a celerity, which rendered 
my numerous and complicated duties much less 
burdensome than they would probably have been 
under other circumstances of diet, or a less agi- 
tated 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 hearse and the 



348 AN ACCOUNT OF 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 cellar of 
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 
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 



BILIOUS YELLOW FEVER OF 1793. 349 

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 
consequence of such negociations (for they are 
not consultations) is the ineffectual result of neu- 
tralized opinions ; and wherever they take place, 
should 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 extremitv 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. 

After the loss of my health I received letters 
from my friends in the country, pressing 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- 



350 AN ACCOUNT OF THE 

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 resolv- 
ed to stick to my principles, my practice, and my 
patients, to the last extremity." 

On the 9th of October, I visited a considerable 
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 
body, followed it. At one o'clock I called for Mr. 
Fisher, who slept in the next room. He came in- 
stantly, 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,, 



BILIOUS YELLOW FEVER OF 1793. 351 

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 distresing 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 
enveloped in foul air, 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 sleepi- 
ness. The next day the fever left me, but in sp 
weak a state, that I awoke two successive nights 
with a 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 



352 AN ACCOUNT OF THE 

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 harassed with a 
cough, and a fever somewhat of the hectic kind. 
The early warmth of the spring removed those 
complaints, and restored me, through Divine good- 
ness, to 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. Wood- 
house, 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 disease, have endeared their names 
to hundreds, and, at the same time, afforded a pre- 
lude of their future eminence and usefulness in 
their profession-. 



BILIOUS YELLOW FEVER OF 1793. 353 

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. 



VOL. III. 2 If 



AN ACCOUNT 



OP THE 



BILIOUS REMITTING AND INTERMITTING 



TEL LOW FEVER> 



AS IT 



APPEARED IN PHILADELPHIA, 



IN THE YEAR 1794. 



AN ACCOUNT, &c. 



I CONCLUDED the history of the symp. 
toms of the bilious remitting yellow fever, as it 
appeared in Philadelphia in the year 1793, by tak- 
ing notice, that the diseases which succeeded that 
fatal epidemic were all of a highly inflammatory 
nature. 

In that history I described the weather and dis- 
eases of the months of March and April, in the 
spring of 1794. 

The weather, during the first three weeks of the 
month of May, was dry and temperate, with now 
and then a cold day and night. The strawberries 
were ripe on the 15th, and cherries on the 22d day 
of the month, in several of the city gardens. A 



358 AN ACCOUNT OF THE 

shower of hail fell on tbe afternoon of the 22d, 
which broke the glass windows of many houses. 
A single stone of this hail was found to weigh two 
drachms. Several people collected a quantity of 
it, and preserved it till the next day in their cellars, 
when they used it for the purpose of cooling their 
wine. The weather, after this hail storm, was rainy 
during the remaining part of the month. The 
diseases were still inflammatory. Many persons 
were afflicted with a sore mouth in this month. 

The weather in June was pleasant and temperate. 
Several intermittents, and two very acute pleuri- 
sies, occurred in my practice during this month. 
The intermittents were uncommonly obstinate, and 
would not yield to the largest doses of the bark. 

In a son of Mr. Samuel Coates, of seven years 
old, the bark produced a sudden translation of this 
state of fever to the head, where it produced all the 
symptoms of the first stage of internal dropsy of 
the brain. This once formidable disease yielded, 
in this case, to three bleedings, and other depleting 
medicines. The blood drawn in every instance 



was sizy. 



From the inflammatory complexion of the dis- 
eases of the spring, and of the beginning of June. 



BILIOUS YELLOW FEVER OF 1794. 359 

I expected the fevers of the summer and autumn 
would be of a violent and malignant nature. I was 
the more disposed to entertain this opinion from 
observing the stagnating filth of the gutters of our 
city ; for the citizens of Philadelphia, having an in- 
terest in rejecting the proofs of the generation of 
the epidemic of 1793 in their city, had neglected to« 
introduce the regulations which were necessary to 
prevent the production of a similar fever from do- 
mestic putrefaction. They had, it is true, taken 
pains to remove the earth and offal matters which 
accumulated in the streets ; but these, from their 
being always dry, were inoffensive as remote causes 
of disease. Perhaps the removal of the earth did 
harm, by preventing the absorption of the mias- 
mata which were constantly exhaled from the gut- 
ters. 

On the 6th of June, Dr. Physick called upon 
me, and informed me that he had a woman in the 
yellow fever under his care. The information did 
not surprise me, but it awakened suddenly in my 
mind the most distressing emotions. I advised him 
to inform the mayor of the city of the case, but by 
no means to make it more public, for I hoped that 
it might be a sporadic instance of the disease, and 
that it might not become general in the city. 



360 AN ACCOUNT OF THE 

On the 12th of the month, my fears of the re- 
turn of the yellow fever were revived by visiting 
Mr. Isaac Morris, whom I found very ill with a 
violent puking, great pain in his head, a red eye, 
and a slow tense pulse. I ordered him to be bled, 
and purged him plentifully with jalap and calomel. 
His blood had that appearance which has been 
compared by authors to the washings of raw flesh 
in water. Upon his recovery, he told me that he 
" suspected he had had the yellow fever, for that 
his feelings were exactly such as they had been in 
the fall of 1793, at which time he had an attack of 
that disease." 

On the 14th of June, I was sent for, in the ab- 
sence of Dr. Mease, to visit his sister in a fever. 
Her mother, who had become intimately acquainted 
with the yellow fever, by nursing her son and mo- 
ther in it, the year before, at once decided upon 
the name of her daughter's disease. Her symp- 
toms were violent, but they appeared in an inter- 
mitting form. Each paroxysm of her fever was 
like a hurricane to her whole system. It excited 
apprehensions of immediate dissolution in the minds 
of all her friends. The loss of sixty ounces of 
blood, by five bleedings, copious doses of calomel 
and jalap, and a large blister to her neck, soon 



BILIOUS YELLOW FEVER OF 1794. 361 

vanquished this malignant intermittent, without the 
aid of a single dose of bark. 

During the remaining part of the month, I was 
called to several cases of fever, which had symp- 
toms of malignity of an alarming nature. The 
son of Mr. Andrew Brown had a haemorrhage 
from his nose in a fever, and a case of menorrhagia 
occurred in a woman, who was affected with but a 
slight degree of fever. 

In the course of this month, I met with several 
cases of swelled testicles, which had succeeded fe- 
vers so slight as to have required no medical aid. 
Dr. Desportes records similar instances of a swell- 
ing in the testicles, which appeared during the pre- 
valence of the yellow fever in St. Domingo, in the 
year 1741*. 

In the month of July, I visited James Lefferty 
and William Adams, both of whom had, with the 
usual symptoms of yellow fever, a yellow colour 
on their skin. I likewise attended three women, 
in whom I discovered the disease under forms in 
which I had often seen it in the year 1793. In 
two of them it appeared with symptoms of a violent 

* Histoire des Maladies de Saint Domingue, p. 112. 



VOL. III. 2 z 



362 AN ACCOUNT OF THE 

colic, which yielded only to frequent bleedings. In 
the third, it appeared with symptoms of pleurisy, 
which was attended with a constant haemorrhage 
from the uterus, although blood was drawn almost 
daily from her arm, for six or seven days. About 
the middle of this month many people complained 
of nausea, which in some cases produced a puking, 
without any symptoms of fever. 

During the month of August, I was called to 
Peter Denham, Mrs. Bruce, a son of Jacob Gi ib- 
ble, Mr. Cole, John Madge, Mrs. Gardiner, Miss 
Purdon, Mrs. Gavin, and Benjamin Cochran, each 
of whom had all the usual symptoms of the yellow 
fever. I found Mr. Cochran sitting on the side of 
his bed, with a pot in his hand, into which he was 
discharging black matter irom his stomach, on the 
6th day of the disease. He died on the next day, 
Mrs. Gavin died on the 6th day of her disease, 
from a want of sufficient bleeding, to which she ob- 
jected from the influence of her friends. Besides 
the above persons, I visited Mr. George Eyre at 
Kensington, Mr. Thomas Fitzsimons, and Thomas 
M'Kean, jun. son of the chief justice of Pennsyl- 
vania, all of whom had the disease, but in a mo- 
derate degree. During this time I took no steps 
to alarm my fellow-citizens with the unwelcome 
news of its being in town. But my mind was 



Bilious yellow fever of 1794. 363 

not easy in this situation, for I daily heard of per- 
sons who died of the disease, who might probably 
have been saved had they applied early for relief, 
or had a suspicion become general among all our 
physicians of the existence of the yellow fever in 
the city. The cholera infantum was common dur- 
ing this, and part of the preceding month. It was 
more obstinate and more fatal than in common 
years. 

On the 12th of this month, a letter from Balti- 
more announced the existence of the yellow fever 
in that city. One of the patients whom I visited 
in this month, in the fever, Mr. Cole, brought the 
seeds of it in his body from that place. 

On the 25th of the month, two members of a 
committee, lately appointed by the government of 
the state, for taking care of the health of the city, 
called upon me to know whether the yellow fever 
w r as in town. I told them it was, and mentioned 
some of the cases that had come under my notice ; 
but informed them, at the same time, that I had 
seen no case in which it had been contagious, and 
that, in every case where I had been called early, 
and where my prescriptions had been followed, the 
disease had yielded to medicine. 



364 AN ACCOUNT OF THE 

On the 29th of the month I received an invita- 
tion to attend a meeting of the committee of health, 
at their office at Walnut-street. They interrogated 
me respecting the intelligence I had given to two 
of their members on the 25th. I repeated it to 
them, and mentioned the names of all the persons I 
had attended in the yellow fever since the 9th of 
June. 

Neither this, nor several subsequent communi- 
cations to the committee of health produced the ef- 
fect that was intended by them. Dr. Physick and 
Dr. Dewees supported me in my declaration, but 
their testimony did not protect me from the cla- 
mours of my fellow-citizens, nor from the calum- 
nies of some of my brethren, who, while they daily 
attended or lost patients in the yellow fever, called 
it by the less unpopular names of 

1. A common intermittent. 2. A bilious fever. 
3. An inflammatory remitting fever. 4. A putrid 
fever. 5. A nervous fever. 6. A dropsy of the 
brain. 7. A lethargy. 8. Pleurisy. 9. Gout. 
10. Rheumatism. 11. Colic. 12. Dysentery. 
And 13. Sore throat. 

It was said further, by several of the physicians 
of the city, not to be the yellow fever, because some 



BILIOUS YELLOW FEVER OF 1794. 365 

who had died of it had not a sighing in the be- 
ginning, and a black vomiting in the close of the 
disease. Even where the black vomiting and yellow 
skin occurred, they were said not to constitute a 
yellow fever, for that those symptoms occurred in 
other fevers. 

Let not the reader complain of the citizens and 
physicians of Philadelphia alone. A similar con- 
duct has existed in all cities upon the appearance 
of great and mortal epidemics. 

Nor is it any thing new for mortal diseases to re- 
ceive mild and harmless names from physicians. 
The plague was called a spotted fever, for several 
months, by some of the physicians of London, in 
the year 1665. 

Notwithstanding the pains which were taken to 
discredit the report of the existence of the yellow 
fever in the city, it was finally believed by many 
citizens, and a number of families in consequence 
of it left the city. And in spite of the harmless 
names of intermitting and remitting fever, and the 
like, which were given to the disease, the bodies 
of persons who had died with it were conveyed to 
the grave, in several instances, upon a hearse, the 



366 AN ACCOUNT OF THE 

way in which those who died of the yellow fever 
were buried the year before. 

From the influence of occasional showers of rain, 
in the months of September and October, the dis- 
ease was frequently checked, so as to disappear 
altogether for two or three days in my circle of 
practice. It was observed, that while showers of 
rain lessened, moist or damp weather, without rain, 
increased it. 

The cold weather in October checked the fever, 
but it did not banish it from the city. It appeared 
in November, and in all the succeeding winter and 
spring months. The weather, during these months, 
being uncommonly moderate, will account for its 
not being destroyed at the time in which the dis- 
ease usually disappeared in former years. 

The causes which predisposed to this fever were 
the same as in the year 1793. Persons of full ha- 
bits, strangers, and negroes, were most subject to 
it. It may seem strange to those persons who have 
read that the negroes are seldom affected with this 
fever in the West- Indies, that they were so much 
affected by it in Philadelphia. There were two 
reasons for it. Their manner of living was as 
plentiful as that of white people in the West- Indies, 



BILIOUS YELLOW FEVER OF 1794. 367 

and they generally resided in ■alleys and on die 
skirts of the city, where they were more exposed 
to noxious exhalation, than in its more open and 
central parts. 

The summer fruits, from being eaten before they 
were ripe, or in too large a quantity, became 
frequently exciting causes of this fever. It was 
awakened in one of my patients by a supper of 
peaches and milk. Cucumbers, in several in- 
stances, gave vigour to the miasmata which had 
been previously received into the system. Terror 
excited it in two of my patients. In one of them, 
a young woman, this terror was produced by hear- 
ing, while she sat at dinner, that a hearse had pass- 
ed by her door with a person on it who had died of 
the yellow fever. Vexation excited it in a foreign 
master of a vessel, in consequence of a young 
woman suddenly breaking an engagement to marry 
him. The disease terminated fatally in this 
instance. 

It was sometimes unfortunate for patients when 
the disease was excited by an article of diet, or by 
any other cause which acted suddenly upon the 
system ; for it led both them, and in some instances 
their physicians, to confound those exciting causes 
with its remote cause, and to view the disease with- 



368 AN ACCOUNT GF THE 

out the least relation to the prevailing epidemic. It 
was from this mistake that many persons were said 
to die of intemperance, of eating ice creams, and 
of trilling colds, who certainly died of the yellow 
fever. The rum, the ice creams, and the changes 
in the air, in all these cases, acted like sparks of 
fire which set in motion the quiescent particles of 
tinder or gunpowder. 

I shall now proceed to describe the symptoms 
Which this fever assumed during the periods which 
have been mentioned. This detail will be interest- 
ing to physicians who wish to see how little nature 
regards the nosological arrangement of authors, in 
the formation of the symptoms of diseases, and how 
much the seasons influence epidemics. A physi- 
cian, who had practised medicine near sixty years 
in the city of Philadelphia, declared that he had 
never seen the dysentery assume the same symp- 
toms in any two successive years. The same may 
be said probably of nearly all epidemic diseases. 

In the arrangement of the symptoms of this fever, 
I shall follow the order I adopted in my Account 
of the Yellow Fever of 1793, and describe them 
as they appeared in the sanguiferous system, the 
liver, lungs, and brain, the alimentary canal, the 
secretions and excretions, the nervous system, 



BILIOUS YELLOW FEVER OF 1794. 369 

the senses and appetites, upon the skin, and in the 
blood. 

Two premonitory symptoms struck me this 
year, which I did not observe in 1793. One of 
them was a frequent discharge of pale urine for a 
day or two before the commencement of the fever; 
the other was sleep unusually sound, the night be- 
fore the attack of the fever. The former symp- 
tom was a precursor of the plague of Bassora, in the 
year 1773. 

I. I observed but few symptoms in the sangui- 
ferous system different from what I have men- 
tioned in the fever of the preceding year. The 
slow and intermitting pulse occurred in many, and 
a pulse nearly imperceptible, in three instances. It 
was seldom very frequent. In John Madge, an 
English farmer, who had just arrived in our city, it 
beat only 64 strokes in a minute, for several days, 
while he was so ill as to require three bleedings a 
day, and at no time of his fever did his pulse exceed 
96 strokes in a minute. In Miss Sally Eyre, the 
pulse at one time was at 176, and at another time 
it was at 140 ; but this frequency of pulse was 
very rare. In a majority of the cases which came 
under my notice, where the danger was great, it 
seldom exceeded 80 strokes in a minute. I have 

VOL. III. 3 A 



37© AN ACCOUNT OF THE 

been thus particular in describing the frequency of 
the pulse, because custom has created an expecta- 
tion of that part of the history of fevers ; but my 
attention was directed chiefly to the different de- 
grees df force in the pulse, as manifested by its 
tension, fulness, intermissions, and inequality of ac- 
tion. The hobbling pulse was common. In John 
Geraud, I perceived a quick stroke to succeed 
every two strokes of an ordinary healthy pulse. 
The intermitting, chorded, and depressed pulse 
occurred in many cases. I called it the year be- 
fore a sulky pulse. One of my pupils, Mr. Alex- 
ander, called it more properly a locked pulse. I 
think I observed this state of the pulse to occur 
chiefly in persons in whom the fever came on with- 
out a chilly fit. 

Haemorrhages occurred in all the grades of this 
fever, but less frequently in my practice this year 
than in the year before. It occurred, after a ninth 
bleeding, in Miss Sally Eyre, from the nose and 
bowels. It occurred from the nose, after a sixth 
bleeding, in Mrs. Gardiner, who was at that time 
in the sixth month of her pregnancy. This symp- 
tom, which was accompanied by a tense and quick 
pulse, induced me to repeat the bleeding a seventh 
time. The blood was very sizy. I mention this 
fact to establish the opinion that haemorrhages de- 



BILIOUS YELLOW FEVER OF 1794. 371 

pend upon too much action in the blood-vessels, 
and that they are not occasioned by a dissolved 
state of the blood. 

There was a disposition at this time to haemor- 
rhage in persons who were in apparent good health, 
A private, in a company of volunteers commanded 
by Major M'Pherson, informed me that three of 
his messmates were affected by a bleeding at the 
nose, for several days after they left the city, on 
their way to quell the insurrection in the western 
counties of Pennsylvania. 

II. The liver did not exhibit the usual marks 
of inflammation. Perhaps my mode of treating the 
fever prevented those symptoms of hepatic affection 
which belong to the yellow fever in tropical cli- 
mates. The lungs were frequently affected ; and 
hence the disease was in many instances called a 
pleurisy or a catarrh. This inflammation of the 
lungs occurred in a more especial manner in the 
winter season. It was distinguished from the pleu- 
risies of common years by a red eye, by a vomit- 
ing of green or yellow bile, by black stools, and 
by requiring very copious blood-letting to cure it. 

The head was affected, in this fever, not only 
with coma and delirium, but with mania. This 



372 AN ACCOUNT OF THE 

symptom was so common as to give rise to an opi- 
nion that madness was epidemic in our city. I 
saw no case of it which was not connected w T ith 
other symptoms of the bilious remitting fever. The 
Rev. Mr. Keating, one of the ministers of the Ro- 
man church, informed me that he had been called 
to visit seven deranged persons in his congregation, 
in the course of one week, in the month of March. 
Two of them had made attempts upon their lives* 
This mania was probably, in each of the above 
cases, a symptom only of general fever. The dila- 
tation of the pupil was universal in this fever. 

Sore eyes were common during the prevalence 
of this fever. In Mrs. Learning, this affection of 
the eyes was attended with a fever of a tertian type. 

III. The alimentary canal suffered as usual in 
tnis fever. A vomiting was common upon the 
first attack of the disease. I observed this symp- 
tom to be less common after the cold and rainy 
weather which took place about the first of Oc- 
tober. 

I have in another place mentioned the influence 
of the weather upon the symptoms of this disease. 
In addition to the facts which have been formerlv 

■r 

recorded, I shall add one more from Dr. Desportes. 



BILIOUS YELLOW FEVER OF 1794. 373 

He tells us, that in dry weather the disease affects 
the head, and that the bowels in this case are 
more obstinately costive than in moist weather. 
This influence of the atmosphere on the yellow 
fever will not surprise those physicians who recol- 
lect the remarkable passage in Hippocrates, in 
which he says, that in the violent heats of summer, 
fevers appeared, but without any sweat ; but if a 
shower, though ever so slight, appeared, a sweat 
broke out in the beginning.* I observed further, 
that a vomiting rarely attended those cases in which 
there was an absence of a chilly fit in the begin- 
ning of the fever. The same observation is made 
by Dr. Desportesf . 

The matter discharged by vomiting was green 
or yellow bile in most cases. Mrs. Jones, the 
wife of Captain Lloyd Jones, and one other per- 
son, discharged black bile within one hour after 
they were attacked by the fever. I have taken 
notice, in the History of the Yellow Fever of 1793, 
that a discharge of bile in the beginning of this fe- 
ver was always a favourable symptom. Dr. Da- 
vidson of St. Vincents, in a letter to me, dated the 
22d July, 1794, makes the same remark. It shows 

* Epidemics, book XI. sect. I. 

t Les Maladies de St. Domingue, vol. I. p. 193. 



374 AN ACCOUNT OF THE 

that the biliary ducts are open, and that the bile is 
not in that viscid and impacted state which is de- 
scribed in the dissections of Dr. Mitchel*. A 
distressing pain in the stomach, called by Dr. Cul- 
len gastrodynia, attended in two instances. A 
burning pain in the stomach, and a soreness to the 
touch of its whole external region, occurred in 
three or four cases. Two of them were in March, 
1795. In Mrs. Vogles, who had the fever in 
September, 1794, the sensibility of the pit of the 
stomach was so exquisite, that she could not bear 
the weight of a sheet upon it. 

Pains in the bowels were very common. They 
formed the true bilious colic, so often mentioned 
by West- India writers. In John Madge these 
pains produced a hardness and contraction of the 
whole external region of the bowels. They were 
periodical in Miss Nancy Eyre, and in Mrs. Gar- 
diner, and in both cases were attended with diar- 
rhoea. 

Costiveness without pain was common, and, in 
some cases, so extremely obstinate as to resist, for 
several days, the successive and alternated use of 
all the usual purges of the shops. 



* Account of the Yellow Fever of 1 79 



a. 



BILIOUS YELLOW FEVER OF 1794. 375 

Flatulency was less common in this fever than in 
the year 1793. 

The disease appeared with symptoms of dysen- 
tery in several cases. 

IV. The following is an account of the state of 
the secretions and excretions in this fever. 

A puking of bile was more common this year 
than in the year 1793. It was generally of a green 
or yellow colour. I have remarked before, that two 
of my patients discharged black bile within an hour 
after they were affected by the fever, and many 
discharged that kind of matter which has been 
compared to coffee grounds, towards the close of 

the disease. 

i 

The fasces were black in most cases where the 
symptoms of the highest grade of the fever attend- 
ed. In one very malignant case the most drastic 
purges brought away, by fifty evacuations, nothing 
but natural stools. The purges were continued, 
and finally black faeces were discharged, which pro- 
duced immediate relief*. In one person the fasces 

* In the account of the effects of morbid action and in- 
flammation, in the Outlines of the Theory of Fever, the au- 
thor neglected to mention the change of certain fluids from 



376 A.N ACCOUNT OF THE 

were of a light colour. In this patient the yellow- 
ness in the face was of an orange colour, and con- 
tinued so for several weeks after his recovery. 

i 

The urine was, in most cases, high coloured. It 
was scanty in quantity in Peter Brown, and totally 
suppressed in John Madge for two days. I ascrib- 
ed this defect of natural action in the kidneys to an 
engorgement in their blood-vessels, similar to that 
which takes place in the lungs and brain in this 
fever. I had for some time entertained this idea 
of a morbid affection of the kidneys, but I have 
lately been confirmed in it by the account which 
Dr. Chisholm gives of the state of one of the 
kidneys, in a man whom he lost with the Beul- 
lam fever, at Grenada. " The right kidney (says 
the doctor) was mortified, although, during his ill- 
ness, no symptom of inflammation of that organ was 
perceived*." It would seem as if the want of 

their natural to a dark colour. It appears in the secretions 
of the stomach and bowels, in the bile, in the urine, in car- 
buncles, and occasionally in the matter which is produced 
by blisters. All these changes occur in the yellow fever, and, 
in common with the other effects of fever that have been 
enumerated, are the result of peculiar actions in the vessels, 
derived from one cause, viz. morbid excitement. 

* Essay on the Malignant Pestilential Fever introduced 
into the West-Indies from Beuliam, p. 137. 



BILIOUS YELLOW FEVER OF 1794. 377 

action in the kidneys, and a defect in their functions 
were not necessarily attended with pain. I recollect 
to have met with several cases in 1793, in which 
there was a total absence of pain in a suppression 
of urine of several days continuance. The same 
observation is made by Dr. Chisholm, in his ac- 
count of the Beullam fever of Grenada*. From 
this fact it seems probable, that pain is not the 
effect of any determinate state of animal fibres, but 
requires the concurrence of morbid or preternatural 
excitement to produce it. I met with but one case 
of strangury in this fever. It terminated favour- 
ably in a few days. I have never seen death, in a 
single instance, in a fever from any cause, where a 
strangury attended, and I have seldom seen a fatal 
issue to a fever, where this symptom was acciden- 
tally produced by a blister. From this fact there 
would seem to be a connection between a morbid 
excitement in the neck of the bladder, and the 
safety of more vital parts of the body. The idea 
of this connection was first suggested to me, above 
thirty years ago, by the late Dr. James Leiper, of 
Maryland, who informed me. that he had some- 
times cured the most dangerous cases of pleurisy, 
after the usual remedies had failed, by exciting a 

* Page 224. 
f 

VOL. III. 3 B 



378 AN ACCOUNT OF THE 

strangury, by means of the tincture of Spanish flies 
mixed with camphorated spirit of wine. 

The tongue was always moist in the beginning 
of the fever, but it was generally of a darker colour 
than last year. When the disease was left to itself, 
or treated with bark and wine, the tongue became 
of a fiery red colour, or dry and furrowed, as in the 
typhus fever. 

Sweats were more common in the remissions of 
this fever, than they were in the year 1793, but 
they seldom terminated the disease. During the 
course of the sweats, I observed a deadly coldness 
over the whole body to continue in several in- 
stances, but without any danger or inconvenience 
to the patient. In two of the worst cases I attended, 
there were remissions, but no sweats until the day 
on which the fever terminated. In several of my 
patients, the fever wore away without the least 
moisture on the skin. The milk, in one case, was 
of a greenish colour, such as sometimes appears in 
the serum of the blood. In another female patient 
who gave suck, there was no diminution in the 
quantity of her milk during the whole time of her 
fever, nor did her infant suffer the least injury from 
sucking her breasts. 



BILIOUS YELLOW FEVER OF 1794. 379 

I observed tears to flow from the eye of a young 
woman in this fever, at a time when her mind 
seemed free from distress of every kind. 

V. I proceed next to mention the symptoms of 
this fever in the nervous system. 

Delirium was less common than last year. I 
was much struck in observing John Madge, who 
had retained his reason while he was so ill as to 
require three bleedings a day, to become delirious 
as soon as he began to recover, at which time his 
pulse rose from between 60 and 70, to 96 strokes 
in a minute. I saw one case of extreme danger, 
in which a hysterical laughing and weeping alter- 
nately attended. 

I have before mentioned the frequency of mania 
as a symptom of this disease. An obstinate wake- 
fulness attended the convalescence from this fever 
in Peter Brown, John Madge, and Mr. Cole. 

Fainting was more common in this fever than in 
the fever of 1793. It ushered in the disease in one 
of my patients, and it occurred in several instances 
after bleeding, where the quantity of blood drawn 
was very moderate. 



38Q AN ACCOUNT OP THE 

Several people complained of giddiness in the 
first attack of the fever, before they were confined 
to their beds. Sighing was less common, but a 
hiccup was more so, than in the year before. 

John Madge had an immobility in his limbs 
bordering upon palsy. A weakness in the wrists 
in one case succeeded a violent attack of the fe- 
ver. 

Peter Brown complained of a most acute pain 
in the muscles of one of his legs. It afterwards 
became so much inflamed as to require external 
applications to prevent the inflammation terminating 
in an abscess. Mrs. Mitchell complained of severe 
cramps in her legs. 

The sensations of pain in this fever were often 
expressed in extravagant language. The pain in 
the head, in a particular manner, was compared to 
repeated strokes of a hammer upon the brain, and 
in two cases, in which this pain was accompanied 
by great heat, it was compared to the boiling of a 
pot. 

The more the pains were confined to the bones 
and back, the less danger was to be apprehended 
from the disease. I saw no case of death from the 



BILIOUS YELLOW FEVER OF 1794. 381 

yellow fever in 1793, where the patient complain- 
ed much of pain in the back. It is easy to con- 
eeive how this external determination of morbid 
action should preserve more vital parts. The bili- 
ous fever of 1780 was a harmless disease, only be- 
cause it spent its whole force chiefly upon the limbs. 
This was so generally the case, that it acquired, 
from the pains in the bones which accompanied it, 
the name of the " break bone fever." Hippocrates 
has remarked that pains which descend, in a fever, 
are more favourable than those which ascend*. 
This is probably true, but I did not observe any 
such peculiarity in the translation of pain in this 
fever. The following fact from Dr. Grainger will 
add weight to the above observations. He observ- 
ed the pains in a malignant fever which were dif- 
fused through the whole head, though excruciating, 
were much less dangerous than when they were 
confined to the temples or foreheadf . 

I saw two cases in which a locked jaw attended. 
In one of them it occurred only during one parox- 
ysm of the fever. In both it yielded in half an 
hour to blood-letting. I met with one case in 

* Epidemics, book ii. sect. 2. 

t Historia Febris Anomaly Batavx Annorum 1746, 1747, 
174-8, cap. i. 



382 AN ACCOUNT OF THE 

which there was universal tetanus. I should have 
puspected this to have been the primary disease, 
had not two persons been infected in the same house 
with the yellow fever. 

The countenance sometimes put on a ghastly ap- 
pearance in the height of a paroxysm of the fever. 
The face of a lady, admired when in health for un- 
common beauty, was so much distorted by the 
commotions of her whole system, in a fit of the 
fever, as to be viewed with horror by all her friends. 

VI. The senses and appetites were affected in 
this fever in the following manner. 

A total blindness occurred in two persons dur- 
ing the exacerbation of the fever, and ceased during 
its remissions. A great intolerance of light occur- 
red in several cases. It was most observable in 
John Madge during his convalescence. 

A soreness in the sense of touch was so exqui- 
site in Mrs. Kapper, about the crisis of her fever, 
that the pressure of a piece of fine muslin upon her 
skin gave her pain. 

Peter Brown, with great heat in his skin, and a 
quick pulse, had no thirst, but a most intense de- 



BILIOUS YELLOW FEVER OF 1794. 383 

gree of thirst was very common in this fever. It 
produced the same extravagance of expression that 
I formerly said was produced by pain. One of my 
patients, Mr. Cole, said he " could drink up the 
ocean." I did not observe thirst to be connected 
with any peculiar state of the pulse. 

George Eyre and Henry Clymer had an unusual 
degree of appetite, just before the usual time of the 
return of a paroxysm of fever. 

A young man complained to me of being afflicted 
with nocturnal emissions of seed during his conva- 
lescence. This symptom is not a new one in malig- 
nant fevers. Hippocrates takes notice of it*. I 
met with one instance of it among the sporadic cases 
of yellow fever which occurred in 1795. It some- 
times occurs, according to Lomius, in the com- 
motions of the whole system which take place in 
epilepsy. 

VII. The disease made an impression upon the 
lymphatic system. Four of my patients had glan- 
dular swellings : two of them were in the groin ; a 
third was in the parotid ; and the fourth was in the 

* Epidemics, book IV. 



384 AN ACCOUNT OF THE 

maxillary glands. Two of these swellings sup* 
purated. 

VIII. The yellowness of the skin, which some* 
times attends this fever, was more universal, but 
more faint than in the year 1793. It was, in many 
cases, composed of such a mixture of colours, as 
to resemble polished mahogany. But, in a few 
cases, the yellowness was of a deep orange colour. 
The former went off with the fever, but the latter 
often continued for several weeks after the patients 
recovered. In some instances a red colour predo- 
minated to such a degree in the face, as to product 
an appearance of inflammation. 

In Mrs. Vogles a yellowness appeared in her 
eyes during the paroxysm of her fever, and went 
off in its remissions. 

In James Lefferty the yellowness affected every 
part of his body, except his hands, which were as 
-pale as in a common fever. 

Peter Brown tinged his sheets of a yellow co- 
lour, by night sweats, many weeks after his reco- 
very. 



BILIOUS YELLOW FEVER OF 1794. 385 

There was an exudation from the soles of the 
feet of Richard Wells's maid, which tinged a towel 
of a yellow colour. 

In my Account of the Yellow Fever of 1793, I 
ascribed the yellow colour of the skin wholly to a 
mixture of bile with the blood. I believe that this 
is the cause of it, in those cases where the colour 
is deep, and endures for several weeks beyond the 
crisis of the fever ; but where it is transitory, and, 
above all, where it is local, or appears only for a 
few hours, during the paroxysm of the fever, it ap- 
pears probable that it is connected with the mode 
of aggregation of the blood, and that it is produced 
wholly by some peculiar action in the blood-vessels. 
A similar colour takes place from the bite of cer- 
tain animals, and from contusions of the skin, in 
neither of which cases has a suspicion been enter- 
tained of an absorption or mixture of bile with the 
blood. 

A troublesome itching, with an eruption of red 
blotches on the skin, attended on the first day of 
the attack of the fever, in Mrs. Gardiner. 

A roughness of the skin, and a disposition in it 
to peel off, appeared about the crisis of the fever, 
in Miss Sally Eyre. 

VOL. III. 3 c 



386 AN ACCOUNT OF THE 

That species of eruption, which I have elsewhere 
compared to moscheto bites, appeared in Mrs. 
Sellers. 

John Ray, a day labourer, to whom I was called 
in the last stage of the fever, had petechia on his 
breast the day before he died. 

That burning heat on the skin, called by the an- 
cients " calor mordens," and from which this fever, 
in some countries, has derived the name of causus, 
was more common this year than last. It was 
sometimes local, and sometimes general. I per- 
ceived it in an exquisite degree in the cheeks only 
of Miss Sally Eyre, and over the whole body of 
John Ray. It had no connection with the rapidity 
or force of the circulation of the blood in the latter 
instance, for it was most intense at a time when he 
had no pulse. 

It is remarkable that the heat of the skin has no 
connection with the state of the pulse. This fact 
did not escape Dr. Chisholm. He says he found 
the skin to be warm while the pulse was at 52, and 
that it was sometimes disagreeably cold when the 
pulse was as quick as in ordinary fever*. 

* Page 117. 



BILIOUS YELLOW FEVER OF 1794. 387 

IX. I have in another place rejected putrefac- 
tion from the blood as the cause or effect of this 
fever. I shall mention the changes which were 
induced in its appearances when I come to treat of 
the method of cure. 

Having described the symptoms of this fever as 
they appeared in different parts of the body, I shall 
now add a few observations upon its type or gene- 
ral character. 

I shall begin this part of the history of the fever 
by remarking, that we had but one reigning dis- 
ease in town during the autumn and winter ; that 
this was a bilious remitting, or intermitting, and 
sometimes a yellow fever ; and that all the fevers 
from other remote causes than putrid exhalation, 
partook more or less of the symptoms of the 
prevailing epidemic. As well might we distin- 
guish the rain which falls in gentle showers in 
Great-Britain, from that which is poured in torrents 
from the clouds in the West- Indies, by different 
names and qualities, as impose specific names and 
characters upon the different states of bilious fever. 

The forms in which this fever appeared were as 
follow. 



388 AN ACCOUNT OF THE 

1. A tertian fever. Several persons died of the 
third fit of tertians, who were so well as to go 
abroad on the intermediate day of the fever, It is 
no new thing for malignant fevers to put on the 
form of a tertian. Hippocrates long ago remarked, 
that intermittents sometimes degenerate into malig- 
nant acute diseases ; and hence he advises physi- 
cians to be on their guard upon the 5th, 7th, 9th f 
and even on the 14th day of such fevers*. 

2. It appeared most frequently in the form of a 
remittent. The exacerbations occurred most com- 
monly in the evening. In some there were exacer- 
bations in the morning as well as in the evening. 
But I met with several patients who appeared to 
be better and worse half a dozen times in a day. 
In each of these cases, there were evident remis* 
sions and exacerbations of the fever. 

It assumed, in several instances, the symptoms 
of a colic and cholera morbus. In one case the 
fever, after the colic was cured, ended in a regular 
intermittent. In another, the colic was accompa- 
nied by a haemorrhage from the nose. I distin- 
guished this bilious colic from that which is excited 
by lighter causes, by its always coming on with 

* De Morb. Popular, lib. VII. 



BILIOUS YELLOW FEVER OF 1794. 389 

more or less of a chilliness*. The symptoms of 
colic and cholera morbus occurred most frequently 
in June and July. 

4. It appeared in the form of a dysentery in a 
boy of William Corfield, and in a man whom my 
pupil, Mr. Alexander, visited in the neighbour- 
hood of Harrowgate. 

5. It appeared, in one case, in the form of an 
apoplexy. 

6. It disguised itself in the form of madness. 

7. During the month of November, and in all 
the winter months, it was accompanied with pains 
in the sides and breast, constituting what nosolo- 
gists call the " pleuritis biliosa." 

8. The puerperile fever was accompanied, dur- 
ing the summer and autumn, with more violent 
symptoms than usual. Dr. Physick informed me, 
that two women, to whom hew r as called soon after 
their delivery, died of uterine haemorrhages ; and 
that he had with difficulty recovered two other 
lying-in women, who were afflicted with that symp- 
tom of a malignant diathesis in the blood-vessels. 

*' See Sydenham, vol. I. p. 212. 



390 AN ACCOUNT OF THE 

9. Even dropsies partook more or less of the in- 
flammatory and bilious character of this fever. 

10. It blended itself with the scarlatina. The 
blood, in this disease, and in the puerperile fever, 
had exactly the same appearance that it had in the 
yellow fever. A yellowness in the eyes accompa- 
nied the latter disease in one case that came under 
my notice. 

A slight shivering ushered in the fever in several 
instances. But the worst cases I saw came on 
without a chilly fit, or the least sense of coldness in 
any part of the body. 

Such was the predominance of the intermitting, 
remitting, and bilious fever, that the measles, the 
small-pox, and even the gout itself, partook more 
or less of its character. There were several in- 
stances in which the measles, and one in which the 
gout appeared with quotidian exacerbations ; and 
two in which madness appeared regularly in the 
form of a tertian. 

I mentioned formerly that this fever sometimes 
went off with a sweat, when it appeared in a tertian 
form. This was always the case with the second 
grade of the fever, but never with the first degree 



BILIOUS YELLOW FEVER OF 1794. 391 

of it, before the third or fourth paroxysm ; nor did 
a sweat occur on the fifth or seventh day, except 
after the use of depleting remedies. This pecu- 
liarity in the fever of this year was so fixed, that it 
gave occasion for my comparing it, in my inter- 
course with my patients, to a lion on the first seven 
days, and to a lamb during the remaining part of 
its duration. 

The fever differed from the fever of the preced- 
ing year in an important particular. I saw or 
heard of no case which terminated in death on the 
first or third day. In every case, the fever came 
on fraught with paroxysms. The moderate de- 
grees of it were of so chronic a nature as to conti- 
nue for several weeks, when left to themselves. I 
wish this peculiarity in the epidemic which I am 
now describing to be remembered ; for it will serve 
hereafter to explain the reason why a treatment ap- 
parently different should be alike successful, in 
different seasons and in different countries. 

The crisis of the fever occurred on uneven days 
more frequently than in the fever of the year 1793. 

I remarked formerly* that remissions were more 
common in the yellow fever than in the common 

* Account of the Yellow Fever of 1793. 



392 AN ACCOUNT OF THE 

bilious fever. The same observation applies to 
critical days. They were observable in almost 
every case in which the disease was not strangled 
in its birth. Dr. Chisholm describes the same pe- 
culiarity in the Beullam fever. " I have not met 
with any disease (says the doctor) in which the pe- 
riods were more accurately ascertained*. " 

In addition to the instances formerly enumerat- 
ed!, °f tne predominance of powerful epidemics 
over other diseases, I shall add two more, which I 
have lately met with in the course of my reading. 

Dr. Chisholm, in describing the pestilential fever 
introduced into the West- Indies from Beullam, 
has the following remarks. " Most other diseases 
degenerated into, or partook very much of this. 
Dysenteries suddenly stopped, and were immedi- 
ately succeeded by the symptoms of the pestilen- 
tial fever. Catarrhal complaints, simple at first, 
soon changed their nature ; convalescents from 
other diseases were very subject to this, but it ge- 
nerally proved mild. Those labouring at the same 
time under chronic complaints, particularly rheu- 
matism and hepatitis, were very subject to it. The 

* Page 141. 

t Account of the Yellow Fever in 1793* 



BILIOUS YELLOW FEVER OF 1794. 393 

puerperile fever became malignant, and of course 
fatal ; and even pregnant negro women, who other- 
wise miffht have had it in the usual mild decree 
peculiar to that description of people, were reduced 
to a very dangerous situation by it. In short, 
every disease in which the patient was liable to in- 
fection, sooner or later assumed the appearance, 
and acquired the danger of the pestilential fever*." 

Dr. Desportes ascribes the same universal empire 
to the yellow fever which prevailed in St. Domingo, 
in the summer of 1733. " The fever of Siam 
(says the doctor) conveyed an infinite number of 
men to the grave, in a short time ; but I saw but 
one woman who was attacked bv it." " The 
violence of this disease was such, that it subjected 
all other diseases, and reigned alone. This is the 
character of all contagious and pestilential diseases. 
Sydenham, and before him Diemerbroek, have re- 
marked this of the plaguef." 

In Baltimore, the small-pox in the natural way 
was attended with unusual malignity and morta- 
lity, occasioned by its being combined with the 
reigning yellow fever. 

* Page 129> 130. 

t Page 40, 41. See also p. 111,230,231. vol. L 
VOL. Ill, 3 D 



394 AN ACCOUNT OF THE 

It has been urged as an objection to the influence 
of powerful epidemics chasing away, or blending 
with fevers of inferior force, that the measles some- 
times supplant the small-pox, and mild intermittents 
take the place of fevers of great malignity. This 
fact did not escape the microscopic eye of Dr. 
Sydenham, nor is it diificult to explain the cause of 
it. It is well known that epidemics, like simple 
fevers, are most violent at their first appearance, 
and that they gradually lose their force as they dis- 
appear ; now it is in their evanescent and feeble 
state, that they are jostled out of their order of dan- 
ger or force, and yield to the youthful strength of 
epidemics, more feeble under equal circumstances 
of age than themselves. It would seem, from this 
fact, that an inflammatory constitution of the air, 
and powerful epidemics, both in their aggregate and 
individual forms, possessed a common character. 
They all invade with the fury of a savage, and re- 
tire with the gentleness of a civilized foe. 

It is agreeable to discover from these facts and 
observations, that epidemic diseases, however irre- 
gular they appear at first sight, are all subject to cer- 
tain laws, and partake of the order and harmony of 
the universe. 



BILIOUS YELLOW FEVER OF 1794. 395 

The action of the miasmata upon the body, 
when, from the absence of an exciting cause, they 
did not produce fever, was the same as I have else- 
where described. The sensations which I expe- 
rienced, in entering a small room where a person 
was confined with this fever, were so exactly the 
same with those I felt the year before, that I think 
I could have distinguished the presence of the dis- 
ease without the assistance of my eyes, or without 
asking a single question. After sitting a few mi- 
nutes in a sick room, I became languid and flinty. 
Weakness and chilliness followed every visit I paid 
to a gentleman at Mr. Ocllers's hotel, which con- 
tinued for half an hour. A burning in my sto- 
mach, great heaviness, and a slight inflammation in 
my eyes, with a constant discharge of a watery 
humour from them for two days, succeeded the 
iirst visit I paid to Mrs. Sellers. These symptoms 
came on in less than ten minutes after I left her 
room. They were probably excited thus early, 
and in the degree which I have mentioned, by my 
having received her breath in my face by inspect- 
ing her tonsils, which were ulcerated on the first 
attack of the fever. I formerly supposed these 
changes in my body were proofs of the contagious 
nature of the yellow fever, but I shall hereafter ex- 
plain them upon other principles. 



396 AN ACCOUNT OF THE 

I recollect having more than once perceived a 
smell which had been familiar to me during the 
prevalence of the yellow fever in 1793. It resem- 
bled the smell of liver of sulphur. I suspected for 
a while that it arose from the exhalations of the" 
gutters of the city. But an accident taught me 
that it was produced by the perspiration of my 
body. Upon rubbing my hands, this odour was 
increased so as to become not only more percepti- 
ble to myself, but in the most sensible degree to 
my pupil, Mr. Otto. From this fact, I was con- 
vinced that I was strongly impregnated with mias- 
mata, and I was led by it to live chiefly upon vege- 
tables, to drink no wine, and to avoid, with double 
care, all the usual exciting causes of fever. 

There was another mark by which I distinguished 
the presence of the seeds of this fever in my sys- 
tem, and that was, wine imparted a burning sensa- 
tion to my tongue and throat, such as is felt after 
it has been taken in excess, or in the beginning of 
a fever. Several persons, who were exposed to 
the miasmata, informed me that wine, even in the 
smallest quantity, affected them exactly in the same 
manner. 

I attended four persons in this fever who had had 
it the year before. 



BILIOUS YELLOW FEVER OF 1794. 397 

It remains now that I mention the origin of this 
fever. This was very evident. It was produced 
by the exhalations from the gutters, and the stag- 
nating ponds of water in the neighbourhood of the 
city. Where there was most exhalation, there 
were most persons affected by the fever. Hence 
the poor people, who generally live in the neigh- 
bourhood of the ponds in the suburbs, were the 
greatest sufferers by it. Four persons had the fever 
in Spruce, between Fourth and Fifth- streets, in 
which part of the city the smell from the gutters 
was extremely offensive every evening. In Water- 
street, between Market and Walnut- streets, many 
persons had the fever : now the filth of that con- 
fined part of the city is well known to every citizen. 

I have before remarked, that one reason why 
most of our physicians refused to admit the presence 
of the yellow fever in the city, was because they could 
not fix upon a vestige of its being imported. On 
the 25th of August, the brig Commerce arrived in 
the river, from St. Mark, commanded by Captain 
Shirtliff. After lying five days at the fort, she 
came up to the city. A boy, who had been shut 
out from his lodgings, went, in a state of intoxica- 
tion, and slept on her deck, exposed to the night 
air, in consequence of which the fever was excited 
in him. This event gave occasion, for a few days, 



398 AN ACCOUNT OF THE 

to a report that the disease was imported, and seve- 
ral of the physicians, who had neglected to attend 
to all the circumstances that have been stated, ad- 
mitted the yellow fever to be in town. An inves- 
tigation of this supposed origin of the disease soon 
discovered that it had no foundation. At the time 
of the arrival of this ship, I had attended nearly 
thirty persons with the fever, and upwards of a hun- 
dred had had it, under the care of other physicians. 

The generation of the yellow fever in our city 
was rendered more certain by the prevalence of 
bilious diseases in every part of the United States, 
and, in several of them, in the grade of yellow fever. 
It was common in Charleston, in South- Carolina, 
where it carried off many people, and where no 
suspicion was entertained of its being of West- In- 
dia origin. It prevailed with great mortality at that 
part of the city of Baltimore, which is known by 
the name of Fell's Point, where, Dr. Drysdale as- 
sures me, it was evidently generated. A few spo- 
radic cases of it occurred in New- York, which were 
produced by the morbid exhalation from the docks 
of that city. Sporadic cases of it occurred likewise 
in most of the states, in which the proofs of its be- 
ing generated were obvious to common observation; 
and where the symptoms of depressed pulse, yellow- 
ness of the skin, and black discharges from the 



BILIOUS YELLOW FEVER OF 1794. 399 

bowels and stomach (symptoms which mark the 
highest grade of bilious remitting fever) did not oc- 
cur, the fevers in all their form of tertian, quotidian, 
colic, and d} 7 sentery, were uncommonly obstinate 
or fatal in every state in the union. In New-Ha- 
ven only, where the yellow fever was epidemic, it 
was said to have been imported from Martinique, 
but this opinion was proved to be erroneous by 
unanswerable documents, published afterwards in 
the Medical Repository, by Dr. Elisha Smith, of 
New- York. 

The year 1795 furnished several melancholy 
proofs of the American origin of the yellow fever. 
All the physicians and citizens of New- York and 
Norfolk agree in its having been generated in their 
respective cities that year. It prevailed with great 
mortality at the same time in the neighbourhood 
of the lakes, and on the waters of the Genesee 
river, in the state of New- York. From its situa- 
tion it obtained the name of the lake and Genesee 
fever. It was so general, in some parts of that new 
country, as to affect horses. 

Thus have I endeavoured to fix the predisposing 
and remote causes of the yellow fever in our coun- 
try. The remote cause is sometimes so powerful 
as to become an exciting cause of the disease, but 



400 AN ACCOUNT OF THE 

in general both the predisposing and remote causes 
are harmless in the system, until they are roused 
into action by some exciting cause, 

I shall conclude this account of the symptoms 
and origin of the yellow fever by relating two facts, 
which serious and contemplating minds will apply 
to a more interesting subject. 

1. Notwithstanding the numerous proofs of the 
prevalence of the yellow fever in Philadelphia in the 
year 1794, which have been mentioned, there are 
many thousands of our citizens, and a majority of 
our physicians, who do not believe that a case of 
it existed at that time in the city ; nor is a single 
record of it to be met with in any of the news- 
papers, or other public documents of that year. 
Let us learn from this fact, that the denial of events, 
or a general silence upon the subject of them, is no 
refutation of their truth, where they oppose the 
pride or interests of the learned, or the great. 

2. Notwithstanding the general denial of the ex- 
istence of the yellow fever in Philadelphia, and the 
silence observed by our newspapers relative to it 
in 1794, there was scarcely a citizen or physician 
who, three years afterwards, did not admit of its 
having prevailed in that year. We learn from this 



BILIOUS YELLOW FEVER OF 1794. 401 

fact another important truth, that departed vice and 
error have no friends nor advocates. 



OF THE METHOD OF CURE, 



THE remedies employed for the cure of 
this fever were the same that I employed the year 
before. I shall only relate such effects of them as 
tend more fully to establish the practice adopted 
in the year 1793, and such as escaped my notice 
in my former remarks upon those remedies. My 
method of cure consisted, 

I. In the abstraction of the stimulus of blood 
and heat from the whole body, and of bile and 
other acrid humours from the bowels, by means of 
the following remedies : 

1. Bleeding. 

2. Purging. 

VOL. III. 3 E 



402 AN ACCOUNT OF THE 

3. Cool air and cold drinks. 

4. Cold water applied to the external parts of 
the body, and to the bowels by means of glysters. 

II. In creating a diversion of congestion, inflam- 
mation, and serous effusion, from the brain and 
viscera to the mouth, by means of a salivation, and 
to the external parts of the body, by means of 
blisters. 

III. In restoring the strength of the system, by 
tonic remedies. 

I proceed to make a few remarks upon the re- 
medies set down under each of the above heads. 

I. I have taken notice that this fever differed 
from the fever of 1793, in coming forward in July 
and August with a number of paroxysms, which 
refused to yield to purging alone. I therefore be- 
gan the cure of every case I was called to by bleed- 
ing. 

I shall mention the effects of this remedy, and 
the circumstances, manner, and degrees in which I 
used it occasionally, in this fever, in my Defence of 
Blood-letting. Under the present head I shall only 
furnish the reader with a table of the quantity of 



BILIOUS YELLOW FEVER OF 1794. 403 



blood drawn from a number of my patients in the 
course of the disease. From several of them the 
quantity set down was taken in three, four, and 
five days. I shall afterwards describe the appear- 
ances of the blood. 



1 — , , — 

Month. 


Patients. 


Quantity^ 


I umber ofl 

if i 1 






ounces. 


times bled. 


August. 


Peter Denham 


50 


5 




Mrs. Bruce 


70 


7 




Andrew Gribble, 








aged 15 years. 


50 


5 




John Madge 


150 


12 




Peter Brown 


80 


8 


September. 


Mrs. Gardiner 


80 


7 




Miss Sally Eyre 


80 


9 




Mrs. Gass 


50 


3 




Richard Wells's 








maid 


100 


10 




Mr. Norval 


100 


9 




Mr. Harrison 


90 


9 




Henry Clymer 


80 


8 


October. 


Mrs. "Mitchell 


120 


13 




Mrs. Lenox 


80 


7 




Mrs. Kapper 


140 


11 




Rev. Dr. Magaw's 






. 


maid 


100 


10 




Miss Hood 


100 


10 


. i 


Mrs. Vogles 


70 


5 


1795 

January. 


Guy Stone 


100 


9 


Benj. Hancock 


100 


10 




Mr. Benton 


130 


13 




Mrs. Fries 


150 


15 




Mrs. Garrigues 


80 


7 

i ■ ■■ n 



404 AN ACCOUNT OF THE 

Three of the women, whose names I have men- 
tioned, were in the advanced stage of pregnancy i 
viz. Mrs. Gardiner, Mrs. Gass, and Mrs. Gar- 
rigues. They have all since borne healthy chil- 
dren. I have omitted the names of above one hun- 
dred persons who had the fever, from whom I 
drew thirty or forty ounces of blood, by two or 
three bleedings. I did not cure a single person 
without at least one bleeding. 

It is only by contemplating the extent in which 
it is necessary to use this remedy, in order to over- 
come a yellow fever, that we can acquire just ideas 
of its force. Hitherto this force has been estimated 
by no other measure than the grave, and this, we 
know, puts the strength of all diseases upon a level. 

The blood drawn in this fever exhibited the fol- 
lowing appearances • 

1. It was dissolved in a few instances. 

2. The crassamentum of the blood was so par- 
tially dissolved in the serum, as to produce an ap- 
pearance in the serum resembling the washings of 
flesh in water. 



BILIOUS YELLOW FEVER OF 1794. 405 

3. The serum was so lightly tinged of a red co- 
lour as to be perfectly transparent. 

4. The serum was, in many cases, of a deep 
yellow colour. 

5. There was, in every case in which the blood 
was not dissolved, or in which the second appear- 
ance that has been mentioned did not take place, a 
beautiful scarlet-coloured sediment in the bottom 
of the bowl, forming lines, or a large circle. It 
seemed to be a tendency of the blood to dissolu- 
tion. This state of the blood occurred in almost 
all the diseases of the last two years, and in some 
in which there was not the least suspicion of the 
miasmata of the yellow fever. 

6. The crassamentum generally floated in the 
serum, but it sometimes sunk to the bottom of the 
bowl. In the latter case the serum had a muddy 
appearance. 

7. I saw but one case in which there was not a 
separation of the crassamentum and serum of the 
blood. Its colour in this case was of a deep scar- 
let. In the year 1793 this appearance was very 
common. 



406 AN ACCOUNT OF THE 

8. I saw one case in which the blood drawn, 
amounting to 14 ounces, separated partially, and 
was of a deep black colour. This blood was taken 
from Mr. Norval, a citizen of North-Carolina. 

9. There was, in several instances, a transparent 
jelly-like pellicle which covered the crassamentum 
of the blood, and which was easily separated from 
it without altering its texture. It appeared to have 
no connection with the blood. 

JO. The blood, towards the crisis of the fever in 
many people, exhibited the usual forms of inflam- 
matory crust. It was cupped in many instances. 

11. After the loss of 70 or 80 ounces of blood 
there was an evident disproportion of the quantity 
of crassamentum to the serum. It was sometimes 
less, by one half, than in the first bleedings. 

Under this head it will be proper to mention 
that the blood, when it happened to flow along the 
external part of the arm in falling into the bowl, 
was so warm as to excite an unpleasant sensation of 
heat in several patients. 

To the appearances exhibited by the blood to 
the eye, I shall add a fact communicated to me by 



BILIOUS YELLOW FEVER OF 1794. 407 

a German bleeder, who followed his business in the 
city during the prevalence of the fever in 1793* 
He informed me that he could distinguish a yellow 
fever from all other states of fever, by a peculiar 
smell which the blood emitted while it was flowing 
from a vein. From the certainty of his decision in 
one case which came under my notice, before a 
suspicion had taken place of the fever being in the 
city, I am disposed to believe that there is a founda- 
tion for his remark. 

II. I have but little to add to the remarks I 
made upon the use of purging in the year 1 793. 
I gave jalap, calomel, and gamboge until I ob- 
tained large and dark-coloured stools; after which I 
kept the bowels gently open every day with castor 
oil, cremor tartar, or glauber's salts. I gave calo- 
mel in much larger quantities than I did the year 
before. John Madge took nearly 150 grains of it 
in six days. I should have thought this a large 
quantity, had I not since read that Dr. Chisholm 
gave 400 grains of it to one patient in the course of 
his fever, and 50 grains to another at a single dose, 
three times a day. I found strong mercurial purges 
to be extremely useful in the winter months, when 
the fever put on symptoms of pleurisy. I am not 
singular in ascribing much to the efficacy of purges 
in the bilious pleurisy. Dr. Desportes tells us 



408 AN ACCOUNT OT THE 

that he found the pleurisy of St. Domingo, which 
was of the bilious kind, to end happily in propor- 
tion as the bowels were kept constantly open*. 
Nor am I singular in keeping my eye upon the 
original type of a disease, which only changes its 
symptoms with the weather or the season, and in 
treating it with the same remedies. Dr. Syden- 
ham bled as freely in the diarrhoea of 1668 as he 
had done in the inflammatory fever of the preceding 
yearf . How long the pleurisies of winter, in the 
city of Philadelphia, may continue to retain the bili- 
ous symptoms of autumn, which they have assumed 
for three years past, I know not ; but the late Dr. 
Faysseaux, of South-Carolina, informed me, that 
for many years he had not seen a pleurisy in Char- 
leston with the common inflammatory symptoms 
which characterised that disease when he was a 
student of medicine. They all now put on bilious 
symptoms, and require strong purges to cure them. 
The pleurisies which the late Dr. Chalmers sup- 
poses he cured by purging were probably nothing 
but bilious fevers, in which the cool weather had, 
excited some pleuritic symptoms. 

* Page 140. 

f Wallis*s edition, p. 211. vol. i* 



BILIOUS YELLOW FEVER OF 1794. 409 

I have nothing to add to the remarks I have else- 
where published upon the efficacy of cool air and 
cold drinks in this fever. They were both equally 
pleasant and useful, and contributed, with cleanli- 
ness, very much to the success of my practice. 

4. Cold water, applied to the external parts of 
the body, and injected into the bowels by way of 
glyster, did great service in many cases. John 
Madge found great relief from cloths dipped in cold 
water, and applied to the lower part of his belly. 
They eased a pain in his bowels, and procured a 
discharge of urine. A throbbing and most dis- 
tressing pain in the head was relieved by the same 
remedy, in Mrs. Vogles and Mrs. Lenox. The 
cloths were applied for three successive days and 
nights to Mrs. Lenox's head, during an inflamma- 
tion of her brain, which succeeded her fever, and 
were changed, during the greater part of the time, 
every ten or fifteen minutes. In 1795, I increased 
the coldness of pump water, when used in this way, 
by dissolving ice in it, and in some cases I applied 
powdered ice in a bladder to the head, with great 
advantage. 

The following facts will show the good effects of 
cold water in this, as well as other fevers of too 
much action. 

VOL, III. 3 F 



410 AN ACCOUNT OF THE 

In the afternoon of one of those days in which 
my system was impregnated with the miasmata of 
the yellow fever, I felt so much indisposed that I 
deliberated whether I should go to bed or visit a 
patient about a mile in the country. The afternoon 
was cool and rainy. I recollected, at this time, a 
ease related by Dr. Daignan, a French physician, 
of a man who was cured of the plague, by being 
forced to lie all night in an open field, in a shower 
of rain. I got into my chair, and exposed myself 
to the rain. It was extremely grateful to my feel- 
ings. In two hours I returned, when, to my great 
satisfaction, I found all my feverish symptoms had 
left me, nor had I the least return of them after- 
wards. 

Dr. Caldwell, who acted as a surgeon of a regi- 
ment, in the expedition against the insurgents in 
the western counties of Pennsylvania, furnished 
me, in a letter dated from Bedford, October 20th, 
1794, with an account of his having been cured of 
a fever, by a more copious use of the same remedy. 
" I was (says the doctor), to use a vulgar expres- 
sion, wet to the skin, and had no opportunity of 
shifting my cloihes for several hours. In conse- 
quence of this thorough bathing, and my subsequent 
exposure to a cool air, I was relieved from every 
symptom of indisposition in a few hours, and have 



BILIOUS YELLOW FEVER OF 1794. 411 

enjoyed more than my usual stock of health ever 
since." 

The efficacy of cold water, in preventing and 
curing inflammation, may be conceived from its 
effects when used with mud or clay, for obviating 
the pain and inflammation which arise from the 
sting of venomous insects. The same remedy, 
applied for half an hour, has lately, it is said, been 
equally effectual in preventing the deleterious effects 
of the bite of a rattle- snake. 

II. The good effects I had observed from a sa- 
livation in the yellow fever of 1793, induced me to 
excite it as early as possible, in all those cases which 
did not yield immediately to bleeding and purging. 
I was delighted with its effects in every case in 
which it took place. These effects were as fol- 
low : 

1. It immediately attracted and concentrated in 
the mouth all the scattered pains of every part of 
the body. 



2. It checked a nausea and vomiting. 



412 AN ACCOUNT OF THE 

3. It gradually, when it was copious, reduced the 
pulse, and thereby prevented the necessity of fur- 
ther bleeding or purging. 

I wish it were possible to render the use of this 
remedy universal in the treatment of malignant fe- 
vers. Dr. Chisholm, in his account of the Boul- 
lam fever, has done much to establish its safety and 
efficacy. It is a rare occurrence for a patient that 
has been sufficiently bled and purged, to die after 
a salivation takes place. The artificial disease ex- 
cited by the mercury suspends or destroys disease 
in every part of the body. The occasional incon- 
veniences which attend it are not to be named 
with its certain and universal advantages. Dur- 
ing the whole of the season in which the yellow 
fever prevailed, I saw but two instances in which 
it probably loosened or destroyed the teeth. I am 
not certain that the mercury was the cause of the 
injury or loss of those teeth ; for who has not seen 
malignant fevers terminate in ulcers, which have 
ended in the erosions of bony parts of the body ? 

It has been justly remarked, that there can be 
but one action at a time in the blood-vessels. This 
was frequently illustrated by the manner in which 
mercury acted upon the system in this fever. It 
seldom salivated until the fever intermitted or de- 



BILIOUS YELLOW FEVER OF 1794. 4l3 

clined. I saw several cases in which the salivation 
came on during the intermission, and went off dur- 
ing its exacerbation; and many, in which there 
was no salivation until the morbid action had ceased 
altogether in the blood-vessels, by the solution of 
the fever. It is because the action of the vessels, 
in epilepsy and pulmonary consumption, surpasses 
the stimulus of the mercury, that it is so difficult 
to excite a salivation in both those diseases. 

Let not the advocates for the healing powers of 
nature complain of a salivation as an unnatural re- 
medy in fevers. Dr. Sydenham speaks in high 
terms of it, in the fever of 1670, 1671, and 1672, 
in which cases it occurred spontaneously, and says 
that it cured it when it was so malignant as to be 
accompanied by purple spots on the body*. 

Blisters, when applied at a proper time, did 
great service in this fever. This time was, when 
the fever was so much weakened by evacuations, 
that the artificial pain excited by the stimulus of 
the blisters destroyed, and, like a conductor, con- 
veyed off all the natural pain of the body. It is 
from ignorance, or inattention to the proper stage 
of fevers in which blisters have been applied, that 

* Vol. ii. p. 212. 



414 AN ACCOUNT OF THE 

there have been so many disputes among physi- 
cians respecting their efficacy. When applied in 
a state of great arterial action, they do harm ; when 
applied after that action has nearly ceased, they do 
little or no service. I have called the period in 
which blisters are useful the blistering point. In 
bilious fevers this point is generally circumscribed 
within eight and forty hours. 

The effects of blisters were as follow : 

1. They concentrated, like a salivation, all the 
scattered pains of the body, and thereby, 

2. Reduced the pulse in force and frequency. 

3. They instantly checked a sickness at the sto- 
mach and vomiting. 

4. They often induced a gentle moisture upon 
the skin. 

I found it of little consequence to what part of 
the body the blisters were applied ; for I observed 
a pain in the head, and even delirium, to be as 
speedily and certainly cured by blisters upon the 
wrists, as they were by a large blister to the neck. 



BILIOUS YELLOW FEVER OF 1794. 415 

III. After the reduction of the morbid action of 
the blood-vessels, by means of the remedies which 
have been mentioned, I seldom made use of any- 
other tonic than a nourishing and gently stimulating 
diet. This consisted of summer fruits, bread and 
milk, chicken broth, the white meats, eggs, oys- 
ters, and malt liquors, more especially porter. I 
made many attempts to cure this fever when it ap- 
peared in the form of a simple intermittent, without 
malignant symptoms, by means of bark, but al- 
ways, except in two instances, without success ; 
and in them it did not take effect until after bleed- 
ing. In several cases it evidently did harm. I 
should have suspected my judgment in these obser- 
vations respecting this medicine, had I not been 
assured by Dr. Griifitts, Dr. Physick, and Dr. 
Woodhouse, that it was equally ineffectual in their 
practice, in nearly all the cases in which they gave 
it, and even where blood-letting had been premised. 
Dr. Woodhouse saw r a case in which near a pound 
of bark had been taken without effect ; and ano- 
ther in which a fatal dropsy succeeded its use. 
Dr. Griffitts excepted, from his testimony against 
the bark, the cases of seven persons from the coun- 
try, who brought the seeds of the intermitting fe- 
ver with them to the city. In them the bark suc- 
ceeded without previous bleeding. The facility 
with which these seven cases of intermitting fever 



416 AN ACCOUNT OF THE 

were cured by the bark, clearly proves that fevers 
of the same season differ very much, according to 
the nature of the exhalation which excites them. 
The intermittents in these strangers were excited 
by miasmata of less force than that which was ge- 
nerated in our city, in which, from the greater heat 
of the atmosphere, and the more heterogeneous 
nature of the putrid matters which stagnate in our 
ponds and gutters, the exhalation probably pos- 
sesses a more active and stimulating quality. Thus 
the mild remittents in June, and in the beginning 
of July, which were produced by the usual filth of 
the streets of Philadelphia, in the year 1793, differ- 
ed very much from the malignant remitting yellow 
fever which was produced by the stench of the pu- 
trid coffee a few weeks afterwards. 

Sir John Pringle long ago taught the inefficacy 
of bark in certain bilious fevers. But Dr. Chis- 
holm has done great service to medicine by record- 
ing its ill effects in the Boullam fever. " Head- 
ach (says the doctor), a heavy dull eye, with a con- 
siderable protrusion from its orbits, low spirits, 
thirst, and a total want of appetite, were the gene- 
ral consequences of the treatment wkh bark with- 
out the previous antiphlogistic." 



BILIOUS YELLOW FEVER OF 1794. 417 

I have mentioned a case of internal dropsy of the 
brain having been produced by the improper use of 
the bark, in a son of Mr. Coates. I have no doubt 
but this disease, as also palsy and consumption, 
obstructions of the liver and bowels, and dropsies 
of the belly and limbs, are often induced by the use 
of the bark, during an inflammatory state of the 
blood-vessels. It is to be lamented that the associ- 
ation of certain diseases and remedies, in the minds 
of physicians, becomes so fixed, as to refuse to yield 
to the influence of reason. Thus pain and opium, 
dropsy and foxglove, low spirits and assafoetida, 
and, above all, an intermitting fever and bark, are 
all connected together, in common practice, as me- 
chanically as the candle and the snuffers are in the 
mind of an old and steady house servant. To abo- 
lish the mischief of these mechanical associations in 
medicine, it will be necessary for physicians to pre- 
scribe only for the different states of the system. 

Finding the bark to be so universally ineffectual 
or hurtful, I substituted Columbo root, the Carri- 
bean bark, and several other bitters, in its place, but 
without success. They did less harm than the 
Jesuit's bark, but they did not check the return of 
a single paroxysm of fever. 

VOL. III. 3 G 



418 AN ACCOUNT OF THE 

I know that bark was given in this fever in some 
instances in which the patients recovered ; but they 
were subject, during the winter, and in the following 
spring, to frequent relapses, and, in some instances, 
to affections of the brain and lungs. In the high- 
est grade of the fever it certainly accelerated a sup- 
posed putrefaction of the blood, and precipitated 
death. The practice of physicians who create this 
gangrenous state of fever by means of the bark, re- 
sembles the conduct of a horse, who attempts by 
pawing to remove his shadow in a stream of water, 
and thereby renders it so turbid that he is unable tq 
drink it. 

Should the immediate success of tonic and de- 
pleting remedies in destroying the fever be equal, 
the effects of the former upon the constitution can- 
not fail of being less safe than the latter remedies. 
They cure by overstraining the powers of life. 
There is the same difference, therefore, between the 
two modes of practice, that there is between gently 
lifting the latch of a door, and breaking it open in 
order to go into a house. 

Wine was hurtful in every case of yellow fever 
in which it was given, while there were any remains 
of inflammatory action in the system. I recollect 
that a few spoonsful of it, which Mr. Harrison of 



BILIOUS YELLOW FEVER OF 1794. 41^ 

Virginia took in the depressed state of his pulse, 
excited a sensation in his stomach which he com- 
pared to a fire. Even wine- whey, in the excitable 
state of the system induced by this fever, was some- 
times hurtful. In a patient of Dr. Physick, who 
was on the recovery, it produced a relapse that had 
nearly proved fatal, in the year 1795. Dr. Desper- 
rieres ascribes the death of a patient to a small 
quantity of wine given to him by a black nurse*. 
These facts are important, inasmuch as wine is a 
medicine which patients are most apt to use in all 
cases, without the advice of a physician. 

I observed opium to be less hurtful in this fever 
than it was in the fever of 1793. I administered a 
few drops of laudanum, in one case, in the form of 
a glyster, in a violent pain of the bowels, with evi- 
dent advantage, before the inflammatory action of 
the blood-vessels was subdued. In this way I 
have often obtained the composing effects of lau- 
danum where it has been rejected by the stomach. 
But I gave it sparingly, and in small doses only, in 
the early stage of the fever. John Madge, whose 
pains in his bowels were often as exquisite as they 
are in the most acute colic, did not take a single 
drop of it. I used no anodyne in his case but 

* Vol. ii. p. 108. 



420 AN ACCOUNT OF THE 

bleeding, and applications of cold water to the in- 
side and outside of his bowels. After the fever 
had passed the seventh day, and had been so far 
subdued by copious evacuations as to put on the 
form of a common inflammatory intermittent, I 
gave laudanum during the intermissions of the fe- 
ver with great advantage. In some cases it sud- 
denly checked the paroxysms of the fever, while 
in many more it only moderated them, but in such 
a manner that they wore themselves away in eight 
or ten days. One of my female patients, who had 
taken bitters of every kind without effect to cure a 
tertian, which succeeded a yellow fever, took a 
large dose of laudanum, in the interval of her pa- 
roxysms, to cure a tooth-ach. To her great sur- 
prise it removed her tertian. The effects of lau- 
danum in this fever were very different from those 
of bark. Where it did no service it did not, like 
the bark, do any harm. 

Perhaps this difference in the operation of those 
two medicines depended upon the bark acting with 
an astringent, as well as stimulating power, chiefly 
upon the blood-vessels, while the action of the opi- 
um was more simply stimulating, and diffused at 
the same time over all the systems of the body. 



BILIOUS YELLOW FEVER OF 1794. 421 

I shall say in another place that I sometimes di- 
rected a few drops of laudanum to be given in that 
state of extreme debility which succeeds a parox- 
ysm of fever, with evident advantage. 

Nitre, so useful in common inflammatory fe- 
vers, was in most cases so offensive to the stomach 
in this fever, that I was seldom able to give it. 
Where the stomach retained it I did not perceive 
it to do any service. 

Antimonials were as ineffectual as nitre in abat- 
ing the action of the sanguiferous system, and in 
producing a sweat. I should as soon expect to 
compose a storm by music, as to cure a yellow 
fever by such feeble remedies. 

Thus have I finished the history of the symp- 
toms, origin, and cure of the yellow fever as it ap- 
peared in Philadelphia in 1794, and in the winter 
of 1795. The efficacy of the remedies which have 
been mentioned was established by almost univer- 
sal success. Out of upwards of 200 patients to 
whom I was called on the first stage of the fever, 
between the 12th of June, 1794, and the 1st of 
April, 1795, I lost but four persons, in whom the 
unequivocal symptoms had occurred, which cha- 
racterize the first grade of the disease. 



422 AN ACCOUNT OF THE 

It will be useful, I hope, to relate the cases of 
the patients whom I lost, and to mention the causes 
of their deaths. The first of them was Mrs. Ga- 
vin. She objected to a fifth bleeding in the begin, 
ning of a paroxysm of her fever, and died from the 
want of it. Her death was ascribed to the frequency 
of her bleedings by the enemies of the depleting 
system. It was said that she had been bled ten 
times, owing to ten marks of a lancet having been 
discovered on her arms after death, five of which 
were occasioned by unsuccessful attempts to bleed 
her. She died with the usual symptoms of con- 
gestion in her brain. 

Mr. Marr, to whom I was called on the first day 
of his disease, died in a paroxysm of his fever which 
came on in the middle of the seventh night, after 
six bleedings. I had left him, the night before, 
nearly free of fever, and in good spirits. He might 
probably have been saved (humanly speaking) by 
one more bleeding in the exacerbation of what ap- 
peared to be the critical paroxysm of his fever. 

Mr. Montford, of the state of Georgia, died un- 
der the joint care of Dr. Physick and myself. He 
had been cured by plentiful bleeding and purging, 
but had relapsed. He appeared to expire in a fain- 
ty fit in the first stage of a paroxysm of the fever. 



BILIOUS YELLOW TEVER OS 1794. 42$ 

Death from this cause (which occurs most fre- 
quently where blood-letting is not used) is common 
in the yellow fever of the West- Indies. Dr. Bis- 
set, in describing the different ways in which the 
disease terminates fatally, says, u In a few cases the 
patient is carried oif by an unexpected syncope**" 

A servant of Mr. Henry Mitchel, to whom I 
was called in the early stage of his disease, died in 
consequence of a sudden effusion in his lungs, 
which had been weakened by a previous pulmonary 
complaint. 

I wish the friends of bark and wine in the yel- 
low fever, or of moderate bleeding with antimonial 
medicines, would publish an account of the number 
of their deaths by the fever, within the period I 
have mentioned, and with the same fidelity I have 
done. The contrast would for ever decide the con- 
troversy in favour of copious depletion. The mor- 
tality under the tonic mode of practice may easily 
be conceived from the acknowledgment of one of 
the gentlemen who used it, but who premised it, 
in many cases, by two and three bleedings. He 
informed Dr. Woodhouse, that out of twenty- seven 
patients, whom he had attended in the yellow fever, 

* Medical Essays and Observations, p. 28. 



424 AN ACCOUNT OF THE 

he had saved but nine. Other practitioners were ? 
I believe, equally unsuccessful, in proportion to the 
number of patients whom they attended. The 
reader will not admit of many deaths having occur- 
red from the diseases (formerly enumerated) to 
which they were ascribed, when he recollects that 
even a single death from most of them, in common 
seasons, is a rare occurrence in the practice of re- 
gular bred physicians. 

In answer to the account I have riven of the mor- 
tality of the fever in 1794, it will be said, that 30 
persons died less in that year, than in the healthy 
year of 1792. To account for this, it will be ne- 
cessary to recollect that the inhabitants of Philadel- 
phia were reduced in number upwards of 4000, 
in the year 1793, and of course that the proportion 
of deaths was greater in 1794 than it was in 1792, 
although the number was less. It is remarkable 
that the burials in the strangers' grave-yard amount- 
ed in the year 1792 to but 201, whereas in 1794 
they were 676. From this it appears, that the deaths 
must have been very numerous among new comers 
(as they are sometimes called) in the year 1794, 
compared with common years. Now this will easily 
be accounted for, when we recollect that these 
people, who were chiefly labourers, were exposed 
to the constantly exciting causes of the disease, and 



BILIOUS YELLOW FEVER OF 1794. 425 

that, in all countries, they are the principal sufferers 
bv it. 

But in order to do justice to this comparative 
view of the mortality induced by the yellow fever 
in the year 1794, it will be necessary to examine 
the bill of mortality of the succeeding year. By 
this it appears that 2274 persons died in 1795, 
making 1139 more than died in 1794. The great- 
ness of this mortality, I well recollect, surprized 
many of the citizens of Philadelphia, who had just 
passed an autumn which was not unusually sickly, 
and who had forgotten the uncommon mortality of 
the months of January, February, and March, 
which succeeded the autumn of 1794. 

It will probably be asked, how it came to pass 
that I attended so many more patients in this fever 
than any of my brethren. To this I answer, that, 
since the year 1793, a great proportion of my pa- 
tients have consisted of strangers, and of the poor ; 
and as they are more exposed to the disease than 
other people, it follows, that of the persons affected 
by the fever, a greater proportion must have fallen 
to my share as patients, than to other physicians. 
My ability to attend a greater number of patients 
than most of my brethren, was facilitated by my 
having, at the time of the fever, several ingenious 

vol. in. 3 H 



426 AN ACCOUNT OF THE 

and active pupils, who assisted me in visiting and 
prescribing for the sick. These pupils were, Ash- 
ton Alexander and Nathaniel Potter (now physi- 
cians at Baltimore), John Otto (now physician in 
Philadelphia), and Gilbert Watson (since dead of 
the yellow fever). 

The antiphlogistic remedies were not successful 
in Philadelphia, in the yellow fever, in my hands 
alone. They were equally, and perhaps more so, 
in the hands of my friends Dr. Griffitts, Dr. Phy- 
sick, Dr. Dewees, and Dr. Woodhouse. 

They were moreover successful at the same time 
in New Haven, Baltimore, and in Charleston, in 
South- Carolina. Eighteen out of twenty died of 
all who took bark and wine in New- Haven, but on- 
ly one in ten of those who used the depleting me- 
dicines. In a letter from Dr. Brown, a physician 
of eminence in Baltimore, dated November 27th, 
1794, he says, " of the many cases which fell to 
my care, two only proved mortal where I was call- 
ed on the first day of the disease, and had an un- 
controuled opportunity to follow my judgment. 
Where salivation took place, I had no case of mor- 
tality ; and in two of those cases, a black vomiting 
occurred." Dr. Ramsay, of Charleston, in a letter 
to one of his friends in this city, dated October 



BILIOUS YELLOW FEVER OF 1794. 427 

14th, 1794, subscribes to the efficacy of the same 
practice in a fever which prevailed at that time in 
Charleston, and which, he says, resembled the yel- 
low fever of Philadelphia in the year 1793. 

But the success of the depleting system was not 
confined to the United States. In a letter before 
quoted, which I received from Dr. Davidson, of 
St. Vincents, dated July 22d, 1794, there is the 
following testimony in favour of evacuations from 
the blood-vessels, bowels, and salivary glands : 

" Where the fever comes on with great deter* 
mination to the head, and an affection of the sto- 
mach, in consequence of that determination, vio- 
lent head-ach, redness of the eyes, turgescence of 
the face, impatience of light, &c. attended with a 
full and hard pulse, blood-letting should be em- 
ployed freely and repeatedly, cold applications 
should be applied to the head, and purging medi- 
cines should be employed. As a purge, calomel 
has been used with the greatest advantage, some- 
times by itself, but most frequently combined with 
some active purgative medicine, such as jalap. 
From some peculiarity in the disease, an uncom- 
mon quantity of the calomel is necessary to affect 
the bowels and salivary glands. As I found a 
small quantity of it did not produce the eifect 1 



428 AN ACCOUNT OF THE 

wished for promptly, I have gradually increased 
the quantity, until I now venture to give ten grains 
of it, combined with five of jalap, every two hours 
until stools are procured. The calomel is then 
given by itself. 

11 The patients have generally an aversion to 
wine. The bark is seldom found of much advan- 
tage in this state of the fever, and frequently brought 
on a return of the vomiting. I preferred to it, in 
a remission of the symptoms, a vinous infusion of 
the quassia, which sat better upon the stomach." 

In the island of Jamaica, the depleting system 
has been divided. It appears, from several publi- 
cations in the Kingston papers, that Dr. Grant had 
adopted blood-letting, while most of the physicians 
of the island rest the cure of the yellow fever upon 
strong mercurial purges. The ill effects of mode- 
rate bleeding probably threw the lancet into disre- 
pute, for the balance of success, from those publi- 
cations, is evidently in favour of simple purging. 
I have no doubt of the truth of the above statement 
of the controversy between the exclusive advocates 
for bleeding and purging ; or perhaps the superior 
efficacy of the latter remedy may be explained in the 
following manner. 



BILIOUS YELLOW FEVER OF 1794. 429 

In warm climates, the yellow fever is generally, 
as it was in Philadelphia in the month of August 
and in the beginning of September, 1793, a disease 
of but two or three paroxysms. It is sometimes, 
I believe, only a simple ephemera. In these cases, 
purging alone is sufficient to reduce the system, 
without the aid of bleeding. It was found to be 
so until the beginning of September, in 1793, in 
most cases in Philadelphia. The great prostration 
of the system in the yellow fever, in warm weather 
and in hot climates, renders the restoration of it to 
a healthy state of action more gradual, and of 
course more safe, by means of purging than bleed- 
ing. The latter remedy does harm, from the sys- 
tem being below the point of re-action, after the 
pressure of the blood is taken from it, or by restor- 
ing the blood-vessels too suddenly to preternatural 
action, without reducing them afterwards. Had 
bleeding been practised agreeably to the method 
described by Riverius (mentioned in the history of 
the fever of 1793), or had the fever in Jamaica run 
on to more than four or five paroxysms, it is pro- 
bable the loss of blood would have been not only 
safe, but generally beneficial. I have, in the same 
history, given my reasons why moderate bleeding 
in this, as well as many other diseases, does harm. 
In those cases where it has occurred in large quan- 
tities from natural haemorrhages, it has always done 



430 AN ACCOUNT OF THE 

service in the West- Indies. The inefficacy, and, 
in some cases, the evils, of moderate blood-letting 
are not confined to the yellow fever. It is equally 
ineffectual, and, in some instances, equally hurtful, 
in apoplexy, internal dropsy of the brain, pleurisy, 
and pulmonary consumption. Where all the dif- 
ferent states of the pulse which indicate the loss of 
blood are perfectly understood, and blood-letting 
conformed in time and in quantity to them, it never 
can do harm, in any disease. It is only when it is 
prescribed empirically, without the direction of 
just principles, that it has ever proved hurtful. 
Thus the fertilizing vapours of heaven, when they 
fall only in dew, or in profuse showers of rain, are 
either insufficient to promote vegetation, or alto- 
gether destructive to it. 

There may be habits in which great and long 
protracted debility may have so far exhausted the 
active powers of the system, as to render bleeding 
altogether improper in this disease, in a West- 
India climate. Such habits are sometimes produced 
in soldiers and sailors, by the hardships of a mili- 
tary and naval life. Bleeding in such cases, Dr. 
Davidson assures me, in a letter dated from Marti- 
nique, February 29th, 1796, did no good. The 
cure was effected, under these circumstances, by 
purges, and large doses of calomel. But where 



BILIOUS YELLOW FEVER OF 1794. 431 

this chronic debility does not occur, bleeding, when 
properly used, can never be injurious, even in a 
tropical climate, in the yellow fever. Of this there 
are many proofs in the writings of the most respect- 
able English and French physicians. In spite of 
the fears and clamours which have been lately ex- 
cited against it in Jamaica, my late friend and con- 
temporary at the college of Edinburgh, Dr. Broad- 
belt, in a letter from Spanish Town, dated January 
6th, 1795, and my former pupil, Dr. Weston, in 
a letter from St. Ann's Bay, dated June 17th, 1795, 
both assure me, that they have used it in this fever 
with great success. Dr. Weston says that he bled 
" copiously three times in twenty-four hours, and 
thereby saved his patient. " 

The superior advantages of the North- American 
mode of treating the yellow fever, by means of all 
the common antiphlogistic remedies, will appear 
from comparing its success with that of the West- 
India physicians, under all the modes of practice 
which have been adopted in the islands. Dr. Des- 
portes lost one half of all the patients he attended in 
the yellow fever in one season in St. Domingo*. 
His remedies were moderate bleeding and purging, 
and the copious use of diluting drinks. Dr. Bisset 

* Vol. i. p. 55, 



432 AW ACCOUNT OF THE 

says, " the yellow fever is often under particular 
circumstances very fatal, carrying off four or five in 
seven whom it attacks, and sometimes, but seldom, 
it is so favourable as to carry oft' only one patient 
in five or six*." The doctor does not describe 
the practice under which this mortality takes place. 

Dr. Home, I have elsewhere remarked-)-, lost 
" one out of four of his patients in Jamaica." His 
remedies were moderate bleeding and purging, and 
afterwards bark, wine, and external applications of 
blankets dipped in hot vinegar. 

Dr. Blane pronounces the yellow fever to be 
" one of the most fatal diseases to which the hu- 
man body is subject, and in which human art is 
the most unavailing." His remedies were bleed- 
ing, bark, blisters, acid drinks, saline draughts.* 
and camomile tea. 

Dr. Chisholm acknowledges that he lost one in 
twelve of all the patients he attended in the fever of 
Grenada. His principal remedy was a salivation. 
I shall hereafter show the inferiority of this single 
mode of depleting, to a combination of it with bleed- 

* Medical Essays and Observations, p. 29. 
t Account of the Yellow Fever of 179S. 



BILIOUS YELLOW FEVER OF 1794. 433 

ing and purging. In Philadelphia and Baltimore, 
where bleeding, purging, and salivation were used 
in due time, and after the manner that has been 
described, not more than one in fifty died of the 
yellow fever. It is probable that greater certainty 
and success in the treatment of this disease will not 
easily be attained, for idiosyncracy, and habits of 
intemperance which resist or divert the operation 
of the most proper remedies, a dread of the lancet, 
or the delay of an hour in the use of it, the partial 
application of that or any other remedy, the unex- 
pected recurrence of a paroxysm of fever in the 
middle of the night, or the clandestine exhibition of 
wine or laudanum by friends or neighbours, often 
defeat the best concerted plans of cure by a physi- 
cian. Heaven in this, as in other instances, kindly 
limits human power and benevolence, that in all si- 
tuations man may remember his dependence upon 
the power and goodness of his Creator. 



VOL. III. 3 I 



AN 



ACCOUNT 



OP 



SPORADIC CASES 



OF 



BILIOUS TELLOW FEVER, 



IN PHILADELPHIA, 



UN THE YEARS 1795 AND 1796. 



AN ACCOUNT, &c. 



IN my account of the yellow fever, as it appeared 
in Philadelphia in the year 1794, I took notice of 
several cases of it which occurred in the spring of 
the year 1795. Before I proceed to deliver the 
history of this disease as it appeared in 1797, I shall 
mention the diseases and state of the weather which 
occurred during the remaining part of the year 
1795, and the whole of the year 1796. This de- 
tail of facts, apparently uninteresting to the reader 
in the present state of our knowledge of epidemics, 
may possibly lead to principles at a future day. 

The month of April, 1795, was wet and cold. 
All the diseases of this month partook of the in- 
flammatory character of the preceding winter and 
autumn, except the measles, which were unusually 
mild. 

VOL. III. 3 K 



438 AN ACCOUNT OF SPORADIC CASES 

The weather in May was alternately wet, cool, 
and warm. A few cases of malignant fever occur- 
red this month, but with moderate symptoms. In 
June the weather was cool and pleasant. The 
measles put on more inflammatory symptoms than 
in the preceding months. I had two cases of ma- 
nia under my care this month, and one of rheuma- 
tism, which were attended with intermissions and 
exacerbations every other day. 

The weather on the 19th, 20th, 21st, and 22d 
days of July was very warm, the mercury being at 
90° in Fahrenheit's thermometer. The fevers of 
this month were all accompanied with black dis- 
charges from the bowels. Mr. Kittera, one of the 
representatives of Pennsylvania in the congress of 
the United States, in consequence of great fatigue 
on a warm day, was affected with the usual symp- 
toms of the yellow fever. During his illness he 
constantly complained of more pain in the left, than 
in the right side of his head. His pulse was more 
tense in his left, than in his right arm. During his 
convalescence, it was more quick in the left arm, 
than it was in the right. He was cured by a sali- 
vation and the loss of above 100 ounces of blood. 
His head-ach was relieved by the application of a 
bladder half filled with ice to his forehead. 



BILIOUS YELLOW FEVER IN 1795 & 1796. 439 

Most of the cases of bilious fever, which came 
under my notice, were attended with quotidian, 
tertian, or quartan intermissions. In a few of my 
patients there was a universal rash* 

Dr. Woodhouse informed me, that he had seen 
several instances in which the yellow fever appeared 
in the same place in which some soldiers had labour- 
ed under the dysentery. These facts show the uni- 
ty of fever, and the impracticability of a nosological 
arrangement of diseases. 

The cholera infantum was severe and fatal, in 
many instances, during this month. It yielded to 
blood- letting in a child of Mr. Conyngham, which 
was but four months old. In a child of seven 
weeks old which came under my care, I observed 
the coldness, chills, hot fits, and remissions of the 
bilious fever to be as distinctly marked as ever I had 
seen them in adult patients. In a child of Mr. 
Darraeh, aged 5 months, the discharges from the 
bowels were of a black colour. I mention these 
facts in support of an opinion I formerly published, 
that the cholera infantum is a bilious fever, and 
that it rises and falls in its violence with the bilious 
fever of grown persons. 



440 AN ACCOUNT OF SPORADIC CASES 0? 

About the latter end of this month and the be- 
ginning of August, there were heavy showers of 
rain, which carried away fences, bridges, barns, 
mills, and dwelling-houses in many places. Seve- 
ral cases of bilious yellow fever occurred in the 
month of August. In one of them it was accom- 
panied with that morbid affection in the wind-pipe 
which has been called cynanche trachealis. It was 
remarkable that sweating became a more frequent 
symptom of the fevers of this month than it had 
been in July. Hippocrates ascribes this change in 
the character of bilious fevers to rainy weather. 
Perhaps it was induced by the rain which fell in 
the beginning of the month, in the fevers which 
have been named. 

Among the persons affected with the yellow fe- 
ver during this month, was William Bradford, Esq. 
the attorney-general of the United States. From a 
dread of the lancet he objected to being bled in the 
early stage of his disease, in consequence of which 
he died on the 23d of August, in the 39th year of 
his age, amidst the tears of numerous friends, and 
the lamentations of his whole country. 

On the 30th and 31st of August, there was a fall 
of rain, which suddenly checked the fever of the 
season, insomuch that the succeeding autumnal 



BILIOUS YELLOW FEVER IN 1795 & 1796. 441 

months were uncommonly healthy. Several show- 
ers of rain had nearly the same effect in New- York, 
where this fever carried off, in a few weeks, above 
700 persons. It prevailed, at the same time, and 
with great mortality, in the city of Norfolk, in Vir- 
ginia. 

In both those cities, as well as in Philadelphia, 
the disease was evidently derived from putrid ex- 
halation. 

In the same month, the dysentery prevailed in 
Newhaven, in Connecticut, and in the same part of 
the town in which the yellow fever had prevailed 
the year before. The latter disease was said to 
have been imported, but the prevalence of the dy- 
sentery, under the above circumstances, proved 
that both diseases were of domestic origin. 

The fever, as it appeared in Philadelphia, yielded 
in most cases to depleting remedies. After purg- 
ing and blood-letting, I gave bark, where the fever 
intermitted, with advantage. It was effectual only 
when given in large doses. In one instance, it 
induced a spitting of blood, which obliged me to 
lay it aside. 



442 AN ACCOUNT OP SPORADIC CASES OF 

The winter of 1796 was uncommonly moderate. 
There fell a good deal of rain, but little snow. 
The navigation of the Delaware was stopped but 
two or three days during the whole season. Ca- 
tarrhs were frequent, but very few violent or acute 
diseases occurred in my practice. The month of 
March and the first week in April were uncom- 
monly dry. Several cases of malignant bilious fe- 
ver came under my care during these months. A 
little girl, of five years old, whom I lost in this 
fever, became yellow in two hours after her death. 

The measles prevailed in April, and were of a 
most inflammatory nature. The weather in May 
and June was uncommonly wet. The fruit was 
much injured, and a great deal of hay destroyed by 
it. On the 14th of June, General Stewart died, 
with all the usual symptoms of a fatal yellow fever. 
Several other cases of it, in this and in the succeed- 
ing month, proved mortal, but they excited no 
alarm in the city, as the physicians who attended 
them called them by other names. 

The rain which fell about the middle of July 
checked this fever. August, September, and Oc- 
tober were unusually healthy. A few cases of 
malignant sore throat appeared in November. 



JBILIOUS YELLOW FEVER IN 1795 & 1796. 443 

They were, in all the patients that came under my 
notice, attended with bilious discharges from the 
stomach and bowels. So little rain fell during the 
autumnal months, that the wheat perished in many 
places. The weather in December was extremely 
cold. The lamps of the city were, in several in- 
stances, extinguished by it, on the night of the 23d 
of the month, at which time the mercury stood at 
2° below in the thermometer. 

The yellow fever prevailed this year in Charles- 
ton, in South- Carolina, where it was produced by 
putrid exhalations from the cellars of houses which 
had been lately burnt. It was said by the physi- 
cians of that place not to be contagious. The same 
fever prevailed, at the same time, at Wilmington, 
in North- Carolina, and at Newburyport, in the 
state of Massachusetts. In the latter place, it was 
produced by the exhalation of putrid fish, which 
had been carelessly thrown upon a wharf. 



END OF VOLUME III. 








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