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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.

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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 wThich 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
wrere 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 wras 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 wras also produced by a
change in the state of the mind directly opposite to
that which has been mentioned. Many persons
that attended patients wrho 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 wrere
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 wTas 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 wThich 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, wThich 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
wras 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 wrere 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 wrere 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}red 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
0
66
84
68
62
57
60

it4 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 0
29 8

29 9
o0 1

30 0
29 9

29 9
o0 1

30 0
30 0
30 0
oO 1
o0 1
30 0
30 0
29 8

29 8

30 0

29 9
o0 0

30 1
30 0
30 0
29 9
30
30
30
30
o0
30
29

1
2
2
1
1
1
9

CO

29 9

29 7

30 0
30 0.
29 9

29 9

30 0
30 1

29 8

30 0
30 0
30

30 0
30 0
29 9
29 7

29 9

30 0

29 9

30 0
30 1
30 0
30 0

29 9

30 1
30 2
30 1
SO 0
30 1
30 0
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 0

65

77

WNW

NW

cloudy,

fair,

2

30 1 30 1

63

81

NW

sw

fair,

fair,

3

30 6 29 95

62

82

N

NNE

fair,

fair,

4

29 97 30 0

65

87

S

SW

fair,

fair,

5

30 5 30 1

73

90

ssw

sw

fair,

fair,

6

30 2 30 0

77

87

sw

w

cloudy,

fair,

7

30 12 30 1

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 0 30 0

70

84

sw

wsw

cloudy,

cloudy,

12

30 0 30 0

70

87

w

w

fair,

fair,

13

30 5 30 0

71

89

sw

w

fair,

fair,

14

30 0 29 95

75

82

sw

sw

fair,

rain,

15

30 0 30 1

72

75

NNE

NE

fair,

cloudy,

16

30 1 30 1

70

83

NNE

sw

NE

fair,

fair,

17

30 1 30 0

71

86

SW

fair,

fair,

18

30 1 30 1

73

89

calm

sw

fair,

fair,

19

30 1 30 0

72

82

N

N

fair,

cloudy,

20

30 1 30 12

69

82

NNE

NNE

fair,

fair,

21

30 15 30 25

62

83

N

NNE

fair,

fair,

22

30 3 30 35

63

86

NE

SE

fair,

fair,

23

30 25 30 15

63

85

calm

S

fair,

fair,

24

30 1 30 1

73

81

calm

calm

cloudy,

rain,

25

30 1 30 1

71

66

NE

NE

rain,

gr, rain,

26

30 15 '30 2

59

69

NE

NE

cloudy,

cloudy,

27

30 2 30 2

65

73

NE

NE

cloudy,

cloudy,

28

30 2 30 15

67

80

S

calm

cloudy,

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 0 30 0

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

0

29

30

71

86

calm

SW

fog,

fair,

2

29

75

29

8

73

86

SW

SW

fair,

fair,

30

0

60

NW

N

fair,

fair,

4

30

15

30

15

55

75

W

w

fair,

fair,

5

30

15

30

1

62

80

SE

s

fair,

cloudy,

6

29

97

29

9o

70

89

VVSW

w

fair,

cloudy,

7

30

0

30

0

65

77

WNW

NW

fair,

fair,

8

30

1

30

1

64

70

calm

calm

cloudy,

cloudy,

g

30

0

30

0

66

80

SE

NW

rain,

fair,

10

30

0

30

0

64

72

N

NNE

fair,

cloudy,

11

30

1

30

0

62

72

NNE

N

cloudy,

fair,

12

29

96

29

9

58

76

NW

NNW

fair,

fair,

13

29

95

30

0

57

72

NW

N

fair,

fair,

14

30

0

30

5

58

79

NW

N V>

fair,

fair,

15

30

0

29

97

65

80

N

S

fair,

fair,

16

29

9

29

70

84

S

SW

cloudy,

fair,

17

29

8

29

85

66

67

N

N

cloudy,

cloudy,

18

30

3

44

N

fair,

19

30

4

30

35

45

70

calm

SW

fair,

fair,

20

30

3

30

15

54

69

calm

SE

hazy,

hazy,

21

30

0

29

0

59

78

calm

cioudy,

fair,

22

30

0

30

0

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

0

61

68

NE

NE

cloudy,

cloudy,

26

29

8

29

7

58

79

N

N

cloudy,

fair,

27

29

7

64

NW

NW

cloudy,

fair,

28

30

5

30

15

54

73

NW

NW

fair,

fair,

29

30

3

30

3

56

74

NE

ENE

cloudy,

fair,

30

30

35

30

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

0 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

0 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

0

52

76

SW

SW

calm,

fair,

15

29

75 29

8

56

54

sw

N

fair,

rain,

16

30

0 30

0

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

0 29

9

51

66

N

N

cloudy,

fair,

20

30

0 30

0

44

54

NW

N

fair,

fair,

21

30

0 30

2

49

59

N

NW

fair,

fair,

22

29

6 29

5

51

65

NW

NW

fair,

fair,

23

29

8 29

8

47

60

W

W

fair,

fair,

24

30

3 30

4

36

59

w

NW

fair,

fair,

25

30

4 30

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 0
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 lowy 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, wras 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 wras 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 wTas 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 dela3rstook 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 wTere 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
wras 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 wTith
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, 9thf
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 hewras 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}7sentery, 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 sawr 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 0 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.

FM1H 1\