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Full text of "Medical inquiries and observations"


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BOSTON PUBLIC LIBRARY. 





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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. IV. 



THE SECOND EDITION, 

REVISED AND ENLARGED BY THE AUTHOR. 



PHILADELPHIA, 

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

PRINTED BY T. tS* G. PALMER, 116, HIGH-STREET, 

1805, 



CONTENTS OF VOLUME IV. 



page 
AN account of the bilious yellow fever, as it appeared 

in Philadelphia in 1797 1 

An account of the bilious yellow fever, as it appeared 

in Philadelphia in 1798 63 

An account of the bilious yellow fever, as it appeared 

in Philadelphia in 1799 89 

An account of sporadic cases of yellow fever, as they 

appeared in Philadelphia in 1800 . 101 

An account of sporadic cases of yellow fever, as they 

appeared in Philadelphia in 1801 109 

fin account of the measles, as they appeared in Phi- 
ladelphia in 1 801 115 
An account of the yellow fever, as it appeared in 1802 121 
An account of the yelloxv fever, as it appeared in 1803 131 
An account of sporadic cases of yellow fever, as they - 

appeared in 1804 145 

An account of the yellow fever, as it appeared in 1805 151 
An inquiry into the various sources of the usual forms 
of the summer and autumnal disease in the United 
States, and the means of preventing them 161 



IV 

page 

Tacts, intended to prove the yellow fever not to be 

contagious 221 

Defence of blood-letting, as a remedy in certain dis- 
eases 273 
An inquiry into the comparative states of medicine in 
Philadelphia, between the years 1760 and 1766, 
and 1805 363 



AN ACCOUNT 



OF THE 



BILIOUS REMITTING AND INTERMITTING 

TEL LOW FEVER, 

AS IT 

-APPEARED IN PHILADELPHIA, 
in 1797. 



VOL. IV. 



AN ACCOUNT, &c. 



THE winter of 1797 was in general healthy. 
During the spring, which was cold and wet, no 
diseases of any consequence occurred. The spring 
vegetables were late in coming to maturity, and 
there were every where in the neighbourhood of 
Philadelphia scanty crops of hay. In June and 
July there fell but little rain. Dysenteries, chole- 
ras, scarlatina, and mumps, appeared in the sub- 
urbs in the latter month. On the 8th of July I 
visited Mr. Frisk, and on the 25th of the same 
month I visited Mr. Charles Burrel in the yellow 
fever, in consultation with Dr. Physick. They 
both recovered by the use of plentiful depleting 
remedies. 

The weather from the 2d to the 9th of August 
was rainy. On the 1st of this month I was called 



4 AN ACCOUNT OF THE 

to visit Mr. Nathaniel Lewis, in a malignant bilious 
fever. On the 3d I visited Mr. Elisha Hall, with 
the same disease. He had been ill several days be- 
fore I saw him . Both these gentlemen died on the 
6th of the month. They were both very yellow 
after death. Mr. Hail had a black vomiting om 
the day he died. 

The news of the death of these two citizens, 
with unequivocal symptoms of yellow fever, excit- 
ed a general alarm in the city. Attempts were 
made to trace it to importation, but a little investi- 
gation soon proved that it was derived from the 
foul air of a ship which had just arrived from Mar- 
seilles, and which discharged her cargo at Pine- 
street wharf, near the stores occupied by Mr. Lewis 
and Mr. Hall. Many other persons about the 
same time w r ere affected with the fever from the 
same cause, in Water and Penn-streets. About 
the middle of the month, a ship from Hamburgh 
communicated the disease, by means of her foul air, 
to the village of Kensington. It prevailed, more- 
over, in many instances in the suburbs, and in 
Kensington, from putrid exhalations from gutters 
and marshy grounds, at a distance from the Dela- 
ware, and from the foul ships which have been 
mentioned. Proofs of the truth of each of these 
assertions were afterwards laid before the public. 



BILIOUS YELLOW FEVER OF 1797. 5 

The disease was confined chiefly to the district 
of Southwark and the village of Kensington, for 
several weeks. In September and October, many- 
cases occurred in the city, but most of them were 
easily traced to the above sources. 

The following account of the weather, during 
the months of August, September, and October 
was obtained from Mr. Thomas Pryor. It is diffe- 
rent from the weather in 1793. It is of conse- 
quence to attend to this fact, inasmuch as it shows 
that an inflammatory constitution of the atmosphere 
can exist under different circumstances of the wea- 
ther. It likewise accounts for the variety in the 
symptoms of the fever in different years and coun- 
tries. Such is the influence of season and climate 
upon the symptoms of this fever, that it led Dr. 
M'Kitterick to suppose that the yellow fever of 
Charleston, so accurately described by Dr. Lining, 
in the second volume of the Physical and Literary 
Essays of Edinburgh, was a different disease from 
the yellow fever of the West- Indies*. 

* De Febre Indiae-Occidentalis Maligna Flava, p. 12. 



6 



AN ACCOUNT OF THE 



METEOROLOGICAL OBSERVATIONS, 

MADE IJV PHILADELPHIA. 

AUGUST, 1797. 



1 

2 



Ther. ,Ba>*om. 



6 

7 

8 
9 

10 
11 
12 



73 
72 

72 

72 
74 



.'5 

76 

78 

78 
79 



1 

14 
15 
10 
17 
18 

19 

20 
21 
22 



73 
70 

72 
72 
69 
70 
71 



70 
56 
60 

60 
68 

72 

70 
74 
68 



30 
30 



30 
29 



76 
76 

76 
76 
73 
74 
74 

75 
74 
60 
64 
65 
75 

78 

77 
76 
76 



Winds and Weather. 



30 6 



84 



30 
30 

29 
29 
30 
30 
30 

29 
29 
30 
30 
30 
30 



86 

4 

95 
86 
16 
25 
5 

87 

9 

15 

24 
24 

4 



S. E« E. kain in the forenoon and afternoon. 

N. E. by E. Cloudy, T vith rain in the after 
noon and night. Wind E. by N. 

E. -| N". Rain in the morning, and all day and 
night. 

E. Rained hard all day and at night. 

Wind light, S. W. Cloudy. Rain this mor 
ning. The air extremely damp ; wind shift- 
ed to N. W. This evening heavy showers, 
with thunder. 

YV. N. W. Cloudy. 

N. W. Close day. Rain in the evening and 
all night. Wind to E. 

iL. Rain this morning. 

S. W. Cloudy morning. 

N. W. Clear. 

N. W. Clear. Rain all night 

S. W. Cloudy. Rain in the morning. Cloudy 
all day. Rain at night. 

S. W. Cloudy. Rain all day 
Clear fine morning 
Clear fine morniug 



29 7 



29 
29 



N. W. 
N. W. 
N. W. 
N. W. 
S. W. 



Clear fine morning. 



Air damp. 

Cloudy. Rain, with thunder at night : 
a fine shower. 
N. W. Clear. Cloudy in the evening, with 

thunder. 
W. N. W. Fine clear morning. 
X. W. Clear to E. 

E. Small shower this morning. Hard shower 
at 11, A. M. Wind N. E. 



BILIOUS YELLOW FEVER OF 1797. 



AUGUST, 1797. 



D. 

23 


Ther. 


Barom. 


Winds and Weather. 




71 


76 


29 


92 


E. Cloudy. At noon calm. 




24 


71 


75 


29 


95 


Calm morning and clear. 




25 


70 


75 


30 


5 


N. E. Clear. Rain in the afternoon, 
thunder. 


with 


26 


70 


75 


30 


5 


S. E. Rain in the morning. Rained hard in 












the night, with thunder, N. W. 




27 


68 


76 


29 


9 


N. W. Fine clear morning. 




28 


64 


75 


29 


96 


N. W. Clear. 


■ 


2 j 


59 


70 


30 





E. Clear. 




30 


70 


76 


30 


1 


E. by S. Rain in the morning. 






68 


74 


30 


14 


S. E. Cloudy. Damp air and sultry. 


1 



SEPTEMBER, 1797. 



D 


Ther. jBarc 


)m. 
6 


Winds and Weather. 


1 


73\80 


30 


S. W. Cloudy. Damp air. Rain in the 












morning. 


2 


79 


80 


29 


9 


N. W. Clear. Cloudy in the evening, with 
lightning to the southward. 


3 


68 


74 


30 





N. by W. Cloudy. Clear in the afternoon 
and night. 


4 


66 


74 


30 


7 


W. N. W. Clear fine morning. 


5 


58 


73 


30 


1 


N. W. Clear. Cloudy in the evening. 


6 


58 


72 


30 


13 


Fresh at E. Clear. Rain in the evening. 


7 


56 


76 


30 


28 


E. Clear. Cloudy in the evening. 


8 


54 


65 


30 


1 


N. E. Clear and cool morning. Flying clouds 
at noon. 


u 


56 


65 


30 


1 


E. N. E. Clear. 


10 


58 


63 


30 


26 


N. E. Clear fine morning. Wind fresh at 












N. E. all day. 


11 


53 


64 


30 


13 


N. to E. with flying clouds. 


12 


51 


62 


130 


6 


W. N. W. Clear cool morning. 



AN ACCOUNT OF THE 



SEPTEMBER, 1797. 



D. 



13 
14 

15 



16 
17 

18 

19 
20 

21 



Ther. .Barom 



56 
64 
66 



62 
56 
58 

55 

47 

46 



22 56 
23^56 

24 52 

25 56 
2658 

274b 
28,48 
29:54 
30 60 



67;30 
70^29 
73 29 



70 
67 
63 

63 
63 

60 

65 
66 
66 

68 
68 
63 
63 
63 
65 



29 
30 
2Q 
29 
29 
30 



30 
30 
29 
29 
29 
29 
30 
30 
30 
30 



3 
98 
85 

95 

88 
62 
75 
8 



Winds and Weather. 



30 



4 



9 

78 

37 

95 

2 

2 

15 

26 



S. W. Cloudy. Clear in the afternoon. 

S. W. Clear. 

S. W. Rain in the morning. Cloudy in the 

afternoon. 
N. W. Clear. 
N. W. Clear. 
E. Cloudy. Rained all day, and thunder. 

Rained very heavy at night. 
W. N. W. Clear fine morning. 
W. N. W. Clear fine morning. New moon 

at 9 50 morning. 
NT. E. Clear fine morning ; to S. E. in the 

evening. Cloudy at night. 
N. W. Rain in the morning. Rain at night 
N. N. E. Cloudy. 
E. by S. Clear fine morning. Cloudy at 

night. 
W. N. W. Clear fine morning ; clear all day. 
E. In the morning flying clouds. 
N. W. Clear fine morning; clear all day. 
W. N. W. Clear fine morning ; clear all day. 
E. Clear fine morning. 
E. Fresh. Cloudy morning. Rain in the 

night. ______„ 









BILIOUS YELLOW FEVER OF 1797. 



OCTOBER, 1797. 



b.lTher. 


Barom. 


Winds and Weather. 


1 


5;, 


6j 


30 


16 


N. E. Rain this morning, and great, part of 
the day. 












9 


55 


66 


30 





N. W. Clear. 


3 


60 


70 


29 


9 


S. E. Clear. Air damp. 


4 


60 


70 


29 


5 


W. N. W. Rain this morning. 


- 


46 


6(j 


50 





W. N. W . to S. by W. in the evening. Clear 
all day. White frost this morning. 


6 


5 3 


65 


30 





b. W. Clear fine morning* VV hite host. 


7 


■ '. 


76 


30 





S* VV. Cloudy. Ram in the night. 




56 


70 


30 


29 


5. Cloudy this morning ; air ciamp. Wind 
shifted to W . N. VV . Blows fresh. 


o 


50 


60 


29 


85 


W. N. Vv . Clear morning, i' resb at N. W. 
in the evening. 


10 


40 


58 


30 


1 


W. N. W 7 . Clear. Frost this morning. 


1 1 


3& 


.■6 


oO 


2 


W. N. W. Cloudy. 


K 


34 


- cs 
06 


30 


38 


W. N. VV. Clear. Ice this morning. 


15 


• 5 


5o 


30 


5 


N". Clear fine morning. Ice tms morning. 


14 


40 


60 


30 


28 


N. E. Cloudy. 


\i 


50 


65 


30 


16 


VV. N. W. Clear. 


10 


36 


56 


30 


2 


VV. N. W. Clear fine morning. 


17 


37 


56 


30 


18 


VV. N. W. Clear fine morning. 


lb 


47 


60 


29 


86 


VV. N. W. Clear fine weather. 


19 


48 


60 


30 


6 


N. W. Clear fine clay. 


'JO 


42 


55 


30 


8 


N. E. Cioudy. Rain in the afternoon and 
night. Blows fresh at N. E. 


21 


42 


50 


29 


92 


N. E. Blows fresh (with a little rain). Thun- 
der in the night, with rain. 


22 


44 


56 


29 


57 


N. W. Rain in the morning. 


25 


44 


56 


29 


95 


:■>. VV. Clear fine morning. 


24 


42 


54 


30 


5 


N. E. Cioudy. A great deal of rain in the 












night. 


25 


40 


52 


50 


15 


N. E. Clear fine morning. 


26 


36 


48 


50 


29 


vV. N. VV. Clear. 


27 


34 


46 


30 


23 


i'resh at S. W. Clear. 


28 


40 


52 


29 


95 


vV. N. W\ Cloudy. 


29 


34 


46 


29 


82 


W. Cloudy. 


30 


32 


42 


29 


93 


N. W. Clear. Hard frost this morning. 


51 


38 


48 


30 


18 


W. S. VV. Cloudy part of this day ; clear the 
remainder. 


I 











VOL. IV. 



B 



10 AN ACCOUNT OF THE 

In addition to die register of the weather it may 
not be improper to add, that moschetoes were more 
numerous during the prevalence oi the fever than 
in 1793. An unusual number of ants and cock- 
roaches were likewise observed ; and it w r as said 
that the martins and swallows disappeared, for a 
while, from the city and its neighbourhood. 

A disease prevailed among the cats some weeks 
before the yellow fever appeared in the city. It 
excited a belief in an unwholesome state of the at- 
mosphere, and apprehensions of a sickly fall. It 
generally proved fatal to them. 

After the first week in September there were no 
diseases to be seen but yellow fever. In that part 
of the town which is between Walnut and Vine- 
streets it was uncommonly healthy. A similar re- 
treat of inferior diseases has been observed to take 
place during the prevalence of the plague in Lon- 
don, Holland, and Germany, according to the his- 
tories of that disease by Sydenham, Diemerbroek, 
Sennertus, and Hildanus. It appears, from the 
register of the weather, that it rained during the 
greatest part of the day on the 1st of October. 
The effects of this rain upon the disease shall be 
mentioned hereafter. On the 10th the weather 
became cool, and on the nights of the 12th and 






BILIOUS YELLOW FEVER OF 1797. 11 

13th of the month there was a frost accompanied 
with ice, which appeared to give a sudden and com- 
plete check to the disease. 

The reader will probably expect an account of 
the effects of this distressing epidemic upon the 
public mind. The terror of the citizens for a while 
was very great. Rumours of an opposite and con- 
tradictory nature of the increase and mortality of 
the fever were in constant circulation. A stoppage 
was put to business, and it was computed that 
about two thirds of the inhabitants left the city. 

The legislature of the state early passed a law, 
granting 10,000 dollars for the relief of the suffer- 
ers by the fever. The citizens in and out of town, 
as also many of the citizens of our sister states, 
contributed more than that sum for the same cha- 
ritable purpose. This money was issued by a com- 
mittee appointed by the governor of the state. An 
hospital for the reception of the poor was establish- 
ed on the east side of the river Schuylkill, and 
amply provided with every- thing necessary for the 
accommodation of the sick. Tents were likewise 
pitched on the east side of Schuylkill;, to which ill 
those people were invited who were exposed to 
dagger oL taking the disease, and who had : 



12 AN ACCOUNT OF THE 

means to provide a more comfortable retreat for 

themselves in the country. 

• 

I am sorry to add that the moral effects of the 
fever upon the minds of our citizens were confined 
chiefly to these acts of benevolence. Many of the 
publications in the newspapers upon its existence, 
mode of cure, and origin partook of a virulent 
spirit, which ill accorded with the distresses of the 
city. It was a cause of lamentation likewise to 
many serious people, that the citizens in general 
were less disposed, than in 1793, to acknowledge 
the agency of a divine hand in their afflictions. In 
some a levity of mind appeared upon this solemn 
occasion. A worthy bookseller gave me a melan- 
choly proof of this assertion, by informing me, 
that he had never been asked for playing cards so 
often, in the same time, as he had been during the 
prevalence of the fever. 

Philadelphia was not the only place in the United 
States which suffered by the yellow fever. It pre- 
vailed, at the same time, at Providence, in Phode- 
Island, at Norfolk, in Virginia, at Baltimore, and in 
many of the country towns of New- England, New> 
Jersey, and Pennsylvania, 



BILIOUS YELLOW FEVER OF 1797. 13 

The influenza followed the yellow fever, as it did 
in the year 1793. It made its appearance in the 
latter end of October, and affected chiefly those 
citizens who had been out of town. 

The predisposing causes of the yellow fever, in 
the year 1797, were the same as in the year 1793. 
Strangers were as usual most subject to it. The 
heat of the body in such persons, in the West- In- 
dies, has been found to be between three and four 
degrees above that of the temperature of the na- 
tives. This fact is taken notice of by Dr. M'Kit- 
terick, and to this he ascribes, in part, the predis- 
position of new comers to the yellow fever. 

In addition to the common exciting causes of 
this disease formerly enumerated, I have only to 
add, that it was induced in one of my patients by 
smoking a segar. He had not been accustomed to 
the use of tobacco. 

I saw no new premonitory symptoms of this fever 
except a tooth-ach. It occurred in Dr. Physick, 
Dr. Caldwell, and in my pupil, Mr. Bellenger. In 
Miss Elliot there was such a soreness in her teeth, 
that she could hardly close her mouth on the day 
in which she was attacked by the fever. Neither 



14 AN" ACCOUNT OF THE 

of these persons had taken mercury to obviate the 
disease. 

I shall now deliver a short account of the symp- 
toms of the yellow fever, as they appeared in seve- 
ral of the different systems of the body. 

I. There was but little difference in the state of 
the pulse in this epidemic from what has been re- 
corded in the fevers of 1793 and 1794. I per- 
ceived a pulse, in several cases, which felt like a 
soft qui 1 which had been shattered by being trod- 
den upon. It occurred in Dr. Jones and Dr. Do- 
bell, and in several other persons who had been 
worn down by great fatigue, and it was> in every 
instance, followed by a fatal issue of the fever. In 
Dr. Jones this state of the pulse was accompanied 
with such a difficulty of breathing, that every breath 
he drew, on the day of his attack, he informed me, 
was the effort of a sigh. He died on the 17th of 
September, and on the sixth day of his fever. 

The action of the arteries was, as usual, very ir- 
regular in many cases. In some there was a dis- 
tressing throbbing of the vessels in the brain, and 
in one of my patients a similar sensation in. the bow- 
els, but without pain. Many people had issues of 
blood from their blisters in this fever. 



BILIOUS YELLOW FEVER OF 1797. 15 

I saw nothing new in the effects of the fever 
upon the liver, lungs, brain, nor upon the stomach 
and bowels. 

II. The excretions were distinguished by no un- 
usual marks. I met with no recoveries where there 
were not black stools. They excoriated the rectum 
in Dr. Way. It was a happy circumstance where 
morbid bilious matter came away in the beginning 
of the disease. But it frequently resisted the 
most powerful cathartics until the 5th or 7th day of 
the fever, at which time it appeared rather to yield 
to the disorganization of the liver than to medi- 
cine. Where sufficient blood-letting had been pre- 
vious y used, the patient frequently recovered, even 
after the black discharges from the bowels took 
place in a late stage of the disease. 

Dr. Coxe informed me, that he attended a child 
of seventeen months old which had white stools for 
several days. Towards the close of its disease it 
had black stools, and soon afterwards died. 

Several of my patients discharged worms during 
the fever. In one instance they were discharged 
from the mouth. 



K 



16 AN ACCOUNT OF THE 

A preternatural frequency in making pale water 
attended the first attack of the disease in Mr. Jo- 
seph Fisher. 

A discharge of an unusual quantity of urine pre- 
ceded, a few hours, the death of the daughter of 
Mrs. Read. 

i 

In two of my patients there was a total suppres. 
sion of urine. In one of them it continued five 
days without exciting any pain. 

There was no disposition to sweat after the first 
and second days of the fever. Even in those states 
of the fever, in which the intermissions were most 
complete, there was seldom any moisture, or even 
softness on the skin. This was so characteristic of 
malignity in the bilious fever, that where I found 
the opposite state of the skin, towards the close of a 
paroxysm, I did not hesitate to encourage my pa- 
tient, by assuring him that his fever was of a mild 
nature, and would most probably be safe in its 
issue. 

III. I saw no unusual marks of the disease in 
the nervous system. The mind was seldom affected 
bv delirium after the loss of blood. There was a 



BILIOUS YELLOW FEVER OF 1797. 17 

disposition to shed tears in two of my patients. 
One of them wept during the whole time of a pa- 
roxysm of the fever. In one case I observed an 
uncommon dulness of apprehension, with no other 
mark of a diseased state of the mind. It was in a 
man whose faculties, in ordinary health, acted with 
celerity and vigour. 

Dr. Caldwell informed me of a singular change 
which took place in the operations of his mind 
during his recovery from the fever. His imagina- 
tion carried him back to an early period of his life, 
and engaged him, for a day or two, in playing with 
a bow and arrow, and in amusements of which he 
had been fond when a boy. A similar change oc- 
curred in the mind of my former pupil, Dr. Fisher, 
during his convalescence from the yellow fever in 
1793. He amused himself for two days in looking 
over the pictures of a family Bible which lay in his 
room, and declared that he found the same kind of 
pleasure in this employment that he did when a 
child. However uninteresting these facts may now 
appear, the time will come when they may proba- 
bly furnish useful hints for completing the physio- 
logy and pathology of the mind. 

Where blood-letting had not been used, patients 
frequently died of convulsions. 
vol. iv. c 



18 AN ACCOUNT OF THE 






IV". The senses of seeing and feeling were im- 
paired in several cases, Mrs. Bradford's vision 
was so weak that she hardly knew her friends at her 
bed-side. I had great pleasure in observing this 
alarming symptom suddenly yield to the loss of 
four ounces of blood. 

Several persons who died of this fever did not, 
from the beginning to the end of the disease, feel 
any pain. I shall hereafter endeavour to explain 
the cause of this insensible state of the nerves. 

The appetite for food was unimpaired for three 
days in Mr. Andrew Brown, at a time when his 
pulse indicated a high grade of the fever. I heard 
of several persons who ate with avidity just before 
they died. 

V. Glandular swellings were very uncommon in 
this fever. I should have ascribed their absence to 
the copious use of depleting remedies in my prac- 
tice, had I not been informed that morbid affections 
of the lymphatic glands were unknown in the city 
hospital, where blood-letting was seldom used, and 
where the patients, in many instances, died before 
they had time to take medicine of any kind, 



BILIOUS YELLOW FEVER OF 1797. 19 

VI. The skin was cool, dry, smooth, and even 
shining in some cases. Yellowness was not uni- 
versal. Those small red spots, which have been 
compared to moscheto bites, occurred in several 
of my patients. Dr. John Duffield, who acted as 
house surgeon and apothecary at the city hospital, 
informed me that he saw vibices on the skin in 
many cases, and that they were all more or less 
sore to the touch. 

VII. The blood was dissolved in a few cases. 
That appearance of the blood, which has been com- 
pared to the washings of flesh, was very common. 
It was more or less sizy towards the close of the 
disease in most cases. I have suspected, from this 
circumstance, that this mark of ordinary morbid 
action or inflammation was in part the effect of the 
mercury acting upon the blood-vessels. It is well 
known that sizy blood generally accompanies a sa- 
livation. IF this conjecture be well founded, it will 
not militate against the use of mercury in malignant 
fevers, for it shows that this valuable medicine pos- 
sesses a power of changing an extraordinary and 
dangerous degree of morbid action in the blood- 
vessels to that which is more common and safe. I 
have seldom seen a yellow fever terminate fatally 
after the appearance of sizy blood. 



JO AN ACCOUNT OF THE 

Dr. Stewart informed me, that in those cases in 
which the serum of the blood had a yellow colour, 
it imparted a saline taste only to his tongue. He 
was the more struck with this fact, as he perceived 
a strong bitter state upon his skin, in a severe at- 
tack of the yellow fever in 1793. 

I proceed next to take notice of the type of the 
fever. 

In many cases, it appeared in the form of a re- 
mitting and intermitting fever. The quotidian and 
tertian forms were most common. In Mr. Robert 
Wharton, it appeared in the form of a quartan. 
But it frequently assumed the character which is 
given of the same fever in Charleston, by Dr. Lin- 
ing. It came on without chills, and continued 
without any remission for three days, after which 
the patient believed himself to be well, and some- 
times rose from his bed, and applied to business. 
On the fourth or fifth day, the fever returned, and 
unless copious evacuations had been used in the 
early stage of the disease, it generally proved fatal. 
Sometimes the powers of the system were depressed 
below the- return of active fever, and the patient 
sunk away by an easy death, without pain, heat, or 
a quick pulse. I have been much puzzled to dis- 
tinguish a crisis of the fever on the third or fourth 



/ 

BILIOUS YELLOW FEVER OF 1797. 21 

day, from the insidious appearance which has been 
described. It deceived me in 1793. It may be 
known by a preternatural coolness in the skin, and 
languor in the pulse, by an inability to sit up long 
without fatigue or faintness, by a dull eye, and by 
great depression of mind, or such a flow of spirits 
as sometimes to produce a declaration from the 
patient that " he feels too well." Where these 
symptoms appear, the patient should be informed 
of his danger, and urged to the continuance of such 
remedies as are proper for him. 

The following states or forms were observable 
in the fever : 

1. In a few cases, the miasmata produced death 
in four and twenty hours, with convulsions, coma, 
or apoplexy. 

2. There were open cases, in which the pulse was 
full and tense as in a pleurisy or rheumatism, from 
the beginning to the end of the fever. They were 
generally attended with a good deal of pain. 

3. There were depressed or locked cases, in 
which there were a sense of great debility, but 
little or no pain, a depressed and slow pulse, a cool 



22 AN ACCOUNT OF THE 

skin, cold hands and feet, and obstructed excre- 
tions. 

4. There were divided or mixed cases, in which 
the pulse was active until the 4th day, after which 
it became depressed. All the other symptoms of 
the locked state of the fever accompanied this de- 
pressed state of the pulse, 

5. There were cases in which the pulse imparted 
a perception like that of a soft and shattered quill. 
I have before mentioned that this state of the pulse 
occurred in Dr. Jones and Dr. Dobell. I felt it but 
once, and on the day of his attack, in the latter 
gentleman, and expressed my opinion of his ex- 
treme danger to one of my pupils upon my return 
from visiting him. I did not meet with a case 
which terminated favourably, where I perceived this 
shattered pulse. A disposition to sweat occurred 
in this state of the fever. 

6. There were what Dr. Caldwell happily called 
walking cases. The patients here were flushed or 
pale, had a full or tense pulse, but complained of no 
pain, had a good appetite, and walked about their 
rooms or houses, as if thev were but little indis- 
posed, until a day or two, and, in some instances, 
until a few hours before they died. We speak of 



BILIOUS YELLOW FEVER OF 1797. 23 

a dumb gout and dumb rheumatism; with equal 
propriety, the epithet might be applied to this form 
of yellow fever in its early stage. The impression 
of the remote cause of the fever, in these cases, 
was beyond sensation, for, upon removing a part of 
it by bleeding or purging, the patients complained 
of pain, and the excitement of the muscles passed 
so completely into the blood-vessels and alimentary 
canal, as to convert the fever into a common and 
more natural form. These cases were always dan- 
gerous, and, when neglected, generally terminated 
in death. Mr. Brown's fever came on in this insi- 
dious shape. It was cured by the loss of upwards 
of 100 ounces of blood, and a plentiful salivation. 

7. There was the intermitting form in this fever. 
This, like the last, often deceived the patient, by 
leading him to suppose his disease was of a com- 
mon or trifling nature. It prevented Mr. Richard 
Smith from applying for medical aid in an attack of 
the fever for several days, by which means it made 
such an impression upon his viscera, that depleting 
remedies were in vain used to cure him. He died 
in the prime of life, beloved and lamented by a nu- 
merous circle of relations and friends. 

8. There was a form of this fever in which it re- 
sembled the mild remittent of common seasons. 



24 AN ACCOUNT OP THE 

It was distinguished from it chiefly by the black 
colour of the intestinal evacuations. 

9. There were cases of this fever so light, that 
patients were said to be neither sick nor well ; or, 
in other words, they were sick and well half a do- 
zen times in a day. Such persons walked about, 
and transacted their ordinary business, but com- 
plained of dulness, and, occasionally, of shooting 
pains in their heads. Sometimes the stomach was 
affected with sickness, and the bowels with diar- 
rhoea or costiveness. All of them complained of 
night sweats. The pulse was quicker than natural, 
but seldom had that convulsive action which consti- 
tutes fever. Purges always brought away black 
stools from such patients, and this circumstance 
served to establish its relationship to the prevailing 
epidemic. Now and then, by neglect or improper 
treatment, it assumed a higher and more danger- 
ous grade of the fever, and became fatal, but it more 
commonly yielded to nature, or to a single dose of 
purging physic. 

10. There were a few cases in which the skin 
was affected with universal yellowness, but without 
more pain or indisposition than usually occurs in 
the jaundice. They were very frequent in the year 



BILIOUS YELLOW FEVER OF 1797. 25 

1793, and generally prevail in the autumn, in all 
places subject to bilious fever. 

11. There were chronic cases of this fever. It 
is from the want of observation that physicians limit 
the duration of the yellow fever to certain days. I 
have seen many instances in which it has been pro- 
tracted into what is called by authors a slow ner- 
vous fever. The wife of captain Peter Bell died 
with a black vomiting after an illness of nearly one 
month. Dr. Pinckard, formerly one of the physi- 
cians of the British army in the West- Indies, in a 
late visit to this city informed me, that he had often 
seen the yellow fever put on a chronic form in the 
West- India islands. 

In delivering this detail of the various forms of 
the yellow fever, I am aware that I oppose the opi- 
nions of many of my medical brethren, who ascribe 
to it a certain uniform character, which is removed 
beyond the influence of climate, habit, predisposi- 
tion, and the different strength and combinations of 
remote and exciting causes. ; This uniformity in 
the symptoms of this fever is said to exist in the 
West- Indies, and every deviation from it in the 
United States is called by another name. The fol- 
lowing communication, which I received from Dr. 
Pinckard, will show that this disease is as different 

VOL. IV« © 



26 AN ACCOUNT OF THE 

in its forms in the West-Indies as it is in this coun- 
try. 

" The yellow fever, as it appeared among the 
" troops in Guiana and the West- India islands, in 
" the years 1796 and 1797, exhibited such perpe- 
" tual instability, and varied so incessantly in its 
" character, that I could not discover any one 
" symptom to be decidedly diagnostic ; and hence 
" I have been led into an opinion that the yellow 
" fever, so called, is not a distinct or specific dis- 
" ease, but merely an aggravated degree of the 
" common remittent or bilious fever of hot cli- 
" mates, rendered irregular in form, and augmented 
" in malignity, from appearing in subjects unac- 
" customed to the climate. 

" Philadelphia, January 12th, 1798. " 

Many other authorities equally respectable with 
Dr. Pinckard's, among whom are Pringle, Huck, 
and Hunter, might be adduced in support of the 
unity of bilious fever. But to multiply them fur- 
ther would be an act of homage to the weakness of 
human reason, and an acknowledgment of the in- 
fant state of our knowledge in medicine. As well 
might we suppose nature to be an artist, and that 
diseases were shaped by her like a piece of statuary. 



BILIOUS YELLOW FEVER OF 1797. 27 

or a suit of clothes, by means of a chissel, or pair 
of scissars, as admit every different form and grade 
of morbid action in the system to be a distinct dis- 
ease. 

Notwithstanding the fever put on the eleven 
forms which have been described, the moderate 
cases were few, compared with those of a malig- 
nant and dangerous nature. It was upon this ac- 
count that the mortality was greater in the same 
number of patients, who were treated with the same 
remedies, than it was in the years 1793 and 1794. 
The disease, moreover, partook of a more malig- 
nant character than the two epidemics that have 
been mentioned. The yellow fever in Norfolk, 
Drs. Taylor and Hansford informed me, in a letter 
I received from them, was much more malignant 
and fatal, under equal circumstances, than it was in 
1795. 

There were evident marks of the disease attack- 
ing more persons three days before, and three days 
after the full and change of the moon, and of more 
deaths occurring at those periods than at any other 
time. The same thing has been remarked in the 
plague by Diemerbroeck, in the fevers of Bengal 
by Dr. Balfour, and in those of Demarara by Dr. 
Pinckard. 



28 AN ACCOUNT OF THE 

During the prevalence of the fever I attended the 
following persons who had been affected by the epi- 
demic of 1793, viz. Dr. Physick, Thomas Learn- 
ing, Thomas Can by, Samuel Bradford, and George 
Loxley, also Mrs. Eggar, who had a violent attack 
of it in the year 1794. Samuel Bradford was like- 
wise affected by it in 1794. 

During my intercourse with the sick, I felt the 
miasmata of the fever operate upon my system in 
the most sensible manner. It produced languor, a 
pain in my head, and sickness at my stomach. A 
sighing attended me occasionally, for upwards of 
two weeks. This symptom left me suddenly, and 
was succeeded bv a hoarseness, and, at times, with 
such a feebleness in my voice as to make speaking 
painful to me. Having observed this affection of 
the trachea to be a precursor of the fever in several 
cases, it kept me under daily apprehensions of be- 
ing confined by it. It gradually went off after the 
first of October. I ascribed my recovery from it, 
and a sudden diminution of the effects of the mias- 
mata upon my system, to a change produced in the 
atmosphere by the rain which fell on that day. 

The peculiar matter emitted by the breath or 
perspiration of persons affected by this fever, in- 
duced a sneezing in Dr. Dobell, every time he went 



BILIOUS YELLOW FEVER OF 1797. 29 

into a sick room. Ambrose Parey says the same 
thing occurred to him, upon entering the room of. 
patients confined by the plague. 

The gutters emitted, in many places, a sulphure- 
ous smell during the prevalence of the fever. Up- 
on rubbing my hands together I could at any time 
excite a similar smell in them. I have taken notice 
of this effect of the matters which produced the dis- 
ease upon the body, in the year 1794. 

In order to prevent an attack of the fever, I care- 
fully avoided all its exciting causes. I reduced my 
diet, and lived sparingly upon tea, coffee, milk, 
and the common fruits and garden vegetables of 
the season, with a small quantity of salted meat, 
and smoked herring. My drinks were milk and 
water, weak claret and water, and weak porter and 
water. I sheltered myself as much as possible from 
the rays of the sun, and from the action of the eve- 
ning air, and accommodated my dress to the changes 
in the temperature of the atmosphere. By similar 
means, I have reason to believe, many hundred 
people escaped the disease, who were constantly 
exposed to it. 

The number of deaths by the fever, in the months 
of August, September, and October, amounted to 



30 AN ACCOUNT OF THE 

between ten and eleven hundred. In the list of the 
dead were nine practitioners of physic, several of 
whom were gentlemen of the most respectable cha- 
racters. This number will be thought considerable 
when it is added, that not more than three or four 
and twenty physicians attended patients in the dis- 
ease. Of the survivors of that number, eight were 
affected with the fever. This extraordinary mor- 
tality and sickness among the physicians must be 
ascribed to their uncommon fatigue in attending 
upon the sick, and to their inability to command 
their time and labours, so as to avoid the exciting 
causes of the fever. 

Among the medical gentlemen whose deaths 
have been mentioned, was my excellent friend, Dr. 
Nicholas Way. I shall carry to my grave an affec- 
tionate remembrance of him. We passed our 
youth together in the study of medicine, and lived 
to the time of his death in the habits of the tender- 
est friendship. In the year 1794, he removed from 
Wilmington, in the Delaware state, to Philadelphia, 
where his talents and manners soon introduced him 
into extensive business. His independent fortune 
furnished his friends with arguments to advise him 
to retire from the city, upon the first appearance of 
the fever. But his humanity prevailed over the 
dictates of interest and the love of life. He was 



BILIOUS YELLOW FEVER OF 1797. 31 

active and intelligent in suggesting and executing 
plans to arrest the progress of the disease, and to 
lessen the distresses of the poor. On the 27th of 
August, he was seized, after a ride from the coun- 
try in the evening air, with a chilly fit and fever. 
I saw him the next day, and advised the usual de- 
pleting remedies. He submitted to my prescrip- 
tions with reluctance, and in a sparing manner, 
from an opinion that his fever was nothing but a 
common remittent. To enforce obedience to my 
advice, I called upon Dr. Griffitts to visit him with 
me. Our combined exertions to overcome his 
prejudices against our remedies were ineffectual. 
At two o'clock in the afternoon, on the sixth day 
of his disease, with an aching heart I saw the sweat 
of death upon his forehead, and felt his cold arm 
without a pulse. He spoke to me with difficulty : 
upon my rising from his bed-side to leave him, his 
eyes filled with tears, and his countenance spoke a 
language which I am unable to describe. I pro- 
mised to return in a short time, with a view of at- 
tending the last scene of his life. Immediately 
after I left his room, he went aloud. I returned 
hastily to him, and found him in convulsions. He 
died a few hours afterwards. Had I met with no 
other affliction in the autumn of 1 797 than that which 
I experienced from this affecting scene, it would 
have been a severe one ; but it was a part only of 



32 AN" ACCOUNT OF THE 

what I suffered from the death of other friends, and 
from the malice of enemies. 

I beg the reader's pardon for this digression. It 
shall be the last time and place in which any notice 
shall be taken of my sorrows and persecutions in 
the course of these volumes. 

Soon after the citizens returned from the coun- 
try, the governor of the state, Mr. Mifflin, addressed 
a letter to the college of physicians of Philadelphia, 
requesting to know the origin, progress, and nature 
of the fever which had recently afflicted the city, 
and the means of preventing its return. He ad- 
dressed a similar letter to me, to be communicated 
to such gentlemen of the faculty of medicine, as 
were not members of the college of physicians. 

The college, in a memorial to the legislature of 
the state, asserted that the fever had been imported 
in two ships, the one from Havannah, the other 
from Port au Prince, and recommended, as the 
most effectual means of preventing its recurrence, 
a more rigid quarantine law. 

The gentlemen of the faculty of medicine, thir- 
teen in number, in two letters to the governor of 
the state, the one in their private capacity, and the 



BILIOUS YELLOW FEVER OF 1797. SB 

other after they had associated themselves into an 
" Academy of Medicine," asserted that the fever 
had originated from the putrid exhalations from the 
gutters and streets of the city, and from ponds and 
marshy grounds in its neighbourhood ; also from 
the foul air of two ships, the one from Marseilles 
and the other from Hamburgh. They enumerated 
all the common sources of malignant fevers, and 
•recommended the removal of them from the city, 
as the most effectual method of preventing the re- 
turn of the fever. These sources of fever, and the 
various means of destroying them, shall be men- 
tioned in another place. 

I proceed now to say a few words upon the 
treatment which was used in this fever. It was, 
in general, the same as that which was pursued in 
the fevers of 1793 and 1794. 

I began the cure, in most cases, by bleedings 
when I was called on the first day of the disease, 
and was happy in observing its usual salutary ef- 
fects in its early stage. On the second day, it fre- 
quently failed of doing service, and on the subse- 
quent days of the fever, I believe, it often did 
harm ; more especially if no other depleting reme- 
dy had preceded it. The violent action of the 
blood-vessels in this disease, when left to itself for 

VOL. IV. e 



34 AN ACCOUNT OF THE 

two or three days, fills and suffocates the viscera 
with such an immense mass of blood, as to leave a 
quantity in the vessels so small, as barely to keep 
up the actions of life. By abstracting but a few 
ounces of this circulating blood, we precipitate 
death. In those cases where a doubt is entertained 
of such an engorgement of stagnating blood having 
taken place, it will always be safest to take but 
three or four ounces at a time, and to repeat it four 
or five times a- day. By this mode of bleeding, we 
give the viscera an opportunity of emptying their 
superfluous blood into the vessels, and thereby pre- 
vent their collapsing, from the sudden abstraction 
of the stimulus which remained in them. I con- 
fine this observation upon bleeding, after the first 
stage of the disease, only to the epidemic of 1797. 
It was frequently effectual when used for the first 
time after the first and second days, in the fevers of 
1793 and 1794, and it is often useful in the ad- 
vanced stage of the common bilious fever. The 
different and contradictory accounts of the effects 
of bleeding in the yellow fever, in the West- Indies, 
probably originate in its being used in different 
staees of the disease. Dr. Jackson, of the British 
army, in his late visit to Philadelphia, informed me, 
that lie had cured nineteen out of twenty of all the 
soldiers whom he attended, by copious bleeding, 
provided it was performed within six hours after 



BILIOUS YELLOW FEVER OF 1797. 35 

the attack of the fever. Beyond that period, it mi- 
tigated its force, but seldom cured. The quantity 
of blood drawn by the doctor, in this early stage of 
the disease, was always from twenty to thirty 
ounces. I have said the yellow fever of 1797 was 
more malignant than the fevers of 1793 and 1794. 
Its resemblance to the yellow fever in the West- 
Indies, in not yielding to bleeding after the first 
day, is a proof of this assertion. 

I was struck, during my attendance upon this 
fever, in observing the analogy between its mixed 
form and the malignant state of the small- pox. 
The fever, in both, continues for three or four 
days without any remission. They both have a 
second stage, in which death usually takes place, 
if the diseases be left to themselves. Bv means of 
copious bleeding in their first, they are generally 
deprived of their malignity and mortality in their 
second stage. This remark, so trite in the small- 
pox, has been less attended to in the yellow fever. 
The bleeding in the first stage of this disease does 
not, it is true, destroy k altogether, any more than 
it destroys an eruption in the second stage of the 
small-pox, but it weakens it in such a manner that 
the patient passes through its second stage without 
pain or danger, and with no other aid from medi- 
cine than what is commonly derived from good 



36 AN ACCOUNT OF THE 

nursing, proper aliment, and a little gently opening 
physic. 

It is common with those practitioners who object 
to bleeding in the yellow fever, to admit it occasion^ 
ally in robust habits. This rule leads to great error 
in practice. From the weak action of predisposing, 
or exciting causes, the disease often exists in a fee- 
ble state in such habits, while from the protracted 
or violent operation of the same causes, it appears 
in great force in persons of delicate constitutions. 
A physician, therefore, in prescribing for a patient 
in t. is fever, should forget the natural strength of 
his muscles, and accommodate the loss of blood 
wholly to the morbid strength of his disease. 

The quantity of blood drawn in this fever was al- 
ways proportioned to its violence. I cured many 
by a single bleeding. A few required the loss of 
upwards of a hundred ounces of blood to cure 
them. The persons from whom that large quantity 
of blood was taken, were, Messieurs Andrew 
Brown, Horace Hall, George Cummins, J. Ramsay, 
and George Eyre. But I w r as not singular in the 
liberal and frequent use of the lancet. The follow- 
ing physicians drew the quantities of blood annex- 
ed to their respective names from the following per- 
sons, viz, 



BILIOUS YELLOW FEVER OF 1797, 37 

Dr. Dewees 176 ounces from Dr. Physick, 

Dr. Griffitts 1 10 Mr. S. Thomson, 

Dr. Stewart 106 Mrs. M'Phail, 

Dr. Cooper 150 Mr. David Evans, 

Dr. Gillespie 103 himself. 

All the above named persons had a rapid and 
easy recovery, and now enjoy good health. I lost 
but one patient who had been the subject of early- 
and copious bleeding. His death was evidently 
induced by a supper of beef- stakes and porter, after 
he had exhibited the most promising signs of con- 
valescence. 



OF PURGING. 

From the great difficulty that was found in dis- 
charging bile from the bowels, by the common 
modes of administering purges, Dr. Griffitts sug- 
gested to me the propriety of giving large doses of 
calomel, without jalap or any other purging medi- 
cine, in order to loosen the bile from its close con- 
nection with the gall-bladder and duodenum, dur- 
ing the first day of the disease. This method of 



38 AN ACCOUNT OF THE 

discharging acrid bile was found useful. I ob- 
served the same relief from large evacuations of 
foetid bile, in the epidemic of 1797, that I have re- 
marked in the fever of 1793. Mr. Bryce has 
taken notice of the same salutary effects from simi- 
lar evacuations, in the yellow fever on board the 
Busbridge Indiaman, in the year 1792. His words 
are : "It was observable, that the more dark-co- 
loured and foetid such discharges were, the more 
early and certainly did the symptoms disappear. 
Their good effects were so instantaneous, that I 
have often seen a man carried up on deck, perfectly 
delirious with subsultus tendinum, and in a state of 
the greatest apparent debility, who, after one or 
two copious evacuations of this kind, has returned 
of himself, and astonished at his newly acquired 
strength*." Very different are the effects of tonic 
remedies, when given to remove this apparent de- 
bility. The clown who supposes the crooked ap- 
pearance of a stick, when thrust into a pail of water, 
to be real, does not err more against the laws of 
light, than that physician errs against a law of the 
animal economy, who mistakes the debility which 
arises from oppression for an exhausted state of the 
system, and attempts to remove it by stimulating 
medicines. 

* Annals of Medicine, p. 123. 



BILIOUS YELLOW FEVER OF 1797. 39 

After unlocking the bowels, by means of calo- 
mel and jalap, in the beginning of the fever, I 
found no difficulty afterwards in keeping them 
gently open by more lenient purges. In addition 
to those which I have mentioned in the account of 
the fever of 1793, I yielded to the advice of Dr. 
Griffitts, by adopting the soluble tartar, and gave 
small doses of it daily in many cases. It seldom 
offended the stomach, and generally operated, with- 
out griping, in the most plentiful manner. 

However powerful bleeding and purging were in 
the cure of this fever, they often required the aid of 
a salivation to assist them in subduing it. 

Besides the usual methods of introducing mer- 
cury into the system, Dr. Stewart accelerated its 
action, by obliging his patients to wear socks filled 
with mercurial ointment ; and Dr. Gillespie aimed 
at the same thing, by injecting the ointment, in a 
suitable vehicle, into the bowels, in the form of 
glysters. 

The following fact, communicated to me by Dr. 
Stewart, w r ill show the safety of large doses of 
calomel in this fever. Mrs. M'Phail took 60 grains 
of calomel, by mistake, at a dose, after having taken 
three or four doses, of 20 grains each, on the same 



40 AN ACCOUNT OF THE^ 

day. She took, in all, 356 grains in six days, and 
yet, says the doctor, " such was the state of her 
stomach and intestines, that that large quantity 
was retained without producing the least griping, 
or more stools than she had when she took three 
grains every two hours. J? < 

I observed the mercury to affect the mouth and 
throat in the following ways. 1. It sometimes pro- 
duced a swelling only in the throat, resembling a 
common inflammatory angina. 2. It sometimes 
produced ulcers upon the lips, cheeks, and tongue, 
without any discharge from the salivary glands. 3. 
It sometimes produced swellings and ulcers in the 
gums, and loosened the teeth without inducing a 
salivation. 4. There were instances in which the 
mercury induced a rigidity in the masseter muscles 
of the jaw, by which means the mouth was kept 
constantly open, or so much closed, as to render it 
difficult for the patient to take food, and impos- 
sible for him to masticate it. 5. It sometimes 
affected the salivary glands only, producing from 
them a copious secretion and excretion of saliva. 
But, 6. It more frequently acted upon all the above 
parts, and it was then it produced most speedily its 
salutary effects. 7. The discharge of the saliva 
frequently took place only during the remission or 
intermission of the fever, and ceased with each re- 



BILIOUS YELLOW FEVER OF 1797. 41 

turn of its paroxysms. 8. The salivation did not 
take place, in some cases, until the solution of the 
fever. This was more especially the case in those 
forms of the fever in which there were no remis- 
sions or intermissions. 9. It ceased in most cases 
with the fever, but it sometimes continued for six 
weeks or two months after the complete recovery 
of the patient. 10. The mercury rarely dislodged 
the teeth. Not a single instance occurred of a 
patient losing a tooth in the city hospital, where the 
physicians, Dr. J. Duffield informed me, relied 
chiefly upon a salivation for a cure of the fever. 
11. Sometimes the mercury produced a discharge 
of blood with the saliva. Dr. Coulter, of Balti- 
more, gave me an account, in a letter dated the 
17th of September, 1797, of a boy in whom a hae- 
morrhage from the salivary glands, excited by calo- 
mel, was succeeded by a plentiful flow of saliva, 
which saved his patient. I saw no inconvenience 
from the mixture of blood with saliva in any of my 
patients. It occurred in Dr. Caldwell, Mr. Brad- 
ford, Mr. Brown, and several others. 

It has been said that mercury does no service 
unless it purges or salivates. I am disposed to be- 
lieve that it may act as a counter stimulus to that 
of the miasmata of the yellow fever, and thus be 
useful without producing any evacuation from the 

T«L. IV. F 



42 AN ACCOUNT OF THE 

bowels or mouth. It more certainly acts in this 
way, provided blood-letting has preceded its exhi- 
bition. I have supposed the stimulus from the re- 
mote cause of the yellow fever to be equal in force 
to five, and that of mercury to three. To enable 
the mercury to produce its action upon the system, 
it is necessary to reduce the febrile action, by bleed- 
ing, to two and a half, or below it, so that the sti- 
mulus of the mercury shall transcend it. The 
safety of mercury, when introduced into the system* 
has three advantages as a stimulus over that of the 
matter which produces the fever. 1. It excites an 
action in the system preternatural only in force. It 
does not derange the natural order of actions. 2. 
It determines the actions chiefly to external parts 
of the body. And, 3. It fixes them, when it affects 
the mouth and throat, upon parts which are capable 
of bearing great inflammation and effusion without 
any danger to life. The stimulus which produces 
the yellow fever acts in ways the reverse of those 
which have been mentioned. It produces violent 
irregular or 'wrong actions. It determines them to 
internal parts of the body, and it fixes them upon 
viscera which bear, with difficulty and danger, the 
usual effects of disease. A late French writer, Dr, 
Sabre, ascribed to diseases a centrifugal, and a cen- 
tripetal direction. From what has been said it 



BILIOUS YELLOW FEVER OF 1797. 4S 

would seem, the former belongs to mercury, and 
the latter to the yellow fever. 

Considering the great prejudices against blood- 
letting, I have wished to combat this fever with 
mercury alone. But, for reasons formerly given, I 
have been afraid to trust to it without the assistance 
of the lancet. The character of the fever, more- 
over, like that which the poet has ascribed to 
Achilles, is of " so swift, irritable, inexorable, and 
" cruel" a nature, that it would be unsafe to rely 
exclusively upon a medicine which is not only of 
less efficacy than bleeding, but often slow and un- 
certain in its operation, more especially upon the 
throat and mouth. 

Let not the reader be ofFended at my attempts to 
reason. I am aware of the evils which the weak 
and perverted exercise of this power of the mind 
has introduced into medicine. But let us act with 
the same consistency upon this subject that we do 
in other things. 

We do not consign a child to its cradle for life, 
because it falls in its first unsuccessful efforts to use 
its legs. In like manner we must not abandon rea- 
son, because, in our first efforts to use it, we have 
been deceived. A single just principle in our 



44 AN ACCOUNT OT THE 

science will lead to more truth, in one year, than 
whole volumes of uncombined facts will do in a 
century. 

I lost but two patients in this epidemic in whom 
the mercury excited a salivation. One of them 
died from the want of nursing ; the other by the 
late application of the remedy. 



OF EMETICS. 

It was said a practitioner, who was opposed to 
bleeding and mercury, cured this fever by means 
of strong emetics. I gave one to a man who refus- 
ed to be bled. It operated freely, and brought on 
a plentiful sweat. The next day he arose from his 
bed, and went to his work. On the fourth day he 
sent for me again. My son visited him, and found 
him without a pulse. He died the next day. 

I heard of two other persons who took emetics 
in the beginning of the fever, without the advice of 
a physician, both of whom died. 



BILIOUS YELLOW FEVER OF 1797. 45 

Dr. Pinckard informed me, that their effects 
were generally hurtful in the violent grades of the 
yellow fever in the West- Indies. The same in- 
formation has since been given to me by Dr. Jack- 
son. In the second and third grades of the bilious 
fever they appear not only to be safe, but useful. 



OF DIET AND DRINKS. 

The advantages of a weak vegetable diet were 
very great in this fever. I found but little difficulty, 
in most cases, in having my prohibition of animal 
food complied with before the crisis of the fever, 
but there was often such a sudden excitement of 
the appetite for it, immediately afterwards, that it 
was difficult to restrain it. I have mentioned the 
case of a young man, who was upon the recovery, 
who died in consequence of supping upon beef- 
stakes. Many other instances of the mortality of 
this fever from a similar cause, I believe, occurred 
in our epidemic, which were concealed from our 
physicians. I am not singular in ascribing the 
death of convalescents to the too early use of ani- 
mal food. Dr. Poissonnier has the following im- 



46 AN ACCOUNT OF THE 

portant remark upon this subject. " The physi- 
cians of Brest have observed, that the relapses in 
the malignant fever, which prevailed in their naval 
hospitals, were as much the effect of a fault in the 
diet of the sick as of the contagious air to which 
they were exposed, and that as many patients pe- 
rished from this cause as from the original fever. 
For this reason light soups, with leguminous vege- 
tables in them, panada, rice seasoned with cinna- 
mon, fresh eggs, &x. are all that they should be 
permitted to eat. The use of flesh should be for- 
bidden for many days after the entire cure of the 
disorder*." 

Dr. Huxham has furnished another evidence of 
the danger from the premature use of animal food, 
in his history of a malignant fever which prevailed 
at Plymouth, in the year 1740. " If any one (says 
the doctor) made use of a flesh or fish diet, be- 
fore he had been very well purged, and his recovery 
confirmed, he infallibly indulged himself herein at 
the utmost danger of his lifef." 

* 

In addition to the mild articles of diet, mention- 
ed by Dr. Poissonnier, I found bread and milk, 

* Maladies de Gens de Mer, vol. i. p. 345. 
t Epidemics, vol. ii. p. 67. 



BILIOUS YELLOW FEVER OF 1797. 47 

with a little water, sugar, and the pulp of a roasted 
apple mixed with it, very acceptable to my patients 
during their convalescence. Oysters were equally 
innocent and agreeable. Ripe grapes were de- 
voured by them with avidity, in every stage of the 
fever. The season had been favourable to the per- 
fection of this pleasant fruit, and all the gardens in 
the city and neighbourhood in which it was culti- 
vated were gratuitously opened by the citizens for 
the benefit of the sick. 

The drinks were, cold water, toast and water, 
balm tea, water in which jellies of different kinds 
had been dissolved, lemonade, apple water, barley 
and rice water, and, in cases where the stomach 
was affected with sickness or puking, weak porter 
and water, and cold camomile tea. In the conva- 
lescent stage of the fever, and in such of its remis- 
sions or intermissions as were accompanied with 
great languor in the pulse, wine- whey, porter and 
water, and brandy and water, were taken with ad- 
vantage. 

Cold water applied to the body, cool and fresh 
air, and cleanliness, produced their usual good ef- 
fects in this fever. In the external use of cold wa- 
ter, care was taken to confine it to such cases as 
were accompanied with preternatural heat, and to 



48 AN ACCOUNT OF THE 

forbid it in the cold fit of the fever, and in those 
cases which were attended with cold hands and feet, 
and where the disease showed a disposition to ter- 
minate, in its first stage, by a profuse perspiration. 
It has lately given me great pleasure to find the 
same practice, in the external use of cold water in 
fevers, recommended by Dr. Currie of Liverpool, 
in his medical reports of the effects of water, cold 
and warm, as a remedy in febrile diseases. Of the 
benefit of fresh air in this fever, Dr. Dawson of 
Tortola has lately furnished me with a striking in- 
stance. He informed me, that by removing pa- 
tients from the low grounds on that island, where 
the fever is generated, to a neighbouring mountain, 
they generally recovered in a few days. 

Finding a disagreeable smell to arise from vine- 
gar sprinkled upon the floor, after it had emitted all 
its acid vapour, I directed the floors of sick rooms 
to be sprinkled only with water. I found the va- 
pour which arose from it to be grateful to my 
patients. A citizen of Philadelphia, whose whole 
family recovered from the fever, thought he per- 
ceived evident advantages from tubs of fresh water 
being kept constantly in the sick rooms. 



BILIOUS YELLOW FEVER OF 1797. 49 

OF TONIC REMEDIES. 

There were now and then remissions and inter- 
missions of the fever, accompanied with such signs 
of danger from debility, as to render the exhibition 
of a few drops of laudanum, a little wine- whey, a 
glass of brandy and water, and, in some instances, 
a cup of weak chicken- broth, highly necessary and 
useful. In addition to these cordial drinks, I di- 
rected the feet to be placed in a tub of warm water, 
which was introduced under the bed-clothes, so 
that the patient was not weakened by being raised 
from a horizontal posture. All these remedies 
were laid aside upon the return of a paroxysm of 
fever. 

I did not prescribe bark in a single case of this 
disease. An infusion of the quassia root was sub- 
stituted in its room, in several instances, with ad- 
vantage. 

Blisters were applied as usual, but, from the 
insensibility of the skin, they were less effectual 
than applications of mustard to the arms and legs. 
It is a circumstance worthy of notice, that while 
the stomach, bowels, and even the large blood- 
vessels are sometimes in a highly excited state, and 

VOL. IV. G 



50 AN ACCOUNT OF THE 

overcharged, as it were, with life, the whole sur- 
face of the body is in a state of the greatest torpor. 
To attempt to excite it by internal remedies is like 
adding fuel to a chimney already on fire. The ex- 
citement of the blood-vessels, and the circulation 
of the blood, can only be equalized by the applica- 
tion of stimulants to the skin. These, to be effec- 
tual, should be of the most powerful kind. Caus- 
tics might probably be used in such cases with 
advantage. I am led to this opinion by a fact com- 
municated to me by Dr. Stewart. A lighted can- 
dle, which had been left on the bed of a woman 
whom he was attending in the apparent last stage 
of the yellow fever, fell upon her breast. She was 
too insensible to feel, or too weak to remove it. 
Before her nurse came into her room, it had made 
a deep and extensive impression upon her flesh. 
From that time she revived, and in the course of a 
few days recovered. As a tonic remedy in this 
fever, Dr. Jackson has spoken to me in high terms 
of the good effects of riding in a carriage. Patients, 
he informed me, who were moved with difficulty, 
after riding a few miles were able to sit up, and, 
when they returned from their excursions, were 
frequently able to walk to their beds. 

Much has been said, of late years, in favour of 
the application of warm olive oil to the body in the 



BILIOUS YELLOW FEVER OF 1797. 51 

plague, and a wish has been expressed, by some 
people, that its efficacy might be tried in the yellow 
fever. Upon examining the account of this re- 
medy, as published by Mr. Baldwin, three things 
suggest themselves to our notice. 1. That the oil 
is effectual only in the forming state of the disease; 

2. That the friction which is used with it contri- 
butes to excite the torpid vessels of the skin ; and 

3. That it acts chiefly by depleting from the pores 
of the body. From the unity of the remedy of 
depletion, it is probable purging or bleeding might 
be substituted to the expensive parade of the sweat 
induced by the warm oil, and the smoke of odori- 
ferous vegetables. But I must not conceal here, 
that there are facts which favour an idea, that oil 
produces a sedative action upon the blood-vessels, 
through the medium of the skin. Bontius says it 
is used in this manner in the East-Indies, for the 
cure of malignant fevers, after the previous use of 
bleeding and purging. It seems to have been a 
remedy well known among the Jews ; hence we 
find the apostle James advises its being applied to 
the body, in addition to the prayers of the elders 
of the church*. It is thus in other cases, the 
blessings of Heaven are conveyed to men through 
the use of natural means. 

* Chapter v. verse 14. 



52 AN ACCOUNT OF THE 

During the existence of the premonitory symp- 
toms, and before patients were confined to their 
rooms, a gentle purge, or the loss of a few ounces 
of blood, in many hundred instances, prevented the 
formation of the fever. I did not meet with a sin- 
gle exception to this remark. 

Fevers are the affliction chiefly of poor people. 
To prevent or to cure them, remedies must be 
cheap, and capable of being applied with but little 
attendance. From the affinity established by the 
Creator between evil and its antidotes, in other parts 
of his works, I am disposed to believe no remedy 
will ever be effectual in any general disease, that is 
not cheap, and that cannot easily be made universal. 

It is to be lamented that the greatest part of all 
the deaths which occur, are from diseases that are 
under the power of medicine. To prevent their 
fatal issue, it would seem to be agreeable to the 
order of Heaven in other things, that they should 
be attacked in their forming state. Weeds, ver- 
min, public oppression, and private vice, are easily 
eradicated and destroyed, if opposed by their pro- 
per remedies, as soon as they show themselves. 
The principal obstacle to the successful use of the 
antidotes of malignant fevers, in their early stage, 
arises from physicians refusing to declare when 



BILIOUS YELLOW FEVER OF 1797. 53 

they appear in a city, and from their practice of 
calling their mild forms by other names than that of 
a mortal epidemic. 

I shall now say a few words upon the success of 
the depleting practice in this epidemic. 

From the more malignant state of the fever, and 
from the fears and prejudices that were excited 
against bleeding and mercury by means of the news- 
papers, the success of those remedies was much 
less than in the years 1793 and 1794. Hundreds 
refused to submit to them at the ti?ne y and in the 
manner ', that were necessary to render them effec- 
tual. From the publications of a number of physi- 
cians, who used the lancet and mercury in their 
greatest extent, it appears that they lost but one in 
ten of all they attended. It was said of several 
practitioners who were opposed to copious bleed- 
ing, that they lost a much smaller proportion of their 
patients with the prevailing fever. Upon inquiry, 
it appeared they had lost many more. To conceal 
their want of success, they said their patients had 
died of other diseases. This mode of deceiving 

o 

the public began in 1793. The men who used it 
did not recollect, that it is less in favour of a phy- 
sician's skill to lose patients in pleurisies, colics, 



54 AN ACCOUNT OF THE 

haemorrhages, contusions, and common remittents, 
than in a malignant yellow fever. 

Dr. Sayre attended fifteen patients in the disease, 
all of whom recovered by the plentiful use of the 
depleting remedies. His place of residence being 
remote from those parts of the city in which the 
fever prevailed most, prevented his being called to 
a greater number of cases. 

A French physician, who bled and purged mode- 
rately, candidly acknowledged that he saved but 
three out of four of his patients. 

In the city hospital, where bleeding was sparing- 
ly used, and where the physicians depended chiefly 
upon a salivation, more than one half died of all 
the patients who were admitted. It is an act of 
justice to the physicians of the hospital to add, that 
many, perhaps most of their patients, were admitted 
after the first day of the disease. 

I cannot conclude this comparative view of the 
success of the different modes of treating the yellow 
fever, without taking notice, that the stimulating 
mode, as recommended bv Dr. Kuhn and Dr. 
Stevens, in the year 1793, was deserted by every 
physician in the city. Dr. Stevens acknowledged 



BILIOUS YELLOW FEVER OF 1797. 55 

the disease to require a different treatment from 
that which it required in the West- Indies ; Dr. 
Kuhn adopted the lancet and mercury in his prac- 
tice ; and several other physicians, who had written 
against those remedies, or who had doubted of their 
safety and efficacy, in 1793, used them with confi- 
dence, and in the most liberal manner, in 1797. 

In the histories I have given of the yellow fevers 
of 1793 and 1794, I have scattered here and there a 
few observations upon their degrees of danger, and 
the signs of their favourable or unfavourable issue. 
I shall close the present history, by collecting those 
observations into one view, and adding to them 
such other signs as have occurred to me in observ- 
ing this epidemic. 

Signs of moderate danger, and a favourable issue 
of the yellow fever. 

1. A chilly fit accompanying the attack of the 
fever. The longer this chill continues, the more 
favourable the disease. 

2. The recurrence of chills every day, or twice 
a day, or every other day, with the return of the 
exacerbations of the fever. A coldness of the 
whole body, at the above periods, without chilis, a 



56 AN ACCOUNT OF THE 

coldness with a profuse sweat, cold feet and hands, 
with febrile heat in other parts of the body, and a 
profuse sweat without chills or coldness, are all less 
favourable symptoms than a regular chilly fit, but 
they indicate less danger than their total absence 
during the course of the fever. 

3. A puking of green or yellow bile on the first 
day of the disease is favourable. A discharge of 
black bile, if it occur on the Jirst day of the fever, 
is not unfavourable. 

4. A discharge of green and yellow stools. It 
is more favourable if the stools are of a dark or 
black colour, and of a foetid and acrid nature, on 
the first or second day of the fever. 

5. A softness and moisture on the skin in the 
beginning of the fever. 

6. A sense of pain in the head, or a sudden 
translation of pain from internal to external parts of 
the body, particularly to the back. An increase 
of pain after bleeding. 

7. A sore mouth. 

8. A moist white, or a yellow tongue- 



. BILIOUS YELLOW FEVER OF 1797. 57 

9. An early disposition to spit freely, whether 
excited by nature or the use of mercury. 



10. Blood becoming sizy, after having exhibited 

S USU2 

vessels. 



the usual marks of great morbid action in the blood- 



11. Great and exquisite sensibility in the sense 
of feeling coming on near the close of the fever. 

12. Acute pains in the back and limbs. 

13. The appearance of an inflammatory spot on a 
finger or toe, Dr. H. M'Clen says, is favourable. 
It appears, the doctor says, as if the cause of the 
fever had escaped by explosion. 

Signs of great danger, and of an unfavourable 
issue of the yellow fever are, 

1. An attack of the fever, suddenly succeeding 
great terror, anger, or the intemperate use of ve- 
nery, or strong drink. 

2. The first paroxysm coming on without any 
premonitory symptoms, or a chilly fit. 

VOL. IV. H 



58 AN ACCOUNT OF THE 

3. A coldness over the whole body without chills 
for two or three days. 

4. A sleepiness on the first and second days of 
the fever. 

5. Uncommon paleness of the face not induced 
by blood-letting. 

6. Constant or violent vomiting, without any 
discharge of bile. 

7. Obstinate costiveness, or a discharge of natu- 
ral, or white stools ; also quick, watery stools after 
taking drink. 

8. A diarrhoea towards the close of the fever. 
I lost two patients, in 1797, with this symptom, 
who had exhibited, a few days before, signs of a 
recovery. Dr. Pinckard informed me, that it was 
generally attended with a fatal issue in the yellow 
fever of the West-Indies. Diemerbroeck declares, 
that " scarcely one in a hundred recovered, with 
this symptom, from the plague*.' ' 

9. A suppression of urine. It is most alarming 
when it is without pain. 

* Lib. i. cap. 15. 



i 



BILIOUS YELLOW FEVER OF 1797. 59 

10. A discharge of dark-coloured and bloody 
urine. 

11. A cold, cool, dry, smooth, or shining skin. 

12. The appearance of a yellow colour in the 
face on the first or second day of the fever. 

13. The absence of pain, or a sudden cessation 
of it, with the common symptoms of great danger. 

14. A disposition to faint upon a little motion, 
and fainting after losing but a few ounces of blood. 

15. A watery, glassy, or brilliant eye. A red 
eye on the fourth or fifth day of the disease. It is 
more alarming if it become so after having been 
previously yellow. 

16. Imperfect vision, and blindness in the close 
of the disease. 

17. Deafness. 

18. A preternatural appetite, more especially in 
the last stage of the fever. 

19. A slow, intermitting, and shattered pulse. 



60 AN ACCOUNT OF THE 

20. Great restlessness, delirium, and long conti- 
nued coma. 

21. A discharge of coffee- coloured or black 
matter from the stomach, after the fourth day of 
the fever. 

*•» 

22. A smooth red tongue, covered with a lead- 
coloured crust, while its edges are of a bright red. 

23. A dull vacant face, expressive of distress. 

24. Great insensibility to common occurrences, 
and an indifference about the issue of the disease. 

25. Uncommon serenity of mind, accompanied 
with an unusually placid countenance. 

I shall conclude this head by the following re- 
marks : 

1. The violence, danger, and probable issue of 
this fever, seem to be in proportion to the duration 
and force of the predisposing and exciting causes. 
However steady the former are in bringing on de- 
bility, and the latter in acting as irritants upon ac- 
cumulated excitability, yet a knowledge of their 
duration and force is always useful, not only in 



BILIOUS YELLOW FEVER OF 1797. 61 

forming an opinion of the probable issue of the fe- 
ver, but in regulating the force of remedies. 

2. The signs of danger vary in different years, 
from the influence of the weather upon the disease. 

3. Notwithstanding the signs of the favourable 
and unfavourable issue of the fever are in general 
uniform, when the cure of the disease is committed 
to nature, or to tonic medicines, yet they are far 
from being so when the treatment of the fever is 
taken out of the hands of nature, and attempted 
by the use of depleting remedies. We often see 
patients recover with nearly all the unfavourable 
symptoms that have been mentioned, and we some- 
times see them die, with all those that are favoura- 
ble. The words of Morellus, therefore, which he 
has applied to the plague, are equally true when 
applied to the yellow fever. *? In the plague, our 
senses deceive us. Reason deceives us. The 
aphorisms of Hippocrates deceive us*." An im- 
portant lesson may be learned from these facts, and 
that is, never to give a patient over. On the con- 
trary, it is our duty in this, as well as in all other 
acute diseases, to dispute every inch of ground with 

* De Feb. Pestilent, cap. v. " Acutorum morborum in- 
cests admodura, ac fallaces sunt pnedictiones." 

Hippocrates. 



62 AN ACCOUNT, &X. 

death. By means of this practice, which is war- 
ranted by science, as well as dictated by humanity, 
the grave has often been deprived for a while of its 
prey, and a prelude thereby exhibited of that ap- 
proaching and delightful time foretold by ancient 
prophets, when the power of medicine over dis- 
eases shall be such, as to render old age the only 
outlet of human life. 



AN ACCOUNT 



OF THE 



BILIOUS TELLOW FEVER, 



AS IT 



APPEARED IN PHILADELPHIA. 

IN THE YEAR 1798. 



AN ACCOUNT, &c 



THE yellow fever of the year 1797 was 
succeeded by scarlatina, catarrhs, and bilious pleu- 
risies, in the months of November and December 
of the same year. The weather favoured the gene- 
ration of the latter diseases. It became suddenly 
cold about the middle of November. On the 5th 
of December, the navigation of the Delaware was 
obstructed. There was a thaw on the 13th and 
14th of this month, but not sufficient to open the 
river. 

In the month of January, 1798, the fevers disco- 
vered an uncommon determination to the brain. 
Four cases of the hydrocephalic state of fever oc- 
curred under my care during this month, all of 
which yielded to depleting remedies. The sub- 
jects of this state of fever were Mr. Robert Lewis, 

VOL. IV* I 



66 AN ACCOUNT OF THE 

and the daughters of Messrs. John Brooks, Andrew 
Ellicott, and David Maffat. 

The weather was variable during the months of 
February and March. The navigation of the De- 
laware was not completely opened until the latter 
end of February. The diseases of these two 
months were catarrhs and bilious pleurisies. The 
former were confined chiefly to children, and were 
cured by gentle pukes, purges of calomel, and 
blood-letting. The last remedy was employed 
twice in a child of Isaac Pisso, of six weeks old, 
and once in a child of Thomas Billington, of three 
weeks old, with success. 

On the 7th of April, I visited Mr. Pollock, lately 
from the state of Georgia, in consultation with Dr. 
Physick, in a yellow fever. He died the evening 
after I saw him, on the third day of his disease. 

There was a snow storm on the 16th of April, 
and the weather was afterwards very cold. Such 
leaves and blossoms as had appeared, were injured 
by it. 

On the 1st of May, the mercury in Fahrenheit's 
thermometer rose to 84°. The weather, during 
the latter part of this month, and in June, was very 



BILIOUS YELLOW FEVER OF 1798. 67 

dry. On the 6th of June, Dr. Cooper lost a patient 
in the yellow fever, near the corner of Twelfth and 
Walnut- streets. Mark Miller died with the same 
state of fever on the 2d of July. About a dozen 
cases of a similar nature occurred, under the care 
of different practitioners, between the 2d and 20th 
of this month, and all of them in parts of the city 
remote from Water-street. 

On the 19th of July, the weather was so cool as 
to render winter clothes comfortable. A severe 
hail storm had occurred, a few days before, in the 
neighbourhood of Wilmington, in the Delaware 
state. 

On the 21st of the month, the ship Deborah ar- 
rived from one of the West- India islands, and dis- 
charged her cargo in the city. She was moored 
afterwards at Kensington, where the foul air which 
was emitted from her hold produced several cases 
of yellow fever, near the shores of that village. 

In August the disease appeared in nearly every 
part of the city, and particularly in places where 
there was the greatest exhalation from foul gutters 
and common sewers. 



68 AN ACCOUNT OF THE 

In describing the disease, as it appeared this 
year, I shall take notice of its symptoms as they 
appeared in the blood-vessels, alimentary canal, the 
tongue, the nervous system, in the eyes, the 
lymphatic system, and the blood. 

The subjects which furnished the materials for 
this history were not only private patients, but the 
poor in the city hospital, who were committed to 
the care of Dr. Physick and myself, by the board 
of health. 

I. The pulse w T as, in many cases, less active 
in the beginning of this fever than in former years. 
It was seldom preternaturally slow. It resembled 
the pulse which occurs in the first stage of the 
common jail fever. Haemorrhages were common 
about the fourth and fifth days, and generally from 
the gums, throat, or stomach. 

II. The whole alimentary canal was much affect- 
ed in most cases. Costiveness and a vomiting 
were general. The alvine discharges were occa- 
sionally green, dark- coloured, black, and natural. 
The black vomiting was more common this year 
than in former years, in all the forms of die fever. 
It was sometimes suspended for several days before 
death, and hopes were entertained of a recovery of 



BILIOUS YELLOW FEVER OF 1798, 69 

patients in whom it had appeared. In a boy, at 
the city hospital, it ceased ten days before he died. 
It was sometimes succeeded by delirium or coma, 
but it more commonly left the patient free of pain, 
and in the possession of all the faculties of his mind. 

III. The tongue was by no means an index of 
the state of the fever, as in the years 1793 and 1797. 
I saw several deaths, attended with a black vomit- 
ing, in which the tongue retained a natural appear- 
ance. This phenomenon at first deceived me. I 
ascribed it to such a concentration of the disease in 
the stomach and other vital parts, as to prevent its 
diffusing itself through the external parts of the 
system. We observe the effects of the same cause 
in a natural state of the skin, and in a natural ap- 
pearance of the urine, in the most malignant forms 
of this fever. 

IV. In the nervous system, the disease appeared 
with several new symptoms. A relation of Peter 
Field attempted to bite his attendants in the deliri- 
um of his fever, just before he died. 

I attended a young woman at Mrs. Easby's, who 
started every time I touched her pulse. Loud 
talking, or a question suddenly proposed to her, 
produced the same convulsive motion. She retain- 



70 AN ACCOUNT ©F THE 

ed her reason during the whole of her illness, and 
was cured by bleeding and a salivation. 

Hiccup was a common symptom. I saw but 
two patients recover who had it. In one of them, 
Dr. Hedges, it came on after the sixth day of the 
fever, and continued, without any other symptom 
of disease, for four or five days. 

I lost a patient who complained of no pain but 
in the calves of his legs. Dr. Physick lost a girl, 
in the city hospital, who complained only of pains 
in her toes. Her stomach discovered, after death* 
strong marks of inflammation. 

Many people passed through every stage of the 
disease, without uttering a complaint of pain of any 
kind. 

An uncommon stiffness in the limbs preceded 
death a few hours, in several cases. This stiffness 
ceased, in one of Dr. Physick 's patients, immedi- 
ately after death, but returned as soon as he became 
cold. 

An obstinate wakefulness continued through the 
whole of the disease in Dr. Leib. It was common 
during the convalescence, in many cases. 



BILIOUS YELLOW FEVER OF 1798. 71 

The whole body was affected, in many cases, 
with a morbid sensibility, or what has been called 
supersensation, so that patients complained of pain 
upon being touched, when they were moved in 
their beds. This extreme sensibility was general 
in parts to which blisters had been applied. It 
continued through every stage of the disease. Dr. 
Physick informed me, that he observed it in a 
man two hours before he died. In this man there 
was an absence of pulse, and a coldness of his ex- 
tremities. Upon touching his wrist, he cried out, 
as if he felt great pain. 

V. A redness in the eyes was a general symp- 
tom. I saw few recoveries where this redness was 
not removed. 

A discharge of matter from one ear relieved Mr. 
J. C. Warren from a distressing pulsation of the 
arteries in his head. 

VI. Glandular swellings occurred in several in- 
stances. Two cases of them came under my no- 
tice. They both terminated favourably. 

VII. The blood had its usual appearances in this 
disease. In the yellow fever which prevailed at 



72 AN ACCOUNT OF THE 

the same time in Boston, Dr. Rand says the blood 
was sizy in but one out of a hundred cases. 

The forms of the fever were nearly similar to 
those which have been described in the year 1797. 
I saw several cases in which the disease appeared 
in the form of a tertian fever. In one of them it 
terminated in death. 

The system, in many cases, was prostrated be- 
low the point of inflammatory re- action. These 
were called, by some practitioners, typhous fevers. 
It was the most dangerous and fatal form of the 
disease. Its frequent occurrence gave occasion to 
a remark, that our epidemic resembled the yellow 
fever of the West- Indies, much more than the fe- 
vers of 1793 and 1797. 

I attended two patients in whom the disease was 
protracted nearly to the 30th day. They both re- 
covered. 

Dr. Francis Sayre informed me, that he saw a 
child, in which the morbid affection of the wind- 
pipe, called cynanche trachealis, appeared with all 
the usual symptoms of yellow fever* 



BILIOUS YELLOW FEVER OF 1798. 73 

I attended one case in which the force of the 
disease was weakened, in its first stage, by a pro- 
fuse haemorrhage from the bowels. This haemor- 
rhage was followed by a bloody diarrhoea, which 
continued for four or five weeks. 

Persons of all ages and colours were affected by 
this fever. I saw a case of it in a child of six 
months old. In the blacks, it was attended with less 
violence and mortality than in white people. It 
affected many persons who had previously had it. 

The disease was excited by the same causes 
which excited it in former years. I observed a 
number of people to be affected by the fever, who 
lived in solitude in their houses, without doing any 
business. The system, in these persons, was pre- 
disposed to the disease, by the debility induced by 
ceasing to labour at their former occupations. It 
was excited in a young man by a fractured leg. 
He died five days afterwards, with a black vomit- 
ing. I observed, in several instances, an interval 
of four and five days betweeivthe debility induced 
upon the system by a predisposing, and the action 
of an exciting cause. Dr. Clark says, he has seen 
an interval of several weeks between the operation 
of those causes, in the yellow fever of Dominique. 

VOL. IV. K 



AN ACCOUNT OF THE 



These facts are worthy of notice, as they lead to a 
protracted use of the means of obviating an attack 
of the disease. 

During my attendance upon the sick, I twice 
perceived in my system the premonitory signs of 
the epidemic. Its complete formation was pre- 
vented each time by rest, a moderate dose of phy- 
sic, and a plentiful sweat. 

I shall now take notice of the different manner in 
which patients died of this fever. The detail may 
be useful, by unfolding new principles in the ani- 
mal economy, as well as new facts in the history of 
the disease. 

1. The disease terminated in death, in some in- 
stances, by means of convulsions. 

2. By delirium, which prompted to exertions 
and actions similar to those which take place in 
madness. 

3. By profuse haemorrhages from the gums. 
This occurred in two patients of Dr. Stewart. 

4. By an incessant vomiting and hiccup. 



BILIOUS YELLOW FEVER OF 1798. 75 

5. By extreme pain in the calves of the legs and 
i toes, which, by destroying the excitement of the 

system, destroyed life. 

6. By a total absence of pain. In this way it 
put an end to the life of Mr. Henry Hill. 

7. By a disposition to easy, and apparently na- 
tural sleep. I have reason to believe that Mr. Hill 
encouraged this disposition to sleep, a few hours 
before he died, under the influence of a belief that 
he would be refreshed by it. Diemerbroeck says 
the plague often killed in the same way. 

8. The mind was in many cases torpid, where 
no delirium attended, and death was submitted to 
with a degree of insensibility, which was often 
mistaken for fortitude and resignation. 

I shall now mention the morbid appearances ex- 
hibited by the bodies of persons who died of this 
fever, as communicated to me by my friend, Dr. 
Physick; being the result of numerous dissections 
made by him at the city hospital. 

In all of them the stomach was inflamed. The 
matter which constitutes what is called ihe black 
vomit, was found in the stomachs of several patients 



76 AN ACCOUNT OF THE 

who had not discharged it at any time by vomiting. 
In some stomachs, he found lines which seemed 
to separate the living from their dead parts. Those 
parts, though dead, were not always in a mortified 
state. They were distinguished from the living 
parts by a peculiar paleness, and by discovering a 
weak texture upon being pressed between the fin- 
gers. He observed the greatest marks of inflam- 
mation in the stomachs of several persons in whom 
there had been no vomiting, during the whole 
course of the disease. The brain, in a few in- 
stances, discovered marks of inflammation. Water 
was now and then found in its ventricles, but al- 
ways of its natural colour, even in those persons 
whose skins were yellow. The liver suffered but 
little in this disease. It may serve to increase our 
knowledge of the influence of local circumstances 
upon epidemics to remark, that this viscus, which 
was rarely diseased in the fever of Philadelphia in 
1798, discovered marks of great inflammation in 
the bodies which were examined by Dr. Rand and 
Dr. Warren, in the town of Boston, where the 
yellow fever prevailed at the same time it did in 
Philadelphia. 

The weather was hot and drv in August and 
September, during the prevalence of this fever. Its 
influence upon animal and vegetable life are worthy 



BILIOUS YELLOW FEVER OF 1798. 77 

of notice. Moschetoes abounded, as usual in sickly 
seasons ; grasshoppers covered die ground in many 
places ; cabbages and other garden vegetables, and 
even fields of clover, were devoured by them. 
Peaches ripened this year three weeks sooner than 
in ordinary summers, and apples rotted much soon- 
er than usual after being gathered in the autumn. 
Many fruit-trees blossomed in October, and a se- 
cond crop of small apples and cherries were seen 
in November, on the west side of Schuylkill, near 
the city. Meteors were observed in several places. 
On the 29th of September there was a white frost. 
Its effects upon the fever were obvious and general. 
It declined, in every part of the city, to such a de- 
gree as to induce many people to return from the 
country. In the beginning of October the weather 
again became warm, and the disease revived. It 
was observable, that all great changes in the wea- 
ther from heat to cold that were short of frost, or 
of cold to heat, increased the mortality of the fever. 
It spread most rapidly in moist weather. 

The origin of this fever was from the exhalations 
of gutters, docks, cellars, common sewers, ponds 
of stagnating water, and from the foul air of the 
ship formerly mentioned. 



78 AN ACCOUNT OF THE 

The fever prevailed at the same time in the town 
of Chester, in Pennsylvania ; in Wilmington, in 
the state of Delaware ; in New- York ; in New- 
London, in Connecticut; in Windsor, in Vermont; 
and in Boston ; in all which places its origin was 
traced to domestic sources. 

I shall now deliver a short account of the reme- 
dies employed in the cure of this disease. 

I have said that the pulse w r as less active in this 
fever than in the fevers of former years. It was 
seldom, however, so feeble as to forbid bleeding. 
In Dr. Mease it called for the loss of 162 ounces 
of blood, and in Mr. J. C. Warren for the loss of 
200, by successive bleedings, before it was sub- 
dued. But such cases were not common. In 
most of them, the pulse flagged after two or three 
bleedings. But there were cases in which the lan- 
cet was forbidden altogether. In these, the sys- 
tem appeared to be prostrated, by the force of the 
miasmata, below the point of re-action. This state 
of the disease manifested itself in a w r eak, quick, 
and frequent pulse, languid eye, sighing, great in- 
quietude, or great insensibility. However unsafe 
bleeding was on the first day of this fever, when it 
appeared with those symptoms, nature often per- 



BILIOUS YELLOW FEVER OF 1798. 79 

formed that operation upon herself from the gums, 
on the fourth or fifth day. I saw several pounds 
of blood discharged on those days, and in that way, 
with the happiest effects. It appeared to take 
place after the revival of the blood-vessels from 
their prostrated state. 

From a conviction that the system was depressed 
only in these cases, and finding that it did not 
rise upon blood-letting, I resolved to try the effects 
of emetics, in exciting and equalizing the action of 
the blood-vessels. The experience I had had of 
the inefficacy of this remedy in 1793, and of its ill 
effects in one instance in 1797, led me to exhibit 
it with a trembling hand. I gave it for the first 
time to a son of Richard Renshaw. I had bled 
him but once, and had in vain tried to bring on a 
salivation. On the fifth day of his disease, his 
pulse became languid and slow, his skin cool, a 
haemorrhage had taken place from his gums, and 
he discovered a restlessness and anxiety which I 
had often seen a few hours before death. He took 
four grains of tartar emetic, with twenty grains of 
calomel, at two doses. They operated powerfully, 
upwards and downwards, and brought away a large 
quantity of bile. The effects of this medicine 
were such as I wished. The next day he was out 
of danger. I prescribed the same medicine in 



80 AN ACCOUNT OF THE 

man}' other cases with the same success. To se- 
veral of my patients I gave two emetics in the 
course of the disease. Some of them discharged 
bile resembling in viscidity the white of an eg^. 
But I saw one case in which great relief was ob- 
tained from the operation of an emetic, where no 
bile was discharged. 

In the exhibition of this remedy, I was regu- 
lated by the pulse. If I found it languid on the 
first day of the fever, I gave it before any other 
medicine. When it was full and tense, I deferred 
it until I had reduced the pulse to the emetic point 
by bleeding and purges. I observed, with great 
pleasure, that mercury affected the mouth more 
speedily and certainly where an emetic had been 
administered, than in other cases, probably from 
awakening, by its stimulus, the sensibility of the 
stomach ; for such was its torpor, that in one case 
ten grains of tartar emetic, and in another thirty 
grains, did not operate upon it, so as to excite even 
the slightest degree of nausea. 

In many cases, an emetic, given in the forming 
state of the disease, seemed to effect an immediate 
cure. 



EILIOUS YELLOW FEVER OF 1798. 81 

Purges produced the same salutary effects that 
they did in former years. I always combined ca- 
lomel with them in the first stage of the disease. 

A salivation was found to be the most certain 
remedy of any that was used in this fever. I did 
not lose a single patient, in whom the mercury 
acted upon the salivary glands. It was difficult to 
excite it in many cases, from the mercury being 
rejected by the stomach, from its passing off by 
the bowels, or from its stimulus being exceeded 
by the morbid action in the blood-vessels. 



Bleeding rendered the action of the mercury 
upon the mouth more speedy and more certain, 
but I saw several cases in which a salivation was 
excited in the most malignant forms of the fever, 
where no blood had been drawn. It will not be 
difficult to explain the reason of this fact if we recur 
to what was said formerly of the prostration of the 
system in this fever. In its worst forms, there is 
- often a total absence, or a feeble degree of action 
in the blood-vessels, from an excess of the stimulus 
of the remote cause of the fever. Here the mer- 
cury meets with no resistance in its tendency to 
the mouth. Bleeding in this case would probably 
do harm, by taking off a part of the pressure upon 
the system, and thereby produce a re-action in the 

VOL. IV. L 



82 * AN ACCOUNT OF THE 

vessels, that might predominate over the action of 
the mercury. The disease here does that for us 
by its force, which, in other cases, we effect by 
depleting remedies. 

Where the mercury showed a disposition to pass 
too rapidly through the bowels, I observed no in- 
convenience from combining it with opium, in my 
attempts to excite a salivation. The calomel was 
constantly aided by mercurial ointment, applied by 
friction to different parts of the body. 

Now and then a salivation continued for weeks 
£nd months after the crisis of this fever, to the great 
distress of the patient, and injury of the credit of 
mercury as a remedy in this disease. Dr. Phy- 
sick has discovered, that in these cases the saliva- 
tion is kept up by carious teeth or bone, and that 
it is to be cured only by removing them. 

From the impracticability of exciting a salivation 
in all cases, I attempted the cure of this fever, af- 
ter bleeding, by means of copious sweats. They 
succeeded in several instances where no other re- 
medy promised or afforded any relief. They were 
excited by wrapping the patient in a blanket, with 
half a dozen hot bricks wetted with vinegar, and 
applied to different parts of the body. The sweat- 



BILIOUS YELLOW FEVER OF 1798. 83 

ing was continued for six hours, and repeated daily 
for four or five days. 

In those cases where the fever put on the form 
of an intermittent, I gave bark after bleeding and 
purging with advantage. I gave it likewise in ail 
those cases where the fever put on the type of the 
slow chronic fever. Laudanum was acceptable 
and useful in many cases of pain, wakefulness, vo- 
miting, and diarrhoea, after the use of depleting re- 
medies. 

I applied blisters in the usual way in this fever, 
but I think with less effect than in the yellow fevers 
of former years. 

To relieve a vomiting, which was very distres- 
sing in many cases about the fourth and fifth days, 
I gave a julep, composed of the salt of tartar and 
laudanum. I also gave Dr. Hosack's anti-emetic 
medicine, composed of equal parts of lime-water 
and milk. I do not know that it saved any lives, 
but I am sure it gave ease by removing a painful 
symptom, and thus, where it did not cure, lessened 
the sufferings of the sick. 

The diet and drinks were the same in this fever 
as they were in the fevers formerly described. 



AN ACCOUNT OF THE 

Cool air, cold water, and cleanliness produced 
their usual salutary effects in this fever. 

I shall now deliver a short account of the symp- 
toms which indicated a favourable and an unfavour- 
able issue of the disease. 

It has been said*, that the signs of danger vary 
in this fever, from the influence of the weather. 
The autumn of 1798 confirmed, in many instances, 
the truth of this remark. 

I saw no instance of death where a bleeding oc- 
curred from the gums on the fourth or fifth day, 
provided depleting remedies had been used from 
the beginning of the disease. Few recovered who 
had this symptom in 1793. 

I saw three recoveries after convulsions in the 
year 1798. All died who were convulsed in 1793 
and 1797. 

A dry, hoarse, and sore throat was followed by 
death in every case in which it occurred in my 
practice. In the fever of 1793 a sore throat was a 
favourable sign. It was one of the circumstances 

* History of the Fever in 1797. 



BILIOUS YELLOW FEVER OF 1798. 85 

which determined me to use a salivation in that 
fever. 

The absence of pain was always a bad sign. 
Small, but frequent stools, and the continuance of 
a redness in the eyes after the ample use of deplet- 
ing remedies, were likewise bad signs. 

An appetite for food on the fourth or fifth day of 
the fever, without a remission or cessation of the 
fever, was always unfavourable. 

A want of delicacy, in exposing parts of the 
body which are usually covered, was a bad symp- 
tom. I saw but one recovery where it took place. 
Boccacio says the same symptom occurred in the 
plague in Italy. " It suspended (he tells us) all 
modesty, so that young women, of great rank and 
delicacy, submitted to be attended, dressed, and 
even cleansed by male nurses." 

I have remarked, in another place, that but two 
of my patients recovered who had the hiccup. 

A dry tongue was a bad sign. I saw but one 
recoverv where it occurred, and none where the 
tongue was black. A moist and natural tongue, 
where symptoms of violence or malignity appeared 



86 AN ACCOUNT OF TH£ 

in other parts of the body, was always followed by 
a fatal issue of the disease. 

A desire to ride out, or to go home, in persons 
who were absent from their families, was, in every 
instance where it took place, a fatal symptom. 
These desires arose from an insensibility to pain, 
or a false idea of the state of the disease. It exist- 
ed to such a degree in some of the patients in the 
city hospital, that they often left their beds, and 
dressed themselves, in order to go home. All 
these patients died, and some of them in the act of 
putting on their clothes. 

From the history that has been eiven of the 
symptoms, treatment, and prognosis of this fever, 
we see how imperfect all treatises upon epidemics 
must be, which are not connected with climate and 
season. As well might a traveller describe a fo- 
reign climate, by the state of the weather, or by 
the productions of the earth, during a single au» 
tumn, as a physician adopt a uniform opinion of 
the history, treatment, and prognosis of a fever, 
from its phenomena in any one country, or during 
a single season. 

o 

There were three modes of practice used in this 
epidemic. The first consisted in the exhibition of 



BILIOUS YELLOW FEVER OF 1798. 87 

purges of castor oil, salts, and manna, and cooling 
glysters, and in the use of the warm bath. These 
remedies were prescribed chiefly by the French 
physicians. The second consisted in the use of 
mercury alone, in such doses, and in such a manner, 
as to excite a salivation. This mode was used chiefly 
by an itinerant and popular quack. The third 
mode consisted in using all the remedies which I 
have mentioned in the account of the treatment of 
this fever, and accommodating them to the state of 
the disease. This mode of practice was followed 
by most of the American physicians. 

The first mode of practice was the least success, 
ful. It succeeded only in such cases as would 
probably have cured themselves. 

The second mode succeeded in mild cases, and 
now and then in that malignant state of the fever, 
in which the action of the blood-vessels was so 
much prostrated by the force of the miasmata, as 
to permit the mercury to pass over them, and thus 
to act upon the salivary glands in the course of 
four or five days. 

The last mode was by far the most successful. 
It is worthy of notice, that the business and repu- 
tation of the physicians, during this epidemic, were 



88 AN ACCOUNT OF THE 

in the inverse ratio of their success. The number 
of deaths by it amounted to between three and four 
thousand, among whom were three physicians, and 
two students of medicine. Its mortality was nearly 
as great as it was in 1793, and yet the number^of 
people who were affected by it was four times as 
great in 1793 as it was in 1798, for, in the latter 
year, the city was deserted by nearly all its inhabi- 
tants. The cause of this disproportion of deaths 
to the number who were sick, was owing to the 
liberal and general use of the lancet in 1793, and 
to the publications in 1797 having excited general 
fears and prejudices against it in 1798. Such was 
the influence of these publications, that many per- 
sons who had recovered from this fever in the 
two former years, by the use of depleting remedies, 
deserted the physicians who had prescribed them, 
and put themselves under the care of physicians of 
opposite modes of practice. Most of them died. 
Two of them had been my patients, one of whom 
had recovered of a third attack of the fever under 
my care. 






AN ACCOUNT 



OF THE 



BILIO US TELL OW FE VER, 



AS IT 



APPEARED IN PHILADELPHIA, 

IN THE YEAR 1799. 



VOL. IV. Hi 



AN ACCOUNT, 0c, 



THE diseases which succeeded die fever 
of 1798, in November and December, were highly 
inflammatory. A catarrh was nearly universal. Se- 
veral cases of sore throat, and one of erysipelas, 
came under my care in the month of November. 
The weather in December was extremely cold. It 
was equally so in the beginning of January, 1 799, 
accompanied with several falls of snow. 

About the middle of the month, the weather mo- 
derated so much, so as to open the navigation of 
the Delaware. I met with two cases of malignant 
colic in the latter part of this month, and one of 
yellow fever. The last was Swen Warner. Dr. 
Physick, who attended him with me, informed me 
that he had, nearly at the same time, attended two 
other persons with the same disease. 



92 AN ACCOUNT OF THE 

The weather was very cold, and bilious pleuri- 
sies were common, during the latter part of the 
month of February. 

March was equally cold. The newspapers con- 
tained accounts of the winter having been uncom- 
monly severe in Canada, and in several European 
countries. 

The first two weeks in April were still cold. 
The Delaware, which had been frozen a second 
time during the winter, was crossed near its origin, 
on the ice, on the 15th day of this month. The 
diseases, though fewer than in the winter, were 
bilious and inflammatory. During this month, I 
was called to a case of yellow fever, which yielded 
to copious bleeding, and other depleting medicines. 

May was colder than is usual in that month, but 
very healthy. 

In the first week of June, several cases of highly 

- 

bilious fever came under my care. In one of them, 
all the usual symptoms of the highest grade of that 
fever occurred. On the 13th of the month, Dr. 
Physick informed me, that he had lost a patient 
with that disease. On the 23d of the same month, 
Joseph Ashmead, a young merchant, died of it 



BILIOUS YELLOW FEVER OF 1799. 93 

Several other cases of the disease occurred between 
the 20th and 29th days of the month, in different 
parts of the city. About this time, I was informed 
that the inhabitants of Keys's-alley had predicted a 
return of the yellow fever, from the trees before their 
doors emitting a smell, exactly the same which they 
perceived just before the breaking out of that dis- 
ease in 1793. 

In July, the city was alarmed, by Dr. Griffitts, 
with an account of several cases of the fever in 
Penn- street, near the water. The strictness with 
which the quarantine law had been executed, for a 
while rendered this account incredible with many 
people, and exposed the doctor to a good deal of 
obloquy. At length a vessel was discovered, that 
had arrived from one of the West-India islands 
on the 14th of May, and one day before the qua- 
rantine law was put into operation, from which the 
disease was said to be derived. Upon investigat- 
ing the state of this vessel, it appeared that she had 
arrived with a healthy crew, and that no person 
had been sick on board of her during her voyage. 

In the latter part of July and in the beginning of 
August, the disease gradually disappeared from 
every part of the city. This circumstance deserves 



94 AN ACCOUNT 0F THE 

attention, as it shows the disease did not spread by 
contagion. 

About this time we were informed by the news- 
papers, that dogs, geese, and other poultry, also 
that wild pigeons were sickly in many parts of 
the country, and that fish on the Susquehannah, 
and oysters in the Delaware bay, were so unplea- 
sant, that the inhabitants declined eating them. 
At the same time, flies were found dead in great 
numbers, in the unhealthy parts of the city. The 
weather was dry in August and September. There 
was no second crop of grass. The gardens yielded 
a scanty supply of vegetables, and of an inferior size 
and quality. Cherries were smaller than usual, 
and pear and apple-trees dropped their fruits prema- 
turely, in large quantities. The peaches, which 
arived at maturity, were small and ill-tasted. The 
grain was in general abundant, and of a good qua- 
lity. A fly, of an unusual kind, covered the pota- 
toe fields, and devoured, in some instances, the 
leaves of the potatoe. This fly has lately been used 
with success in our country, instead of the fly im- 
ported from Spain. It is equal to it in every re- 
spect. Like the Spanish fly, it sometimes induces 
strangury. 



BILIOUS YELLOW FEVER OF 1799. 95 

About the middle of August the disease revived, 
and appeared in different parts of the city. A pub- 
lication from the academy of medicine, in which 
they declared the seeds of the disease to spread from 
the atmosphere only, produced a sudden flight of the 
inhabitants. In no year, since the prevalence of 
the fever, was the desertion of the city so general. 

I shall now add a short account of the symptoms 
and treatment of this epidemic. 

The arterial system was in most cases active. I 
met with a tense pulse in a patient after the appear- 
ance of the black vomiting. Delirium was less 
frequent in adults than in former years. In chil- 
dren there was a great determination of the disease 
to the brain. 

I observed no new symptoms in the stomach 
and bowels. One of the worst cases of the fever 
which I saw was accompanied with colic. A girl 
of Thomas Shortall, who recovered, discharged 9 
worms during her fever. It appeared in Mr. Tho- 
mas Roan, one of my pupils, in the form of a dy- 
sentery. 

A stiffness, such as follows death, occurred in 
several patients in the city hospital before death. 



96 AN ACCOUNT OF THE 

Miss Shortall had an eruption of pimples on her 
breast, such as I have described in the short ac- 
count I gave of the yellow fever of 1762 in this 
city, in my account of the disease in 1793* 

The blood exhibited its usual appearances in the 
yellow fever. It was seldom sizy till towards the 
close of the disease. 

The tongue was generally whitish. Sometimes 
it was of a red colour, and had a polished appear- 
ance. I saw no case of a black tongue, and but 
few that were yellow before the seventh day of the 
disease. 

The type of this disease was nearly the same 
as described in 1797. It now and then ap- 
peared in the form of a quartan, in which state it 
generally proved fatal. It appeared with rheumatic 
pains in one of my patients. It blended itself with 
gout and small-pox. Its union with the latter dis- 
ease was evident in two patients in the city hospital, 
in each of whom the stools were such as were dis- 
charged in the most malignant state of the fever. 

The remedies for this fever were bleeding, vo- 
mits, purges, sweats, and a salivation and blisters. 



BILIOUS YELLOW FEVER OF 1799. 97 

There were few cases that did not indicate bleed- 
ing. It was performed, when proper, in the usual 
way, and with its usual good effects. It was indi- 
cated as much when the disease appeared in the 
bowels as in the blood-vessels. Mr. Roan, in 
whom it was accompanied with symptoms of dy- 
sentery, lost nearly 200 ounces of blood by twenty- 
two bleedings. 

I found the same benefit from emetics, in this 
fever, that I did in the fever of 1798. They were 
never administered except on the first day, before 
violent action had taken place in the system, or af- 
ter it was moderated by one or two bleedings. 

Purges of calomel and jalap, also castor oil, salts, 
and injections were prescribed with their usual ad- 
vantages. 

In those cases where the system was prostrated 
below the point of re-action, I began the cure by 
sweating. Blankets, with hot bricks wetted with 
vinegar, and the hot bath, as^ mentioned formerly, 
when practicable, were used for this purpose. 
The latter produced, in a boy of 14 years of age, 
who came into the city hospital without a pulse, 
and with a cold skin, in a few hours, a general 
warmth and an active pulse. The determination 

vol. IV. N 



98 AN ACCOUNT OF THE 

of the disease to the pores was evinced in one of 
my patients, by her sweating under the use of the 
above-mentioned remedies, for the first time in her 
life. A moisture upon her skin had never before 
been induced, she informed me, even by the wann- 
est day in summer. 

The advantages of a salivation were as great as 
in former years. From the efficacy of bleeding, 
purges, emetics, and sweating, I had the pleasure 
of seeing many recoveries before the mercury had 
time to affect the mouth, In no one case did I 
rest the cure exclusively upon any one of these re- 
medies. The more numerous the outlets were to 
convey off superfluous fluids and excitement from 
the body, the more safe and certain were the reco- 
veries. A vein, the gall-bladder, the bowels, the 
pores, and the salivary glands were all opened, in 
succession, in part, or together, according to cir- 
cumstances, so as to give the disease every possible 
chance of passing out of the body without injuring 
or destroying any of its vital parts. 

Blisters were applied with advantage. The vo- 
miting and sickness which attend this fever were 
relieved, in many instances, by a blister to the sto- 
mach. 



BILIOUS YELLOW FEVER OF 1799. 99 

In those cases in which the fever was protracted 
to the chronic state, bark, wine, laudanum, and aether 
produced the most salutary effects. I think I saw 
life recalled, in several cases in which it appeared 
to be departing, by frequent and liberal doses of 
the last of those medicines. The bark was given, 
with safety and advantage, after the seventh day, 
when the fever assumed the form of an intermit- 
tent. 

The following symptoms were generally favour- 
able, viz. a bleeding from the mouth and gums, 
and a disposition to weep, when spoken to in any 
stage of the fever. 

A hoarseness and sore throat indicated a fatal 
issue of the disease, as it did in 1798. Dr. Phy- 
sick remarked, that all those persons who sighed 
after waking suddenly, before they were able to 
speak, died. 

The recurrence of a redness of the eyes, after it 
had disappeared, or of but one eye, was generally 
followed by death. I saw but one recovery with 
a red face. 

I saw several persons, a few hours before death, 
in whom the countenance, tongue, voice, and pulse 



100 AN ACCOUNT, &C. 

Were perfectly natural. They complained of no 
pain, and discovered no distress nor solicitude of 
mind. Their danger was only to be known by the 
circumstances which had preceded this apparently 
healthy and tranquil state of the system. They 
had all passed through extreme suffering, and some 
of them had puked black matter. 

The success of the mode of practice I have de- 
scribed was the same as in former years, in private 
families ; but in the city hospital, which was again 
placed under the care of Dr. Physick and myself, 
there was a very different issue to it, from causes 
that are too obvious to be mentioned. 

There were two opinions given to the public upon 
the subject of the origin of this fever; the one by the 
academy of medicine, the other by the college of 
physicians. The former declared it to be generated 
in the city, from putrid domestic exhalations, be- 
cause they saw it only in their vicinity, and disco- 
vered no channel by which it could have been 
derived from a foreign country ; the latter asserted 
it to be " imported, because it had been imported 
in former years,-" 



AN 



ACCOUNT OF SPORADIC CASES 



OF 



TELL OW FE VER, 



AS THEY 



APPEARED IN PHILADELPHIA, 



IN 1800. 



AN ACCOUNT, &c. 



THE weather in the month of January was 
less cold than is common in that month. Catarrhs, 
the cynanche trachealis, and bilious pleurisies were 
prevalent in every part of it. A few cases of yel- 
low fever occurred likewise during this month. 

Several cases of erysipelas appeared in February. 

The month of March was unusually healthy. 

The weather was warm in April, and the city as 
healthy as in March. 

It was equally so in May and June. The spring 
fruits appeared early in the latter month, in large 
quantities, and were of an excellent quality. Locusts 
were universal in June. They had not appeared 



104 AN ACCOUNT OF SPORADIC CASES 

since the year 1783. A record from the journal 
of the Swedish missionaries was published at this 
time, which described their appearance in 1715, 
in which year it was said to be very healthy. 

On the 14th of June there was a severe thunder 
gust, with more lightning than had been known for 
seven years before. 

There fell, during all the months that have been 
mentioned, frequent and plentiful showers of rain, 
which rendered the crops of grass luxuriant in the 
neighbourhood of Philadelphia. 

The winds at this time were chiefly from the 
south-east. 

A few intermittents appeared in June, which 
yielded readily to the bark. 

On the 16th day of June, Dr. Physick informed 
me he had a black boy under his care with the 
yellow fever. 

In July, the hooping cough, cholera infantum, 
and some cases of dysentery and bilious fever ap- 
peared in the city. 



OF YELLOW FEVER IN 1800. 105 

On the 30th of July, Dr. Pascalis informed me 
that he had lost a patient on the fifth day of a yel- 
low fever. 

In August, the dysentery was the principal form 
of disease that prevailed in the city. 

On the 22d of this month, a woman died of the 
yellow fever in Gaskill- street, under the care of Dr. 
Church. 

On the 28th and 30th, there fell an unusual 
quantity of rain. The winds were south-west and 
north west during the greatest part of the summer 
months. The latter were sometimes accompanied 
with rain. 

On the 1 1th of September, a clerk of Mr. Levi 
Hollingsworth, and, on the 12th, a clerk of Mr, 
John Connelly, died with the yellow fever. 

A plentiful shower of rain fell on the night of the 
21st of this month. 

About this time there appeared one and twenty 
cases of yellow fever in Spruce- street, between 
Front and Second- streets. They were all in the 

VOL. iv, o 



106 AN ACCOUNT OF SPORADIC CASES 

neighbourhood of putrid exhalations. Fourteen 
of them ended fatally. 

No one of the above cases of malignant fever 
could be traced to a ship, or to a direct or indirect 
intercourse with persons affected by that disease. 

While Philadelphia was thus visited by a few 
sporadic cases only of yellow fever, it was epide- 
mic in several of the cities of the United States, 
particularly in New- York, Providence, in Rhode 
Island, Norfolk, and Baltimore. In the last named 
place, it was publicly declared by the committee 
of health to be of domestic origin. 

The dysentery was epidemic, at the same time, 
in several of the towns of Massachusetts and New- 
Hampshire. It was attended with uncommon 
mortality at Hanover, in the latter state. 

This difference in the states of health and sick- 
ness in the different parts of the United States must 
be sought for chiefly in the different states of the 
weather in those places. The exemption of Phila- 
delphia from the yellow fever, as an epidemic, may 
perhaps be ascribed to the strength and vigour of 
the vegetable products of the year, which retarded 
their putrefaction ; to frequent showers of rain, 



OF YELLOW FEVER IN 1800. 107 

which washed away the filth of the streets and gut- 
ters ; and to the perfection of the summer and au- 
tumnal fruits. 

The months of November and December this 
year were uncommonly healthy. During the for- 
mer, several light shocks of earthquakes were felt 
in Lancaster and Harrisburg, in Pennsylvania, and 
in Wilmington, in the state of Delaware. 



AN 



ACCOUNT OF SPORADIC CASES 



OF 



YELLOW FEVER, 



AS THEY 



APPEARED IN PHILADELPHIA, 



in 1801. 



AN ACCOUNT, &c. 



THE month of January was intensely cold. 
In February it became more moderate. The dis- 
eases, during these two months, were catarrhs and 
a few pleurisies. 

In March and April there fell an unusual quan- 
tity of rain. The hay harvest began in the neigh- 
bourhood of Philadelphia on the 28th of May. A 
few mild cases of scarlatina anginosa occurred dur- 
ing these months. 

In June the weather was dry and healthy. 

On the 8th of July, a case of yellow fever oc- 
curred in the practice of Dr. Stewart. About the 
15th of the month, a patient died with it in the 
Pennsylvania hospital. Dr. Physick informed me 



112 AN ACCOUNT OF SPORADIC CASES 

that he had, at the same time, two patients under 
his care with that disease. Several cases of the 
measles appeared in the south end of the city dur- 
ing this month. In every part of it, the weather 
was warm and dry, in consequence of which there 
were no second crops of grass, and a smaller quan- 
tity than usual of summer fruits and vegetables. 
The winds were less steady than they had been for 
seven years. They blew, every two or three days, 
from nearly every point of the compass. 

On the 4th of August there fell a considerable 
quantity of rain, which w r as succeeded by cool and 
pleasant weather. The cholera morbus was a fre- 
quent disease among both adults and children in 
the city, and the dysentery in several of the adjoin- 
ing counties of the state. 

A number of emigrant families arrived this month 
from Ireland and Wales, who brought with them 
the ship fever. They were carefully attended, at 
the lazaretto and the city hospital, in airy rooms, 
by which means they did not propagate the disease. 
Contrary to its usual character, it partook of the 
remissions of the bilious fever, probably from the 
influence of the season upon it. 



OF YELLLOW FEVER IN 1801* 113T 

In September there were a few extremely warm 
days. In the beginning and middle of the month 
a number of mild remittents occurred, and about 
the 22d there were five or six cases of yellow fever 
in Eighth-street, between Chesnut and Walnut- 
streets, in two houses ill ventilated, and exposed to 
a good deal of exhalation. I attended most of these 
cases in consultation with Dr. Gallaher. One of 
the persons who was affected with this fever puked 
black matter while I sat by his bed-side, a few hours 
before he died. 

During the summer and autumn of this year, a 
number of cases of yellow fever appeared at New- 
Bedford, Portland, and Norwich, in the New- Eng- 
land states ; in New- York ; in some parts of New- 
Jersey ; and in Northampton and Bucks counties, 
in Pennsylvania. It prevailed so generally in New- 
York, as to produce a considerable desertion of the 
city. In none of the above places could the least 
proof be adduced of the disease being imported. 
In Philadelphia its existence was doubted or denied 
by most of the citizens, because it appeared in si- 
tuations remote from the water, and of course could 
not be derived from any foreign source. 

It will be difficult to tell why the fever appeared 
only in sporadic cases in Philadelphia. Perhaps its 

VOL. IV. p 



114 AN ACCOUNT OF SPORADIC CASES, &C. 

prevalence as an epidemic was prevented by the 
plentiful rains in the spring months, by the absence 
of moisture from the filth of the streets and gutters, 
in consequence of the dry weather in June and July, 
by the vigour and perfection of the products of the 
earth, and by the variable state of the winds in the 
month of July. If none of these causes defended 
the city from more numerous cases of the yellow 
fever, it must be resolved into the want of a con. 
curring inflammatory constitution of the atmos- 
phere with the common impure sources of that 
disease. 

On the 12th of November, about twelve o'clock 
in the night, an earthquake was felt in Philadelphia, 
attended with a noise as if something heavy had 
fallen upon a floor. Several cases of scarlet fever 
appeared in December, but the prevailing disease, 
during the two last autumnal and the first winter 
months, was the measles. I have taken notice that 
it appeared in the south end of the city in July, 
During the months of August and September it 
was stationary, but in October, November, and 
December it spread through every part of the city. 
The following circumstances occurred in this epi- 
demic, as far as it came under my notice. 



AN ACCOUNT 



OF 



THE MEASLES, 



AS THEY 



APPEARED IN PHILADELPHIA, 

IN THE YEAR 1 80 L 



i 



AN ACCOUNT, &c. 



I. THE disease wore the livery of the au- 
tumnal fever in the following particulars. 

It was strongly marked by remissions and inter- 
missions. The exacerbations came on chiefly at 
night. 

There were in many cases a constant nausea, and 
discharge of bile by puking. 

I saw one case in which the disease appeared 
with a violent cholera morbus, and several in which 
it was accompanied with diarrhoea and dysentery. 

II. Many severe cases of phrenzy, and two of 
cynanche trachealis appeared with the measles. 



118 AN ACCOUNT OF THE 

III. A distressing sore mouth followed them, in 
a child of two years old, that came under my care. 

IV. A fatal hydrocephalus internus followed them 
in a boy of eight years old, whom I saw two days 
before he died. 

• 

V. I met with a few cases in which the fever 
and eruption came on in the same day, but I saw 
one case in which the eruption did not take place 
until the tenth, and another, in which it did not ap- 
pear until the fourteenth day after the fever. 

VI. Two children had pustules on their skins, 
resembling the small-pox, before the eruption of 
the measles. 

VII. Many children had coughs and watery eyes, 
but without the measles. The same children had 
them two or three weeks afterwards. 

VIII. Many people who had had the measles, 
had coughs during the prevalence of the measles, 
resembling the cough which occurs in that disease. 

The remedies made use of in my practice were, 



MEASLES IN 1801. 119 

1. Bleeding, from four to sixty ounces, accord- 
ing to the age of the patient, and the state of the 
pulse. This remedy relieved the cough, eased 
the pains in the head, and in one case produced, 
when used a third time, an immediate eruption of 
the measles. 

2. Lenient purges. 

3. Demulcent drinks, 

4. Opiates at night. 

5. Blisters. And, 

6. Astringent medicines, where a diarrhoea took 
place. 

I saw evident advantages from advising a vege- 
table diet to many children, as soon as any one of 
the families to which they belonged were attacked 
by the measles. 

I lost but one patient in this disease, and that 
was a child in convulsions. I ascribed my success 
to bleeding more generally and more copiously than 
I had been accustomed to do, in the measles of for- 



mer vears. 



AN ACCOUNT 



OF THE 



BILIOUS TELLOW FEVER, 



AS IT 



APPEARED IN PHILADELPHIA, 

IN THE YEAR 1802, 



VOL. IT. 



AN ACCOUNT, &c. 



THE weather during the month of January 
was unusually moderate and pleasant. In the latter 
end of it, many shrubs put forth leaves and blos- 
somed. I saw a leaf of the honeysuckle, which was 
more than an inch in length, and above half an inch 
in breadth. There was but one fall of snow, and 
that a light one, during the whole month. 

The winds blew chiefly from the south-west in 
February. There was a light fall of snow on the 
6th. A shad was caught in the Delaware, near the 
city, on the 17th. On the 18th and 19th of the 
month, the weather became suddenly very cold. 
On the 22d there was a snow storm, and on the 
28th, rain and a general thaw. 



124 AN ACCOUNT OF THE 

In March, the weather was wet, cold, and stormy, 
with the exception of a few pleasant days. 

The scarlatina anginosa and the cynanche trache- 
alis were the principal diseases that prevailed dur- 
ing the three months that have been mentioned. 

■ 

In April, there were several frosts, which de- 
stroyed the blossoms of the peach-trees. 

In May, the weather was so cool as to make fires 
agreeable to the last day of the month. The wind 
blew chiefly, during the whole of it, from the north- 
east. 

The scarlatina continued to be the reigning dis- 
ease. I saw one fatal case of it, in which a redness 
only, without any ulcers or sloughs, appeared in 
the throat ; and I attended another, in which a total 
immobility in the limbs was substituted by nature 
for the pain and swellings in those parts which ge- 
nerally attend the disease. There were three distinct 
grades of this epidemic. It was attended with such 
inflammatory or malignant symptoms, in some in- 
stances, as to require two or three bleedings ; in 
others it appeared with a typhoid pulse, which yield- 
ed to emetics : turbith mineral was preferred for this 



BILIOUS YELLOW FEVER OF 1802. 125 

purpose ; while a redness, without a fever, which 
yielded to a single purge, was the only symptom of 
it in many people. 

The weather was cool, rainy, and hot, in suces- 
sion, in the month of June. The scarlatina conti- 
nued to be the prevailing disease. 

During the first and second weeks in July, there 
fell a good deal of rain. On the 4th of the month 
I was called to visit Mrs. Harris, in Front- street, 
between Arch and Market- streets, with a bilious 
fever. The scarlatina had imparted to it a general 
redness on her skin, which induced her to believe 
it was that disease, and to neglect sending for me- 
dical relief for several days. She died on the 13 th 
of the month, with a red eye, a black tongue, hic- 
cup, and a yellow skin. Three other cases of ma- 
lignant bilious fever occurred this month. Two 
of them were attended by Dr. Dewees and Dr. 
Otto. 

On the 15th of the month, the city was alarmed 
by an account of this fever having appeared near the 
corners of Front and Vine-streets, a part of the citv 
which had for many weeks before been complained 
of by many people for emitting a foetid smell, de- 
rived from a great quantity of filthy matters stag- 



126 AN ACCOUNT OF THE 

nating in that neighbourhood, and from the foul 
air discharged from a vessel called the Esperanza, 
which lay at Vine- street wharf. 

On the 2d of August, it appeared in other parts 
of the city, particularly in Front and Water- streets, 
near the draw-bridge, where it evidently originated 
from putrid sources. Reports were circulated that 
it was derived from contagion, conveyed to Vine- 
street wharf in the timbers of a vessel called the St. 
Domingo Packet, but faithful and accurate inqui- 
ries proved that this vessel had been detained one 
and twenty days, and well cleaned at the lazaretto, 
and that no one, of fourteen men who had worked 
on board of her afterwards, had been affected with 
sickness of any kind. 

On the 5th of August, the board of health pub- 
licly declared the fever to be contagious, and ad- 
vised an immediate desertion of the city. The 
advice was followed with uncommon degrees of 
terror and precipitation. 

The disease continued, in different parts of the 
city, during the whole of August and September. 
On the 5th of October, the citizens were publicly 
invited from the country by the board of health. 



BILIOUS YELLOW FEVER OF 1802. 127 

During this season, the yellow fever was epide- 
mic in Baltimore and Wilmington. It the former 
place it was admitted by their board of health, and 
in the latter it was proved by Dr. Vaughan, to be 
of domestic origin. It prevailed, at the same time, 
in Sussex county and near Woodbury, in New- 
Jersey. Sporadic cases of it likewise occurred in 
New- York and Boston, and in Portsmouth, in 
New- Hampshire. The chronic fever was epide- 
mic in several of the towns of North- Carolina ; 
cases of fever, which terminated in a swelling and 
mortification of the legs, and in death on the third 
day, appeared on the waters of the Juniata, in Penn- 
sylvania ; and bilious fevers, of a highly inflamma- 
tory grade, were likewise common near German- 
town and Frankford, in the neighbourhood of Phi,, 
ladelphia. 

But few of the cases of yellow fever which have 
been mentioned came under my care, but I saw a 
considerable number of fevers of a less violent 
grade. They were the inflammatory, bilious, mild 
remitting, chronic, and intermitting fevers, and 
the febrieula. They appeared, in some instances, 
distinct from each other, but they generally blend- 
ed their symptoms in their different stages. The 
yellow fever often came on in the mild form of an 
intermittent, and even a febrieula, and as often, 



123 AN ACCOUNT OF THE 

after a single paroxysm, ended in a mild remittent 
or chronic fever. When it appeared in the latter 
form, it was frequently attended with a slow or low 
pulse, and a vomiting and hiccup, such as attend in 
the yellow fever. This diversity of symptoms, 
with which the summer and autumnal fever came 
on, made it impossible to decide upon its type on 
the day of its attack. Having been deceived in 
one instance, I made it a practice afterwards to 
watch every case I was called to with double vigi- 
lance, lest it should contract a malignant form in 
my hands, without my being prepared to meet it. 
Of the five original and obvious cases of yellow fe- 
ver to which 1 was called, I saved none, for I saw 
but one of them before the last stage of the disease. 
In many others, I have reason to believe I pre- 
vented that malignant form of fever, by the early 
and liberal use of depleting medicines. The prac- 
tice of those physicians who attended most of the 
persons who had the yellow fever, was much less 
successful than in our former epidemics. I sus- 
pected at the time, and I was convinced afterwards, 
that it was occasioned by relying exclusively upon 
bleeding, purges, and mercury. The skin, in se- 
veral of the cases which I saw, was covered with 
moisture. This clearly pointed out nature's at- 
tempt to relieve herself by sweating. Upon my 
mentioning this fact to the late Dr. Pfeiffer, jun. 



BILIOUS YELLOW FEVER OF 1802. 129 

he instantly adopted my opinion, and informed me, 
as a reason for doing so, that he had heard of seve- 
ral whole families in the Northern Liberties, where 
the disease prevailed most, who, by attacking it in 
its forming state by profuse sweats, had cured them- 
selves, without the advice of a physician. 



v©l. iv. » 



AN ACCOUNT 



OF THE 



BILIOUS YELLOW FEVER, 



AS IT 



APPEARED IN PHILADELPHIA, 

in 1803. 



AN ACCOUNT, &c. 



THE weather in January was uniformly 
cold. On the 21st of the month, the Delaware 
was completely frozen. 

On the 4th of February there was a general thaw, 
attended with a storm of hail, thunder, and light- 
ning, which lasted about three quarters of an hour. 
The diseases of both these winter months were 
catarrhs and bilious pleurisies. The latter appeared 
in a tertian type. The pain in the side was most 
sensible every other day. 

The weather was cold and dry in March, in 
consequence of which, vegetation was unusually 
backward in April. The hooping cough, catarrhs, 
and scarlatina were the diseases of this month. 



134 AN ACCOUNT OF THE 

The beginning of May was very cool. There 
was ice on the 7th of the month. The winds, dur- 
ing the greatest parts of this and the previous 
month, were from the north-east. 

In June, the weather was cool. Intermittents 
were common in this month, as well as in May. 
Such was the predominance of this type of fever 
over all other diseases, that it appeared in the 
form of profuse sweats, every other night, in a lady 
under the care of Dr. Dewees and myself, in the pu- 
erperile fever. On the intermediate nights she had a 
fever, without the least moisture on her skin. There 
were a few choleras this month. During the lat- 
ter end of the month, I lost a patient with many of 
the symptoms of yellow fever. 

s The weather in July was alternately hot, mode- 
rate, and cool, with but little rain. The first two 
weeks of this month were healthy. A few tertian 
fevers occurred, which readily yielded to bark, 
without previous bleeding. Between the 25th and 
31st of the month, three deaths took place from the 
yellow fever. 

In the month of August, the weather was the same 
as in July, except that there fell more rain in it. 
Mild remittents and cholera infantum were now 



BILIOUS YELLOW FEVER OF 1803. 135 

common. There were likewise several oases of 
yellow fever during this month. One of them was 
in Fromberger's-court. It was induced by the 
foe tor of putrid fish in a cellar. A malignant dysen- 
tery was epidemic during this month in the upper 
part of Germantown, and in its neighbourhood. Se- 
veral persons, Dr. Bensell informed me, died of it 
in thirty hours sickness. It prevailed, at the same 
time, in many parts of the New-England states. 

In September, cases of yellow fever appeared in 
different parts of the city, but chiefly in Water, 
near Walnut- street. On the 12th of the month, 
the board of health published a declaration of its 
existence in the city, but said it was not contagious. 
This opinion gave great offence, for it was generally 
said to have been imported by means of a packet- 
boat from New- York, where the fever then pre- 
vailed, because a man had sickened and died in 
the neighbourhood of the wharf where this packet 
was moored. It was to no purpose to oppose to this 
belief, proofs that no sick person, and no goods 
supposed to be infected, had arrived in this boat, 
and that no one of three men, who had received the 
seeds of the disease in New- York, had communi- 
cated it to any one of the families in Philadelphia, 
in which they had sickened and died. 



136 AN ACCOUNT OF THE 

The disease assumed a new character this year, 
and was cured by a different force of medicine from 
that which was employed in some of the years in 
which it had prevailed in Philadelphia. 

I shall briefly describe it in each of the systems, 
and then take notice of some peculiarities which at- 
tended it. Afterwards I shall mention the reme- 
dies which were effectual in curing it. 

1. The pulse was moderately tense in most cases. 
It intermitted in one case, and in several others the 
tension was of a transient nature. 

Haemorrhages occured in many cases. They 
were chiefly from the nose, but in some instances 
they occurred from the stomach, bowels, and hse- 
morrhoidal vessels. 

2. Great flatulency attended in the stomach, but 
sickness and vomiting were much less frequent 
than in former years. I saw but one case in which 
diarrhoea attended this fever. 

3. I did not meet with a single instance of a 
glandular swelling in any part of the body. 



BILIOUS YELLOW FEVER OF 1803. 137 

4. There was a general disposition to sweat in 
this fever from its beginning. Two of my patients 
died, in whom no moisture could be excited on 
the skin. But 1 recovered one with a dry skin, by 
means of a purge, two bleedings, and blisters. 

An efflorescence on the skin occurred in several 
instances. I saw black matter discharged from a 
blister in one case, and blood in another. 

5. The stools were green and black. Bile was 
generally discharged in puking. 

6. The blood exhibited the following appear- 
ances: siziness, lotura carnium, sunken crassamen- 
tum, red sediment, and what is called dense or un- 
separated blood. I saw no instance of its being 
dissolved. 

7. The tongue was whitish and dark- coloured* 
This diseased appearance continued, in some in- 
stances, several days after a recovery took place^ 
I saw no smooth, red, nor black tongue, and but 
One dry and one natural tongue. The latter was 
followed by death, 

I did not see a single case in which the disease 
came on without an exciting cause ; such as light 
vol. iv. s 



138 AN ACCOUNT OF THE 

clothing and bed-clothes, sitting at doors after night, 
a long walk, gunning, and violent and unusual ex- 
ercises of any kind. It was excited in a number 
of people by their exertions to extinguish a fire 
which took place in Water- street, between Market 
and Chesnut-streets, on the morning of the 25th of 
August. I saw a fatal instance of it succeed a se- 
vere tooth-ach. Whether this pain was the ex- 
citing cause, or the first morbid symptom of the 
fever, I know not ; but I was led by it to bleed a 
young lady twice who complained of that pain, and 
who had at the same time a tense pulse. Her 
blood had the usual appearances which occur in 
the yellow fever. 

The disease had different appearances in differ- 
ent parts of the city. It was most malignant in 
Water- street ; but in many instances it became less 
so, as it travelled westward, so that about Ninth- 
street it appeared in the form of a common inter- 
mittent. 

In every part of the city it often came on, as in 
the year 1802, in all the milder forms of autumnal 
fever formerly enumerated, and went off with the 
usual symptoms of yellow fever. Again, it came 
on with all the force and malignity of a yellow fe- 
ver, and terminated, in a day or two, in a common 



BILIOUS YELLOW FEVER OF 1803. 139 

remittent or intermittent. These modes of attack 
were so common, that it was impossible to tell 
what the character, or probable issue of a fever 
would be, for two or three days. 

The following remedies were found, very ge- 
nerally, to be effectual in this fever. 

1. Moderate bleeding. I bled but three patients 
three, and only one, four times. In general, the 
loss of from ten to twenty ounces of blood, reduced 
the pulse from a synocha to a synoichoid or typhoid 
state, and thereby prepared the system for other 
remedies. 

2. Purges were always useful. I gave calomel 
and jalap, castor oil, salts, and senna, according to 
the grade of the disease, and often according to the 
humour or taste of the patient. I aided these 
purges by glysters. In one case, where a griping 
and black stools attended, I directed injections of 
lime water and milk to be used, with the happiest 
effects. 

3. I gave emetics in many cases with advantage, 
but never while the pulse was full or tense. 



140 AN ACCOUNT OF THE 

4. Having observed, as in the year 1802, a 
spontaneous moisture on the skin on the first day 
of the disease, in several cases, I was led to assist 
this disposition in nature to be relieved by the 
pores, by means of sweating remedies, but in no 
instance did I follow it, without previous evacua- 
tions from the blood-vessels or bowels ; for, how- 
ever useful the intimations of nature may be in 
acute diseases, her efforts should never be trusted 
to alone, inasmuch as they are in most cases too 
feeble to do service, or so violent as to do mischief. 
I saw one death, and I heard of another, from an 
exclusive reliance upon spontaneous sweats in the 
beginning of this fever. The remedies I employed 
to promote this evacuation by the pores were, an 
infusion of the eupatorium perfoliatum in boiling 
water, aided by copious warm drinks, and hot 
bricks and blankets, applied to the external sur- 
face of the body. The eupatorium sometimes 
sickened the stomach, and puked. The sweats 
were intermitted, and renewed two or three times 
in the course of four and twenty hours. 

5. I derived great advantage from the application 
of blisters to the wrists, before the system descend- 
ed to what I have elsewhere called, the blistering 
point. This was on the second and third days. 
My design, in applying them thus early, was to 



JBILIOUS YELLOW FEVER OF 1803. 141 

attract morbid excitement to the extremities, and 
thereby to create a substitute for a salivation. 
They had this effect. The pain, increase of fever, 
and occasional strangury, which were produced by 
them, served like anchors to prevent the system 
being drifted and lost, by the concentration of mor- 
bid excitement in the stomach and brain, on the 
fourth, fifth, sixth, and seventh days of the disease. 
It gave me great pleasure to find, upon revising 
Dr. Home's account of the vellow fever, that this 
mode of applying blisters, in the early stage of the 
disease, was not a new one. He often applied 
them in the first stage of the fever, more especially 
when the yellow colour of the skin made its ap- 
pearance on the first or second day. By the ad- 
vice of Dr. Cheney, of Jamaica, he was led to pre- 
fer them to the thighs, instead of the trunk of the 
body, or the legs and arms. He forbids their ever 
being applied below the calf of the legs. This cau- 
tion is probably more necessary in the West- Indies 
than in the United States. The pain and inflam- 
mation excited by the blisters were mitigated 
by soft poultices of bread and milk. The stran- 
gury soon yielded to demulcent drinks, particu- 
larly to flaxseed tea. 

I was happy in not being compelled, by the vio- 
lence or obstinacy of this fever, to resort to a sali- 



142 AN ACCOUNT OF THE 

vation in order to cure it, in a single instance ; the 
discharges from the stomach and bowels, and from 
the veins, pores, and skin, having proved sufficient 
to convey the disease out of the system. 

Two persons recovered this year who had the 
black vomiting. One of them was by means of 
large quantities of brandy and volatile alkali, admi- 
nistered by Dr. John Dorsey, in the city hospital ; 
the other was by means of lime and water and milk, 
given by an intelligent nurse to one of my patients, 
during the interval of my visits to her. 



/ 



From the history which has been given of the 
symptoms of this fever; from the less force of medi- 
cine that was necessary to subdue it ; from the safe- 
ty and advantage of blisters in its early stage ; and 
from the small proportion which the deaths bore to 
the number of those who were affected, being sel- 
dom more than five in a hundred (including all the 
grades and forms of the disease), in the practice of 
most of the physicians, it is evident this fever was 
of a less malignant nature than it had been in most 
of the years in which it had been epidemic. There 
was one more circumstance which proved its dimi- 
nution of violence, and that was, a more feeble 
operation of its remote cause. In the year 1802, 
nearly all the persons who were affected with the 



BILIOUS YELLOW FEVER OF 1803. 143 

fever in the neighbourhood of Vine and Water- 
streets, and in Water, between Walnut and Spruce- 
streets, died. This year, but two died of a great 
number who were sick in the former, and not 
one out of twelve who were sick in the latter place. 
The filth, in both parts of the city, was the same 
in both years. This difference in the violence and 
mortality of the fever was probably occasioned by a 
less concentrated state of the miasmata which pro- 
duced it, or by the co-operation of a less inflamma- 
tory constitution of the atmosphere. 

The yellow fever was epidemic, during the sum- 
mer and autumn of this year, in New- York, and 
in Alexandria, in Virginia. In the latter place. 
Dr. Dick has informed the public, it was derived 
from domestic putrefaction. 



AN 



j. 



\CCOUNT OF SPORADIC CASES 



OF 



TELLOW FEVER, 



AS THEY 



APPEARED IN PHILADELPHIA, 



IN 1804, 



VOL. IV* 



AN ACCOUNT, &c< 



THE month of January was marked by- 
deep snows, rain, clear and cold weather, and by 
the general healthiness of the city. 

In February there fell a deep snow, which was 
followed by several very cold days. There was 
likewise a fall of snow in March, which was suc- 
ceeded by an uncommon degree of cold. Catarrhs 
and bilious pleurisies were very common during 
both these months. 

In the beginning of April, the weather was cold 
and rainy. There were but few signs of vegeta- 
tion before the 15th of the month. Bilious pleuri- 
sies were still the principal diseases which prevailed 
in the citv. 



148 AN ACCOUNT OF SPORADIC CASES 

The month of May was wet, cool, and healthy. 

In June, the winds were easterly, and the wea- 
ther rainy. The crops of grass were luxuriant. 
It was remarked, that the milk of cows that fed 
upon this grass yielded less butter than usual, and 
that horses that fed upon it, sweated profusely with 
but little exercise. On the third of the month, I 
was called upon by Dr. Physick to visit his father, 
who was ill with a bilious fever. He died on the 
seventh, with a red eye, hiccup, and black vomit- 
ing. 

Four persons had the yellow fever in the month 
of July. One of them was in Fourth- street, be- 
tween Pine and Lombard- streets, another was in 
Fifth-street, between Race and Vine-streets, both of 
whom recovered. The remaining two were in the 
Pennsylvania hospital, both of whom died. Remit- 
ting and intermitting fevers were likewise common 
in this month. 

In August, those fevers assumed a chronic form. 
During this month, there died an unusual number 
of children with the cholera morbus. 

The city was uncommonly healthy in Septem- 
ber. A storm of wind and rain, from the south- 



OJF YELLOW FEVER IN 1804. 149 

cast, proved destructive to the crops of cotton this 
month, on the sea coast of South- Carolina. 

In October, intermittents were very common 
between Eighth-street and Schuylkill. One case 
of yellow fever came under my care, in conjunc- 
tion with Dr. Gallaher, on the western banks of 
that river. 

While Philadelphia and all the cities of the Unit- 
ed States (Charleston excepted) were thus exemp- 
ted from the yellow fever as an epidemic, the 
western parts of all the middle, and several of the 
southern states, were visited with the bilious fever, 
in all its different forms. In Delaware county, in 
the state of New- York, at Mill river, in Connecti- 
cut, and in several of the middle counties of Penn- 
sylvania, it prevailed in the form of a yellow fever. 
In other parts of the United States, it appeared 
chiefly as a highly inflammatory remittent. It was 
so general, that not only whole families, but whole 
neighbourhoods were confined by it. Many suf- 
fered from the want of medical advice and nursing, 
and some from the want of even a single attendant. 
In consequence of the general prevalence of this 
fever in some parts of Pennsylvania, the usual la- 
bours of the season were suspended. Apples fell 
and perished upon the ground ; no winter grain was 



150 AN ACCOUNT OF SPORADIC CASES, &C. 

sowed ; and even cows passed whole days and nights 
without being milked. 

The mortality of this fever was considerable, 
where those distressing circumstances took place. 
In more favourable circumstances, it yielded to early 
depletion, and afterwards to the bark. Relapses 
were frequent, from premature exposure to the air. 
Those only escaped them who had been salivated, 
by accident or design, for the cure of the fever. 

This disease was observed very generally to pre- 
vail most in high situations, which had been for 
years distinguished for their healthiness, while the 
low grounds, and the banks of creeks and rivers, 
were but little affected by it. The unusual quan- 
tity of rain, which had fallen during the summer 
months, had produced moisture in the former 
places, which favoured putrefaction and exhalation, 
while both were prevented, in the latter places, by 
the grounds being completely covered with water. 



AN ACCOUNT 



OF THE 



BILIO US TELL OW FE VER, 



AS IT 



APPEARED IN PHILADELPHIA, 

IN THE YEAR 1805. 



AN ACCOUNT, &c. 



FOR a history of the uncommonly cold and 
tempestuous winter of 1804 and 1805, the reader 
is referred to the Account of the Climate of Penn- 
sylvania, in the first volume of these Inquiries and 
Observations. 

During the months of January, February, and 
March, there were a number of bilious catarrhs and 
pleurisies. 

On the 7th of April, I visited a patient in the yel- 
low fever with Dr. Stewart. He was cured, chiefly 
by copious bleeding. 

The weather was rainy in May. After the mid- 
dle of June, and during the whole month of July, 
there fell no rain. The mercury in Fahrenheit 

VOL. iv. u 



154 AN ACCOUNT OF THE 

fluctuated, for ten days, between 90° and 94°, dur- 
ing this month. The diseases which occurred in 
it were cholera infantum, dysenteries, a few com- 
mon bilious, and eight cases of yellow fever. 
Three of the last were in Twelfth, between Locust 
and Walnut-streets, and were first visited, on the 
14th and 15th of the month, by Dr. Hartshorn, as 
out-patients of the Pennsylvania hospital. Two of 
them were attended, about a week afterwards, by 
Dr. Church, in South wark, and the remaining three 
by Dr. Rouisseau and Dr. Stewart, in the south 
end of the city. 

On the third of August, there fell a heavy shower 
of rain, but the weather, during the remaining part 
of the month, was warm and dry. The pastures 
were burnt up, and there was a great deficiency of 
summer vegetables in the neighbourhood of Phila- 
delphia. The water in the Schuylkill was lower 
by three inches than it had been in the memory of 
a man of 70 years of age, who had lived constantly 
within sight of it. 

In September, a number of cases of yellow fever 
appealed in Southwark*, near Catharine-street. 

* This extensive district is continued, from the city of 
Philadelphia, along the Delaware* but is not subject to itfs 
government. 



BILIOUS YELLOW FEVER OF 1805. 155 

They were readily traced to a large bed of oysters, 
which had putrifitd on Catharine -street wharf, and 
which had emitted a most offensive exhalation 
throughout the whole neighbourhood, for several 
weeks before the fever made its appearance. This 
exhalation proved fatal to a number of cats and 
dogs, and it now became obvious that the two cases 
of yellow fever, that were attended by Dr. Church, 
in the month of July, were derived from it. . An 
attempt was made to impose a belief that they were 
taken by contagion from a ship at the lazaretto, 
which had lately arrived from the West- Indies, but a 
careful investigation of this tale proved, that neither 
of the two subjects of the fever had been on board 
that, nor any other ship, then under quarantine. 

The fever prevailed during the whole of this 
month in South wark. A few cases of it appeared 
in the city, most of which were in persons who had 
resided in, or visited that district. Ii was brought 
on by weak exciting causes in South wark, but the 
cases which originated in the city, required strong 
exciting causes to produce them. 

A heavy rain, accompanied with a good deal of 
wind, on the :L8th of September, and a frost on the 
night of the 7th of October, gave a considerable 
check to the fever. 



156 AN ACCOUNT OF THE 

But few cases of it came under my care. Hav- 
ing perceived the same disposition in nature to re- 
lieve herself by the pores, that I observed in the 
years 1802 and 1803, my remedies were the same 
as in the latter year, and attended with the same 
success. Dr. Caldwell and Dr. Stewart, whose 
practice was extensive in Southwark, informed me, 
those remedies had been generally successful in 
their hands. 

The only new medicine that the experience of 
this year suggested in this disease, was for one of 
its most distressing and dangerous symptoms, that 
is, the vomiting which occurs in its second stage. 
Dr. Physick discovered, that ten drops of the spirit 
of turpentine, given every two hours, in a little mo- 
lasses, or syrup, or sweet oil, effectually checked it 
in several instances, in patients who afterwards re- 
covered. It was administered with equal success 
in a case which came under my care, after an ab- 
sence of pulse, and a coldness of the extremities 
had taken place. Dr. Church informed me that 
he gave great relief to the sick in the city hospital, 
by this medicine, by prescribing it in glysters, as 
well as by the mouth, in distressing affections of 
the stomach and bowels. 



BILIOUS YELLOW FEVER OF 1805. 157 

Dr. Stewart observed that all those persons who 
had been affected by the yellow fever in former 
years, had mild remittents in the same situations 
that others had the prevailing epidemic in a malig- 
nant form. 

In one of four bodies the doctor examined, he 
found six, and in another three intussusceptions of 
the intestines, without any signs of inflammation. 
He discovered the common marks of disease from 
this fever in other parts of those bodies. 

The deaths from this fever amounted to between 
three and four hundred. They would probably 
have been more numerous, had not those families 
who were in competent circumstances fled into the 
country, and had not the poor been removed, by 
the board of health, from the infected atmosphere 
of Southwark, to tents provided for them in the 
neighbourhood of the city ; and they would proba- 
bly have been fewer, considering the tractable na- 
ture of the disease, when met by suitable remedies 
in its early stage, had not the sick concealed their 
indisposition, in many instances, for two or three 
days, lest they should • be dragged to the city hos- 
pital, or have centinels placed at their doors, to pre- 
vent any communication with their friends and 
neighbours. While these attempts were made to 



158 AN ACCOUNT OF THE 

check the progress of the fever, it did not escape 
the notice of many of the citizens of Philadelphia, 
that not a single instance occurred of its being com- 
municated by contagion, in any of the families in 
the city, in which persons had sickened or died 
with it, and that while the sick were deprived of 
the kind offices of their friends and neighbours, lest 
they should be infected, physicians, and the mem- 
bers of the board of health, passed by the guards 
every day, in their visits to the same sick people, 
and afterwards mixed with their fellow-citizens, 
in every part of the city, without changing their 
clothes. 

The yellow fever appeared early in the season in 
New- Haven, in Connecticut, and in Providence, on 
Rhode Island, in both of which places it was de- 
rived from putrid exhalation, and was speedily and 
effectually checked by removing the healthy persons 
who lived in its neighbourhood to a distance from 
it. Several sporadic cases of it occurred dur- 
ing the autumn in Gloucester county, in New- 
Jersey, and in Mifflin and Chester counties, in 
Pennsylvania. It was epidemic in New- York at 
the same time it prevailed in South wark and Phi- 
ladelphia. The following extract of a letter from 
the health officer of New- York, to one of his 



BILIOUS YELLOW FEVER OF 1805. 159 

friends, contains a satisfactory proof that it was not. 
in that city, an imported disease. 

Quarantine ground, Sept, 7. 

I most sincerely and tenderly deplore the unfor- 
tunate situation of our city. What do people say 
now of the origin of the disease ? You may state, 
for the information of those who wished to be in- 
formed, that not a single vessel, on board of which 
a person has been sick with fever of any kind, or 
on board of which any person has died with any 
disease, while in the West- Indies, or on the voy- 
age home, has ever gone up to the city during this 
whole season. This we know, and this we vouch 
for ; and farther state, that all the cases of fever 
that have come down as from the city, have been 
all people of, and belonging to the city, and uncon- 
nected with the shipping, excepting one, a sailor, 
who had no connection with any foul vessel. There 
is not a shadow of proof or suspicion that can at- 
tach to the health- office, or to infected vessels, this 
season. I am, &x. 

JOHN R. B. RODGERS. 

Having concluded the history of the bilious yel- 
low fever, as it has appeared in eleven successive 
years, since 1793, as an epidemic, or in sporadic 



160 AN ACCOUNT, &C. 

cases, I shall proceed next to enumerate all the 
sources of that fever, as well as all the other usual 
forms of the summer and autumnal disease of the 
United States, and afterwards mention the means 
of preventing them. 



AN INQUIRY 



INTO 



THE VARIOUS SOURCES 

OF THE USUAL FORMS OF 

SUMMER QT AUTUMNAL DISEASE 

IN THE UNITED STATES, 

AND THE MEANS OF PREVENTING THEM. 



VOL. IV. X 



AN INQUIRY, &c. 



THE business of the following inquiry is, 

I. To enumerate the various sources of the usual 
forms of the summer and autumnal disease in the 
United States. And, 

II. To mention the means of preventing them. 

To render the application of those means as ex- 
tensive as possible, it will be proper to mention, 
under the first head, all those sources of summer 
and autumnal disease, which have been known to 
produce it in other countries, as well as in the 
United States. They are, . 

1. Exhalations from marshes. These are sup- 
posed to be partly of a vegetable, and partly of an 
animal nature. They are derived from the shores 
of creeks and mill ponds, as well as from low and 
wet grounds ; also from the following vegetable 
substances in a state of putrefaction. 



164 ON THE SOURCES OF 

2. Cabbage. A malignant fever was produced 
at Oxford, by a putrid heap of this vegetable some 
years ago, which proved fatal to many of the inha- 
bitants, and to several of the students of the univer- 
sity at that place. 

3. Potatoes. Nearly a whole ship's crew pe- 
rished at Tortola, by removing from her hold, a 
quantity of putrid potatoes. 

4. Pepper. 

5. Indian meal. 

6. Onions. 

7. Mint. 

8. Anise and caraway seeds, confined in the 
hold of a ship. 

9. Coffee. " About the time," savsDr. Trot- 
ter, " when notice was taken of the putrefying 
coffee on the wharf at Philadelphia, in the year 
1793, a captain of a man of war, just returned from 
the Jamaica station, informed me, that several ves- 
sels laden with the same produce came to Kingston, 
from St. Domingo. During the distracted state 



SUMMER AND AUTUMNAL DISEASE. 165 

of that colony, this article, with other productions, 
had been allowed to spoil and ferment. The evo- 
lution of a great quantity of fixed air, or carbonic 
acid gas, was the consequence ; and in these ves- 
sels, when opening the hatchways, such was its con- 
centrated state, that the whole of the crew, in some 
of them, were found dead on the deck. A pilot 
boarded one of them in this condition, and had 
nearly perished himself*." 

10. Chocolate shells. 

11 . Cotton which had been wetted on board of a 
vessel that arrived in New- York, a few years ago, 
from Savannah, in Georgia. 

12. Hemp, flax,„and straw. 

13. The canvas of an old tent. 

14. Old books, and old paper money, that had 
been wetted, and confined in close rooms and clo- 
sets. 

15. The timber of an old house. A fever pro- 
duced by this cause is mentioned by Dr. Haller, in 
his Bibliotheca Medicine. 

* Medicine Nautica, p. 324. 



166 ON THE SOURCES OF 

16. Qreen wood confined in a close cellar during 
the summer months. A fever from this cause was 
once produced in this city, in a family that was at- 
tended by the late Dr. Cadwallader. 

17. The green timber of a new ship. Captain 
Thomas Bell informed me, that in a voyage to the 
East- Indies, in the year 1784, he lost six of his men 
with the scurvy, which he supposed to be derived 
wholly from the foul air emitted by the green tim- 
ber of his ship. The hammocks which were near 
the sides of the ship rotted during the voyage, while 
those which were suspended in the middle of the 
ship, retained their sound and natural state. This 
scurvy has been lately proved by Dr. Claiborne, 
in an ingenious inaugural dissertation, published 
in Philadelphia, in the year 1798, to be a mis- 
placed state of malignant fever. Dr. Lind mentions 
likewise the timber of new ships as one of the 
sources of febrile diseases. The timber of soldiers' 
huts, and of the cabins of men who follow the bu- 
siness of making charcoal in the woods, often pro- 
duce fevers, as soon as the bark begins to rot and 
fall from them, which is generally on the second 
year after they are erected. Fevers have been ex. 
cited even by the exhalation from trees, that have 
been killed by being girdled in an old field. 



SUMMER AND AUTUMNAL DISEASE. 167 

18. The stagnating air of the hold of a ship. 

19. Bilge water. 

20. Water that had long been confined in hogs* 
iieads at sea. 

#1. Stagnating rain water. 

22. The stagnating air of close cellars. 

23. The matters which usually stagnate in the 
gutters, common sewers, docks, and alleys of ci- 
ties, and in the sinks of kitchens. A citizen of 
Philadelphia, who had a sink in his kitchen, lost a 
number of cats and dogs by convulsions. At 
length one of his servants was affected with the 
same disease. This led him to investigate the 
cause of it. He soon traced it to his sink. By 
altering its construction, so as to prevent the es- 
cape of noxious air from it, he destroyed its un- 
wholesome quality, so that all his domestics lived 
in good health in his kitchen afterwards. 

24. Air emitted by agitating foul and stagnating 
water. Dr. Franklin was once infected with an 
intermitting fever from this cause. 



168 ON THE SOURCES OF 

25. A duck pond. The children of a family in 
this city were observed, for several successive 
years, to be affected with a bilious remitting fever. 
The physician of the family, Dr. Phineas Bond, 
observing no other persons to be affected with the 
same fever in the neighbourhood, suspected that 
it arose from some local cause. He examined 
the yard belonging to the house, where he found 
an offensive duck pond. The pond was filled with 
earth, and the family were afterwards free from an 
annual bilious fever. 

26. A hog- stye has been known to produce vio- 
lent bilious fevers throughout a whole neighbour- 
hood in Philadelphia. 

27. Weeds cut down, and exposed to heat and 
moisture near a house. 

Fevers are less frequently produced by putrid 
animal, than by putrid vegetable matters. There 
are, however, instances of their having been gene- ; 
rated by the following animal substances in a state 
of putrefaction. 

1 . Human bodies that have been left unburied 
upon a field of battle. 



SUMMER AND AUTUMNAL DISEASE. 169 

2. Salted beef and pork. 

3. Locusts. 

4. Raw hides confined in stores, and in the holds 
of ships. 

5. A whale thrown upon the sea shore in Hol- 
land. 

6. A large bed of oysters. The malignant fe- 
vers which prevailed in Alexandria, in Virginia, in 
1803, and in South wark, adjoining Philadelphia, 
in the year 1805, were derived from this cause*. 

7. The entrails of fish. And, 

8. Privies. The diarrhoea and dysentery are 
produced, oftener than any other form of sum- 
mer and autumnal disease, by the foe tor of privies. 
During the revolutionary war, an American regi- 

* It has been a common practice with many families, in 
New- York and Philadelphia, for several years past, to lay in 
a winter store of oysters in their cellars in the fall of the 
year. May not a part of these oysters, left in these cellars 
from forgetfulness, or from being unfit for use, become, by 
putrifying there, the cause of malignant fevers in the siufcs 
ceeding summer and autumn ? 

VOL. IV. Y 



170 ON THE SOURCES OF 

ment, consisting of 600 men, were affected with a 
dysentery, from being encamped near a large mass 
of human faeces. The disease was suddenly check- 
ed by removing their encampment to a distance 
from it. Five persons in one family were affected 
with the yellow fever in Philadelphia, in 1805, who 
lived in a house in which a privy in the cellar emit- 
ted a most offensive smell. No one of them had 
been exposed to the foul air of South wark, in which 
the fever chiefly prevailed in the autumn of that 
year. Three of them sickened at the same time, 
which obviated the suspicion of the disease being 
produced by contagion. 

There are several other sources of malignant fe- 
vers besides those which have been mentioned. 
They are, exhalations from volcanoes, wells, and 
springs of water ; also flesh*, fish, and vegetables, 

* The following fact, communicated to me by Mr. Sa- 
muel Lyman, a member of congress from the state of Mas- 
sachusetts, shows the importance of attending to the condi- 
tion of butchers' meat in our attempts to prevent malignant 
fevers. 

A farmer in New-Hampshire, who had overheated a fat 
ox by excessive labour in the time of harvest, perceiving 
him to be indisposed, instantly killed him, and sent his flesh 
to a neighbouring market. Of twenty- four persons who ate 
of this flesh, fifteen died in a few days. The fatal disease 



SUMMER AND AUTUMNAL DISEASE. 171 

eaten in a putrid state ; but these seldom act in 
any country, and two of them only, and that rarely, 
in the United States. 

The usual forms of the disease produced by mi- 
asmata from the sources of them which have been 
enumerated are, 

1. Malignant or bilious yellow fever. 

2. Inflammatory bilious fever. 

3. Mild remittent. 

4. Mild intermittent. 

5. Chronic, or what is called nervous fever. 

6. Febricula. 

7. Dysentery* 

8. Colic. 

9. Cholera morbus. 

produced by this aliment fell, with its chief force, upon the 
stomach and bowels. 



172 ON THE SOURCES OF 

10. Diarrhoea. 

In deriving all the above forms of disease from 
miasmata, I do not mean to insinuate, that sporadic 
cases of each of them are not produced by other 
causes. 

In designating them by a single name, I commit 
no breach upon the ancient nomenclature of medi- 
cine. The gout affects not only the blood-vessels 
and bowels, but every other part of the body, and 
yet no writer has, upon that account, distinguished 
it by a plural epithet. 

The four last of the forms of disease, that have 
been mentioned, have been very properly called in- 
testinal states of fever. They nearly accord, in 
their greater or less degrees of violence and danger, 
with the first four states of fever which occupy the 
blood-vessels, and in the order in which both of 
them have been named. I shall illustrate this re- 
mark by barely mentioning the resemblance of the 
yellow fever to the dysentery, in being attended 
with costiveness in its first stage, from a suspended 
or defective secretion or excretion of bile, and in 
terminating very generally in death, when not met 
by the early use of depleting remedies. 



SUMMER AND AUTUMNAL DISEASE. 173 

The variety in the forms and grades of the sum- 
mer and autumnal disease, in different seasons, and 
their occasional changes into each other in the same 
seasons, are to be sought for in the variety of the 
sensible and insensible qualities of the atmosphere, 
of the course of the winds, and of the aliments of 
different years. 

II. The means of preventing the different forms 
of disease that have been mentioned, come next 
under our consideration. 

Happily for mankind, Heaven has kindly sent 
certain premonitory signs of the most fatal of them. 
These signs appear, 

I. Externally, in certain changes in previous dis- 
eases, in the atmosphere, and in the animal and 
vegetable creation. 

II. In the human body. 

1. The first external premonitory sign that I 
shall mention is, an unusual degree of violence in 
the diseases of the previous year or season. Many 
proofs of the truth of this remark are to be met 
with in the works of Dr. Sydenham. It has been 
confirmed in Philadelphia, in nearly all her malig- 



174 ON THE MEANS OF PREVENTING 

nant fevers since the year 1793. It would seem as 
if great and mortal epidemics, like the planets, had 
satellites revolving round them, for they are not 
only preceded, but accompanied and followed, by 
diseases which appear to reflect back upon them 
some of their malignity. But there is an excep- 
tion to this remark, for we now and then observe 
uncommon and general healthiness, before the ap- 
pearance of a malignant epidemic. This was the 
case in Philadelphia, previously to the fevers of 
1798 and 1799. I have ascribed this to the stimu- 
lus of the pestilential miasmata barely overcoming 
the action of weak diseases, without being power- 
ful enough to excite a malignant fever. 

2. Substances, painted with white lead, and ex- 
posed to the air, suddenly assuming a dark colour; 
and winds from unusual quarters, and unusual and 
long protracted calms, indicate the approach of a 
pestilential disease. The south winds have blown 
upon the city of Philadelphia, ever since 1793, 
more constantly than in former years. A smoki- 
ness or mist in the air, the late Dr. Matthew Wil- 
son has remarked, generally precedes a sickly au- 
tumn in the state of Delaware. 

3. Malignant and mortal epidemics are often pre- 
ceded by uncommon sickness and mortality among 



SUMMER AND AUTUMNAL DISEASE. 175 

certain birds and beasts. They have both appeared, 
chiefly among wild pigeons and cats in the United 
States. The mortality among cats, previous to the 
appearance of epidemics, has been taken notice of in 
other countries. Dr. Willan says, it occurred in 
the city of London, between the 20th of March 
and the 20th of April, in the year 1797, before a 
sickly season, and Dr. Buneiva says it preceded a 
mortal epidemic in Paris. The cats, the doctor 
remarks, lose, on the second day of their disease, 
the power of emitting electrical sparks from their 
backs, and, when thrown from a height, do not, as 
in health, fall upon their feet*. 

4. The common house fly has nearly disappear- 
ed from our cities, moschetoes have been multi- 
plied, and several new insects have appeared, just 
before the prevalence of our late malignant epide- 
mics. 

5. Certain trees have emitted an unusual smell ; 
the leaves of others have fallen prematurely ; sum- 
mer fruits have been less in size, and of an inferior 
quality ; and apples and pears have been knotty, in 
the summers previous to several of our malignant 

* Medical Journal, vol. iv. 



176 ON THE MEANS OF PREVENTING 

■ 

autumnal fevers. Dr. Ambrose Parey says, an un- 
usually rapid growth of mushrooms once preceded 
the plague in Paris. 

II. The premonitory signs of an approaching 
malignant epidemic in the human body are, 

1. A sudden drying up, or breaking out of an 
old sore ; fresh eruptions in different parts of the 
body ; a cessation of a chronic disease, or a conver- 
sion of a periodical into a continual disease. Of 
this there were many instances in Philadelphia, in 
the year 1793. 

2. A peculiar sallowness of the complexion. 
This was observed to be general in Philadelphia, 
previous to the yellow fever of 1793. Dr. Dick 
informed me, that he had observed the same ap- 
pearance in the faces of the people of Alexandria, 
accompanied in some cases with a yellowness of 
the eyes, during the summer of 1793, and previous 
to the appearance of a violent bilious fever on the 
banks of the Potowmac. 



3. I have observed one or more of the following 
symptoms, namely, head-ach ; a decay, or increase 



SUMMER AND AUTUMNAL DISEASE. 177 

of appetite ; costiveness ; a diminished or increased 
secretion of urine -, a hot and offensive breath*; 
constant sweats, and sometimes of a foetid nature, 
or a dry skin ; wakefulness, or a disposition to 
early or protracted sleep ; a preternaturally frequent 
pulse ; unusual vivacity, or depression of spirits ; 
fatigue and sweats from light exertions ; hands, 
when rubbed, emitting a smell like hepar sulphu- 
ris ; and, lastly, a sense of burning in the mouth; 
to be present in different persons, during the pre- 
valence of our malignant epidemics. 



* I have once known this breath, in a gentleman who had 
carried the seeds of the yellow fever in his body from Phi- 
ladelphia into its neighbourhood, create sickness at the sto- 
mach in his wife ; and I have heard of an instance in which 
a person, who left Philadelphia when highly impregnated with 
the miasmata of the same fever, creating sickness at the sto- 
mach in four or five persons who sat at the same table with 
him in the country. None of the above persons were after- 
wards affected by the fever. In an anonymous history of 
the plague in London, in the year 1664, in the possession of 
the author, it is said, the breath was a well-known signal of 
infection to persons who were not infected, and that when- 
ever it was perceived, individuals and companies fled from 
it. The sickness in the above-mentioned persons was simi- 
lar to that which is sometimes excited by the smell of a 
sore leg, or a gun-shot wound, upon the removal of its first 
dressing. It does not produce fever, because there is no 
predisposition to it. 

VOL. IV. Z 



178 ON THE MEANS OF PREVENTING 

The means of preventing the different forms of 
our summer and autumnal disease come next under 
our consideration. I shall first mention such as 
have been most effectual in guarding against its 
malignant form, and afterwards take notice of such 
as are proper in its milder grades. These means 
naturally divide themselves again, „ 

I. Into such as are proper to protect individuals. 

II. Such as are proper to defend whole commu- 
nities from the disease. And, 

III. Such as are proper to exterminate it, by re- 
moving its causes. 

I. Of the means of protecting individuals. 

Where flight is practicable, it should be resorted 
to in every case, to avoid an attack of a malignant 
fever. The heights of Germantown and Darby 
have, for many years, afforded a secure retreat to a 
large number of the citizens of Philadelphia, from 
their late annual epidemics. It were to be wished 
our governments possessed a power of compelling 
our citizens to desert the whole, or parts, of in- 
fected cities and villages. In this way the yellow 
fever was suddenly annihilated in Providence, on 



SUMMER AND AUTUMNAL DISEASE. 179 

Rhode- Island, and in New- Haven, in Connecticut, 
in the year 1805. But the same power should ri- 
gorously prevent the removal of the sick, except it 
be that class of them which have neither homes nor 
friends. The less the distance they are carried 
beyond the infected atmosphere, the better. The 
injury sustained by conveying them in a jolting 
carriage, for two or three miles, has often been pro- 
claimed in the reports of our city hospitals, of pa- 
tients being admitted without a pulse, and dying a 
few hours afterwards; 

In leaving a place infected by miasmata, care 
should be taken not to expose the body to great 
cold, heat, or fatigue, for eighteen or twenty days, 
lest they should excite the dormant seeds of the 
disease into action. 

But where flight is not enforced by law, or where 
it is not practicable, or preferred, safety should be 
sought for in such means as reduce the preternatu- 
ral tone and fulness induced in the blood-vessels 
by the stimulus of the miasmata, and the suppres- 
sion of customary secretions. These are, 

1. A diet, accommodated to the greater or less 
exposure of the body to the action of miasmata, 
and to the greater or less degrees of labour, or ex- 



180 ON THE MEANS OF PREVENTING 

ercise, which are taken. In cases of great expo* 
sure to an infected atmosphere, with but little exer- 
cise, the diet should be simple in its quality, and 
small in its quantity. Fresh meats and wine should 
be avoided. A little salted meat, and Cayenne 
pepper with vegetables, prevent an undue languor 
of the stomach, from the want of its usual cordial 
aliments. The less mortality of the yellow fever 
in the French and Spanish West- India islands than 
in the 'British, has been justly attributed to the 
more temperate habits of the natives of France and 
Spain. The Bramins, who live wholly upon ve- 
getables, escape the malignant fevers of India, while 
whole regiments of Europeans, who eat animal 
food, die in their neighbourhood. The people 
of Minorca, Dr. Cleghorn says, who reside near 
gardens, and live chiefly upon fruit during the sum- 
mer, escape the violent autumnal fever of that 
island. The field negroes of South- Carolina owe 
their exemption from bilious fevers to their living 
chiefly upon vegetables. There is a fact which 
shows, that not only temperance, but abstinence 
bordering upon famine, has afforded a protection 
from malignant fevers. In a letter which I re- 
ceived a few months ago, from the Rev. Thomas 
Hall, chaplain to the British factory at Leghorn, 
containing an account of the yellow fever which 
prevailed in that city, in the summer and autumn 



SUMMER AND AUTUMNAL DISEASE. 181 

of 1804, there is the following communication. 
*f Of the rich, who live in large airy houses, there 
died but four persons with the fever. Of the com- 
modious, who live comfortably, but not affluenuy, 
there died ten. Of the poor, who inhabited small 
and crowded rooms, in the dirty and confined parts 
of the city, there died nearly seven hundred. But 
of the beggars, who had scarcely any thing to eat, 
and who slept half naked every night upon hard 
pavements, not one died." From the reduced and 
exhausted state of the system in these people, they 
were incapable, if I may be allowed the expression, 
of the combustion of fever. Persons reduced by 
chronic diseases, in like manner, often escape such 
as are acute. S/x French ships of the line landed 
300 sick, at St. Domingo, while the yellow fever 
prevailed there in the year 1745, and yet no one of 
them was infected by it*. 

Where the body is exposed to miasmata, and a 
great deal of exercise taken at the same time, 
broths, a little wine, or malt liquors, may be used 
with the fruits and garden vegetables of the season, 
with safety and advantage. The change from a 
full to a low diet should be made gradually. When 
made suddenly, it predisposes to an attack of the 
disease. 

* Desportes, vol. i. p. 140. 



1S2 ON THE MEANS OF PREVENTING 

2. Laxative medicines. Hundreds, perhaps 
thousands, of the citizens of Philadelphia were in- 
debted for their preservation from the yellow fever 
to the occasional use of a calomel pill, a few grains 
of rhubarb, or a table- spoonful of sweet, or castor oil, 
during the prevalence of our late pestilential fevers. 
Even the air of Batavia has been deprived of its 
poisonous quality, by means of this class of medi- 
cines. A citizen of Philadelphia asked a captain 
of a New- England ship, whom he met at that 
island, how he preserved the whole crew of his 
ship in health, while half the sailors of all the other 
ships in the harbour were sick or dead. He in- 
formed him, that it was by giving each of them a 
gentle purge of sulphur every day. 

3. A plentiful perspiration, or moderate sweats, 
kept up by means of warm clothing and bed-clothes. 
The excretion which takes place by the skin, is a 
discharge of the first necessity. I have never 
known an instance of a person's being attacked by 
the yellow fever in whom this discharge was con- 
stant, and equally diffused all over the body. Its 
effects are equally salutary in preventing the plague. 
So well known is this fact, that Mr. Volney informs 
us, in his Travels into Egypt, that the common 
salutation at Cairo, during the prevalence of the 
plague, is, " Do you sweat freely ?" For the pur- 



SUMMER AND AUTUMNAL DISEASE. 183 

pose of promoting this excretion, flannel shirts or 
waistcoats worn next to the skin have been found 
more useful than linen. As the perspiration and 
sweats, which are thus discharged in a pestilential 
season, are often unusual in their quantity, and of 
a morbid quality, clean body-linen or flannel should 
be put on every day, and where this is not practi- 
cable, that which has been worn should be ex- 
changed every morning and evening for that which 
has been exposed during the previous day and 
night, in a dry air. 

4. Blood-letting. In addition to the authorities 
of Dr. Haller and Dr. Hodges, mentioned in ano- 
ther place*, in favour of this remedy, I shall sub- 
join a few others. Dr. Mitchell, in his Account 
of the Yellow Fever which prevailed in Virginia, 
in the year 1741, informs us, that it was often pre- 
vented in persons who were under the influence of 
its remote cause, by the loss of a few ounces of 
blood. It was formerly a practice among the phy- 
sicians in St. Domingo, to bleed whole regiments 
of troops as soon as they arrived from France, by 
which means they were preserved from the malig- 
nant fever of the island. 

* Account of the Yellow Fever in 17y3, vol. iii. 



184 ON THE MEANS OF PREVENTING 

During the short visit paid to this city, in the year 
1798, by Dr. Borland, a respectable physician of the 
British army, he put into my hands the following 
communication. " In the beginning of August, 
" 1797, 109 Dutch artillery arrived at Port au 
" Prince, in the Bangalore transport. The florid 
u appearance of the men, their cumbersome cloth- 
" ing, and the season of the year, seemed all unfa- 
" vourable omens of the melancholy fate we pre- 
" sumed awaited them. It was, however, thought 
" a favourable opportunity, by Dr. Jackson and 
" myself, to try what could be done in warding off 
" the fever. It was accordingly suggested to 
", Monsieur Conturier, the chief surgeon of the 
" foreign troops, and the surgeon of the regiment, 
" that the whole detachment should be blooded 
" freely, and that, the morning after, a dose of phy- 
" sic should be administered to every man. This 
11 was implicitly complied with, a day or two after, 
" and at this moment in which I write, although 
" a period of four months has elapsed, but two of 
u that detachment have died, one of whom was in a 
" dangerous state when he landed. A success un- 
" paralleled during the war in St Domingo ! It is 
" true, several have been attacked with the disease, 
" but in those the symptoms were less violent, and 
" readily subsided by the use of the lancet. 



SUMMER AND AUTUMNAL DISEASE. 185 

" The crew of the Bangalore, on her arrival at 
" Port au Prince, consisted of twenty-eight men. 
" With them no preventive plan was followed. In 
" a very few weeks eight died, and at present, of 
" the original number, but fourteen remain." 

All these depleting remedies, whether used sepa- 
rately or together, induce such an artificial debility 
in the system, as disposes it to vibrate more rea- 
dily under the impression of the miasmata. Thus 
the willow rises, after bowing before a blast of 
wind, while the unyielding oak falls to the ground 
by its side. It is from the similarity of the natural 
weakness in the systems of women, in the West- 
Indies, with that which has been induced by the 
artificial means that have been mentioned, that they 
so generally escape the malignant endemic of the 
islands. 

A second class of preventives of malignant fever 
are such as obviate the internal action of miasmata, 
by exciting a general or partial determination to 
the external surface of the body. These are, 

1. The warm bath. I have known this grateful 
remedy used with success in our city. It serves 
the treble purposes of keeping the skin clean, and 
the pores open, and of defending what are called 

vol. iv. 2 a 



186 ON THE MEANS OF PREVENTING 

the vital organs from disease, by inviting its remote 
cause to the external surface of the body. 

2. The cold bath, or cold water applied to the 
external surface of the body. Ulloa, in his travels 
through Cuba, tells us the Spaniards make it a 
practice, when partially wetted by the rain, to 
plunge themselves, with their wet clothes on, into 
the first stream of water the}* meet with afterwards, 
by which means they avoid taking the fever of the 
island. Where this cannot be conveniently done, 
the peasants strip oil their clothes, and put them 
under a shelter, and receive showers of rain upon 
their naked bodies, and thus preserve themselves 
from the fever. Dr. Baynard has left it upon re- 
cord, in his treatise upon the cold bath, that those 
persons who lived in water-mills, also watermen, 
bargemen, and fishermen, who were employed up- 
on the river, and in dabbling in cold water, were 
rarely affected by the plague in London, in 1665, 
and that but two persons died with it on London 
bridge. The water carriers at Cairo, Mr. Volney 
says, uniformly escape the plague ; and Dr. Chis- 
holm informs us, that those negroes in Demarara 
who go naked, and are thereby disposed not to 
avoid showers of rain, are never affected with the 
fever of that countrv. 



.SUMMER AND AUTUMNAL DISEASE. 187 

3. Washing the body, every morning and eve- 
ning, with salt water. A whole ship's crew from 
Philadelphia was preserved by this means from the 
yellow fever, some years ago, in one of the West- 
India islands, while a large proportion of the crews 
of several ships, that lay in the same harbour, pe- 
rished by that disease. 

4. Anointing the body with oil. The natives 
of Africa, and some American Indians, use this pre- 
ventive with success during their sickly seasons. It 
has lately been used, it is said, with effect in pre- 
venting the plague. Its efficacy for that purpose 
was first suggested by no oilman having died of 
that disease during four years, in which time 
100,000 people perished with it in Egypt. Oliver, 
in his Travels into that country, says the men who 
make and sell butter, are equally fortunate in escap- 
ing it. 

5. Issues, setons, and blisters belong to this class 
of preventives of malignant and bilious fevers. 
Issues, according to Parisinus, Florentinus, Fores- 
tus, and several other authors quoted by Diemer- 
broeck, have prevented the plague in many hundred 
instances. Paraeus says, all who had ulcers from 
the venereal disease, or any other cause, escaped it. 
Dr. Hodges owed his preservation from the plague 



188 ON THE MEANS OF PREVENTING 

in London, in 1665, to an issue in his leg. He 
says he always felt a slight pain in it when he went 
into a sick room. Dr. Gallaher ascribed his 
escape from the yellow fever of 1799 to a perpetual 
blister, which he applied to his arm for that pur- 
pose. Dr. Barton favoured me with the sight of 
a letter from Dr. James Stevens, dated January 12, 
1801, in which he says he believed Dr. Beach 
(formerly of Connecticut) had been preserved from 
the bilious fever by a seton in his side. He adds 
further, that Dr. Beach had been called to attend 
the labourers at the Onandoga salt springs, in the 
state of New- York, ninety-eight of whom out of a 
hundred had the bilious fever. Of the two who 
escaped it, one had a sore leg, the other what 
is called a scald-head. The discharge from the 
sores in each of them, as well as from the doctor's 
issue, was more copious during the prevalence of 
the fever, than it had been at any other time. 

A third class of preventives of malignant fever, 
are such as excite a general action, more powerful 
than that which the miasmata are disposed to cre- 
ate in the system, or an action of a contrary nature. 
These are, 

1. Onions and garlic. All those citizens who 
used these vegetables in their diet, escaped the yel- 



SUMMER AND AUTUMNAL DISEASE. 189 

low fever in 1793. The greater exemption of the 
natives of France from this disease, wherever they 
are exposed to it, than of the inhabitants of other 
European countries, has been ascribed in part to the 
liberal use of those condiments in their food. The 
Jews, it has been said, have often owed to them their 
preservation from the plagues which formerly pre- 
vailed in Europe. It is probable leeks and onions, 
which to this day form a material part of the diet 
of the inhabitants of Egypt, were cultivated and 
eaten originally as the means of obviating the 
plagues of that country. I have been at a loss to 
know why the Author of Nature, who has endowed 
these vegetables with so many excellent qualities 
for diet and medicine, should have accompanied 
them with such a disagreeable smell. Perhaps the 
reason was, kindly to force them into universal use ; 
for it is remarkable their smell in the breath is im- 
perceptible to those who use them. 

2. Calomel, taken in such small doses as gently 
to affect the gums. It preserved most of the 
crew of a Russian ship at Plymouth, in the year 
1777, from a fever generated by filth in her hold. 
In a letter which I received from Captain Thomas 
Truxton, in the year 1797, he informed me, that 
an old and respectable merchant at Batavia had as- 
sured him, he had been preserved in good health 



190 ON THE MEANS OF PREVENTING 

by calomel, taken in the way that has been men- 
tioned, during the sickly seasons, for upwards of 
thirty years. The mortality of the fevers of that 
island may easily be conceived of, when I add, on 
the authority of a physician quoted in Sir George 
Staunton's Account of his Embassy to China, that 
one half of all new comers die there on the first 
year of their arrival. 

Our principal dependence should be placed up- 
on those two preventives under this head. There 
are several others which have been in common use, 
some of which I believe are hurtful, and the rest 
are of feeble, or doubtful efficacy. They are, 

3. Wine and ardent spirits. They both prevent 
a malignant fever, only when they excite an action 
in the system above that which is ordinarily ex- 
cited by the miasmata of the fever ; but this cannot 
be done without producing intoxication, which, to 
be effectual, must be perpetual ; for the weakness 
and excitability, which take place in the intervals 
of drunkenness, predispose to the disease. Agree- 
ably to this remark, I observed three persons, who 
were constantly drunk, survive two of our most 
fatal epidemics, while all those persons who were 
alternately drunk and sober, rarely escaped an at- 



SUMMER AND AUTUMNAL DISEASE. 191 

tack of the fever. In most of them, it terminated 
in death. 

4. Tobacco. Many hundreds of the citizens of 
Philadelphia can witness, that no benefit was de- 
rived from this weed, in any of the ways in which 
it is commonly used, in the late epidemics of our 
city. Mr. Howard says it has no effect in preserv- 
ing from the plague. 

5. Camphor suspended in a bag round the neck, 
and rags wetted in vinegar, and applied to the nose. 
These means were in general use in the fever of 
1793, in Philadelphia, but they afforded no pro- 
tection from it. It is possible .they had a contrary 
effect, by entangling, in their volatile particles, 
more of the miasmata of the fever, and thus in- 
creasing a predisposition to it. 

A fourth class of the preventives of malignant fe- 
vers are certain substances which are said to destroy 
miasmata bv entering into mixture with them. 
Two persons, who were very much exposed to the 
causes of the fever in 1798, took each of them a 
table spoonful of sweet oil every morning. They 
both escaped the fever. Did the oil, in these 
cases, act by destroying miasmata in the stomach 
chemically ? or did it defend the stomach mecha- 



192 ON THE MEANS OF PREVENTING 

nically from their action ?- or did it prevent the dis- 
ease, only by gently opening the bowels? It is 
certain the fat of pork meat protects the men who 
work in the lead-mines of Great-Britain from the 
deleterious effects which the fumes of that metal 
are apt to bring upon the stomach and bowels, and 
that a poisoned arrow, discharged into the side of 
a hog, will not injure him, if it be arrested by the 
fat which lines that part of his body. 

The vapour which issues from fresh earth has 
been supposed to destroy the miasmata which pro- 
duce malignant fevers, by entering into mixture 
with them. Most of the men who were employed 
in digging graves and cellars, and in removing the 
dirt from the streets of Philadelphia, in 1793, 
escaped the fever of that year. In the new settle- 
ments of our country, it is said, the poison of the 
rattlesnake is deprived of its deadly effects upon 
the body, by thrusting the wounded limb into a 
hole, recently made in the earth. The fable of An- 
teus, who rose with renewed strength from the 
ground after repeated falls, was probably intended 
to signify, among other things, the salutary virtues 
which are contained in the effluvia which issue from 
fresh clods of earth. 



, SUMMER AND AUTUMNAL DISEASE. 193 

3. There are many facts which show the effi- 
cacy of the volatile alkali in destroying, by mix- 
ture, the poison of snakes. One of them was 
lately communicated to the public by Dr. Kamsay, 
of South- Carolina. What would be the effect of the 
daily use of a few tea- spoonfuls of this medicine in 
a liquid form, and of frequently washing the body 
with it, during the prevalence of pestilential epi- 
demics? 

The miasmata which produce malignant fevers 
often exist in an inoffensive state in the body, for 
w r eeks, and perhaps months, without doing any 
harm. With but a few exceptions, they seldom 
induce a disease without the reinforcement of an 
exciting cause. In vain, therefore, shall we use 
all the preventives that have been recommended, 
without, 

V. Avoiding of all its exciting causes. These 
are, 

1. Heat and cold. While {he former has excit- 
ed the yellow fever in thousands, the latter has ex- 
cited it in tens of thousands. It is not in middle 
latitudes only that cold awakens this disease in the 
body. Dr. Mosely says it is a more frequent ex- 
citing cause of that, and of other diseases, in the 

VOL. IV. 2 B 



194 ON THE MEANS OF PREVENTING 

island of Jamaica, than in any of the most tempe- 
rate climates of the globe. It is this which renders 
cases of yellow fever, when epidemic in our cities, 
more numerous in the cool months of September 
and October, than in July and August. For the 
purpose of avoiding this pernicious and universal 
influence of cold, the clothing and bed-covers should 
be rather warmer in those months, in middle and 
northern latitudes, than is agreeable, and fires should 
be made every morning and evening in common 
sitting rooms, and during the whole day, when the 
weather is damp or cool. They serve, not only 
to prevent the reduction of the excitement of the 
blood-vessels, by the gradual and imperceptible ab- 
straction of the heat of the body, but to convey up 
a chimney all the unwholesome air that accumulates 
in those rooms during a sickly season. By these 
precautions, I have known whole families preserv- 
ed in health, while all their neighbours who neg- 
lected them, have been confined by a prevailing 
autumnal fever. 

3. The early morning and evening air, even in 
warm weather. 

4. Fatigue from amusements, such as fishing, 
gunning, and dancing, and from unusual labour or 
exercise. The effects of fatigue from this cause 



SUMMER AND AUTUMNAL DISEASE. 195 

have been already noticed*, in the maids of large 
families being the only persons who die of the fe- 
ver, in consequence of their having performed 
great and unusual services to those branches of the 
family who survive them, while nurses, who only 
exercise their ordinary habits in attending sick peo- 
ple, are seldom carried off by it. 

5. Intemperance in eating and drinking. 

6. Partaking of new aliments and drinks. The 
stomach, during the prevalence of malignant fevers, 
is always in an irritable state, and constantly dis- 
posed to be affected by impressions that are not ha- 
bitual to it. 

7. Violent emotions or passions of the mind. 

8. The entire cessation of moderate labour. 
This, by permitting the mind to ramble upon subjects 
of terror and distress, and by exposing the body to 
idleness and company, favours an attack of fever. 
A predisposition to it, is likewise created by alter- 
nating labour and idleness with each other. 

9. The continuance of hard labour. The 
miasmata which produce malignant fevers some- 

* Account of the Yellow Fever in 1793, vol. iii. 



196 ON THE MEANS OF PREVENTING 

times possess so much force, that the least addition 
to it, even from customary acts of labour, is suffi- 
cient to excite the disease. In this case, safety 
should be sought in retirement, more especially by 
those persons whose occupations expose them to 
the heat of fires, and the rays of the sun, such as 
hatters, smiths, bricklayers, and house and ship 
carpenters. The wealthy inhabitants of Constan- 
tinople and Smyrna erroneously suppose they 
escape the contagion of the plague, by shutting 
themselves up in their houses during its preva- 
lence. They owe their preservation chiefly to their 
being removed, by an exemption from care 
and business, from all its exciting causes. Most 
of the nobility and gentry of Moscow, by these 
means escaped a plague which carried off 27,000 
persons in that city, in the year 1771, and many 
whole families in Philadelphia were indebted 
for their safety to the same precautions in the year 
1793. Confinement is more certain in its benefi- 
cial effects, when persons occupy the upper stories 
only of their houses. The inhabitants of St. Lu- 
cia, Dr. Chisholm says, by this means often escape 
the yellow fever of that island. Such is the differ- 
ence between the healthiness of the upper and low- 
er stories of a house, that, travellers tell us, birds 
live in the former, and die in the latter, during the 
prevalence of a plague in the eastern countries. 



SUMMER AND AUTUMNAL DISEASE. 197 

All the exciting causes that have been enume- 
rated should be avoided with double care three days 
before, and three days after, as well as on the days 
of the full and change of the moon. The reason 
for this caution was given in the account of the yel- 
low fever in Philadelphia in the year 1797. 

To persons who have retired from infected ci- 
ties, or countries, it will be necessary to suggest a 
caution, not to visit them while the malignant fever 
from which they fled prevails in them. Dr. Dow 
informed me, in his visit to Philadelphia in the year 
1800, that the natives and old citizens of New- Or- 
leans who retired into the country, and returned 
during the prevalence of the yellow fever in that 
city, the year before, were often affected by it, while 
all such persons as did not change their residence, 
escaped it. The danger from visiting an infected 
city is greater to persons who breathe an atmo- 
sphere of a uniform temperature, than one that is 
subject to alternate changes in its degrees of heat 
and cold. The inhabitants of Mexico, Baron 
Humboldt informed me, who descend from their 
elevated situation, where the thermometer seldom 
varies more than ten degrees in the year, and visit 
Vera Cruz during the prevalence of the yellow fe- 
ver in that city, are much oftener affected by it 
than the new comers from the variable climates of 



1§8 ON THE MEANS OF PREVENTING 

European countries. But the habits of insensibi- 
lity to the impressions of the miasmata of this dis- 
ease in one country, do not always protect the sys- 
tem from their action in another. The same illus- 
trious traveller informed me, that the inhabitants of 
the Havannah who visit Vera Cruz, and the inha- 
bitants of Vera Cruz who visit the Havannah, are 
affected in common with strangers with the fever 
of those places. 

I shall take leave of this part of our subject, by 
adding, that I am so much impressed with a belief 
in the general, and almost necessary connection of 
an exciting cause with a yellow fever, that were I 
to enter a city, and meet its inhabitants under the 
first impressions of terror and distress from its ap- 
pearance, my advice to them should be, "Beware, 
not of contagion, for the yellow fever of our coun- 
try is not contagious, nor of putrid exhalations, 
when the duties of humanity or consanguinity re- 
quire your attendance, but beware of exciting 

CAUSES !" 

In the mild grades of the summer and autumnal 
fevers of the United States, the means of preven- 
tion should be different from those which have 
been recommended to prevent the yellow fever. 
They consist of such things as gently invigorate 



SUMMER AND AUTUMNAL DISEASE. 199 

the system, and thus create an action superior to 
that which the miasmata have excited in it. The 
means commonly employed for this purpose are, 

1. Cordial diet and drinks ; consisting of salted 
meat, and fish, with a moderate quantity of wine 
and malt liquors. Dr. Blane says, the British sol- 
diers who lived upon salt meat, during the Ameri- 
can war, were much less afflicted with the intermit- 
ting fever than the neighbouring country people ; 
and, it is well known, the American army was much 
less afflicted with summer and autumnal fevers, 
after they exchanged their fresh meat for rations of 
salted beef and pork. Ardent spirits should be 
used cautiously, for, when taken long enough to 
do good, they create a dangerous attachment to 
them. A strong infusion of any bitter herb in wa- 
ter, taken upon an empty stomach, is a cheap sub- 
stitute for all the above liquors where they cannot 
be afforded. The Peruvian bark has in many in- 
stances been used with success as a preventive of 
the mild grades of the summer and autumnal fevers 
of our country. 

2. An equable and constant perspiration. This 
should be kept up by all the means formerly men- 
tioned for that purpose. 



200 ON THE MEANS OF PREVENTING 

3. Avoiding certain exciting causes, particularly 
great heat and cold, fatigue, long intervals between 
meals, intemperance, and the morning and evening 
air, more especially during the lunar periods for- 
merly mentioned. Dr. Lind says, the farmers of 
Holdernesse, in England, who go out early to their 
work, are seldom long lived, probably from their 
constitutions being destroyed by frequent attacks 
of intermitting fevers, to which that practice exposes 
them. Where peculiar circumstances of business 
render it necessary for persons to inhale the morn- 
ing air, care should be taken never to do it with- 
out first eating a cordial breakfast. 

The intestinal state of our summer and autumnal 
disease requires several specific means to prevent 
it, different from those which have been advised to 
defend the blood-vessels from fever. Unripe and 
decayed fruit should be avoided, and that which is 
ripe and sound should not be eaten in an excessive 
quantity. Spices, and particularly Cayenne pep- 
per, and the red pepper of our country, should be 
taken daily with food. Mr. Dewar, a British sur- 
geon, tells us, the French soldiers, while in Egypt, 
carried pepper in boxes with them, wherever they 
went, to eat with the fruits of the country, and 
thereby often escaped its diseases. The whole 
diet, during the prevalence of intestinal diseases, 



SUMMER AND AUTUMNAL DISEASE. 201 

when they are not highly inflammatory, should be 
of a cordial nature. A dysentery prevailed, a few 
years ago, upon the Potomac, in a part of the coun- 
try which was inhabited by a number of protestant 
and catholic families. The disease was observed 
to exist only in the former. The latter, who ate 
of salted fish every Friday, and occasionally ©n 
other days of the week, very generally escaped it. 
In the year 1759, a dysentery broke out in the vil- 
lage of Princeton, in New-Jersey, and affected ma- 
ny of the students of the college. It was remark- 
ed, that it passed by all those boys who came from 
the cities of New- York and Philadelphia. This 
was ascribed to their having lived more upon tea 
and coffee than the farmers's sons in the college ; 
for those cordial articles of diet were but rarely 
used, six and forty years ago, in the farm houses 
of the middle states of America. I mentioned for- 
merly that the cordial diet of the inhabitants of our 
cities was probably the reason why the dysentery 
so seldom prevailed as an epidemic in them. 

Another means of preventing the dysentery is, 
by avoiding costiveness, and by occasionally tak- 
ing purging physic, even when the bowels are in 
their natural state. A militia captain, in the Penn- 
sylvania service, preserved his whole company from 
a dysentery which prevailed in a part of the Ame- 

vol. iv. 2 c 



202 ON THE MEANS OF PREVENTING 

rican army at Amboy, in the year 1776, by giving 
each of them a purge of sea- water. He preserved 
his family, and many of his neighbours, some years 
afterwards, from the same disease, by dividing 
among them a few pounds of purging salts. It 
was prevented, a few years ago, in the academy of 
Bordentown, in New- Jersey, by giving all the 
boys molasses, in large quantities, in their diet and 
drinks. The molasses probably acted only by 
keeping the bowels in a laxative state. 

As the dysentery is often excited by the damp- 
ness of the night air, great care should be taken to 
avoid it, and, when necessarily exposed to it, to 
defend the bowels by more warmth than other parts 
of the body. The Egyptians, Mr. Dewar says, 
tie a belt about their bowels for that purpose, and 
with the happiest effects. 

II. I come now, according to theorder I proposed, 
to mention the means of preserving whole cities or 
communities from the influence of those morbid 
exhalations which produce the different forms of 
summer and autumnal disease, and, in particular, 
that which is of a malignant nature. 



SUMMER AND AUTUMNAL DISEASE. 203 

As the flight of a whole city is rarely practicable, 
it will be necessary to point out the means of de- 
stroying the morbid miasmata. 

1. Where the putrid matters which emit them 
are of a small extent, they should be covered with 
water or earth. Purchas tells us, 500 persons less 
died of the plague the day after the Nile overflowed 
the grounds which had emitted the putrid exhala- 
tions that produced it, than had died the day before. 
During the prevalence of a malignant fever, it will 
be unsafe to remove putrid matters. A plague was 
generated by an attempt to remove the filth which 
had accumulated on the banks of the waters which 
surround the city of Mantua, during the sum- 
mer and autumnal months*. Even a shower of 
rain, by disturbing the green pellicle which is some- 
times formed over putrid matters, I shall mention 
in another place, has let loose exhalations that have 
produced a pestilential disease. 

2. Impregnating the air with certain eifluvia, 
which act either by destroying miasmata by means 
of mixture, or by exciting a new action in the sys- 
tem, has, in some instances, checked the progress 
of a malignant fever. The air extricated from fer- 

* Burserus. 



204 ON THE MEANS OF PREVENTING 

meriting wines, during a plentiful vintage, Van- 
sweitcn tells us, has once checked the ravages of a 
plague in Germany. Ambrose Parey informs u$, 
the plague was checked in a city in Italy by killing 
all the cats and dogs in the place, and leaving them 
to putrify in the streets. Mr. Bruce relates, that 
all those persons who lived in smoky houses, in 
one of the countries which he visited, escaped bili- 
ous fevers, and Dr. Clark mentions an instance, in 
which several cooks, who were constantly exposed 
to smoke, escaped a fever which affected the whole 
crew of a galley. The yellow fever has never ap- 
peared within the limits of the effluvia of the sal 
ammoniac manufactory, nor of the tan-pits in the 
suburbs of Philadelphia, nor has the city of Lon- 
don been visited with a plague since its inhabitants 
have used sea-coal for fuel. But other causes 
have contributed more certainly to the exemption 
of that city from the plague for upwards of a cen- 
tury, one of which shall be mentioned under our 
next head. 

3. Desquenette tells us, the infection of the 
plague never crosses the Nile, and that it is arrest- 
ed by means of ditches, dug and filled with water 
for that purpose. Dr. Whitman has remarked, 
that the plague never passes from Abydos, on the 
Turkish, to Mito, on the European side of the wa- 



SUMMER AND AUTUMNAL DISEASE. 205 

ter of the Dardanelles, which forms the entrance to 
Constantinople. The yellow fever has never been 
known to pass from Philadelphia to the Jersey shore, 
and the miasmata generated on the east side of the 
Schuylkill rarely infect the inhabitants of the opposite 
side of the river. Many persons found safety from 
the plague of London, in 1665, by flying to ships 
which lay in the middle of the Thames, and, it is 
well known, no instance of yellow fever occurred 
in those Philadelphia families that confined them- 
selves to ships in the middle of the Delaware, in 
the year 1793. But three or four, of four hun- 
dred men, on board a ship of war called the Jason, 
commanded by captain Coteneuil, perished with an 
epidemic yellow fever, in the year 1746, at St. Do- 
mingo, in consequence, Dr. Desportes says, of her 
hold being constantly half filled with water*. I 
have multiplied facts upon this subject, because 
they lead to important conclusions. They show 
the immense consequence of frequently washing 
the streets and houses of cities, both to prevent 
and check pestilential fevers. What would be the 
effect of placing tubs of fresh water in the rooms 
of patients infected with malignant fevers, and in 
an atmosphere charged with putrid exhalations? 

* Vol. I. p, 161. 



206 ON THE MEANS OF PREVENTING 

Their efficacy in absorbing the matter which con- 
stitutes the odour of fresh paint, favours a hope that 
they would be useful for that purpose. I have 
mentioned an instance, in the Account of the Yel- 
low Fever in Philadelphia, in the year 1797, in 
which they were supposed to have been employed 
with evident advantage. 

4. Intercepting the passage of miasmata to the 
inhabitants of cities. Varro, in his Treatise upoa 
Agriculture, relates, that his namesake Varro, a 
Roman general, was in great danger of suffering, 
with a large fleet and army, from a malignant fever 
at Conyra. Having discovered the course of the 
miasmata which produced it to be from the south, 
he fastened up all the southern windows and doors 
of the houses in which his troops were quartered, 
and opened new ones to the north, by which means 
he preserved them from the fever which prevailed 
in all the other houses of the town and neighbour- 
hood. Mr. Howaru advises keeping the doors 
and windows, of houses which are exposed to the 
plague, constantly shut, except during the time of 
sunshine. 

Several other means have been recommended to 
preserve cities from malignant fevers during their 



SUMMER AND AUTUMNAL DISEASE. 207 

prevalence, which are of doubtful efficacy, or evi- 
dently hurtful. They are, 

5. Strewing lime over putrid matters. Dr. 
Dalzelle says, he once checked a bilious fever, by 
spreading twelve barrels of lime on a piece of 
marshy ground, from whence the exhalations that 
produced it were derived*. A mixture of quick 
lime and ashes in water, when thrown into a 
privy, discharges from it a large quantity of offen- 
sive air, and leaves it afterwards without a smell. 
As this foul air is discharged into the atmosphere, 
it has been doubted whether the lime and ashes 
should be used for that purpose, after a malignant 
fever has made its appearance. 

6. Mr. Quiton Morveau has lately proposed the. 
muriatic gas as a means of destroying miasmata. 
However effectual it may be in destroying the vo- 
latile and foul excretions which are discharged from 
the human body in confined situations, as in filthy 
jails, hospitals, and ships, it is not calculated to 
oppose the seeds of a disease which exist in the at- 
mosphere, and which are diffused over a large ex- 
tent of city or country. Mr. Morveau ascribes 
great virtues to it, in checking the malignant fever 

* Sur les Maladies des Climats Chauds. 



208 ON THE MEANS OF PREVENTING 

in Cadiz, in 1801, but from the time at which it 
was used, being late in the autumn, there is more 
reason to believe it had run its ordinary course, or 
that it was destroyed by cold weather. 

7. The explosion of gunpowder has been re- 
commended for checking pestilential diseases. Mr. 
Quiton Morveau says, it destroys the offensive 
odour of putrid exhalations, but does not act upon 
the fevers produced by them. 

8. Washing the floors of houses with a solution 
of alkaline salts in water, has been recommended 
by Dr. Mitchell, as an antidote to malignant fevers. 
As yet, I believe, there are no facts which establish 
the efficacy of the practice, when they are produced 
by exhalations from decayed vegetable and animal 
substances in a putrid state. 

9. Large fires have sometimes been made in ci- 
ties, in order to destroy the miasmata of pestilential 
diseases. They were obviously hurtful in the 
plague of London, in the year 1665. Dr. Hodges, 
who relates this fact, says, " Heaven wept for the 
mistake of kindling them, and mercifully put them 
out, with showers of rain." 



SUMMER AND AUTUMNAL DISEASE. 209 

I cannot conclude this head, without lamenting 
the want of laws in all our states, to compel physi- 
cians to make public the first cases of malignant 
fever that come under their notice. The cry of 
fire is not more useful to save a city from destruc- 
tion, than the early knowledge of such cases would 
be to save it from the ravages of pestilential and 
mortal epidemics. Hundreds of instances have oc- 
curred, in all ages and countries, in which they 
might have been stifled in their birth, by the means 
that have been mentioned, had this practice been 
adopted. But when, and where, will science, hu- 
manity, and government first combine to accom- 
plish this salutary purpose ? Most of our histories 
of mortal epidemics abound with facts which show 
a contrary disposition and conduct in physicians, 
rulers, and the people. I shall mention one of 
these facts only, to show how far we must tra- 
vel over mountains of prejudice and error, be- 
fore we shall witness that desirable event. It is 
extracted from the second volume of the Life of 
the late Empress of Russia. " The Russian army 
(says the biographer), after defeating the Turks, on 
entering their territories were met by the plague, 
and brought it to their country, where the folly of 
several of their generals contributed to its propaga- 
tioiij as if they thought by a military w T ord of com- 
mand to alter the nature of things. Lieutenant- 

vol. iv. 2d 



210 ON THE MEANS OF PREVENTING 

general Stoffeln, at Yassy, where the pestilence 
raged in the winter of 1770, issued peremptory or- 
ders that its name should not be pronounced ; he 
even obliged the physicians and surgeons to draw 
up a declaration in writing, that it was only a spot- 
ted fever. One honest surgeon of the name of 
Kiuge refused to sign it. In this manner the sea- 
son of prevention was neglected. Several thou- 
sand Russian soldiers were by this means carried 
off. The men fell dead upon the road in heaps. 
The number of burghers that died was never 
known, as they had run into the country, and into 
the forests. At length the havoc of death reached 
the general's own people : he remained true to his 
persuasion, left the town, and went into the more 
perilous camp. But his intrepidity availed him 
nothing ; he died of the plague in July, 1771*." 

III. Let us now consider, in the last place, the 
means of exterminating malignant and other forms 
of summer and autumnal disease, by removing their 
causes. These means are, 

1 . The removal or destruction of all those pu- 
trid matters formerly enumerated, which are capa- 

* The above disease appears to have been the camp fever, 
the origin and character of which will be noticed in the next 
article. 



SUMMER AND AUTUMNAL DISEASE. 211 

ble of producing fevers. Many of the institutions 
of the Jewish nation, for this purpose, are worthy 
of our imitation. The following verses contain a 
fund of useful knowledge upon this subject. — 
" Thou shalt have a place without the carnp, whe- 
ther thou shalt go forth abroad ; and shalt have a 
paddle upon thy weapon, and it shall be when thou 
wilt ease thyself abroad, thou shalt dig therewith, 
and shalt turn back, and cover that which cometh 
from thee ; for the Lord thy God walketh in the 
midst of thy camp to deliver thee, therefore shall 
he see no unclean thing in thee, and turn away 
from thee." Deuteronomy, chapter xxiii. verses 
12, 13, and 14. " But the flesh of the bullock, 
and his skin, and his dung, shalt thou burn with 
fire 'without the campy Exodus, chapter xxxix. 
verse 14. The advantages of thus burying 
and removing all putrid matters, and of burning 
such as were disposed to a speedy putrefaction, in 
a crowded camp, and in a warm climate, are very 
obvious. Their benefits have often been realized 
in other countries. The United Provinces of Hol- 
land hold their exemption from the plague, only by 
the tenure of their cleanliness. In the character 
given by Luther of Pope Julius, he says, " he 
kept the streets of Rome so clean and sweet, that 
there were no plagues nor sicknesses during his 
time." The city of Oxford was prepared to aiford 



212 ON THE MEANS OF PREVENTING 

an asylum to the roval family of Great-Britain 
from the plague, when it ravaged London, and 
other parts of England, in the year 1665, only 
in consequence of its having been cleaned, some 
years before, by the Bishop of Winchester. In a 
manuscript account of the life of Doctor, afterwards 
Governor Col den, of New- York, there is the fol- 
lowing fact. It was first communicated to the 
public in the daily gazette of the capital of that 
state, on the 30th of October, 1799. " A malig- 
nant fever having raged with exceeding violence 
for two summers successively in the city of New r 
York, about forty years ago, he communicated his 
thoughts to the public, on the most probable cure 
of the calamity. He published a little treatise on 
the occasion, in winch he collected the sentiments 
of the best authority, on the bad effects of stagnat- 
ing waters, moist air, damp cellars, filthy shores, 
and dirty streets. He showed how much these 
nuisances prevailed in many parts of the city, and 
pointed out the remedies. The corporation of the 
city voted him their thanks, adopted his reasoning, 
and established a plan for draining and cleaning the 
city, which was attended with the most happy ef- 
fects." The advantages of burning offal matters, 
capable by putrefaction of producing fevers, has 
been demonstrated by those housekeepers, who, 
instead of collecting the entrails of fish and poultry, 



SUMMER AND AUTUMNAL DISEASE. 215 

and the parings and skins of vegetables, in barrels, 
instantly throw them into their kitchen fires. The 
families of such persons are generally healthy. 

2. In the construction of cities, narrow streets 
and alleys should be carefully avoided. Deep lots 
should be reserved for yards and gardens for all the 
houses, and subterraneous passages should be dug 
to convey, when practicable, to running water, the 
contents of privies, and the foul water of kitchens. 
In* cities that are wholly supplied with fresh water 
by pipes from neighbouring springs or rivers, all 
the evils from privies might be prevented by dig- 
ging them so deep as to connect them with water. 
Great advantages, it has been suggested, would 
arise in the construction of cities, from leaving open 
squares, equal in number and size to those which 
are covered with houses. The light and dark 
squares of a chequer-board might serve as models 
for the execution of such a plan. The city of 
London, which had been afflicted nearly every year 
for above half a century by the plague, has never 
been visited by it since the year 1666. In that 
memorable year, while the inhabitants were venting 
their execrations upon a harmless bale of silks im- 
ported from Holland, as the vehicle of the seeds of 
their late mortal epidemic, Heaven kindly pointed 
out, and removed its cause, by permitting a fire to 



214 ON THE MEANS OF PREVENTING 

destroy whole streets and lanes of small wooden 
buildings, which had been die reservoirs of filth 
for centuries, and thereby the sources of all the 
plagues of that city*. Those streets and lanes 
were to London, what Water-street and Farmer's- 
row are to Philadelphia, Fell's-point to Baltimore, 
the slips and docks to New- York, and Water- 
street to the town of Norfolk. 

3. Where the different forms of summer and au- 
tumnal disease arise from marsh exhalations, they 
should be destroyed by drains, by wells communi- 
cating with their subterraneous springs, or by cul- 
tivating upon them certain grasses, which form a 
kind of mat over the soil, and, when none of these 
modes of destroying them is practicable, by over- 
flowing them with water. 

I have met with many excellent quotations from 
a work, upon this part of our subject, by Tozzetti, 
an Italian physician, from which, I have no doubt, 
much useful information might be obtained. The 
Rev. Thomas Hall, to whom I made an unsuccess- 

* A proposal was made to replace the houses that had 
been burnt, by similar buildings, and upon the same space 
of ground. Sir Christopher Wren opposed it, and with the 
following argument : " By so doing, you will show you 
have not deserved the late fire !" 



SUMMER AND AUTUMNAL DISEASE. 215 

ful application for this work, speaks of it, in his 
answer to my letter, in the following terms. 
" It is in such high estimation, that the late empe- 
ror Leopold, when grand duke of Tuscany, caused 
it to be re-printed at his own expence, and present- 
ed it to his friends. The consequence of this was, 
it influenced the owners of low marshy grounds, in 
the neighbourhood of the river Arno, to drain and 
cultivate them, and thereby rendered the abode of 
noxious air, and malignant fevers, a terrestrial pa- 
radise." 

4. The summer and autumnal diseases of our 
country have often followed the erection of mill- 
dams. They may easily be obviated by surround- 
ing those receptacles of water with trees, which 
prevent the sun's acting upon their shores, so as to 
exhale miasmata from them. Trees planted upon 
the sides of creeks and rivers, near a house, serve 
the same salutary purpose. 

5. It has often been observed, that families enjoy 
good health, for many years, in the swamps of De- 
laware and North- Carolina, while they are in their 
natural state, but that sickness always follows the 
action of the rays of the sun upon the moist surface 
of the earth, after they are cleared. For this rea- 
son, the cultivation of a country should always fol- 



216 ON THE MEANS OF PREVENTING 

low the cutting down of its timber, in order to pre- 
vent the new ground becoming, by its exhalations, 
a source of disease. 

6. In commercial cities, no vessel that arrives 
with a cargo of putrescent articles should ever be 
suffered to approach a wharf, before the air that has 
been confined in her hold has been discharged. 
The same thing should be done after the arrival of 
a vessel from a distant or hot country, though her 
cargo be not capable of putrefaction, for air acquires 
a morbid quality by stagnating contiguous to wood, 
under circumstances formerly mentioned. 

All these modes of removing the causes of ma- 
lignant and yellow fevers, and of promoting strict 
and universal cleanliness, are of more consequence 
in the middle and northern states of America, than 
in countries uniformly warm, inasmuch as the dis- 
ease may be taken as often as our inhabitants are 
exposed to its sources. In the West- Indies, a se- 
cond attack of the yellow fever is prevented by the 
insensibility induced upon the system, by its being 
constantly exposed to the impressions of heat and 
exhalation. After a seasoning, as it is called, or 
a residence of two or three years in those islands, 
the miasmata affect the old settlers, as they do the 
natives, onlv with mild remittents. Nearly the 



SUMMER AND AUTUMNAL DISEASE. 217 

same thing takes place at Madras, in the East- In- 
dies, where, Dr. Clark says, the exhalations which 
bring on bilious fevers, colic, cholera, and spasmo- 
dic affections in new comers, produce a puking in 
the morning, only in old residents. But very difw 
ferent is the condition of the inhabitants of the mid- 
dle and northern states of America, in whom the 
winters prevent the acquisition of habits of insensi- 
bility to the heat and exhalations of the previous 
summers, and thus place them every year in the 
condition of new comers in the West and East- 
Indies, or of persons who have spent two or three 
years in a cold climate. This circumstance in- 
creases the danger of depopulation from our malig- 
nant epidemics, and should produce corresponding 
exertions to prevent them. 

In enumerating the various means of preventing 
and exterminating the malignant forms of fever, it 
may appear strange that I have said nothing of the 
efficacy of quarantines for that purpose. Did I be- 
lieve these pages would be read only by the citi- 
zens of Pennsylvania, I would do homage to their 
prejudices, by passing over this subject by a res- 
pectful and melancholy silence ; but as it is proba- 
ble they will fall into the hands of physicians and 
citizens of other states, I feel myself under an obli- 
gation to declare, that I believe quarantines are of no 

tol. iv. 2e 



^ . 



218 ON THE MEANS OF PREVENTING 

efficacy in preventing the yellow fever, in any other 
way than by excluding the unwholesome air that is 
generated in the holds of ships, which may be done 
as easily in a single day, as in weeks or months. 
They originated in error, and have been kept up 
by a supine and traditional faith in the opinions 
and conduct of our ancestors in medicine. Mil- 
lions of dollars have been wasted by them. From 
their influence, the commerce, agriculture, and ma- 
nufactures of our country have suffered for many 
years. But this is not all. Thousands of lives 
have been sacrificed, by that faith in their efficacy, 
which has led to the neglect of domestic cleanliness. 
Distressing as these evils are, still greater have ori- 
ginated from them ; for a belief in the contagious 
nature of the yellow fever, which is so solemnly en- 
forced by the execution of quarantine laws, has de- 
moralized our citizens. It has, in many instances, 
extinguished friendship, annihilated religion, and 
violated the sacraments of nature, by resisting even 
the loud and vehement cries of filial and parental 
blood. 

While I thus deny the yellow fever to be the 
offspring of a specific contagion, and of course in- 
capable of being imported so as to become an epi- 
demic in any country, I shall admit presently, that 
the excretions of a patient in this disease may, by 



SUMMER AND AUTUMNAL DISEASE. 219 

eonfinement, become so acrid as to produce, under 
circumstances to be mentioned hereafter, a similar 
disease in a person, but from this person it cannot 
be communicated, if he possess only the common 
advantages of pure air and cleanliness. To enforce 
a quarantine law, therefore, under such a contin- 
gent circumstance, and at the expence of such a 
profusion of blessings as have been mentioned, is to 
imitate the conduct of the man, who, in attempting 
to kill a fly upon his child's forehead, knocked out 
its brains. 

From the detail that has been given of the sources 
of malignant fevers, and of the means of preventing 
them, it is evident that they do not exist by an un- 
changeable law of nature, and that Heaven has sur- 
rendered every part of the globe to man, in a state 
capable of being inhabited, and enjoyed. The facts 
that have been mentioned show further, the con- 
nection of health and longevity, with the reason and 
labour of man. 

To every natural evil the Author of Nature has 
kindly prepared an antidote. Pestilential fevers 
furnish no exception to this remark. The means 
of preventing them are as much under the power 
of human reason and industry, as the means of 
preventing the evils of lightning and common fire. 



220 ON THE MEANS OF PREVENTING, &C. 

I am so satisfied of the truth of this opinion, that 
I look for a time when our courts of law shall 
punish cities and villages, for permitting any of the 
sources of bilious and malignant fevers to exist 
within their jurisdiction. 

I have repeatedly asserted the yellow fever of the 
United States not to be contagious. I shall now 
mention the proofs of that assertion, and endeavour 
to explain instances of its supposed contagion upon 
other principles. 



FACTS, 



INTENDED TO PROVE 



THE TELLOW FEVER 



NOT TO BE CONTAGIOUS. 



FACTS, &c. 



WHEN fevers are communicated from one 
person to another, it is always in one of the follow- 
ing ways. 1. By secreted matters. 2. By excreted 
matters. The small-pox and measles are commu- 
nicated in the former way ; the jail, or, as it is some- 
times called, the ship, or camp, and hospital fever, 
is communicated only by means of the excretions of 
the body. The perspiration, by acquiring a morbid 
and irritating quality more readily than any other 
excretion, in consequence of its stagnation and con- 
finement to the body in a tedious jail fever, is the 
principal means of its propagation. The perspira- 
tion* is, moreover, predisposed to acquire this mor- 

* The deleterious nature of this fluid, and its disposition 
to create disease, under the above circumstances, has been 
happily illustrated by Dr. Mitchill, in an ingenious letter to 
Dr. Duncan, of Edinburgh, published in the fourth volume 
of the Annals of Medicine. 



224 YELLOW FEVER NOT CONTAGIOUS. 

bid and acrid quality by the filthiness, scanty, or 
bad aliment, and depression of mind, which gene- 
rally precede that fever. It is confined to sailors, 
passengers, soldiers, prisoners, and patients, in 
foul and crowded ships, tents, jails, and hospitals, 
and to poor people who live in small, damp, and 
confined houses. It prevails chiefly in cool and 
cold weather, but is never epidemic ; for the 
excreted matters which produce the fever do 
not float in the external atmosphere, nor are they 
communicated, so as to produce disease, more than 
a few feet from the persons who exhale them. 
They are sometimes communicated by means of 
the clothes which have been worn by the sick, and 
there have been instances in which the fever has 
been produced by persons who had not been con- 
fined by it, but who had previously been exposed 
to all the causes which generate it. It has been 
but little known in the United States since the re- 
volutionary war, at which time it prevailed with great 
mortality in the hospitals and camps of the Ameri- 
can army. It has now and then appeared in ships 
that were crowded with passengers from different 
parts of Europe. It is a common disease in the 
manufacturing towns of Great- Britain, where it has 
been the subject of several valuable publications, 
particularly by Dr. . Smith and Dr. John Hunter. 
Dr. Hay garth has likewise written upon it, but he 



YELLOW FEVER WOT CONTAGIOUS. 225 

has unfortunately confounded it with the West- 
India and American yellow fever, which differs 
from it in prevailing chiefly in warm climates and 
seasons ; in being the offspring of dead and putrid 
vegetable and animal matters ; in affecting chiefly 
young and robust habits ; in being generally ac- 
companied with a diseased state of the stomach, 
and an obstruction or preternatural secretion and 
excretion of bile ; in terminating, most commonly, 
within seven days ; in becoming epidemic only by 
means of an impure atmosphere ; and in noi fur- 
nishing ordinarily those excretions which, when re- 
ceived into other bodies, re-produce the same dis- 
ease. 

I have been compelled to employ this tedious 
description of two forms of fever, widely different 
from each other in their causes, symptoms, and 
duration, from the want of two words which shall 
designate them. Dr. Miller has boldly and inge- 
niously proposed to remedy this deficiency in our 
language, by calling the former idio-miasmatic, and 
the latter koino-miasmatic fevers, therebv denoting 
their private or personal, and their public or com- 
mon origin- . My best wishes attend the adoption 
of those terms ! 

* Medical Repository, hexade ii. vol. i. 
VOL. IV. . 2 F 



226 YELLOW FEVER NOT CONTAGIOUS. 

I return to remark, that the yellow fever is not. 
contagious in its simple state, and that it spreads 
exclusively by means of exhalations from putrid 
matters, which are diffused in the air. This is evi- 
dent from the following considerations: 

1. It does not spread by contagion in the West- 
Indies. This has been proved in the most satis- 
factory manner by Drs. Hillary, Huck, Hunter, 
Hector M'Lean, Clark, Jackson, Borland, Pinck- 
ard, and Scott. Dr. Chisholm stands alone, among 
modern physicians, in maintaining a contrary opi- 
nion. It would be easy to prove, from many pas- 
sages in the late edition of the doctor's learned and 
instructive volumes, that he has been mistaken ; 
and that the disease was an endemic of every island 
in which he supposed it to be derived from conta- 
gion. A just idea of the great incorrectness of all 
his statements, in favour of his opinion, may be 
formed from the letter of J. F. Eckard, Esq. Da- 
nish consul, in Philadelphia, to Dr. James Mease, 
published in a late number of the New- York Me- 
dical Repository*. 

* For February, March, and April, 1$04. 



YELLOW FEVER NOT CONTAGIOUS. 227 

2. The yellow fever does not spread in the coun- 
try, when carried thither from the cities of the 
United States. 

3. It does not spread in yellow fever hospitals, 
when they are situated beyond the influence of the 
impure air in which it is generated. 

4. It does not spread in cities (as will appear 
hereafter) from any specific matter emitted from 
the bodies of sick people. 

5. It generally requires the co-operation of an 
exciting cause, with miasmata, to produce it. 
This is never the case with diseases which are uni- 
versally acknowledged to be contagious. 

6. It is not propagated by the artificial means 
which propagate contagious diseases. Dr. Ffirth 
inoculated himself above twenty times, in different 
parts of his body, with the black matter discharged 
from the stomachs of patients in the yellow fever, 
and several times with the serum of the blood, and 
the saliva of patients ill with that disease, without 
being infected by them ; nor was he indisposed 
after swallowing half an ounce of the black matter 
recently ejected from the stomach, nor by exposing 
himself to the vapour which was produced by 



228 YELLOW FEVER NOT CONTAGIOUS. 

throwing a quantity of that matter upon iron heated 
over a fire*. 

To the first four of these assertions there are 
some seeming exceptions in favour of the propaga- 
tion of this fever by contagion. I shall briefly 
mention them, and endeavour to explain them up- 
on other principles. 

The circumstances which seem to favour the 
communication of the yellow fever from one person 
to another, by means of what has been supposed to 
be contagion, are as follow : 

1. A patient being attended in a small, filthy, and 
close room. The excretions of the body, when thus 
accumulated, undergo an additional putrefactive pro- 
cess, and acquire the same properties as those putrid 
animal matters which are known to produce malig- 
nant fevers. I have heard of two or three instances 
in which a fever was produced by these means in 
the country, remote from the place where it origi- 
nated, as well as from every external source of pu- 
trid exhalation. The plague is sometimes propa- 
gated in this way in the low and filthy huts which 

* Inaugural Dissertation on Malignant Fever, Sec. pub- 
lished in June, 1804. 



YELLOW FEVER NOT CONTAGIOUS. 229 

compose the alleys and narrow streets of Cairo, 
Smyrna, and Constantinople. 

2. A person sleeping in the sheets, or upon a bed 
impregnated with the sweats or other excretions, or 
being exposed to the smell of the foul linen, or other 
clothing of persons who had the yellow fever. 
The disease here, as in the former case, is commu- 
nicated in the same way as from any other putrid 
animal matters. It was once received in Philadel- 
phia from the effluvia of a chest of unwashed clothes, 
which had belonged to one of our citizens who had 
died with it in Barbadoes ; but it extended no fur- 
ther in a large family than to the person who open- 
ed the chest. I have heard of but two instances 
more of its having been propagated by these means 
in the United States, in which case the disease pe- 
rished with the unfortunate subjects of it. 

To the above insolated cases of the yellow fever 
being produced by the clothing of persons who had 
died of it, I shall oppose a fact communicated to 
me by Dr. Mease. While the doctor resided at 
the lazaretto, as inspector of sickly vessels, be- 
tween May, 1794, and the same month in 1798, 
the clothing contained in the chests and trunks of 
all the seamen and others, belonging to Philadel- 
phia, who had died of the yellow fever in the West- 



230 YELLOW FEVER NOT CONTAGIOUS. 

Indies, or on their passage home, and the linen of 
all the persons who had been sent from the city 
to the lazaretto with that disease, amounting in all 
to more than one hundred, were opened, exposed 
to the air, and washed, by the family of the steward 
of the hospital, and yet no one of them contracted 
the least indisposition from them. 

I am disposed to believe the linen, or any other 
clothing of a person in good health that had been 
strongly impregnated with sweats, and afterwards 
suffered to putrify in a confined place, would be 
more apt to produce a yellow fever in a summer or 
autumnal month, than the linen of a person who had 
died of that disease, with the usual absence of a 
moisture on the skin. The changes which the 
healthy excretions by the pores undergo by pu- 
trefaction, may easily be conceived, by recollecting 
the offensive smell which a pocket-handkerchief ac- 
quires that has been used for two or three days to 
wipe away the sweat of the face and hands in warm 
weather*. 

3. The protraction of a yellow fever to such a 
period as to dispose it to assume the symptoms, and 
to generate the peculiar and highly volatilised ex- 

* See Van Swieten on Epidemic Diseases, Aphorism 1408. 



YELLOW FEVER NOT CONTAGIOUS. 231 

halation from the pores of the skin which takes 
place in the jail fever. I am happy in finding I am 
not the author of this opinion. Sir John Pringle, 
Dr. Monro, and Dr. Hillary, speak of a contagious 
fever produced by the combined action of marsh 
and human miasmata. The first of those physicians 
supposes the Hungarian bilious fever, which prevail- 
ed over the continent of Europe in the seventeenth 
century, was sometimes propagated in this way, as 
well as by marsh and other putrid exhalations. 
Dr. Richard Pearson, in his observations upon the 
bilious fevers which prevailed in the neighbourhood 
of Birmingham, in England, in the years 1797, 
1798, and 1799, has the folllowing remark : " In 
its first stage, this fever did not appear to be conta- 
gious, but it evidently was so after the eleventh and 
fourteenth day, when the typhoid state was in- 
duced*." As this protracted state of bilious fever 
rarely occurs in our country, it has seldom been 
communicated in this way. 

It is not peculiar, I believe, to a bilious and yel- 
low fever, when much protracted beyond its ordi- 
nary duration, to put on the symptoms of the jail 
fever. The same appearances occur in the pleurisy, 

"*Page 13. 



232 YELLOW FEVER NOT CONTAGIOUS. 

and in other, of what Dr. Sydenham calls intercur- 
rent fevers, all of which I have no doubt, under cer- 
tain circumstances of filth, confinement, and long du- 
ration, would produce a fever in persons who were 
exposed to it. This fever, if the weather were 
cold, would probably put on inflammatory symp- 
toms, and be added, in our nosologies, to the class 
of contagious diseases. 

From the necessary influence of time, in thus 
rendering fevers of all kinds now and then conta- 
gious by excretion, it follows, that the yellow fever, 
when of its usual short duration, is incapable of 
generating that excretion, and that, instead of be- 
ins: considered as the onlv form of bilious fever that 
possesses a power of propagating itself, it should 
be considered as the only one that is devoid of it. 

4. Miasmata, whether from marshes, or other 
external sources, acting upon a system previously 
impregnated with the excreted matters which pro- 
duce the jail or ship fever. Mr. Lempriere informs 
us, that he saw what were supposed to be cases of 
yellow fever communicated by some sailors who 
brought the seeds of the ship fever with them to 
the island of Jamaica. The fevers which affected 
most of the crews of the Hussar frigate, mentioned 



YELLOW FEVER NOT CONTAGIOUS. 233 

by Dr. Trotter*, and of the Busbridge Indiaman, 
described by Mr. Brycef , appear to have been the 
effect of the combined operation of foul air in those 
ships, and human excretions, upon their systems. 
The disease was barely tinged with bilious symp- 
toms, and hence the facility with which it was cured, 
for the jail fever more readily yields to medicine 
than the yellow fever. The former was probably 
excited by some latent exhalation from dead mat- 
ters in the holds of the ships, and hence we find it 
ceased on shore, where it was deprived of its ex- 
citing cause. It is true, great pains were taken to 
clean the hold and decks of the Busbridge, but 
there are foul matters which adhere to the timbers 
of ships, and which, according to Dr. Lind, are 
sometimes generated by those timbers when new, 
that are not to be destroyed by any of the common 
means employed for that purpose. Of this Dr. 
Kollock has furnished us with a most satisfactory 
proof, in his history of the yellow fever, which 
prevailed on board of the frigate General Greene, 
on her voyage to the Havanna, in the year 1799. 
" The air in the hold of the vessel (says the doctor) 
was so contaminated, as to extinguish lights imme- 

* Medicina Nautica, p. 360. 

t Annals of Medicine, vol. i. p. 116. 
VOL. IV. 2 G 



234 YELLOW FEVER NOT CONTAGIOUS. 

diately, and candles in the cockpit were almost as 
useless from the same cause. The fish were thrown 
overboard, and the decks washed and scoured, the 
ventilator and wind sails put in motion, and every 
measure of purification adopted that their situation 
allowed ; notwithstanding these precautions disease 
invaded us. The men were unceasing in their 
exertions to purify the ship ; washing, scouring 
with vinegar, burning powder and vinegar, old 
junk, and sulphur, added to constant ventilation, 
proved unequal even to the amelioration of their 
calamities, while they were in the latitude of great 
heat. After the removal of the sick, the ship was 
disburthened of her stores, ballast, 8cc. cleansed 
and white- washed throughout ; still new eases oc- 
curred for nearly two months. Some days, two, 
three, or four were sent off to the hospital, which 
would seem to indicate the retention of some por- 
tion of this noxious principle, which was lodged 
beyond the reach of the cleansing process." That 
this noxious principle or matter existed in the ship, 
and not in the bodies of the crew, is evident from 
its not having been communicated, in a single in- 
stance, by a hundred of them who were sent to an 
hospital on Rhode- Island, notwithstanding an inter- 
course sufficient to propagate it was necessarily 



YELLOW FEVER NOT CONTAGIOUS. 235 

kept up with the inhabitants. Even their nurses 
did not take it*. 

5. A fifth instance in which contagion has been 
supposed to take place in the yellow fever is, where 
the exhalation from the excretions of a patient in 
that disease acts as an exciting cause, in persons 
previously impregnated with the marsh, or other 
external miasmata, which produce it. The acti- 
vity of this exhalation, even when it is attended 
with no smell, is so great, as to induce sickness, 
head-ach, vertigo, and fainting. It is not peculiar 
to the exhalations from such patients to produce 
morbid effects upon persons who visit them. The 
odour emitted by persons in the confluent small- 
pox has been known to produce the same symp- 
toms, together with a subsequent fever and apthous 
sore throat. This has been remarked long ago by 
Dr. Lind, and latterly by Dr. Willan, in his Re- 
ports of the Diseases of Londonf. That the yellow 
fever is often excited in this way, without the inter- 
vention of a supposed specific contagion, I infer 
from its sometimes spreading through whole fami- 
lies, who have breathed the same impure atmo- 
sphere with the person first infected by the fever. 

* Medical Repository, vol. iv. No. 1. 
f- Page 13 and 113. 



236 YELLOW FEVER NOT CONTAGIOUS. 

This is more especially the case where the impres- 
sion made by the exhalation from the sick person 
is assisted by fear, fatigue, or anxiety of mind in 
other branches of the family. In favour of this 
mode of exciting the yellow fever, Dr. Otto com- 
municated to me the following fact. In the au- 
tumn of the year 1798, it prevailed upon the shores 
of the Delaware, in Gloucester county, in New- 
Jersey. A mild remittent prevailed at the same 
time on the high grounds, a few miles from the 
river. During this time, the doctor observed, if a 
person who had inhaled the seeds of the yellow fe- 
ver in Philadelphia afterwards came into a family 
near the river, the same disease appeared in several 
instances in one or more branches of that family ; 
but where persons brought the fever from the city, 
and went into a family on the high grounds, where 
the mild remittents prevailed, there was not a sin- 
gle instance of a yellow fever being excited by them 
in any of its members. This fact is important, 
and of extensive application. It places the stimu- 
lus from the breath, or other exhalations of persons 
affected by the yellow fever, upon a footing with 
intemperance, fatigue, heat, and all the common 
exciting causes of the disease ; none of which, it is 
well known, can produce it, except in persons who 
have previously inhaled the putrid miasmata, which 
in all countries are its only remote cause. The 



YELLOW FEVER NOT CONTAGIOUS. 237 

city of Philadelphia has furnished, in all our yellow 
fever years, many additional proofs of the correct- 
ness of Dr. Otto's remark. In the months of July 
and August, when miasmata are generally local, 
and float chiefly near to their hot beds, the docks 
and holds of ships, persons who are affected by 
these miasmata, and sicken in other parts of the 
city, never communicate the disease ; but after the 
less prepared and heterogeneous filth of our whole 
city has been acted on by an autumnal, as well 
as summer sun, so as to emit pestilential exhala- 
tions into all our streets and alleys, the fever is now 
and then excited in the manner that has been men- 
tioned, by a single person in a whole family. The 
common intermittents of the southern states are 
often excited in the same way, without being sus- 
pected of spreading by contagion. Even the jail 
or hospital fever is vindicated by Dr. Hunter from 
the highly contagious nature which has been as- 
cribed to it, upon the same principle. His words, 
which are directly to my purpose, are as follow : 
cc In considering the extent and power of the con- 
tagion [meaning of the jail or hospital fever], I am 
not inclined to impute to this cause the fevers of 
all those who are taken ill in one family after the 
first, as they are all along exposed to the same vi- 
tiated air which occasions the first fever. In like 
manner, when a poor woman visits some of her 



238 YELLOW FEVER NOT CONTAGIOUS. 

sick neighbours, and is taken ill herself, and after- 
wards some of her children, I would not impute the 
disease to infection alone ; she and her family hav- 
ing previously lived in the same kind of vitiated air 
which originally produced the fever. If the cases 
in which the infection meets with the poison al- 
ready half formed be excepted, the disease in itself 
will be found to be much less infectious than has 
been commonly supposed*." By the modes of 
communicating the yellow fever which have been 
admitted, the dysentery, and all the milder forms of 
autumnal fevers, have been occasionally propagated, 
and perhaps oftener than the first- named disease, 
from their being more apt to run on to the typhus or 
chronic state. Of this I could adduce many proofs, 
not only from books, but from my own observa- 
tions ; but none of these diseases spread by conta- 
gion, or become epidemic from that cause in any 
country. A contrary opinion, I know, is held by 
Dr. Cleghorn, and Dr. Clarke ; but they have de- 
ceived themselves, as they formerly deceived me, 
by not attending to the difference between secreted 
contagions and morbid excretions from the body, 
produced by the causes which have been enumer- 
ated, and which are rare and accidental concomi- 
tants of bilious or summer diseases. 

* Medical Transactions, vol. iii- p. 351. 



BELLOW FEVER NOT CONTAGIOUS. 239 

6. The last instance of supposed contagion of 
the yellow fever is said to arise from the effluvia of 
a putrid body that has died of that disease. The 
effluvia in this case act either as the putrified ex- 
cretions mentioned under the first head, or as an 
exciting cause upon miasmata, previously received 
into the system. A dead body, in a state of putre- 
faction from any other disease, would produce, un- 
der the same circumstances of season and predispo- 
sition, the same kind and degrees of fever. 

The similarity of the fever induced by the means 
that have been enumerated, with the fever from 
which it was derived, has been supposed to favour 
the opinion of its being communicated by a speci- 
fic contagion. But let it be recollected that the 
yellow fever is, at the time of its being supposed 
to be thus received, the reigning epidemic, and 
that irritants of all kinds necessarily produce that 
disease. The morbid sweats which now and then 
produce an intermitting fever, and the alvine ex- 
cretions which occasionally produce a dysentery, 
act only by exciting morbid actions in the system, 
which conform in their symptoms to an immutable 
and universal law of epidemics. It is only when 
those two diseases generally prevail, that they seem 
to produce each other. 



240 YELLOW FEVER NOT CONTAGIOUS. 

Thus have I explained all the supposed cases of 
f ontagion of the yellow fever. To infer from the 
solitary instances of it thus excited, is to reason as 
incorrectly as to say the small-pox is not contagious, 
because we now and then meet with persons whe 
cannot be infected by it. 

From the explanation that has been given of the 
instances of supposed contagion of the yellow fe- 
ver, we are compelled to resort to certain noxious 
qualities in the atmosphere, as the exclusive causes 
of the prevalence, not only of that fever, but (with 
a few exceptions) of all other epidemic diseases. 
It is true, we are as yet ignorant of the precise 
nature of those qualities in the air which produce 
epidemics ; but their effects are as certainly felt by 
the human body as the effects of heat, and yet who 
knows the nature of that great and universal prin- 
ciple of activity in our globe ? 

That the yellow fever is propagated by means of 
an impure atmosphere, at all times, and in all places, 
I infer from the following facts : 

1. It appears only in those climates and seasons 
of the year in which heat, acting upon moist ani- 
mal and vegetable matters, fills the air with their 
putrid exhalations. A vertical sun, pouring its 



YELLOW FEVER NOT CONTAGIOUS. 241 

beams for ages upon a dry soil ; and swamps, de- 
fended from the influence of the sun by extensive 
forests, have not, in a single instance, produced 
this disease. 

2. It is unknown in places where a connection 
is not perceptible between it, and marshes, mill- 
ponds, docks, gutters, sinks, unventilated ships, 
and other sources of noxious air. The truth of 
this remark is established by the testimonies of 
Dr. Lind and Dr. Chisholm, and by many facts in 
Lempriere's excellent History of the Diseases of 
Jamaica. Dr. Davidson furnished me with a strik- 
ing confirmation of their remarks, in the following 
extract from a letter, dated November 12th, 1794. 
" I have mentioned (says the doctor) an instance 
of the remarkable good health which the 66th re- 
giment enjoyed at St. Vincents for several years, 
upon a high hill above the town, removed from all 
exhalations, and in a situation kept at all times cool 
by the blowing of a constant trade wind. They 
did not lose, during eighteen months, above two 
or three men (the regiment -was completed to the 
peace establishment), and during eight years they 
lost but two officers, one of whom, the quarter- 
master, resided constantly in town, and died from 
over fatigue ; the other arrived very ill from An- 
tigua, and died within a few days afterwards." 

vol. iv. 2 h 



242 YELLOW FEVER NOT CONTAGIOUS. 

In the United States, no advocate for the speci- 
fic nature or importation of the yellow fever, has 
ever been able to discover a single case of it beyond 
the influence of an atmosphere rendered impure by 
putrid exhalations. 

It is no objection to the truth of this remark, 
that malignant bilious fevers sometimes appear up- 
on the summits of hills, while their declivities, and 
the vallies below, are exempted from them. The 
miasmata, in all these cases, are arrested by those 
heights, and are always to be traced to putrefaction 
and exhalation in their neighbourhood. Nor is it 
any objection to the indissoluble connection be- 
tween putrid exhalations and the yellow fever, 
which has been mentioned, that the disease some- 
times appears in places remote from the source of 
miasmata in time and place. The bilious pleuri- 
sies, which occur in the winter and spring, after a 
sickly autumn, prove that they are retained in th§ 
body for many months, and although they are 
sometimes limited in their extent to a single house, 
and often to a village, a city, and the banks of a 
creek or river, yet they are now and then carried 
to a much greater distance. Mr. Lempriere, in 
his valuable Observations upon the Diseases of the 
British Army in Jamaica, informs us, that Kings- 
ton is sometimes rendered sickly by exhalations 



YELLOW FEVER NOT CONTAGIOUS. 243 

from a lagoon, which lies ?iine miles to the east- 
ward of that town*. The greater or less distance, 
to which miasmata are carried from the place 
where they are generated, appears to depend upon 
their quantity, upon the force and duration of cur- 
rents of wind which act upon them, and upon their 
being more or less opposed by rivers, woods, wa- 
ter, houses, wells, or mountains. 

3. It is destroyed, like its fraternal diseases, the 
common bilious and intermitting fevers, by means 
of long- continued and heavy rainsf . When rains 
are heavy, but of short duration, they suspend it 
only in warm weather ; but when they are suc- 
ceeded by cold weather, they destroy all the forms 
of bilious fever. The malignant tertians, described 
by Dr. Cleghorn, always ceased about the autum- 
nal equinox ; for at that time, says the doctor, 
" Rain falls in such torrents as to tear up trees by 
the roots, carry away cattle, break down fences, 
and do considerable mischief to the gardens and 
vineyards ; but, after a long and scorching sum- 
mer, they are very acceptable and beneficial, for 
they mitigate the excessive heat of the air, and give 

* Vol. i. p. 84. 

t Clarke on the Diseases of Long Voyages to Hot Cli- 
mates, p. 116. 



244 YELLOW FEVER NOT CONTAGIOUS. 

a check to epidemical diseases*." There are facts, 
however, which would seem to contradict- the as- 
sertion that miasmata are suspended or destroyed 
by heavy rains. Dr. Lind, in his Treatise upon 
the Diseases of Hot Climates, mentions instances 
in which they suddenly created fevers. It is proba- 
ble, in these cases the rains may have had that effect, 
by disturbing the pellicle which time often throws 
over the surface of stagnating pools of water, and 
putrid matters on dry land. I was led to entertain 
this opinion by a fact mentioned in a letter I re- 
ceived from Dr. Davidson, dated November 4th, 
1794. " Being ordered (says the doctor) up to 
Barbadoes, last November, upon service, I found 
that the troops had suffered considerably by that 
formidable scourge, the yellow fever. The season 
had been remarkably dry. It was observed, a rainy 
season contributed to make the season healthier, 
excepting at Constitution- Hill, where the sixth re- 
giment was stationed, and where a heavy shower 
of rain seldom failed to bring back the fever, after 
it had ceased for some time. I found the barrack, 
where this regiment was, surrounded by a pond of 
brackish water, which, being but imperfectly drain- 
ed by the continuance of the drought, the surface 
was covered with a green scum, which prevented 

* Diseases of Minorca, p. 8. 



YELLOW FEVER NOT CONTAGIOUS. 245 

the exhalation of marshy putrefaction. After a 
heavy shower of rain, this scum was broken, and 
the miasmata evolved, and acted with double force, 
according to the time of their secretion,' ' 

4. It is completely destroyed by frost. As 
neither rains nor frosts act in sick rooms, nor af- 
fect the bodies of sick people, they must annihilate 
the disease by acting exclusively upon the atmo- 
sphere. Very different in their nature are the 
small-pox and measles, which are propagated by 
specific contagion. They do not wait for the suns 
of July or August, nor do they require an impure 
atmosphere, or an exciting cause, to give them ac- 
tivity. They spread in the winter and spring, as 
well as in the summer and autumnal months : wet 
and dry weather do not arrest their progress, and 
frost (so fatal to the yellow fever), by rendering it 
necessary to exclude cold air from sick rooms, 
increases the force of their contagion, and thereby 
propagates them more certainly through a country. 

5. It is likewise destroyed, by intense heat, and 
high winds. The latter, we are sure, like heavy 
rains and frost, do not produce that salutary effect 
by acting upon the bodies, or in the rooms of sick 
people. 



246 YELLOW FEVER NOT CONTAGIOUS. 

It is worthy of notice, that while the activity of 
miasmata is destroyed by cold, when it descends to 
frost ; by heat, when it is so intense as to dry up 
all the sources of putrid exhalation ; by heavy rains, 
when they are succeeded by cool weather ; and by 
high winds, when they are not succeeded by warm 
weather ; they are rendered more active by cool, 
warm, and damp weather, and by light winds. 
The influence of damp weather, in retaining and 
propagating miasmata, will be readily admitted, by 
recollecting how much more easily hounds track 
their prey, and how much more extensively odours 
of all kinds pervade the atmosphere, when it is 
charged with moisture, than in dry weather. 

It has been asked, if putrid matters produce 
malignant bilious fevers in our cities, why do they 
not produce them in Lisbon, and in several other 
of the filthiest cities in the south of Europe ? To 
this I answer, that filth and dirt are two distinct 
things. The streets of a city may be very dirty, 
that is, covered with mud composed of inoffensive 
clay, sand, or lime, and, at the same time, be per- 
fectly free from those filthy vegetable and animal 
matters which, by putrefaction, contaminate the 
air. But, admitting the streets of those cities to 
abound with the filthy matters that produce pesti- 
lential diseases in other countries, it is possible the 



YELLOW FEVER NOT CONTAGIOUS. 247 

exhalations from them may be so constant, and so 
powerful, in their impressions upon the bodies of 
the inhabitants, as to produce, from habit, no mor- 
bid effects, or but feeble diseases, as was re- 
marked formerly, is the case in the natives and old 
settlers in the East and West- Indies. But if this 
explanation be not satisfactory, it may be resolved 
into a partial absence of an inflammatory constitu- 
tion of the air, which, I shall say presently, must 
concur in producing pestilential diseases. Such 
deviations from uniformity in the works of Nature 
are universal. In the present instances, they no 
more invalidate the general proposition of malignant 
fevers being every where of domestic origin, than 
the exemption of Ireland from venomous reptiles, 
proves they are not generated in other countries, 
or that the pleurisy and rheumatism are not the 
effects of the alternate action of cold and heat upon 
the body, because hundreds, who have been ex- 
posed to them under equal circumstances, have not 
been affected by those diseases. There may be 
other parts of the world in which putrid matters do 
not produce bilious malignant diseases from the 
causes that have been mentioned, or from some 
unknown cause, but I am safe in repeating, there 
never was a bilious epidemic yellow fever that could 
not be traced to putrid exhalation . 



248 YELLOW FEVER NOT CONTAGIOUS, 

It has been asked, if the yellow fever be not im- 
ported, why does it make its first appearance among 
sailors, and near the docks and wharves of our 
cities? I answer, this is far from being true. 
The disease has as often appeared first at a distance 
from the shores of our cities as near them, but, 
from its connection with a ship not being disco- 
vered, it has been called by another name. But 
where the first cases of it occur in sailors, I believe 
the seeds of it are always previously received by 
them from our filthy docks and wharves, or from 
the foul air which is discharged with the cargoes 
of the ships in which they have arrived, which seeds 
are readily excited in them by hard labour, or in- 
temperance, so as to produce the disease. That 
this is the case, is further evident from its appearing 
in them, only in those months in which the bilious 
fever prevails in our cities. 

It has been asked further, why were not these 
bilious malignant fevers more common before the 
years 1791, 1792, and 1793 ? To this I answer, 
by repeating what was mentioned in another place*, 
that our climate has been gradually undergoing a 
change. The summers are more alternated by hot 
and cool, and wet and dry weather, than in former 

* Account of the Climate of Pennsylvania, vol i. 



YELLOW FEVER NOT CONTAGIOUS. 249 

years. The winters are likewise less uniformly 
cold. Grass is two or three weeks later in the 
spring in affording pasture to cattle than it was 
within the memory of many thousand people. 
Above all, the summer has encroached upon the 
autumn, and hence the frequent accounts we read 
in our newspapers of trees blossoming, of full grown 
strawberries and raspberries being gathered, and of 
cherries and apples, of a considerable size, being 
seen, in the months of October and November, in 
all the middle states. By means of this protraction 
of the heat of summer, more time is given for the 
generation of putrid exhalations, and possibly for 
their greater concentration and activity in producing 
malignant bilious diseases. 

It has been asked again, why do not the putrid 
matters which produce the yellow fever in some 
years produce it every year ? This question might 
be answered by asking two others. 1st. Why, if 
the yellow fever be derived from the West- Indies, 
was it not imported every year before 1791, and 
before the existence, or during the feeble and partial 
operation of quarantine laws ? It is no answer to 
this question to say, that a war is necessary to ge- 
nerate the disease in the islands, for it exists in 
some of them at all times, and the seasons of its 
prevalence in our cities have, in many instances, 

vol. iv. 2 I 



250 YELLOW FEVER NOT CONTAGIOUS. 

had no connection with war, nor with the presence 
of European armies in those and in other sickly 
parts of the globe. During the seven years revo- 
lutionary war it was unknown as an epidemic in the 
United States, and yet sailors arrived in all our 
cities daily from sickly islands, in small and crowd- 
ed vessels, and sometimes covered with the rags 
they had worn in the yellow fever, in British hos- 
pitals and jails. I ask, 2dly, why does the dysen- 
tery (which is certainly a domestic disease) rise up 
in our country, and spread sickness and death 
through whole families and villages, and disappear 
from the same places for fifteeen or twenty years 
afterwards ? 

The want of uniformity in the exhalations of our 
country in producing those diseases depends upon 
their beino; combined with more or less heat or 
moisture ; upon the surface of the earth being com- 
pletely dry, or completely covered with water* ; 

* In the Account of the Yellow Fever of 1793, the differ- 
ent and opposite effects of a dry and rainy season in pro- 
ducing bilious fevers are mentioned from Dr. Dazilles. In 
the autumn of 1804, I have elsewhere remarked, after a 
summer in which there had fallen an unusual quantity of 
rain, the bilious fevers appeared chiefly on the high grounds 
in Pennsylvania, which were in a state of moisture, while 
scarcely a case of them appeared in the neighbourhood of 



YELLOW FE^VER NOT CONTAGIOUS. 251 

upon different currents of winds, or the total absence 
of wind ; upon the disproportion of the tempera- 
ture of the air in the day and night ; upon the quan- 
tity of dew ; upon the early or late appearance of 
warm or cold weather ; and upon the predisposi- 
tion of the body to disease, derived from the quality 
of the aliments of the season. A similar want of 
uniformity in the annual operations of our climate 
appears in the size and quality of grain, fruits, and 
vegetables of all kinds. 

But the greater violence and mortality of our bi- 
lious fevers, than in former years, must be sought 
for chiefly in an inflammatory or malignant consti- 
tution of the atmosphere, the effects of which have 
been no less obvious upon the small- pox, measles, 
and the intercurrent fevers of Dr. Sydenham, than 
they are upon the summer and autumnal disease 
that has been mentioned. 

This malignant state of the air has been noticed, 
under different names, by all the writers upon epi- 
demics, from Hippocrates down to the present day. 
It was ascribed, by the venerable father of physic, 

marshes, or low grounds, owing to their being so completely 
covered with water, as to be incapable of generating, by pu- 
trefaction, the miasmata which produce those forms of dis- 
ease. 



252 YELLOW FEVFR NOT CONTAGIOUS. 

to a " divine something" in the atmosphere. Dr. 
Sydenham, whose works abound with references to 
it, supposes it to be derived from a mineral exhala- 
tion from the bowels of the earth. From nume- 
rous other testimonies of a belief in the influence of 
the insensible qualities of the air, altering the cha- 
racter of epidemics, I shall select the following : 

" It is certain (says Dr. Mosely) that diseases 
undergo changes and revolutions. Some continue 
for a succession of years, and vanish when they 
have exh?aisted the temporary, but secret cause 
which produced them. Others have appeared and 
disappeared suddenly ; and others have their peri- 
odical returns," 

The doctor ascribes a malignant fever among 
the dogs in Jamaica (improperly called, from one 
of its symptoms, hydrophobia), to a change in the 
atmosphere, in the year 1783. It was said to have 
been imported, but experience, he says, proved the 
fact to be otherwise*. 

" This latent malignity in the atmosphere (says 
Baron Vansweiten) is known only by its effects^ 
and cannot easily be reduced to any known species 

* Treatise upon Tropical Diseases, p. 43, 44. 



YELX0W FEVER NOT CONTAGIOUS. 253 

of acrimony." In another place he says, " It 
seems certain that this unknown matter disposes all 
the humours to a sudden and bad putrefaction*." 

Dr. John Stedman has related many facts, in his 
Essay upon Insalutary Constitutions of the Air, 
which prove, that diseases are influenced by a qua- 
lity in it, which, he says, " is productive of cor- 
ruption," but which has hitherto eluded the re- 
searches of physiciansf . 

Mr. Lempriere, after mentioning the unusual 
mortality occasioned by the yellow fever, within 
the last five or six years, in the island of Jamaica, 
ascribes it wholly " to that particular constitution 
of atmosphere upon which the existence of epide- 
mics, at one period rather than another, depend;):." 

Not only diseases bear testimony to a change in 
the atmosphere, but the whole vegetable and ani- 
mal creation concur in. it, proofs of which were 
mentioned in another place. Three things are re- 

* Commentaries on Boerhaave's Aphorisms, vol. v. p. 

226, 230. 



f Page 135. 
£ Vol. ii. p, 31. 



254 YELLOW FEVER NOT CONTAGIOUS. 

markable with respect to this inflammatory consti- 
tution of the air. 



1 . It is sometimes of a local nature, and influences 
the diseases of a city, or country, while adjoining 
cities and countries are exempted from it. 

2. It much oftener pervades a great extent of 
country. This was evident in the years 1793 and 
1794, in the United States. During the same 
years, the yellow fever prevailed in most of the 
West- India islands. Many of the epidemics men- 
tioned by Dr. Sims, in the first volume of the Me- 
dical Memoirs, affected, in the same years, the 
most remote parts of the continent of Europe. 
Even the ocean partakes of a morbid constitution 
of its atmosphere, and diseases at sea sympathise 
in violence with those of the land, at an immense 
distance from each other. This appears in a letter 
from a surgeon, on board a British ship of war, to 
Mr. Gooch, published in the third volume of his 
Medical and Surgical Observations. 

3. The predisposing state of the atmosphere to 
induce malignant diseases continues for several 
years, under all the circumstances of wet and dry, 
and of hot and cold weather. This will appear, 
from attending: to the accounts which have been 



YELLOW FEVER NOT CONTAGIOU§. 255 

given of the weather, in all the years in which the 
yellow fever* has prevailed in Philadelphia since 
1792*. The remark is confirmed by all the records 
of malignant epidemics. 

It is to no purpose to say, the presence of the 
peculiar matter which constitutes an inflammatory 
or malignant state of the air has not been detected 
by any chemical agents. The same thing has been 
justly said of the exhalations which produce the 
bilious intermitting, remitting, and yellow fever. 
No experiment that has yet been made, has disco- 
vered their presence in the air. The eudiometer 
has been used in vain for this purpose. In one 
experiment made by Dr. Gattani, the air from a 
marsh at the mouth of the river Vateline was found 
to be apparently purer by two degrees than the air 
on a neighbouring mountain, which was 2880 feet 
higher than the sea. The inhabitants of the moun- 
tain were notwithstanding healthy, while those who 
lived in the neighbourhood of the marsh were an- 
nually afflicted with bilious and intermitting feversf . 
The contagions of the small-pox and measles con- 
sist of matter, and yet who has ever discovered 
this matter in the air ? We infer the existence of 

* Vol. iii. and iv. 

f Alibert's Dissertation sur les Fievres Pernicieuses et 
Attaxiques Intermittentes, p. 185. 



256 YELLOW FEVER NOT CONTAGIOUS. 

those remote causes of diseases in the atmosphere 
only from their effects. Of the existence of putrid 
exhalations in it, there are other evidences besides 
bilious and yellow fevers. They are sometimes 
the objects of the sense of smelling. We see them 
in the pale or sallow complexions of the inhabitants 
of the countries which generate them, and we ob- 
serve them occasionally in the diseases of several 
domestic animals. The most frequent of these dis- 
eases are inflammation, tubercles, and ulcers in 
the liver. Dr. Cleghorn describes a diseased state 
of that viscus in cattle, in an unhealthy part of the 
island of Minorca. Dr. Grainger takes notice of 
several morbid appearances in the livers of domes- 
tic animals in Holland, in the year 1743. But the 
United States have furnished facts to illustrate the 
truth of this remark. Mr. James Wardrobe, near 
Richmond, in Virginia, informed me, that in Au- 
gust, 1794, at a time when bilious fevers were 
prevalent in his neighbourhood, his cattle were 
seized with a disease, which, I said formerly, is 
known by the name of the yellow water, and 
which appears to be a true yellow fever. They 
were attacked with a staggering. Their eyes were 
muddy, or ferocious. A costiveness attended in 
all cases. It killed in two days. Fifty-two of his 
cattle perished by it. Upon opening the bodies of 
several of them, he found the liver swelled and ul- 



YELLOW FEVER NOT CONTAGIOUS. 257 

cerated. The blood was dissolved in the veins. 
In the bladder of one of them, he found thirteen 
pints of blood and water. Similar appearances 
were observed in the livers of sheep in the neigh- 
bourhood of Cadiz, in the year 1799, during the 
prevalence of the yellow fever in that city. They 
were considered as such unequivocal marks of an 
unwholesome atmosphere among the ancients, that 
they examined the livers of domestic animals, in 
order to determine on the healthy or unhealthy si- 
tuation of the spot on which they wished to live. 

The advocates for the yellow fever being a spe- 
cific disease, and propagated only by contagion, 
will gain nothing by denying an inflammatory con- 
stitution of the atmosphere (the cause of which is 
unknown to us) to be necessary to raise common 
remittents to that grade in which they become ma- 
lignant yellow fevers ; for they are obliged to have 
recourse to an unknown quality in the a ; r, every 
time they are called upon to account for the dis- 
ease prevailing chiefly in our cities, and not spread- 
ing when it is carried from them into the country. 
The same reference to an occult quality in the air 
is had by all the writers upon the plague, in ac- 
counting for its immediate and total extinction, 
when it is carried into a foreign port. 

vol. IV. 2 K 



258 YELLOW FEVER NOT CONTAGIOUS. 

In speaking of the influence of an inflammatory- 
constitution of the atmosphere in raising common 
bilious, to malignant yellow fevers, I wish not to 
have it supposed, that its concurrence is necessary 
to produce sporadic cases of that, or any other 
malignant disease. Strong exciting causes, com- 
bined with highly volatilized and active miasmata, 
I believe, will produce a yellow fever at any- 
time. I have seen one or more such cases 
almost every year since I settled in Philadelphia, 
and particularly when my business was confined 
chiefly to that class of people who live near the 
wharves, and in the suburbs, and who are still the 
first, and frequently the only victims of the yellow 
fever. 

It has been said, exultingly, that the opinion of 
the importation of the yellow fever is of great anti- 
quity in our country, and that it has lately been ad- 
mitted by the most respectable physicians in Britain 
and France, and sanctioned by the laws of several of 
the governments in Europe. Had antiquity, num- 
bers, rank, and power been just arguments in fa- 
vour of existing opinions, a thousand truths would 
have perished in their birth, which have diffused 
light and happiness over every part of our globe. 
In favour of the ancient and general belief of the im- 
portation of the yellow fever, there are several obvi- 



YELLOW FEVER NOT CONTAGIOUS. 259 

ous reasons. The idea is produced by a single act of 
the mind. It requires neither comparison nor reason- 
ing to adopt it, and therefore accords with the natu- 
ral indolence of man. It, moreover, flatters his ava- 
rice and pride, by throwing the origin of a mortal dis- 
ease from his property and country. The principle 
of thus referring the origin of the evils of life from 
ourselves to others is universal. It began in para- 
dise, and has ever since been an essential feature 
in the character of our species. It has constantly 
led individuals and nations to consider loathsome 
and dangerous diseases as of foreign extraction. 
The venereal disease and the leprosy have no na- 
tive country, if we believe all the authors who have 
written upon them. Prosper Alpinus derives the 
plagues of Cairo from Syria, and the physicians of 
of Alexandria import them from Smyrna or Con- 
stantinople. The yellow fever is said to have been 
first brought from Siam (where there are proofs' it 
never existed) to the West- Indies, whence it is be- 
lieved to be imported into the cities of the United 
States. From them, Frenchmen and Spaniards say 
it has been re- shipped, directly or indirectly, to St. 
Domingo, Havanna, Malaga, Cadiz, and other 
parts of the world. Weak and absurd credulity ! 
the causes of the ferocious and mortal disease 
which we thus thrust from our respective ports, 



260 YELLOW FEVER NOT CONTAGIOUS. 

like the sin of Cain, u lie exclusively at our own 
doors." 

Lastly, it has been asserted, if we admit the yel- 
low fever to be an indigenous disease of our cities, 
we shall destroy their commerce, and the value of 
property in them, by disseminating a belief, that 
the cause of our disease is fixed in our climate, 
and that it is out of the power of human means to 
remove it. The reverse of this supposition is 
true. If it be an imported disease, our case is 
without a remedy ; for if, with all the advantages 
of quarantine laws enforced by severe penalties, 
and executed in the most despotic manner, the 
disease has existed annually, in most of our cities, 
as an epidemic, or in sporadic cases, ever since the 
year 1791, it will be in vain to expect, from simi- 
lar measures, a future exemption from it. No- 
thing but a belief in its domestic origin, and the 
adoption of means founded upon that belief, can 
restore the character of our climate, and save our 
commercial cities from destruction. Those means 
are cheap, practicable, and certain. They have 
succeeded, as I shall say presently, in other coun- 
tries. 

From the account that has been given of the dif- 
ferent wavs in which this disease is communicated 



YELLOW FEVER NOT CONTAGIOUS. 261 

from one person to another, and from the facts 
which establish its propagation exclusively through 
the medium of the atmosphere, when it becomes 
epidemic, we may explain several things which be- 
long to its history, that are inexplicable upon the 
principle of its specific contagion. 

1. We learn the reason why, in some instances, 
the fever does not spread from a person who sickens 
or dies at sea, who had carried the seeds of it in his 
body from a sickly shore. It is because no febrile 
miasmata exist in the bodies of the rest of the crew 
to be excited into action by any peculiar smell from 
the disease, or by fear or fatigue, and because no 
morbid excretions are generated by the person who 
dies. The fever which prevailed on board the 
Nottingham East-Indiaman, in the year 1766, af- 
fected those forty men only, who had slept on shore 
on the island of Joanna twenty days before. Had 
the whole crew been on shore, the disease would 
probably have affected them all, and been ascribed to 
contagion generated by the first persons who were 
confined by it*. A Danish ship, in the year 1768, 

* Observations on the Bilious Fevers usual in voyages to 
the East-Indies, by James Badinach, M. D. Medical Obser- 
vations and Inquiries, vol. iv. 



262 YELLOW FEVER NOT CONTAGIOUS. 

sent twelve of her crew on shore for water. They 
were all seized after their return to the ship with a 
malignant fever, and died without infecting any 
person on board, and from the same causes which 
preserved the crew of the Nottingham Indiaman*. 

2. We learn the reason why the disease some- 
times spreads through a whole ship's crew, appa- 
rently from one or more affected persons. It is 
either because they have been confined to small 
and close births by bad weather, or because the 
fever has been protracted to a typhus or chronic 
state, or because the bodies of the whole crew are 
impregnated with morbid miasmata, and thus pre- 
disposed to have the disease excited in the manner 
that has been mentioned. In the last way it was 
excited in most of the crew of the United States 
frigate, in the Delaware, opposite to the city of 
Philadelphia, in the year 1797. It appears to have 
spread, from a similar cause, from a few sailors, on 
board the Grenville Indiaman, after touching at Ba- 
tavia. The whole crew had been predisposed to 
the disease by inhaling the noxious air of that 
island. 

f Clarke on the Diseasesof Long Voyages to Hot Climates, 
p. 123, 125. 



YELLOW FEVER NOT CONTAGIOUS. 263 

The same reasons account for the fever expiring 
in a healthy village or country ; also for its spread- 
ing when carried to those towns which are seated 
upon creeks or rivers, and in the neighbourhood of 
marsh exhalations. It has uniformly perished in 
the high and healthy village of Germantown, when 
carried from Philadelphia, and has three times ap- 
peared to be contagious near the muddy shores of 
the creeks which flow through Wilmington and 
Chester. 

3. From the facts that have been mentioned, 
we are taught to disbelieve the possibility of the 
dise ise being imported in the masts and sails of a 
ship, by a contagious matter secreted by a sailor 
who may have sickened or died on board her, on a 
passage from a West- India island. The death in 
most of the cases supposed to be imported, in this 
way, occurs within a few days after the ship leaves 
her West- India port, or within a few days after her 
arrival. In the former case, the disease is derived 
from West- India miasmata ; in the latter, it is de- 
rived, as was before remarked, either from the foul 
air of the hold of the ship, or of the dock or 
wharf to which the ship is moored. 

Many other facts might be adduced to show the 
yellow fever not to be an imported disease. It has 



264 YELLOW FEVER NOT CONTAGIOUS. 

often prevailed among the Indians remote from the 
sea coast, and many hundred cases of it have oc- 
curred, since the year 1793, on the inland waters 
of the United States, from the Hudson and Sus- 
quehanna, to the rivers of the Mississippi. In 
South-America, Baron Humboldt assured me, it 
is every where believed to be an endemic of that 
country. 

These simple and connected facts, in which all 
the physicians in the United States who derive the 
yellow fever from domestic causes have agreed, will 
receive fresh support by comparing them with the 
different and contrary opinions of the physicians 
who maintain its importation. Some of them have 
asserted it to be a specific disease, and derived it 
from the East and West- Indies ; others derive it 
from Beulam, on the coast of Africa ; a third sect 
have called it a ship fever ; a fourth have ascribed 
it to a mixture of imported contagion with the foul 
air of our cities ; while a fifth, who believed it to 
be imported in 1793, have supposed it to be the off- 
spring of a contagion left by the disease of that 
year, revived by the heat of our summers, and dis- 
seminated, ever since, through the different cities of 
our country. The number of these opinions, clearly 
proves, that no one of them is tenable. 



YELLOW FEVER NOT CONTAGIOUS. 265 

A belief in the non-contagion of the yellow fever, 
or of its being incommunicable except in one of 
the five ways that have been mentioned, is calcu- 
lated to produce the following good effects : 

1. It will deliver the states which have sea-ports 
from four-fifths of the expences of their present 
quarantine laws and lazarettoes. A very small ap- 
paratus, in laws and officers, would be sufficient to 
prevent the landing of persons affected by the ship 
fever in our cities, and the more dangerous prac- 
tice, of ships pouring streams of pestilential air, from 
their holds, upon the citizens who live near our 
docks and wharves. 

2. It will deliver our merchants from the losses 
incurred by the delays of their ships, by long and 
unnecessary quarantines. It will, moreover, tend 
to procure the immediate admission of our ships 
into foreign ports, by removing that belief in the 
contagious nature of the yellow fever, which origi- 
nated in our country, and which has been spread, 
by the public acts of our legislatures and boards of 
health, throughout the globe. 

3. It will deliver our citizens from the danger 
to which they are exposed, by spending the time 
of the quarantine, on board of vessels in the neigh- 

VOL. iv. 2 x» 



266 YELLOW FEVER NOT CONTAGIOUS. 

bourhood of the marshes, which form the shores 
of the rivers or coasts of quarantine roads. This 
danger is much increased by idleness, and by the 
vexation which is excited, by sailors and passen- 
gers being detained, unnecessarily, fifteen or twen- 
ty days from their business and friends. 

4. It will lead us to a speedy removal of all the 
excretions, and a constant ventilation of the rooms 
of patients in the yellow fever, and thereby to pre- 
vent the accumulation, and further putrefaction of 
those exhalations which may reproduce it. 

5. It is calculated to prevent the desertion of 
patients in the yellow fever, by their friends and fa- 
milies, and to produce caution in them to prevent 
the excitement of the disease in their own bodies, 
by means of low diet and gentle physic, propor- 
tioned to the impurity of the air, and to the anxiety 
and fatigue to which they are exposed in attending 
the sick. 

6. It will put an end to the cruel practice of 
quieting the groundless fears of a whole neigh- 
bourhood, by removing the poor who are affected 
by the fever, from their houses, and conveying them, 
half dead with disease and terror,- to a solitary or 
crowded hospital, or of nailing a yellow flag upon 



YELLOW FEVER NOT CONTAGIOUS. 267 

the doors of others, or of fixing a guard before 
them, both of which have been practised in Phila- 
delphia, not only without any good effect, but to 
the great injury of the sick. 

7. By deriving the fever from our own climate 
and atmosphere, we shall be able to foresee its ap- 
proach in the increased violence of common dis- 
eases, in the morbid state of vegetation, in the 
course of the winds, in the diseases of certain brute 
animals, and in the increase of common, or the ap- 
pearance of uncommon insects. 

8. A belief in the non- contagion of the yellow 
fever, and its general prevalence from putrid ani- 
mal and vegetable matters only, is calculated to lead 
us to drain or cover marshy grounds, and to re- 
move from our cities all the sources of impure air, 
whether they exist in the holds of ships, in docks, 
gutters, and common sewers, or in privies, gar- 
dens, yards, and cellars, more especially during the 
existence of the signs of a malignant constitution 
of the air. A fever, the same in its causes, and 
similar to it in many of its symptoms, that is, the 
plague, has been extirpated, by extraordinary de- 
grees of cleanliness, from the cities of Holland, 
Great-Britain, and several other parts of Europe. 



268 YELLOW PEVER NOT CONTAGIOUS. 

The reader will perceive, from these facts and 
reasonings, that I have relinquished the opinion 
published in my account of the yellow fever in the 
years 1793, 1794, and 1797, respecting its conta- 
gious nature. I was misled by Dr. Lining, and 
several West- India writers, in ascribing a much 
greater extent to the excreted matters in producing 
the disease, than I have since discovered to be cor- 
rect, and by Bianchi, Lind, Clark, and Cleghorn, 
in admitting even the common bilious fever to be 
contagious. The reader will perceive, likewise, 
that I have changed my opinion respecting one of the 
modes in which the plague is propagated. I once 
believed, upon the authorities of travellers, physi- 
cians, and schools of medicine, that it was a highly 
contagious disease. I am now satisfied this is not 
the case ; but, from the greater number of people 
who are depressed and debilitated by poverty and 
famine, and who live in small and filthy huts* in 
the cities of the east, than in the cities of the 
United States, I still believe it to be more fre- 
quently communicated from an intercourse with 
sick people by the morbid excretions of the bo- 
dy, than the yellow fever is in our country. For 
the change of my opinion upon this subject, I am 

* M. Savary, in his Travels, says, two hundred persons 
live in Cairo within a compass that accommodates but thirty 
persons in Paris. 



YELLOW FEVER NOT CONTAGIOUS. 269 

indebted to Dr. Caldwell's and Mr. Webster's 
publications upon pestilential diseases, and to 
the travels of Mariti and Sonnini into Syria and 
Egypt. I reject, of course, with the contagi- 
ous quality of the plague, the idea of its ever being 
imported into any country so as to become epide- 
mic, by means of a knife-case, a piece of cotton, 
or a bale of silks, with the same decision that I do 
all the improbable and contradictory reports of an 
epidemic yellow fever being imported in a sailor's 
jacket, or in the timbers and sails of a ship that had 
been washed by the salt water, and fanned by the 
pure air of the ocean, for several weeks, on her pas- 
sage from the West- Indies to the United States. 

It gives me pleasure to find this unpopular opi- 
nion of the non-contagion of the plague is not a 
new one. It was held by the Faculty of Medicine 
in Paris, in the beginning of the eighteenth cen- 
tury, and it has since been defended by Dr. Stoll, 
of Vienna, Dr. Samoilowitz, of Russia, and seve- 
ral other eminent physicians. Dr. Herberden 
has lately called in question the truth of all the sto- 
ries that are upon record of the plague having been 
imported into England in the last century, and the 
researches of Sir Robert Wilson of the British ar- 
my, and of Assellini, and several other French phy- 



270 YELLOW FEVER NOT CONTAGIOUS. 

sicians, have produced the most satisfactory proofs 
of its not being a contagious disease in its native 
country. A discovery more pregnant with bles- 
sings to mankind has seldom been made. Pyramids 
of error, the works of successive ages and nations, 
must fall before it, and rivers of tears must be dried 
up by it. It is impossible fully to appreciate the 
immense benefits which await this mighty achieve- 
ment of our science upon the affairs of the globe. 
Large cities shall no longer be the hot-beds of dis- 
ease and death. Marshy grounds, teeming with 
pestilential exhalations, shall become the healthy 
abodes of men. A powerful source of repulsion 
between nations shall be removed, and commerce 
shall shake off the fetters which have been imposed 
upon it by expensive and vexatious quarantines. 
A red or a yellow eye shall no longer be the signal 
to desert a friend or a brother to perish alone in a 
garret or a barn, nor to expel the stranger from our 
houses, to seek an asylum in a public hospital, to 
avoid dying in the street. The number of dis- 
eases shall be lessened, and the most mortal of 
them shall be struck out of the list of human evils. 
To accelerate these events, it is incumbent upon 
the physicians of the United States to second the 
discoveries of their European brethren. It be- 
comes them constantly to recollect, that we are 



YELLOW FEVER NOT CONTAGIOUS. 271 

the centinels of the health and lives of our fellow- 
citizens, and that there is a grade of benevolence 
In our profession much higher than that which 
arises from the cure of diseases. It consists in. 
exterminating their causes. 



A DEFENCE 



OF 



BLOOD-LETTING, 



AS A 



REMEDY FOR CERTAIN DISEASES, 



VOL. IV. 2 M 



DEFENCE OF BLOOD-LETTING. 



BLOOD-LETTING, as a remedy for fe- 
vers, and certain other diseases, having lately been 
the subject of much discussion, and many objec- 
tions having been made to it, which appear to be 
founded in error and fear, I have considered that a 
defence of it, by removing those objections, might 
render it more generally useful, in every part of 
the United States. 

I shall begin this subject by remarking, that 
blood-letting is indicated, in fevers of great morbid 
excitement, 

1. By the sudden suppression or diminution of 
the natural discharges by the pores, bowels, and 
kidneys, whereby a plethora is induced in the sys- 
tem. 



276 DEFENCE OF BLOOD-LETTING. 

2. By the habits of the persons who are most 
subject to such fevers. 

3. By the theory of fever. I have attempted to 
prove that the higher grades of fever depend upon 
morbid and excessive action in the blood-vessels. 
It is connected, of course, with preternatural sen- 
sibility in their muscular fibres. The blood is the 
most powerful irritant which acts upon them. By 
abstracting a part of it, we lessen the principal 
cause of the fever. The effect of blood-letting is 
as immediate and natural in removing fever, as the 
the abstraction of a particle of sand is, to cure an 
inflammation of the eye, when it arises from that 
cause. 

4. By the symptoms of the first stage of violent 
fevers, such as a sleepiness and an oppressed pulse, 
or by delirium, with a throbbing pulse, and great 
pains in every part of the body. 

§. By the rupture of the blood-vessels, which 
takes place from the quantity or impetus of the 
blood in fevers of great morbid action. Let no 
one call bleeding a cruel or unnatural remedy. It 
is one of the specifics of nature ; but in the use of 
it she seldom affords much relief. She frequently 
pours the stimulating and oppressing mass of blood 



DEFENCE OF BLOOD-LETTING. 277 

into the lungs and brain ; and when she finds an 
outlet for it through the nose, it is discharged either 
in such a deficient or excessive quantity, as to be 
useless or hurtful. By artificial blood-letting, we 
can chuse the time and place of drawing blood, and 
we may regulate its quantity by the degrees of ac- 
tion in the blood-vessels. The disposition of na- 
ture to cure violent morbid action by depletion, is 
further manifested by her substituting, in the room 
of blood-letting, large, but less safe and less bene- 
ficial, evacuations from the stomach and bowels. 

6. By the relief which is obtained in fevers of 
violent action by remedies of less efficacy (to be 
mentioned hereafter), which act indirectly in re- 
ducing the force of the sanguiferous system. 

7. By the immense advantages which have at- 
tended the use of blood-letting in violent fevers, 
when used at a proper time, and in a quantity suit- 
ed to the force of the disease. I shall briefly enu- 
merate these advantages. 

1. It frequently strangles a fever, when used in 
its forming state, and thereby saves much pain, 
time, and expence to a patient. 



278 DEFENCE OF BLOOD-LETTING. 

2. It imparts strength to the body, by removing 
the depression which is induced by the remote 
cause of the fever. It moreover obviates a dispo- 
sition to faint, which arises from this state of the 
system. 

3. It reduces the uncommon frequency of the 
pulse. The loss of ten ounces of blood reduced 
Miss Sally Eyre's pulse from 176 strokes to 140, 
in a few minutes, in the fever of the year 1794. 
Dr. Gordon mentions many similar instances of 
its reducing the frequency of the pulse, in the puer- 
perile fever. 

4. It renders the pulse more frequent when it is 
preternaturally slow. 

5. It checks the nausea and vomiting, which at- 
tend the malignant state of fever. Of this I saw 
many instances in the year 1794. Dr. Poissonnier 
Desperrieres confirms this remark, in his Account 
of the Fevers of St. Domingo ; and adds further, 
that it prevents, when sufficiently copious, the 
troublesome vomiting which often occurs on the 
fifth day of the yellow fever*. It has the same ef- 
fect in preventing the diarrhoea in the measles. 

* Traite des Fievres de l'lsle de St. Domingue, vol. ii. 
p. 75. 



DEFENCE OF BLOOD-LETTING. 279 

6. It renders the bowels, when costive, more 
easily moved by purging physic. 

7. It renders the action of mercury more speedy 
and more certain, in exciting a salivation. 

8. It disposes the body to sweat spontaneously, 
or renders diluting and diaphoretic medicines more 
effectual for that purpose. 

9. It suddenly removes a dryness, and gradually 
a blackness, from the tongue. Of the former ef- 
fect of bleeding, I saw two instances, and of the lat- 
ter, one, during the autumn of 1794. 

10. It removes or lessens pain in every part of 
the body, and more especially in the head. 

* 

11. It removes or lessens the burning heat of 
the skin, and the burning heat in the stomach, so 
common and so distressing in the yellow fever. 

12. It removes a constant chilliness, which 
sometimes continues for several days, and which 
will neither yield to cordial drinks, nor warm bed- 
clothes. 



280 DEFENCE OF BLOOD-LETTING. 

13. It checks such sweats as are profuse with- 
out affording relief, and renders such as are partial 
and moderate, universal and salutary. 

14. It sometimes checks a diarrhoea and tenes- 
mus, after astringent medicines have been given to 
no purpose. This has often been observed in the 
measles. 

15. It suddenly cures the intolerance of light 
which accompanies many of the inflammatory states 
of fever. 

16. It removes coma. Mr. Henry Clymer 
was suddenly relieved of this alarming symptom, 
in the fever of 1794, by the loss of twelve ounces 
of blood. 

17. It induces sleep. This effect of bleeding is 
so uniform, that it obtained, in the year 1794, the 
name of an anodyne in several families. Sleep 
sometimes stole upon the patient while the blood 
was flowing. 

18. It prevents effusions of serum and blood. 
Haemorrhages seldom occur, where bleeding has 
been sufficiently copious. 



DEFENCE OF BLOOD-LETTING. 281 

19. It belongs to this remedy to prevent the 
chronic diseases of cough, consumption, jaundice, 
abscess in the liver, and all the different states of 
dropsy which so often follow autumnal fevers. 

My amiable friend, Mrs. Lenox, furnished an ex- 
ception to this remark, in the year 1794. After 
having been cured of the yellow fever by seven 
bleedings, she was affected, in consequence of tak- 
ing a ride, with a slight return of fever, accompanied 
by an acute pain in the head, and some of the 
symptoms of a dropsy of the brain. As her pulse 
was tense and quick, I advised repeated bleedings 
to remove it. This prescription, for reasons which 
it is unnecessary to relate, was not followed at the 
time, or in the manner, in which it was recom- 
mended. The pain, in the mean time, became 
more alarming. In this situation, two physicians 
were proposed by her friends to consult with me. 
I objected to them both, because I knew their prin- 
ciples and modes of practice to be contrary to mine, 
and that they were proposed only with a view of 
wresting the lancet from my hand. From this de- 
sire of avoiding a controversy with my brethren, 
where conviction was impossible on either side, as 
well as to obviate all cause of complaint by my pa- 
tient's friends, I offered to take my leave of her, 
and to resign her wholly to the care of the two gen- 

VOL. TV. 2 N 



282 DEPENCE OF BLOOD-LETTING. 

tlemen who were proposed to attend her with me. 
To this she objected in a decided manner. But 
that I might not be suspected of an undue reliance 
upon my own judgment, I proposed to call upon 
Dr. Griffitts or Dr. Physick to assist me in my at- 
tendance upon her. Both these physicians had re- 
nounced the prejudices of the schools in which 
they had been educated, and had conformed their 
principles and practice to the present improving 
state of medical science. My patient preferred Dr. 
Griffitts, who, in his first visit to her, as soon as 
he felt her pulse, proposed more bleeding. The 
operation was performed by the doctor himself, and 
repeated daily for five days afterwards. From an 
apprehension that the disease was so fixed as to re- 
quire some aid to blood-letting, we gave her calo- 
mel in such large doses as to excite a salivation. 
By the use of these remedies she recovered slowly, 
but so perfectly as to enjoy her usual health. 

20. Bleeding prevents the termination of malig- 
nant, in the gangrenous state of fever. This effect 
of blood-letting will enable us to understand some 
things in the writings of Dr. Morton and Dr. Sy- 
denham, which at first sight appear to be unintel- 
ligible. Dr. Morton describes what he calls a pu- 
trid fever, which was epidemic and fatal, in the 
year 1678. Dr. Sydenham, who practised in Lon- 



DEFENCE OF BLOOD-LETTING. 283 

don at the same time, takes no notice of this fever. 
The reason of his silence is obvious. By copious 
bleeding, he prevented the fever of that year from 
running on to the gangrenous state, while Dr. 
Morton, by neglecting to bleed, created the sup- 
posed putrid fevers which he has described. 

It has been common to charge the friends of 
blood-letting with temerity in their practice. From 
this view which has been given of it, it appears, 
that it would be more proper to ascribe timidity 
to them, for they bleed to prevent the offensive and 
distressing consequences of neglecting it, which 
have been mentioned. 



2: 



11. It cures, without permitting a fever to put 
on those alarming symptoms, which excite con- 
stant apprehensions of danger and death, in the 
minds of patients and their friends. It is because 
these alarming symptoms are prevented, by bleed- 
ing, that patients are sometimes unwilling to believe 
they have been cured by it, of a malignant fever. 
Thus, the Syrian leper of old, viewed the water of 
Jordan as too simple and too common to cure a 
formidable disease, without recollecting that the re- 
medies for the greatest evils of life are all simple, 
and within the power of the greatest part of man- 
kind. 



284 DEFENCE OF BLOOD-LETTING. 

22. It prepares the way for the successful use of 
the bark and other tonic remedies, by destroying, 
or so far weakening, a morbid action in the blood- 
vessels, that a medicine of a moderate stimulus af- 
terwards exceeds it in force, and thereby restores 
equable and healthy action to the system. 

23. Bleeding prevents relapses. It, moreover, 
prevents that predisposition to the intermitting and 
pleuritic states of fever, which so frequently attack 
persons in the spring, who have had the biliousTe- 
mitting fever in the preceding autumn. 

But great and numerous as the advantages of 
blood-letting are in fevers, there have been many 
objections to it. I shall briefly enumerate, and en- 
deavour to refute the errors upon this subject. 

Blood-letting has been forbidden by physicians, 
by the following circumstances, and states of the 
system. 

1. By warm weather. Galen bled in a plague, 
and Arasteus in a bilious fevei\ in a warm climate. 
Dr. Sydenham and Dr. Hillary inform us, that 
the most inflammatory fevers occur in, and suc- 
ceed hot weather. Dr. Cleghorn prescribed it 
copiously in the warm months, in Minorca. Dr. 



DEFENCE OF BLOOD-LETTING. 285 

Mosely cured the yellow fever by this remedy, in 
Jamaica. Dr. Broadbelt, and Dr. Weston, in the 
same island, have lately adopted his successful prac- 
tice. Dr. Desportes speaks in the highest terms 
of it in all the inflammatory diseases of St. Domin- 
go. He complains of the neglect of it in the rheu- 
matism, in consequence of which, he says, the dis- 
ease produces abscesses in the lungs*. I have ne- 
ver, in any year of my practice, been restrained 
by the heat of summer in the use of the lancet, 
where the pulse has indicated it to be necessary, 
and have always found the same advantages from 
it, as when I have prescribed it in the winter or 
spring months. 

In thus deciding in favour of bleeding in warm 
weather, I do not mean to defend its use to the 
same extent, as to diseases, or to quantity, in the 
native and long settled inhabitants of hot climates, 
as in persons who have recently migrated to them, 
or who live in climates alternately hot and cold. 

2. Being born, and having lived in a warm cli- 
mate. This is so far from being an objection to 
blood-letting in an inflammatory disease, that it ren- 
ders it more necessary. I think I have lost seve- 



Page 



JO. 



286 DEFENCE OF BLOOD-LETTING. 

ral West- India patients from the influence of this 
error. 

3. Great apparent weakness. This, in acute 
and violent fevers, is always from a depressed state 
of the system. It resembles, in so many particu- 
lars, that weakness which is the effect of the ab- 
straction of stimulus, that it is no wonder they have 
been confounded by physicians. This sameness 
of symptoms from opposite states of the system is 
taken notice of by Hippocrates. He describes con- 
vulsions, and particularly a hiccup, as occurring 
equally from repletion and inanition, which answer 
to the terms of depression, and debility from action 
and abstraction. The natural remedy for the for- 
mer is depletion, and no mode of depleting is so 
effectual or safe as blood-letting. But the great 
objection to this remedy is, when a fever of great 
morbid excitement affects persons of delicate con- 
stitutions, and such as have long been subject to 
debility of the chronic kind. In this state of the 
system there is the same morbid and preternatural 
action in the blood-vessels, that there is in persons 
of robust habits, and the same remedy is necessary 
to subdue it in both cases. It is sometimes indi- 
cated in a larger quantity in weakly than in robust 
people, by the plethora which is more easily induced 
in their relaxed and yielding blood-vessels, and by 



DEFENCE OF BLOOD-LETTING. 287 

the greater facility with which ruptures and effu- 
sions take place in their viscera. Thus it is more 
necessary to tfirow overboard a large part of the 
cargo of an old and leaky vessel in a storm, than of 
a new and strong one. I know that vomits, purges, 
sweats, and other evacuating remedies, are prefer- 
red to bleeding in weakly constitutions, but I hope 
to show hereafter, that bleeding is not only more 
effectual, but more safe in such habits, than any 
other depleting remedy. 

4. Infancy and childhood. This is so far from 
being an objection to bleeding, that the excitable 
state of the blood-vessels in those periods of life, 
renders it peculiarly necessary in their inflammatory 
diseases. Dr. Sydenham bled children in the 
hooping cough, and in dentition e I have followed 
his practice, and bled as freely in the violent states 
of fever in infancy as in middle life. I bled my 
eldest daughter when she was but six weeks old, 
for convulsions brought on by an excessive dose of 
laudanum given to her by her nurse ; and I bled 
one of my sons twice, before he was two months 
old, for an acute fever which fell upon his lungs 
and bowels. In both cases, life appeared to be 
saved by this remedy. 



288 DEFENCE OF BLOOD-LETTING. 

5. Old age. The increase of appetite in old 
people, their inability to use sufficient exercise, 
whereby their blood-vessels become relaxed, ple- 
thoric, and excitable, and above all, the translation 
of the strength of the muscles to the arteries, and 
of plethora to the veins, all indicate bleeding to be 
more necessary (in equal circumstances) in old, 
than in middle aged people. My practice in the 
diseases of old people has long been regulated by 
the above facts. I bled Mrs. Fullarton twice in a 
pleurisy in January, 1804, in die 84th year of her 
age, and thereby cured her disease. I am not the 
author of this practice. Botallus left a testimony 
in favour of it nearly 200 years ago*, and it has 
since been confirmed by the experience of Hoff- 
man, and many other physicians. An ignorance of, 
or inattention to this change in the state of the 
blood-vessels, in persons in the decline of life, and 
the neglect of the only remedy indicated by it, is 
probably the reason why diseases often prove fatal 
to them, which in early or middle life cured them- 
selves, or yielded to a single dose of physic, or a 
few ounces of bark. 

* Magis esse adjuvandos series, missione sanguinis dum 
morbus postulat, aut corpus eorum habitus malus est, quam 
(quod absonum videbitur) juvenibus ccntingunt. 

De Cur. per Sang, missionem, cap. 11. § 11. 



DEFENCE OF BLOOD-LETTING. 289 

6. The time of menstruation. The uterus, dur- 
ing this period, is in an inflamed state, and the whole 
system is plethoric and excitable, and of course 
disposed to a violent degree of fever, from all the 
causes which excite it. Bleeding, therefore, is 
more indicated, in fever of great morbid action, at 
this time, than at any other. Formerly the natural 
discharge from the uterus was trusted to, to remove 
a fever contracted during the time of menstruation ; 
but what relief can the discharge of four or five 
ounces of blood from the uterus afford, in a fever 
which requires the loss of 50, or perhaps of 100 
ounces to cure it ? 

7. Pregnancy. The inflammation and distention 
induced upon the uterus directly, and indirectly 
upon the whole system by pregnancy, render^bleed- 
ing, in the acute states of fever, more necessary than 
at other times. I have elsewhere mentioned the 
advantages of bleeding pregnant women, in the yel- 
low fever. I did not learn the advantages of the 
practice in that disease. I bled Mrs. Philler 11 
times in seven days, in a pleurisy during her preg- 
nancy, in the month of March, 1783. Mrs. Fiss 
was bled 13 times in the spring of 1783 ; and Mrs. 
Kirby 16 times in the same condition, by my or- 
ders, in the winter of 1786, in a similar disease. 
All these women recovered, and the children they 

vol. iv. 2 o 



290 DEFENCE OF BLOOD-LETTING. 

carried during their illness, are at this time alive, 
and in good health. 

8. Fainting after bleeding. This symptom is 
accidental in many people. No inference can be 
drawn from it against blood-letting. It often oc- 
curs after the first and second bleedings in a fever, 
but in no subsequent bleeding, though it be re- 
peated a dozen times. Of this I saw several in- 
stances, in the yellow fever of 1794. The pulse, 
during the fainting, is often tense and full. 

9. Coldness of the extremities, and of the whole 
body. This cold state of fever when it occurs 
early, yields more readily to bleeding, than to the 
most cordial medicines. 



10. Sweats are supposed to forbid blood-letting. 
I have seen two instances of death, from leaving a 
paroxysm of malignant fever to terminate itself by 
sweating. Dr. Sydenham has taught a contrary 
practice in the following case. " While this con- 
stitution (says the doctor) prevailed, I was called to 
Dr. Morice, who then practised in London. He 
had this fever, attended with profuse sweats, and 
numerous petechias. By the consent of some other 
physicians, our joint friends, he was blooded, and 
rose from his bed, his body being first wiped dry. 



DEFENCE OP BLOOD-LETTING. 291 

He Found immediate relief from the use of a cool- 
ing diet and medicines, the dangerous symptoms 
soon going off; and by continuing this method he 
recovered in a few days*." In the same fever, the 
doctor adds further, " For though one might ex- 
pect great advantages in pursuing an indication 
taken from what generally proves serviceable (viz. 
sweating), yet I have found, by constant experience, 
that the patient not only finds no relief, but, con- 
trariwise, is more heated thereby ; so that fre- 
quently a delirium, petechia?, and other very danger- 
ous symptoms immediately succeed such sweats\." 

Morgagni describes a malignant fever which pre- 
vailed in Italy, in which the patients died in pro- 
fuse sweats, while their physicians were looking for 
a crisis from them. Bleeding would probably have 
checked these sweats, and cured the fever. 

11. Dissolved blood, and an absence of an in- 
flammatory crust on its crassamentum. I shall 
hereafter place dissolved blood at the highest point 
of a scale, which is intended to mark the different 
degrees of morbid action in the system. I have 
mentioned, in the Outlines of a Theory of Fe- 

* Wallis's edition, vol. i. p. 210. 
t Vol. i. p. 208. 



292 DEFENCE OF BLOOD-LETTING. 

ver, that it is the effect of a tendency to a palsy, in- 
duced by the violent force of impression upon the 
blood-vessels. This appearance of the blood in 
certain states of fever, instead of forbidding bleed- 
ing, is the most vehement call of the system for it. 
Nor is the absence of a crust on the crassamentum 
of the blood, a proof of the absence of great mor- 
bid diathesis, or a signal to lay aside the lancet. 
On the contrary, I shall show hereafter, that there 
are several appearances of the blood which indi- 
cate more morbid action in the blood-vessels than 
a sizy or inflammatory crust. 

12. An undue proportion of serum to crassa- 
mentum in the blood. This predominance of wa- 
ter in the blood has often checked sufficient blood- 
letting. But it should be constantly disregarded 
while it is attended with those states of pulse (to be 
mentioned hereafter) which require bleeding. 

14. The presence of petechias on the skin. 
These, I have elsewhere said, are the effects of the 
gangrenous state of fever. Dr. S}*denham and Dr. 
de Haen have taught the safety and advantage of 
bleeding, when these spots are accompanied by an 
active pulse. A boy of Mr. John Carrol owes 
his recovery from the small- pox to the loss of fifty 
ounces of blood, by five bleedings, at a time when 



DEFENCE OF BLOOD-LETTING. 293 

nearly every pock on his arms and legs had a pur- 
ple appearance. Louis XIV was bled five times 
in the small-pox, when he was but thirteen years of 
age, and thereby probably saved from the grave, 
to the great honour and emolument of the single 
physician who urged it against the advice of all the 
other physicians of the court. Dr. Cleghorn men- 
tions a single case of the success of bleeding in the 
petechial small-pox. His want of equal success 
afterwards, in similar cases, was probably occasion- 
ed by his bleeding too sparingly, that is, but three 
or four times. 

Abscesses and sore breasts, which accompany or 
succeed fever, are no objections to blood-letting, 
provided the pulse indicate the continuance of in- 
flammatory diathesis. They depend frequently up- 
on the same state of the system as livid effusions 
on the skin. 

14. The long duration of fever. Inflammatory 
diathesis is often protracted for many weeks, in the 
chronic state of fever. It, moreover, frequently re- 
vives after having disappeared, from an accidental 
irritant affecting some part of the body, particularly 
the lungs and brain. I bled a young man of James 
Cameron, in the autumn of 1794, four times be- 
tween the 20th and 30th days of a chronic fever, 



294 DEIENCE OF BLOOD-LETTIN G. 

in consequence of a pain in the side, accompanied 
by a tense pulse, which suddenly came on after the 
20th day of his disease. His blood was sizy. His 
pain and tense pulse were subdued by the bleeding, 
and he recovered. I bled the late Dr. Prowl 
twelve times, in a fever which continued thirty days, 
in the autumn of the year 1800. I wish these 
cases to be attended to by young practitioners. 
The pulmonary consumption is often the effect of 
a chronic fever, terminating with fresh inflamma- 
tory symptoms, by effusions in the lungs. It may 
easily be prevented by forgetting the number of the 
days of our patient's fever, and treating the pulmo- 
nary affection as if it were a recent complaint. 

15. Tremors and slight convulsions in the limbs. 
Bark, wine, laudanum, and musk are generally pre- 
scribed to remove these symptoms ; but, to be ef- 
fectual, they should, in most cases, be preceded by 
the loss of a few ounces of blood. 

16. Bleeding is forbidden after the fifth or se- 
venth day in a pleurisy. This prohibition was in- 
troduced into medicine at a time when a fear was 
entertained of arresting the progress of nature in 
preparing and expelling morbific matter from the 
system. From repeated experience I can assert, 
that bleeding is safe in every stage of pleurisy in 



DEFENCE OF BLOOD-LETTING. 295 

which there is pain, and a tense and oppressed 
pulse ; and that it has, when used for the first time 
after the fifth and seventh days, saved many lives. 
Bleeding has likewise been limited to a certain 
number of ounces in several states of fever. Were 
the force of the remote cause of a fever, its degrees 
of violence, and the habits of the subject of it, al- 
ways the same, this rule would be a proper one ; 
but, this not being the case, we must be governed 
wholly by the condition of the system, manifested 
chiefly by the state of the pulse. To admit of co- 
pious bleeding in one state of fever, and not in ano- 
ther, under equal circumstances of morbid excite- 
ment, is to prescribe for its name, and to forget 
the changes which climate, season, and previous 
habits create in all its different states. 

17. The loss of a sufficient quantity of blood is 
often prevented by patients being apparently worse, 
after the first or second bleeding. This change for 
the worse, shows itself in some one or more of the 
following symptoms, viz. increase of heat, chills, 
delirium, haemorrhages, convulsions, nausea, vomit- 
ing, faintness, coma, great weakness, pain, a tense, 
after a soft pulse, and a reduction of it in force 
and frequency. They are all occasioned by the 
system rising suddenly from a state of extreme de- 
pression, in consequence of the abstraction of the 



296 DEFENCE OF BLOOD-LETTING. 

pressure of the blood to a state of vigour and acti- 
vity, so great, in some instances, as to reproduce 
a depression below what existed in the system be- 
fore a vein was opened ; or it is occasioned by a 
translation of morbid action from one part of the 
body to another. 

The chills which follow bleeding are the effects 
of a change in the fever, from an uncommon to a 
common state of malignity. They occur chiefly in 
those violent cases of fever which come on without 
a chilly fit. 

The haemorrhages produced by bleeding are 
chiefly from the nose, hemorrhoidal vessels, or ute- 
rus, and of course are, for the most part, safe. 

Uncommon weakness, succeeding blood-letting, 
is the effect of sudden depression induced upon the 
whole system, by the cause before- mentioned, or 
of a sudden translation of the excitement of the 
muscles into the blood-vessels, or some other part 
of the body. These symptoms, together with all 
the others which have been mentioned, are so far 
from forbidding, that they all most forcibly indicate 
a repetition of blood-letting. 



DEFENCE OF BLOOD-LETTING. 297 

I shall briefly illustrate, by the recital of three 
cases, the good effects of bleeding, in removing 
pain, and the preternatural slowness and weakness 
of the pulse, when produced by the use of that re- 
medy. 

In the month of June of 1795, I visited Dr. Say 
in a malignant fever, attended with pleuritic symp- 
toms, in consultation with Dr. Physick. An acute 
pain in his head followed six successive bleedings. 
After a seventh bleeding, he had no pain. His fe- 
ver soon afterwards left him. In thus persevering 
in the use of a remedy, which, for several days, 
appeared to do harm, we were guided wholly by 
the state of his pulse, which uniformly indicated, 
by its force, the necessity of more bleeding. 

In the autumn of 1794, I was sent for to visit 
Samuel Bradford, a young man of about 20 years 
of age, son of Mr. Thomas Bradford, who was ill 
with the reigning malignant epidemic. His pulse 
was at 80. I drew about 12 ounces of blood from 
him. Immediately after his arm was tied up, his 
pulse fell to 60 strokes in a minute. I bled him a 
second time, but more plentifully than before, and 
thereby, in a few minutes, brought his pulse back 
again to 80 strokes in a minute. A third bleeding 

vol. iv. 2 p 



298 DEFENCE OF BLOOD-LETTING. 

the next day, aided by the usual purging physic, 
cured him in a few davs. 



In the month of March, 1795, Dr. Physick re- 
quested me to visit, with him, Mrs. Fries, the wife 
of Mr. John Fries, in a malignant fever. He had 
bled her four times. After the fourth bleeding, 
her pulse suddenly fell, so as scarcely to be percep- 
tible. I found her hands and feet cold, and her 
x countenance ghastly, as if she were in the last mo- 
ments of life. In this alarming situation, I sug- 
gested nothing to Dr. Physick but to follow his 
judgment, for I knew that he was master of that 
law of the animal economy which resolved all her 
symptoms into an oppressed state of the system. 
The doctor decided in a moment in favour of more 
bleeding. During the flowing of the blood, the 
pulse rose. At the end of three, ten, and seven- 
teen hours it fell, and rose again by three succes- 
sive bleedings, in all of which she lost about thirty 
ounces of sizy blood. So great was the vigour 
acquired by the pulse, a few days after the parox- 
ysms of depression, which have been described, 
were relieved, that it required seven more bleedings 
to subdue it. I wish the history of these two cases 
to be carefully attended to by the reader. I have 
been thus minute in the detail of them, chiefly be- 
cause I have heard of practitioners who have lost 



DEFENCE OE BLOOD-LETTING. 299 

patients by attempting to raise a pulse that had 
been depressed by bleeding, in a malignant fever, 
by means of cordial medicines, instead of the re- 
peated use of the lancet. The practice is strictly 
rational ; for, in proportion as the blood-vessels are 
weakened by pressure, the quantity of blood to be 
moved should be proportioned to the diminution 
of their strength. 

This depressed state of the pulse, whether in- 
duced by a paroxysm of fever, or by blood-letting, 
is sometimes attended with a strong pulsation of the 
arteries in the bowels and head. 

I have mentioned, among the apparent bad ef- 
fects of bleeding, that it sometimes changes a soft 
into a tense pulse. Of this I saw a remarkable in- 
stance in Captain John Barry, in the autumn of 
1795. After the loss of 130 ounces of blood in a 
malignant yellow fever, his pulse became so soft as 
to indicate no more bleeding. In this situation he 
remained for three days, but without mending as 
rapidly as I expected from the state of his pulse. 
On the fourth day he had a haemorrhage from his 
bowels, from which he lost above a pint of blood. 
His pulse now suddenly became tense, and conti- 
nued so for two or three days. I ascribed this 
change in his pulse to the vessels of the bowels, 



300 DEFENCE OF BLOOD-LETTING. 

which had been oppressed by congestion, being so 
much relieved by the haemorrhage, as to resume an 
inflammatory action. I have observed a similar 
change to take place in the pulse, after a third bleed- 
ing, in a case of hemorrhoidal fever, which came 
under my notice in the month of January, 1803. 
It is thus we see the blood-vessels, in a common 
phlegmon, travel back again, from a tendency to 
mortification, to the red colour and pain of common 
inflammation. 

From a review of the commotions excited in the 
system by bleeding, a reason may be given why 
the physicians, who do not bleed in the depressed 
state of the pulse, have so few patients in what they 
call malignant fevers, compared with those who use 
a contrary practice. The disease, in such cases, 
being locked up, is not permitted to unfold its true 
character ; and hence patients are said to die of 
apoplexy, lethargy, cholera, dysentery, or nervous 
fever, who, under a different treatment, would have 
exhibited all the marks of an ordinary malignant 
fever. 

In obviating the objections to blood-letting from 
its apparent evils, I have said nothing of the appa- 
rent bad effects of other remedies. A nausea is 
often rendered worse by an emetic, and pains in the 



DEFENCE OF BLOOD-LETTING. 301 

bowels are increased by a purge. But these reme- 
dies notwithstanding maintain, and justly too, a 
high character among physicians. 

19. Bleeding has been accused of bringing on a 
nervous, or the chronic state of fever. The use 
of this remedy, in a degree so moderate as to obvi- 
ate the putrid or gangrenous state of fever only, 
may induce the chronic state of fever ; for it is the 
effect, in this case, of the remains of inflammatory 
diathesis in the blood-vessels ; but when blood is 
drawn proportioned to the morbid action in the sys- 
tem, it is impossible for a chronic fever to be pro- 
duced by it. Even the excessive use of blood-let- 
ting, however injurious it may be in other respects, 
cannot produce a chronic fever, for it destroys 
morbid action altogether in the blood-vessels. 

20. Bleeding has been charged with being a 
weakening remedy. I grant that it is so, and in 
this, its merit chiefly consists. The excessive mor- 
bid action of the blood-vessels must be subdued 
in part, in a fever, before stimulating remedies can 
be given with safety or advantage. Now this is 
usually attempted by depleting medicines, to be 
mentioned hereafter, or it is left to time and nature, 
all of which are frequently either deficient, or exces- 
sive in their operations ; whereas bleeding, by sud- 



302 DEFENCE OF BLOOD-LETTING. 

denly reducing the morbid action of the blood- 
vessels to a wished- for point of debility, saves a 
great and unnecessary waste of excitability, and 
thus prepares the body for the exhibition of such 
cordial remedies as are proper to remove the debi- 
lity which predisposed to the fever. 

21. It has been said that bleeding renders the 
habitual use of it necessary to health and life. This 
objection to blood-letting is founded upon an igno- 
rance of the difference between the healthy, and 
morbid action of the blood-vessels. Where blood 
is drawn in health, such a relaxation is induced in 
the blood-vessels, as to favour the formation of 
plethora, which may require habitual bleeding to 
remove it ; but where blood is drawn only in the 
inflammatory state of fever, the blood-vessels are 
reduced from a morbid degree of strength to that 
which is natural, in which state no predisposition 
to plethora is created, and no foundation laid for 
periodical blood-letting. But there are cases which 
require even this evil, to prevent a greater. Thus 
we cure a strangulated hernia, when no fever at- 
tends, by the most profuse bleeding. The ple- 
thora and predisposition to disease which follow it 
are trifling, compared with preventing certain and 
sudden death. 



DEFENCE OF BLOOD-LETTING. 303 

22. Bleeding has been accused of bringing on an 
intermitting fever. This is so far from being an 
objection to it, that it should be considered as a 
new argument in its favour ; for when it produces 
that state of fever, it converts a latent, and perhaps 
a dangerous disease, into one that is obvious to the 
senses, and under the dominion of medicine. Nor 
is it an objection to blood-letting, that, when used 
in an inflammatory intermittent, it sometimes 
changes it into a continual fever. An instance of 
die good effects of this change occurred in the 
Pennsylvania hospital, in an obstinate tertian, in the 
year 1804. The continual fever, which followed 
the loss of blood, was cured in a few days, and by 
the most simple remedies. 

23. It has been said that bleeding, more especi- 
ally where it is copious, predisposes to effusions of 
serum in the lungs, chest, bowels, limbs, and brain. 
In replying to this objection to bleeding, in my 
public lectures, I have addressed my pupils in the 
following language : u Ask the poor patients who 
come panting to the door of our hospital, with 
swelled legs and hard bellies, every fall, whether 
they have been too copiously bled, and they will 
all tell you, that no lancet has come near their arms. 
Ask the parents who still mourn the loss of children 
who have died, in our city, of the internal dropsy 



304 DEFENCE OF BLOOD-LETTING. 

of the brain, whether they were destroyed by ex- 
cessive blood-letting ? If the remembrance of the 
acute sufferings which accompanied their sickness 
and death will permit these parents to speak, they 
will tell you, that every medicine, except bleeding, 
had been tried to no purpose in their children's 
diseases. Go to those families is which I have 
practised for many years, and inquire, whether 
there is a living or a dead instance of dropsy having 
followed, in any one of them, the use of my lancet? 
Let the undertakers and grave-diggers bear witness 
against me, if I have ever, in the course of my 
practice, conveyed the body of a single dropsical 
patient into their hands, by excessive blood-letting ? 
No. Dropsies, like abscesses and gangrenous erup- 
tions upon the skin, arise, in most cases, from the 
iv ant of sufficient bleeding in inflammatory diseases. 
Debility, whether induced by action or abstraction, 
seldom disposes to effusion. Who ever heard of 
dropsy succeeding famine? And how rarely do 
we see it accompany the extreme debility of old 
age?" 

" If ever bleeding kills," says Botallus, either 
directly or indirectly, through the instrumentality 
of other diseases, " it is not from its excess, but 
because it is not drawn in a sufficient quantity, or 



JDEFENCE OF BLOOD-LETTING. 305 

at a proper time*." And, again, says this excel- 
lent writer, " One hundred thousand men perish 
from the want of blood-letting, or from its being 
used out of time, to one who perishes from too 
much bleeding, prescribed by a physicianf." 

It is remarkable, that the dread of producing a 
dropsy by bleeding, is confined chiefly to its use'in 
malignant fevers ; for the men who urge this ob- 
jection to it, do not hesitate to draw four or five 
quarts of blood in the cure of the pleurisy. The 
habitual association of the lancet with this disease, 
has often caused me to rejoice when I have heard 
a patient complain of a pain in his side, in a malig- 
nant fever. It insured to me his consent to the 
frequent use of the lancet, and it protected me, 
when it was used unsuccessfully, from the cla- 
mours of the public, for few people censure copious 
bleeding in a pleurisy. 

24. Against blood-letting it has been urged, that 
the Indians of our country cure their inflammatory 
fevers without it. To relieve myself from the dis- 
tressing obloquy to which my use of this remedy 
formerly exposed me, I have carefully sought for, 

* Cap. viii. § 4. 

t Cap. xxxvi. § 4. 
VOL. IV. 2 O^ 



306 DEFENCE OF BLOOD-LEfTrKC. 

and examined their remedies for those fevers, with 
a sincere desire to adopt them ; but my inquiries 
have convinced me, that they are not only dispro- 
portioned to the habits and diseases of civilized life, 
but that they are far less successful than blood-let- 
ting, in curing the inflammatory fevers which oc- 
cur among the Indians themselves. 

25. Evacuating remedies of another kind have 
been said to be more safe than bleeding, and equal- 
ly effectual, in reducing the inflammatory state of 
fever. I shall enumerate each of these evacuating 
remedies, and then draw a comparative view of 
their effects with blood-letting. They are, 

I. Vomits. 

II. Purges. 

III. Sweats. 

IV. Salivation. And, 

V. Blisters. 



I. Vomits have often been effectual in curing 
fevers of a mild character. They discharge offen- 
sive and irritating matters from the stomach ; they 



DEFENCE OF BLOOD-LETTING. 307 

lessen the fulness of the blood-vessels, by deter- 
mining the serum of the blood through the pores ; 
and they equalize the excitement of the system, by 
inviting its excessive degrees from the blood-ves- 
sels to the stomach and muscles. But they are, 

1. Uncertain in their operation, from the torpor 
induced by the fever upon the stomach. 

2. They are unsafe in many conditions of the 
system, as in pregnancy, and a disposition to apo- 
plexy and ruptures. Life has sometimes been 
destroyed by their inducing cramp, haemorrhage, 
and inflammation in the stomach. 

3. They are not subject to the controul of a phy- 
sician, often operating more, or less than was intend- 
ed by him, or indicated by the disease. 

4. They are often ineffectual in mild, and always 
so in fevers of great morbid action. 

II. Purges are useful in discharging acrid feces 
and bile from the bowels in fevers. They act, 
moreover, by creating an artificial weak part, and 
thus invite morbid excitement from the blood-ves- 
sels to the bowels. They likewise lessen the quan- 



308 DEFENCE OF BLOOD-LETTING. 

tity of blood, by preventing fresh accessions ot 
chyle being added to it ; but like vomits they are, 

1. Uncertain in their operation ; and from the 
same cause. Many ounces of salts and castor oil, 
and whole drachms of calomel and jalap, have often 
been given, without effect, to remove the costive- 
ness which is connected with the malignant state of 
fever. 

2. They are not subject to the direction of a 
physician, with respect to the time of their opera- 
tion, or the quantity or quality of matter they are 
intended to discharge from the bowels. 

3. They are unsafe in the advanced stage of fe- 
vers. Dr. Physick informed me, that three patients 
died in the water-closet, under the operation of 
purges, in St. George's hospital, during his attend- 
ance upon it. I have seen death, in several instan- 
ces, succeed a plentiful spontaneous stool in debili- 
tated habits. 

III. Sweating was introduced into practice at a 
time when morbific matter was supposed to be the 
proximate cause of fever. It acts, not by expelling 
any thing exclusively morbid from the blood, but 



DEFENCE OF BLOOD-LETTING. 309 

by abstracting a portion of its fluid parts, and thus 
reducing the action of the blood-vessels. This 
mode of curing fever is still fashionable in genteel 
life. It excites no fear, and offends no sense. The 
sweating remedies have been numerous, and fa- 
shion has reigned as much among them, as in 
other things. Alexipharmic waters, and powders, 
and all the train of sudorific medicines, have lately- 
yielded to the different preparations of antimony, 
particularly to James's powder. I object to them 
all, 

1. Because they are uncertain ; large and re- 
peated doses of them being often given to no pur- 
pose. 

2. Because they are slow, and disagreeable, 
where they succeed in curing fever. 

3. Because, like vomits and purges, they are not 
under the direction of a physician, with respect to 
the quantity of fluid discharged by them. 

4. Because they are sometimes, even when most 
profuse, ineffectual in the cure of fever. 

5. The preparations of antimony, lately employ- 
ed for the purpose of exciting sweats, are by no 



310 DEFENCE OF BLOOD-LETTING. 

means safe. They sometimes convulse the sys- 
tern by a violent puking. Even the boasted James's 
powder has done great mischief. Dr. Goldsmith 
and Mr. Howard, it is said, were destroyed by it. 

None of these objections to sweating remedies 
are intended to dissuade from their use, when na- 
ture shows a disposition to throw off a fever by the 
pores of the skin ; but, even then, they often re- 
quire the aid of bleeding to render them effectual 
for that purpose. 

IV. Mercury, the Sampson of the materia me. 
dica, after having subdued the venereal disease, the 
tetanus, and many other formidable diseases, has 
lately added to its triumphs and reputation, by 
overcoming the inflammatory and malignant state 
of fever. I shall confine myself, in this place, to 
its depleting operation, when it acts by exciting a 
salivation. From half a pound to two pounds of 
fluid are discharged by it in a day. The depletion 
in this way is gradual, whereby fainting is prevent- 
ed. By exciting and inflaming the glands of the 
mouth and throat, excitement and inflammation are 
abstracted from more vital parts. In morbid coiir 
gestion and excitement in the brain, a salivation is 
of eminent service, from the proximity of the di*?, 



DEFENCE OF BLOOD-LETTING. 311 

charge to the part affected. But I object to it, as 
an exclusive evacuant in the cure of fever, 

1. Because it is sometimes impossible, by the 
largest doses of mercury, to excite it, when the 
exigences of the system render it most necessary. 

2. Because it is not so quick in its operation, as 
to be proportioned to the rapid progress of the ma- 
lignant state of fever. 

3. Because it is at all times a disagreeable, and 
frequently a painful remedy, more especially where 
the teeth are decayed. 

4. Because it cannot be proportioned in its dura- 
tion, or in the quantity of fluid discharged by it, to 
the violence or changes in the fever. 

Dr. Chisholm relied, for the cure of the Beullam 
fever at Grenada, chiefly upon this evacuation. I 
have mentioned the ratio of success which attended 
it. 

V. Blisters are useful in depleting from those 
parts which are the seats of topical inflammation. 
The relief obtained by them in this way more than 
balances their stimulus upon the whole system. 



312 DEFENCE OF BLOOD-LETTING. 

need hardly say, that their effects in reducing the 
morbid and excessive action of the blood-vessels 
are very feeble. To depend upon them in cases of 
great inflammatory action, is as unwise as it would 
be to attempt to bale the water from a leaky and 
sinking ship by the hollow of the hand, instead of 
discharging it by two or three pumps. 

VI. Abstemious diet has sometimes been pre- 
scribed as a remedy for fever. It acts directly by 
the abstraction of <he stimulus of food from the 
stomach, and indirectly by lessening the quantity of 
blood. It can bear no proportion, in its effects, to 
the rapidity and violence of an inflammatory fever. 
In chronic fever, such as occurs in the pulmonary 
consumption, it has often been tried to no purpose. 
Long before it reduces the pulse, it often induces 
such a relaxation of the tone of the stomach and 
bowels as to accelerate death. To depend upon it 
therefore in the cure of inflammatory fever, whether 
acute or chronic, is like trusting to the rays of the 
sun to exhale the water of an overflowing tide, in- 
stead of draining it off immediately, by digging a 
hole in the ground. But there are cases in which the 
blood-vessels become so insolated, that they refuse 
to yield their morbid excitement to depletion from 
any outlet, except from themselves. I attended a 
sailor, in the Pennsylvania hospital, in 1799, who 



DEFENCE OF BLOOD-LETTING. 313 

was affected with deafness, attended with a full and 
tense pulse. I prescribed for it, purging, blisters, 
and low diet, but without any effect. Perceiving 
no change in his pulse, nor in his disease, from those 
remedies, I ordered him to lose ten ounces of 
blood. The relief obtained by this evacuation in- 
duced me to repeat it. By means of six bleedings 
he was perfectly cured, without the aid of any other 
remedy. 

Bleeding has great advantages over every mode 
of depleting that has been mentioned. 

1. It abstracts one of the exciting causes, viz. 
the stimulus of the blood, from the seat of fever. I 
have formerly illustrated this advantage of blood- 
letting, by comparing it to the abstraction of a grain 
of sand from the eye to cure an opthalmia. The 
other depleting remedies are as indirect and circui- 
tous in their operation in curing fever, as vomits 
and purges would be to remove an inflammation in 
the eye, while the grain of sand continued to irri- 
tate it. 

. 

2. Blood-letting is quick in its operation, and 
may be accommodated to the rapidity of fever, 
when it manifests itself in apoplexy, palsy, and syn- 
cope. 

VOL. IV. 2 R 



314 DEFENCE OF BLOOD-LETTING. 

3. It is under the command of a physician. He 
may bleed when and where he pleases, and may 
suit the quantity of blood he draws, exactly to the 
condition of his patient's system. 

4. It may be performed with the least attendance 
of nurses or friends. This is of great importance 
to the poor at all times, and to the rich during the 
prevalence of mortal epidemics. 

5. It disturbs the system much less than any of 
the other modes of depleting, and therefore is best 
accommodated to that state of the system, in which 
patients are in danger of fainting or dying upon be- 
ing moved. 

6. It is a more delicate depleting remedy than 
most of those which have been mentioned, particu ? 
larly vomits, purges, and a salivation. 

7. There is no immediate danger to life from its 
use. Patients have sometimes died under the ope- 
ration of vomits and purges, but I never saw nor 
heard an instance of a patient's dying in a fainty fit, 
brought on by bleeding. 

8. It is less weakening, when used to the extent 
that is necessary to cure, than the same degrees of 
vomiting, purging, and sweating. 



DEFENCE OF BLOOD-LETTING. 315 

9. Convalescence is more rapid and more per- 
fect after bleeding, than after the successful use of 
any of the other evacuating remedies. 

By making use of blood-letting in fevers, we are 
not precluded from the benefits of the other evacu- 
ating remedies. Some of them are rendered more 
certain and more effectual by it, and there are cases 
of fever, in which the combined or successive ap- 
plication of them all is barely sufficient to save life. 

To rely upon any one evacuating remedy, to the 
exclusion of the others, is like trusting to a pair of 
oars in a sea voyage, instead of spreading every sail 
of a ship. 

I suspect the disputes about the eligibility of the 
different remedies which have been mentioned, have 
arisen from an ignorance that they all belong to one 
class, and that they differ only in their force and 
manner of operation. Thus the physicians of the 
last century ascribed different virtues to salts of dif- 
ferent names, which the chemises of the present day 
have taught us are exactly the same, and differ only 
in the manner of their being prepared. 

Having replied to the principal objections to 
blood-letting, and stated its comparative advantages 



316 DEFENCE OF BLOOD-LETTING. 

over other modes of depletion, I proceed next to 
mention the circumstances which should regulate 
the use of it. These are, 

I. The state of the pulse. 

The following states of the pulse indicate the ne- 
cessity of bleeding. 

1. A full, frequent, and tense pulse, such as oc- 
curs in the pulmonary, rheumatic, gouty, phrenitic, 
and maniacal states of fever. 

2. A full, frequent, and jerking pulse, without 
tension, such as frequently occurs in the vertigi- 
nous, paralytic, apoplectic, and hydropic states of 
fever. 

3. A small, frequent, but tense pulse, such as 
occurs in the chronic, pulmonary, and rheumatic 
states of fever. 

4. A tense and quick pulse, without much preter- 
natural frequency. This state of the pulse is com- 
mon in the vellow fever. 

5. A slow but tense pulse, such as occurs in the 
apoplectic, hydrocephalic, and malignant states of 



DEFENCE OF BLOOD-LETTING. 317 

fever, in which its strokes are from 60 to 9, in a 
minute. 

6\ An uncommonly frequent pulse, without 
much tension, beating from 120 to 170 or 180 
strokes in a minute. This state of the pulse oc- 
curs likewise in the malignant states of fever. 

7. A soft pulse, without much frequency or ful- 
ness. I have met with this state of the pulse in af- 
fections of the brain, and in that state of pulmonary 
fever which is known by the name of pneumonia 
notha. It sometimes, I have remarked, becomes 
tense after bleeding. 

8. An intermitting pulse, 

9. A depressed pulse. 

10. An imperceptible pulse. The slow, inter- 
mitting, depressed, and imperceptible states of the 
pulse are supposed exclusively to indicate conges- 
tion in the brain. But they are all, I believe, occa- 
sioned likewise by great excess of stimulus acting 
upon the heart and arteries. A pulse more tense 
in one arm than in the other, I have generally found 
to attend a morbid state of the brain. Much yet 
remains to be known of the signs of a disease in the 



318 DEFENCE OF BLOOD-LETTING. 

brain, by the states of the pulse ; hence Mr. Hun- 
ter has justly remarked, that " In inflammation of 
the brain, the pulse varies more than in inflamma- 
tions of any other part ; and perhaps we are led to 
judge of inflammation there, more from other symp- 
toms than the pulse*." 

The slow, uncommonly frequent, intermitting, 
and imperceptible states of the pulse, which require 
bleeding, may be distinguished from the same states 
of the pulse, which arise from an exhausted state 
of the system, and that forbid bleeding, by the fol- 
lowing marks : 

1. They occur in the beginning of a fever. 

2. They occur in the paroxysms of fevers which 
have remissions and exacerbations. 

3. They sometimes occur after blood-letting, 
from causes formerly mentioned. 

4. They sometimes occur, and continue during 
the whole course of an inflammation of the stomach 
and bowels. And, 

* Treatise on Inflammation, cha^p. tii. 9. 



i 
DEFENCE OF BLOOD-LETTING. 319 

5. They occur in relapses, after the crisis of a 
fever. 

The other states of the pulse indicate bleeding in 
every stage of fever, and in every condition of the 
system. I have taken notice, in another place, of 
the circumstances which render it proper in the ad- 
vanced stage of chronic fever. 

If all the states of pulse which have been enu- 
merated indicate bleeding, it must be an affecting 
consideration to reflect, how many lives have been 
lost, by physicians limiting the use of the lancet 
only to the tense or full pulse ! 

I wish it comported with the proposed limits of 
this essay to illustrate and establish, by the recital 
of cases, the truth of these remarks upon the indi- 
cations of bleeding from the pulse. It communi- 
cates much more knowledge of the state of the 
system than any other sign of disease. Its fre- 
quency (unconnected with its other states), being 
under the influence of diet, motion, and the pas- 
sions of the mind, is of the least consequence. In 
counting the number of its strokes, we are apt to 
be diverted from attending to its irregularity and 
force ; and in these, it should always be remem- 
bered, fever chieflv consists. The knowledge ac- 



320 DEFENCE OF BLOOD-LETTING. 

quired by attending to these states of the pulse is 
so definite and useful, and the circumstances which 
seduce from a due attention to them are so erro- 
neous in their indications, that I have sometimes 
wished the Chinese custom of prescribing, from 
feeling the pulse only, without seeing or convers- 
ing with the patient, were imposed upon all phy- 
sicians. 

To render the knowledge of the indications of 
blood-letting, from the state of the pulse, as definite 
and correct as possible, I shall add, for the benefit 
of young practitioners, the following directions for 
feeling it. 

1. Let the arm be placed in a situation in which 
all the muscles which move it shall be completely 
relaxed ; and let it, at the same time, be free from 
the pressure of the body upon it. 

2. Feel the pulse, in all obscure or difficult cases, 
in both arms. 

3. Apply all the fingers of one hand, when prac- 
ticable, to the pulse. For this purpose, it will be 
most convenient to feel the pulse of the right hand 
with your left, and of the left hand with your right. 



DEFENCE OF BLOOD-LETTING* 321 

4. Do not decide upon blood-letting, in difficult 
cases, until you have felt the pulse for some time. 
The Chinese physicians never prescribe until they 
have counted 49 strokes. 

5. Feel the pulse at the intervals of four or five 
minutes, when you suspect that its force has been 
varied by any circumstance not connected with the 
disease, such as emotions of the mind, exercise, 
eating, drinking, and the like. 

6. Feel the pulsations of the arteries in the tem- 
ples and in the neck, when the pulse is depressed 
or imperceptible in the wrists. 

7. Request silence in a sick room, and close 
your eyes, in feeling a pulse in difficult cases. By 
so doing, you will concentrate the sensations of 
your ears and eyes, in your fingers. 

In judging of the states of the pulse which have 
been enumerated, it will be necessary always to re- 
member the natural difference^ in its frequency and 
force, in old people and children ; also in the morn- 
ing and evening, and in the sleeping and waking 
states of the system. 

vol. iv. 2 s 



322 DEFENCE OF BLOOD-LETTING. 

Much yet remains to be known upon this sub- 
ject. I have mentioned the different states of the 
pulse, which call for bleeding, but it is more diffi- 
cult to know when to prescribe it, when the pulse 
imparts no sign of disease. In general it may be 
remarked, where the disease is recent y the part af- 
fected important to life, and incapable of sustaining 
violent morbid action long, without danger of dis- 
organization, where pain is great, and respiration 
difficult, the pulse may be disregarded in the use of 
the lancet. 

But to return. 

II. Regard should be had to the character of the 
reigning epidemic, in deciding upon blood-letting. 
If the prevailing fever be of a highly inflammatory 
nature, bleeding may be used with more safety, in 
cases where the indications of it from the pulse are 
somewhat doubtful. The character of a previous 
epidemic should likewise direct the use of the lan- 
cet. The pestilential fever which followed the 
plague in London, in 1665, Dr. Sydenham says, 
yielded only to blood-letting. It is equally neces- 
sarv in all the febrile diseases which succeed ma- 
lignant fevers. 



DEFENCE OF BLOOD-LETTING. 323 

III. Regard should be had to the weather and 
season of the year. Dr. Hillary and Dr. Huxham 
both say it is much more necessary in dry, than in 
wet weather, and, all physicians know, it is more 
copiously indicated in the spring and autumn, than 
in summer and winter. 

IV. The constitution of a patient, and more es- 
pecially his habits with respect to blood-letting, 
should be taken into consideration, in prescribing 
it. If he be plethoric, and accustomed to bleed- 
ing in former indispositions, it will be more neces- 
sary, than in opposite states and habits of the sys- 
tem. Nature will expect it. 

V. The corpulency of a patient should regulate 
the use of the lancet. A butcher of great observa- 
tion informed me, that a fat ox did not yield more 
than from one half, to one third of the quantity of 
blood of a lean one, of the same size of bone, and it 
is well known, that the loss of a small quantity of 
blood, after cutting off the head of a fowl, is always 
a sign of its being fit for the table. The pressure 
of fat upon the blood-vessels produces the same 
effects in the human species that it does in those 
animals ; of course, less blood should be drawn 
from fat, than from lean people, under equal circum- 
stances of disease. 



324 DEFENCE OF BLOOD-LETTING. 

VI. As persons have more or less blood in their 
vessels, according to their size, less blood should 
be drawn, under equal circumstances, from small 
than large people. 

VII. Regard should be had to the age of adults 
in prescribing bleeding. In persons between fifty 
and sixty years of age, for reasons formerly men- 
tioned, more blood may be drawn than in middle 
life, in similar diseases. In persons beyond 70, it 
will be necessary to regulate the quantity to be 
drawn by other signs than the pulse, or the appear- 
ances of the blood, the former being generally full, 
and sometimes tense, and the latter often putting on 
the sign of the second grade of morbid action for- 
merlv described. 

VIII. Regard should be had to the country or 
place from which persons affected with fevers have 
arrived, in prescribing the loss of blood. Fevers, 
in America, are more inflammatory than fevers, in 
persons of equal rank, in Great-Britain. A French 
physician once said, it was safer to draw a hogs- 
head of wine from a Frenchman's veins, than a 
quarter of a hundred pounds of beef from an Eng- 
lishman's, meaning to convey an idea of the differ- 
ence in the grades of morbid or inflammatory action 
in the diseases of the inhabitants of France and 



DEFENCE OF BLOOD-LETTING. 325 

England, and of the difference in the quantity of 
blood proper to be drawn in each of them. A 
similar difference exists between the grades of 
fever in Great-Britain and America. From a want 
of attention to this circumstance, I saw a common 
pleurisy end in an abscess of the lungs, in a sea 
captain, in the city of London, in the year 1769, 
who was attended by a physician of the first repu- 
tation in England. He was bled but once. His 
pulse and American constitution called for the loss 
of 50 or 60 ounces of blood. 

IXc Regard should be had to the structure and 
situation of the parts diseased with febrile action. 
The brain, from its importance to all the functions of 
life, the rectum, the bladder, and the trachea, when 
inflamed, and the intestines, when strangulated, 
from their being removed so much out of the in- 
fluence of the great circulation, all require more 
copious bleeding than the same degrees of disease 
in the lungs, and some other parts of the body. 

X. After blood-letting has been performed, the 
appearances of the blood should be attended to, in 
order to judge of the propriety of repeating it. I 
shall briefly describe these appearances, and ar- 
range them in the order in which they indicate the 



326 DEFENCE OF BLOOD-LETTING, 

different degrees of inflammatory diathesis, begin- 
ning with the highest. 

1. Dissolved blood. It occurs in the malignant 
states of fever. I have seen it several times in the 
pleurisy, and have once heard of it in a case of 
gout. I have ascribed this decomposition of the 
blood to such a violent degree of action in the 
blood-vessels, as to dispose them to a paralytic 
state. It is generally considered as a signal to lay 
aside the lancet. If it occur in the first stage of a 
fever, it indicates a very opposite practice. By 
repeated bleedings, the vessels recover their natu- 
ral action, and the blood becomes reduced to its 
original texture. Of this I have had frequent ex- 
perience, since the year 1793. It required three 
successive bleedings to restore the blood from a 
dissolved, to a coagulable state, in Mr. Benton. It 
afterwards became very sizy.. If this dissolved 
blood appear towards the close of a malignant fever, 
no other benefit than the protraction of life for a day 
or two, or an easy death, can be expected from 
repeating the bleeding, even though it be indicated 
by a tense pulse ; for the viscera are generally so 
much choaked by the continuance of violent action 
in the blood-vessels, that they are seldom able to 
discharge the blood which distends them, into the 
cavity in the vessels, which is created by the ab- 



DEFENCE OF BLOOD-LETTING. 327 

straction of blood from a vein. There is some 
variety in the appearance of this state of the blood, 
which indicates more or less violent pressure upon 
the blood-vessels. It threatens most danger to life 
when it resembles molasses in its consistence. The 
danger is less when the part which is dissolved oc- 
cupies the bottom of the bowl, and when its sur- 
face is covered with a sizy pellicle or coat. 

Does not the restoration of the blood from its 
disorganized state, by means of bleeding, suggest 
an idea of a similar change being practicable in the 
solids, when they are disorganized by disease? 
And are we not led hereby to an animating view of 
the extent and power of medicine ? 

2. Blood of a scarlet colour, without any separa- 
tion into crassamentum or serum, indicates a se- 
cond degree of morbid action. It occurs likewise 
in the malignant state of fever. It is called impro- 
perly dense blood. It occurs in old people. 

3. Blood in which part of. the crassamentum is 
dissolved in the serum, forming a resemblance to 
what is called the lotura carnium, or the washings 
of flesh in water. 



328 DEFENCE OF BLOOD-LETTING. 

4. Crassamentum sinking to the bottom of a 
bowl in yellow serum. 

5. Crassamentum floating in serum, which is at 
first turbid, but which afterwards becomes yellow 
and transparent, by depositing certain red and fiery 
particles of the blood in the bottom of the bowl. 

6. Sizy blood, or blood covered with a buffy 
coat. The more the crassamentum appears in the 
form of a cup, the more inflammatory action is said 
to be indicated by it. This appearance of the blood 
occurs in all the common states of inflammatory 
fever. It occurs too in the mild state of malignant 
fevers, and in the close of such of them as have 
been violent. It is not always confined to the 
common inflammatory state of the pulse, for I have 
observed it occasionally in most of the different 
states of the pulse which have been described. The 
appearance of this buffy coat on the blood in the 
yellow fever is always favourable. It shows the 
disease to be tending from an uncommon to a com- 
mon degree of inflammatory diathesis. It has been 
remarked, that blood which resembles claret in its 
colour, while flowing, generally puts on, when it 
cools, a sizy appearance. 



DEFENCE OF BLOOD-LETTING. 329 

It would seem, from these facts, that the power 
of coagulation in the blood was lessened in an ex- 
act ratio to the increase of action upon the blood- 
vessels, and that it was increased in proportion to 
the diminution of that action, to that degree of it 
which constitutes what I have called common in- 
flammatory action. 

Here, as upon a former occasion, we may say 
with concern, if bleeding be indicated by all the 
appearances of the blood which have been enumer- 
ated, how many lives have been lost by physicians 
limiting the use of the lancet to those cases only, 
where the blood discovered an inflammatory crust ! 

These remarks upon the relative signs of inflam- 
matory action in the blood-vessels, should be ad- 
mitted with a recollection that they are all liable to 
be varied by a moderate, or violent exacerbation of 
fever, by the size of the stream of blood, and by 
the heat, coldness, and form of the cup into which 
the blood flows. Even blood drawn, under exactly 
equal circumstances, from both arms, exhibited, in 
a case of pleurisy communicated to me by Dr. 
Mitchell, of Kentucky, very different appearances. 
That which was taken from one arm was sizy, 
while that which was taken from the other was of 
a scarlet colour. That which is drawn from a vein 

VOL. iv. 2 T 



330 DEFENCE OF BLOOD-LETTING. 

in the arm, puts on, likewise, appearances very dif- 
ferent from that which is discharged from the 
bowels, in a dysentery. These facts were alluded 
to in the Outlines of the Theory of Fever*, in order 
to prove that unequal excitement takes place, not 
only in the different systems of the body, but in 
the same system, particularly in the blood-vessels. 
They likewise show us the necessity of attending 
to the state of the pulse in both arms, as well as in 
other parts of the body, in prescribing blood-letting. 
When time, and more attention to that index of 
the state of the system in fevers, shall have brought 
to light all the knowledge that the pulse is capable 
of imparting, the appearances of the blood, in fe- 
vers, will be regarded as little as the appearances 
of the urine. 

XI. Blood-letting should always be copious 
where there is danger from sudden and great con- 
gestion or inflammation, in vital parts. This dan- 
ger is indicated most commonly by pain ; but 
there may be congestion in the lungs, liver, bowels, 
and even in the head, without pain. In these 
cases, the state of the pulse should always govern 
the use of the lancet. 

* Vol. Ui. 



D.EFENCE OF BLOOD-LETTING. 331 

XII. What quantity of blood may be taken, 
with safety, from a patient in an inflammatory fever? 
To answer this question it will be necessary to re- 
mark, 1. That, in a person of an ordinary size, 
there are supposed to be contained between 25 and 
28 pounds of bipod ; and 2. That much more blood 
may be taken when the blood-vessels are in a state 
of morbid excitement and excitability, than at any- 
other time. One of the uses of the blood is to sti- 
mulate the blood-vessels, and thereby to assist in 
originating and preserving animal life. In a healthy 
state of the vessels, the whole mass of the blood is 
necessary for this purpose ; but in their state of 
morbid excitability, a much less quantity of blood 
than what is natural (perhaps in some cases four or 
five pounds) are sufficient to keep up an equal and 
vigorous circulation. Thus very small portions of 
light and sound are sufficient to excite vision and 
hearing in an inflamed, and highly excitable state 
of the eyes and ears. Thus too, a single glass of 
wine will often produce delirium in a fever in a 
man, who, when in health, is in the habit of drink- 
ing a bottle every day, without having his pulse 
quickened by it. 

An ignorance of the quantity of blood which has 
been drawn by design, or lost by accident, has con- 
tributed very much to encourage prejudices against 



332 - DEFENCE OF BLOOD-LETTING. 

blood-letting. Mr. Cline drew 320 ounces of blood 
in 20 days from a patient in St. Thomas's hospital, 
who laboured under a contusion of the head. But 
this quantity is small compared with the quantity 
lost by a number of persons, whose cases are record- 
ed by Dr. Haller*. I shall mention a few of them. 
One person lost 9 pounds of blood, a second 12, 
a third 18, and a fourth 22, from the nose, at one 
time. A fifth lost 12 pounds by vomiting in one 
night, and a sixth 22 from the lungs. A gentle- 
man at Angola lost between 3 and 4 pounds daily 
from his nose. To cure it, he was bled 97 times 
in one year. A young woman was bled 1020 times 
in 19 years, to cure her of plethora which disposed 
her to hysteria. Another young woman lost 125 
ounces of blood, by a natural haemorrhage, every 
month. To cure it, she was bled every day, and 
every other day, for 14 months. In none of these 
instances, was death the consequence of these great 
evacuations of blood. On the contrary, all the 
persons alluded to, recovered. Many similar in- 
stances of the safety, and even benefit of profuse 
discharges of blood, by nature and art, might be 
mentioned from other authors. I shall insert only 
one more, which shall be taken from Dr. Syden- 
ham's account of the cure of the plague. " Among 

* Elementa Physiologic, vol. iv. p. 45. 



DEFENCE OF BLOOD-LETTING. 333 

the other calamities of the civil war which afflicted 
this nation, the plague also raged in several places, 
and was brought by accident from another place to 
Dunstar Castle, in Somersetshire, where some of 
the soldiers dying suddenly, with an eruption of 
spots, it likewise seized several others. It happened 
at that time that a surgeon, who had travelled much 
in foreign parts, was in the service there, and ap- 
plied to the governor for leave to assist his fellow- 
soldiers who were afflicted with this dreadful dis- 
ease, in the best manner he was able ; which being- 
granted, he took so large a quantity of blood from 
every one at the beginning of the disease, and be- 
fore any swelling was perceived, that they were 
ready to faint, and drop down, for he bled them all 
standing, and in the open air, and had no vessel to 
measure the blood, which falling on the ground, 
the quantity each person lost could not, of course, 
be known. The operation being over, he ordered 
them to lie in their tents ; and though he gave no 
kind of remedy after bleeding, yet of the numbers 
that were thus treated, not a single person died. I 
had this relation from Colonel Francis Windham, 
a gentleman of great honour and veracity, and at 
this time governor of the castle*.' » 

* Vol. i. p. 131, 



334 DEFENCE OF BLOOD-LETTING. 

Again. An ignorance of the rapid manner in 
which blood is regenerated, when lost or drawn, 
has helped to keep up prejudices against blood-let- 
ting. A person (Dr. Haller says) lost five pounds 
of blood daily from the haemorrhoidal vessels for 
62 days, and another 75 pounds of blood in 10 
days. The loss each day was supplied by fresh 
quantities of aliment. 

These facts, I hope, will be sufficient to establish 
the safety and advantages of plentiful blood-letting, 
in cases of violent fever ; also to show the fallacy 
and danger of that practice which attempts the cure 
of such cases of fever, by what is called moderate 
bleeding. There are, it has been said, no half 
truths in government. It is equally true, that there 
are no half truths in medicine. This half-way prac- 
tice of moderate bleeding, has kept up the morta- 
lity of pestilential fevers, in all ages, and in all coun- 
tries. I have combated this practice elsewhere*, and 
have asserted, upon the authority of Dr. Syden- 
ham, that it is much better not to bleed at all, than 
to draw blood disproportioned in quantity to the 
violence of the fever. If the state of the pulse be 

* Account of the Yellow Fever in 1793. 



DEFENCE OF BLOOD-LETTING. 335 

our guide, the continuance of its inflammatory ac- 
tion, after the loss of even 100 ounces of blood, in- 
dicates the necessity of more bleeding, as much as 
it did the first time a vein was opened. In the 
use of this remedy it may be truly said, as in many 
of the enterprizes of life, that nothing is done, while 
any thing remains to be done. Bleeding should be 
repeated while the symptoms which first indicated 
it continue, should it be until four-fifths of the blood 
contained in the body are drawn away. In this 
manner we act in the use of other remedies. Who 
ever leaves off giving purges in a colic, attended 
with costiveness, before the bowels are opened ? or 
who lays aside mercury as a useless medicine, be- 
cause a few dqses of it do not cure the venereal 
disease ? 

I shall only add under this head, that I have 
always observed the cure of a malignant fever to be 
most complete, and the convalescence to be most 
rapid, when the bleeding has been continued until 
a paleness is induced in the face, and until the pa- 
tient is able to sit up without being fainty. After 
these circumstances occur, a moderate degree of 
force in the pulse will gradually wear itself away, 
without doings anv harm. 



336 DEFENCE OF BLOOD-LETTING. 

XIII. In drawing blood, the quantity should be 
large or small at a time, according to the state of 
the system. In cases where the pulse acts with 
force and freedom, from 10 to 20 ounces of blood 
may be taken at once ; but in cases where the pulse 
is much depressed, it will be better to take away 
but a few ounces at a time, and to repeat it three 
or four times a day. By this means the blood-ves- 
sels more gradually recover their vigour, and the 
apparent bad effects of bleeding are thereby pre- 
vented. Perhaps the same advantages might be 
derived, in many other cases, from the gradual ab- 
straction of stimuli, that are derived from the gra- 
dual increase of their force and number, in their 
application to the body. For a number of facts in 
support of this practice, the reader is referred to 
the history of the yellow fever, in the year 1793. 
In an inflammatory fever, the character of which is 
not accurately known, it is safest to begin with 
moderate bleeding, and to increase it in quantity, 
according as the violence and duration of the dis- 
ease shall make it necessary. In fevers, and other 
diseases, which run their courses in a few days or 
hours, and which threaten immediate dissolution, 
there can be no limits fixed to the quantity of blood 
which may be drawn at once, or in a short time. 
Botallus drew three, four, and five pints in a day, 



DEFENCE OF BLOOD-LETTING. 337 

in such cases. Dr. Jackson drew fifty- six ounces 
of blood, at one time, from a Mr. Thompson, of 
the British hospitals, in a fever of great violence 
and danger. This patient was instantly relieved 
from what he styled " chains and horrors." In 
three or four hours he was out of danger, and in 
four days, the doctor adds, returned to his duty*. 
Dr. Physick drew ninety ounces, by weight, from 
Dr. Dewees, in a sudden attack of the apoplectic 
state of fever, at one bleeding, and thereby restored 
him so speedily to health, that he was able to at- 
tend to his business in three days afterwards. In 
chronic states of fever, of an inflammatory type, 
small and frequent bleedings, are to be preferred to 
large ones. We use mercury, antimony, and diet 
drinks as alteratives in many diseases with advan- 
tage. We do not expect to remove debility by 
two or three immersions in a cold bath. We per- 
sist with patience in prescribing all the above re- 
medies for months and years, before we expect to 
reap the full benefits of them. Why should not 
blood-letting be used in the same way, and have 
the same chance of doing good? I have long ago 
adopted this alterative mode of using it, and I can 

* Remarks on the Constitution of the Medical Depar 
ment of the British Army. 
VOL. IV. 2 U 



338 DEFENCE OF BLOOD-LETTING. 

now look around me, and with pleasure behold a 
number of persons of both sexes who owe their 
lives to it. In many cases I have prescribed it 
once in two or three months, for several years, and 
in some I have advised it every two weeks, for se- 
veral months. 

There is a state of fever in which an excess in 
the action of the blood-vessels is barely percepti- 
ble, but which often threatens immediate danger to 
life, by a determination of blood to a vital part. In 
this case I have frequently seen the scale turn in 
favour of life, by the loss of but four or five ounces 
of blood. The pressure of this, and even of a 
much less quantity of blood in the close of a fever, 
I believe, as effectually destroys life as the excess 
of several pounds does in its beginning. 

In cases where bleeding does not cure, it may be 
used with advantage as a palliative remedy. Many 
diseases induce death in a full and highly excited 
state of the system. Here opium does harm, 
while bleeding affords certain relief. It belongs to 
this remedy, in such cases, to ease pain, to pre- 
vent convulsions, to compose the mind, to protract 
the use of reason, to induce sleep, and thus to 
smooth the passage out of life. 



DEFENCE OF BLOOD-LETTING. 339 

XIV. Bleeding from an artery, commonly called 
arteriotomy, would probably have many advantages 
over venesection, could it be performed at all times 
with ease and safety. Blood discharged by haemor- 
rhages affords more relief, in fevers, than an equal 
quantity drawn from a vein, chiefly because it is 
poured forth, in the former case, from a ruptured 
artery. I mentioned formerly, that Dr. Mitchell 
had found blood drawn from an artery to be what 
is called dense, at a time when that which was drawn 
from a vein, in the same persons, was dissolved. 
This fact may possibly admit of some application. 
In the close of malignant fevers, where bleeding has 
been omitted in the beginning of the disease, blood 
drawn from a vein is generally so dissolved, as to t?e 
beyond the reach of repeated bleedings to restore it 
to its natural texture. In this case, arteriotomy 
might probably be performed with advantage. The 
arteries, which retain their capacity of life longer 
than the veins, by being relieved from the imme- 
diate pressure of blood upon them, might be ena- 
bled so to act upon the torpid veins, as to restore 
their natural action, and thereby to arrest departing 
life. Arteriotomy might further be used with ad- 
vantage in children, in whom it is difficult, and 
sometimes impracticable to open a vein. 



340 DEFENCE Of BLOOD-LETTING. 

XV. Much has been said about the proper place 
from whence blood should be drawn. Bleeding in" 
the foot was much used formerly, in order to ex- 
cite a revulsion from the head and breast ; but our 
present ideas of the circulation of the blood have 
taught us, that it may be drawn from the arm with 
equal advantage in nearly all cases. To bleeding in 
the foot there are the following objections : 1. The 
difficulty of placing a patient in a situation favoura- 
ble to it. 2. The greater danger of wounding a 
tendon in the foot than in the arm, And, 3. The 
impossibility of examining the blood after it is 
drawn ; for, in this mode of bleeding, the blood 
generally flows into a bason or pail of water. 

Under this head I shall decide upon the method 
of drawing blood by means of cups and leeches, in 
the inflammatory state of fever. Where an inflam- 
matory fever arises from local affection, or from 
contusion in the head or breast, or from a morbid 
excitement in those, above other parts of the arte- 
rial system, they may be useful ; but where local 
affection is a symptom of general and equable fe- 
ver only, it can seldom be necessary, except where 
bleeding from the arm has been omitted, or used 
too sparingly, in the beginning of a fever ; by which 
means such fixed congestion often takes place, as 
will not yield to general bleeding. 



DEFENCE OF BLOOD-LETTING. 341 

XVI. Much has been said likewise about the 
proper time for bleeding in fevers. It may be 
used at all times, when indicated by the pulse and 
other circumstances, in continual fevers ; but it 
should be used chiefly in the paroxysms of such as 
intermit. I have conceived this practice to be of 
so much consequence, that, when I expect a return 
of the fever in the night, I request one of my pu- 
pils to sit up with my patients all night, in order to 
meet the paroxysm, if necessary, with the lancet. 
But I derive another advantage from fixing a centi- 
nel over a patient in a malignant fever. When a 
paroxysm goes off in the night, it often leaves the 
system in a state of such extreme debility, as to 
endanger life. In this case, from five to ten dr<5ps 
of laudanum, exhibited by a person who is a judge 
of the pulse, obviate this alarming debility, and 
often induce easy and refreshing sleep. By treat- 
ing the human body like a corded instrument, in 
thus occasionally relaxing or bracing the system, 
according to the excess or deficiency of stimulus, 
in those hours in which death most frequently oc- 
curs, I think I have been the -means of saving seve- 
ral valuable lives. 

XVII. The different positions of the body influ- 
ence the greater or less degrees of relief which are 
obtained by blood-letting. Where there is a great 



342 DEFENCE OF BLOOD-LETTING. 

disposition to syncope, and where it is attended 
with alarming and distressing circumstances, blood 
should be drawn in a recumbent posture, but 
where there is no apprehension or dread of faint- 
ing, it may be taken in a sitting posture. The re- 
lief will be more certain if the patient be able to 
stand while he is bled. A small quantity of blood, 
drawn in this posture, brings on fainting, and the 
good effects which are often derived from it. It 
should therefore be preferred, where patients ob- 
ject to copious or frequent bleedings. The history 
of the success of this practice in the British army, 
recently mentioned from Dr. Sydenham, furnishes 
a strong argument in its favour. 

I regret that the limits I have fixed to this De- 
fence of Blood-letting will not admit of my apply- 
ing the principles which have been delivered, to 
all the inflammatory states of fever. In a future 
essay, I hope to establish its efficacy in the ma- 
naical state of fever. I have said that madness is 
the effect of a chronic inflammation in the brain. 
Its remedy, of course, should be frequent and co- 
pious blood-letting. Physical and moral evil are 
subject to similar laws. The mad-shirt, and all 
the common means of coercion, are as improper 
substitutes for bleeding, in madness, as the whip- 
ping-post and pillory are for solitary confinement 



DEFENCE OF BLOOD-LETTING. 343 

and labour, in the cure of vice. The pulse should 
govern the use of the lancet in this, as well as in all 
the ordinary states of fever. It is the dial- plate of 
the system. But in the misplaced states of fever, 
the pulse, like folly in old age, often points at a 
different mark from nature. In all such cases, we 
must conform our practice to that which has been 
successful in the reigning epidemic. A single 
bleeding, when indicated by this circumstance, of- 
ten converts a fever from a suffocated, or latent, to 
a sensible state, and thus renders it a more simple 
and manageable disease. 

It is worthy of consideration here, how far local 
diseases, which have been produced by fevers, 
might be cured by re-exciting the fever. Sir 
William Jones says, the physicians in Persia always 
begin ^the cure of the leprosy by blood-letting*. 
Possibly this remedy diffuses the disease through 
the blood-vessels, and thereby exposes it to be 
more easily acted upon by other remedies. 

Having mentioned the states of fever in which 
blood-letting is indicated, and the manner in which 
it should be performed, I shall conclude this in- 
quiry by pointing out the states of fever in which 

* Asiatic Essays* 



344 DEFENCE OF BLOOD-LETTING. 

it is forbidden, or in which it should be cautiously 
or sparingly performed. This subject is of con- 
sequence, and should be carefully attended to by all 
who wish well to the usefulness and credit of the 
lancet. 

1. It is forbidden in that state of fever, as well 
as in other diseases, in which there is reason to be- 
lieve the brain or viscera are engorged with blood, 
and the whole system prostrated below the point of 
re- action. I have suggested this caution in ano- 
ther place*. The pulse in these cases is feeble, 
and sometimes scarcely perceptible, occasioned by 
the quantity of blood in the blood-vessels being 
reduced, in consequence of the stagnation of large 
portions of it in the viscera. By bleeding in these 
cases, we deprive the blood-vessels of the feeble 
remains of the stimulus which keep up their ac- 
tion, and thus precipitate death. The remedies 
here should be frictions, and stimulating applica- 
tions to the extremities, and gentle stimuli taken 
by the mouth, or injected into the bowels. As 
soon as the system is a little excited by these reme- 
dies, blood may be drawn, but in small quantities 
at a time, and perhaps only by means of cups or 
leaches applied ta the seats of the congestions of 

* Vol. iiu 



DEFENCE OF BLOOD-LETTING. 345 

the blood. After the vessels are excited by the 
equable diffusion of the blood through all their 
parts, it may with safety be drawn from the arm, 
provided it be indicated by the pulse. 

2. It is seldom proper beyond the third day, in 
a malignant fever, if it has not been used on the 
days previous to it, and for the same reason that 
has been given under the former head. Even the 
tension of the pulse is not always a sufficient war- 
rant to bleed, for in three days, in a fever which 
runs its course in five days, the disorganization of 
the viscera is so complete, that a recovery is scarce- 
ly to be expected from the lancet. The remedies 
which give the only chance of relief in this case, 
are purges, blisters, and a salivation. * 

3. Where fevers are attended with paroxysms, 
bleeding should be omitted, or used with great 
caution, in the close of those paroxysms. The 
debility which accompanies the intermission of 
the fever is often so much increased by the recent 
loss of blood, as sometimes to endanger life. 

4. Bleeding is forbidden, or should be used 
cautiously in that malignant state of fever, in which 
a weak morbid action, or what Dr. Darwin calls 
a tendency to inirritability, takes place in the bloods 

vol. iv. 2 x 



346 DEFENCE OF BLOOD-LETTING. 

vessels. It is known by a weak and frequent 
pulse, such as occurs in the typhus fever, and in 
the plague in warm climates. I have often met 
with it in the malignant sore throat, and occasion- 
ally in the pleurisy and yellow fever. The reme- 
dies here should be gentle vomits or purges, and 
afterwards cordials. Should the pulse be too much 
excited by them, bleeding may be used to reduce 
it. 

5 . It should be used sparingly in the diseases of 
habitual drunkards. The morbid action in such 
persons, though often violent, is generally transient. 
It may be compared to a soap-bubble. The arte- 
ries, by being often overstretched by the stimulus 
of strong drink, do not always contract with the di- 
minution of blood, and such patients often sink, 
from this cause, from the excessive use of the lan- 
cet. 

6. It has been forbidden after the suppurative 
process has begun in local inflammation. It con- 
stantly retards the suppuration, when begun, in 
the angina tonsillaris, and thus protracts that dis- 
ease. To this rule there are frequent exceptions. 

7. It should be omitted in pneumony, after co- 
pious expectoration has taken place. This dis- 



DEFENCE OF BLOOD-LETTING. 347 

charge is local depletion, and, though slow in its 
effects compared with bleeding, it serves the same 
purpose in relieving the lungs. The lancet can 
only be required where great pain in coughing, 
and a tense pulse, attend this stage of the disease. 

8. It may be omitted (except when the blood- 
vessels are insulated) in those diseases in which 
there is time to wait, without danger to life, or fu- 
ture health, for the circuitous operation of purging 
medicines, or abstemious diet. 

9. It should be avoided, when it can be done 
without great danger to life, where there is a 
great and constitutional dread of the operation. In 
such cases, it has sometimes done harm to the pa- 
tient, and injured the credit of the lancet. 

10. There are cases in which sizy blood should 
not warrant a repetition of blood-letting. Mr. 
White informs us, in the History of the Bilious 
Fever which has lately prevailed at Bath, that bleed- 
ing, in many cases in which this appearance of the 
blood took place, was useless or hurtful. In some 
of the fevers of our own country, we sometimes see 
sizy blood followed by symptoms which forbid the 
repeated use of the lancet, but which yield to other 
depleting remedies, or to such as are of a cordial 



348 DEFENCE OF BLOOD-LETTING. 

nature. I have seen the same kind of blood, a 
few hours before death, in a pulmonary consump- 
tion, and three days after a discharge of a gallon 
and a half of blood from the stomach by vomiting. 

11. Even a tense pulse does not always call for 
the repeated use of the lancet. I have mentioned 
one case, viz. on the third or fourth days of a ma- 
lignant fever, in which it is improper. There are 
instances of incurable consumptions from tubercles 
and ulcers in the lungs, in which the pulse cannot 
be made to feel the least diminution of tension by 
either copious or frequent bleedings. There are 
likewise cases of hepatic fever, in which the pulse 
cannot be subdued by this remedy. This tense 
state of the pulse is the effect of a suppurative pro- 
cess in the liver. If a sufficient quantity of blood 
has been drawn in the first stage of this disease, 
there is little danger from leaving the pulse to re- 
duce or wear itself down by a sudden or gradual 
discharge of the hepatic congestion. The recove- 
ry in this case is slow, but it is for the most part 
certain. I have once known a dropsy and death 
induced by the contrary practice. 

12. and lastly. There is sometimes a tension in 
the pulse in haemorrhages, that will not yield to 
the lancet. The man whose blood was sizy, three 



DEFENCE OF BLOOD-LETTING. 349 

days after losing a gallon and a half of it from his 
stomach, had a tense pulse the day before he died; 
and I once perceived its last strokes to be tense, in 
a patient whom I lost in a yellow fever by a hae- 
morrhage from the nose. The only circumstance 
that can justify bleeding in these cases is ex- 
treme pain, in which case, the loss of a few ounces 
of blood is a more safe and effectual remedy than 
opium. 

I shall now add a few remarks upon the efficacy 
of blood-letting, in diseases which are not supposed 
to belong to the class of fevers, and which have 
not been included in the preceding volumes. 

I. The philosophers, in describing the humble 
origin of man, say that he is formed " inter stercus 
et urinam." The divines say that he is " con- 
ceived in sin, and shapen in iniquity." I believe it 
to be equally true, and alike humiliating, that he is 
conceived and brought forth in disease. 

This disease appears in pregnancy and parturi- 
tion. I shall first endeavour to prove this to be 
the case, and afterwards mention the benefits of 
blood-letting in relieving it, in both cases. 



350 DEFENCE OF BLOOD-LETTING. 

In pregnancy, the uterus is always affected with 
that grade of morbid action which I formerly call- 
ed inflammation. This is evident from its exhibit- 
ing all its usual phenomena in other parts of the 
bodv. These are, 

1. Swelling, or enlargement. 

2. Haemorrhage. The lochia are nothing but 
a slow and spontaneous bleeding performed by na- 
ture, and intended to cure the inflammation of the 
uterus after parturition. 

3. Abscesses, schirri, and cancers. It is true, 
those disorders sometimes occur in women that 
have never borne children. In these cases, they 
are the effects of the inflammation excited by the 
menstrual disease. 

4. A full, quick, and tense or frequent pulse ; 
pain ; want of appetite* ; sickness at stomach ; 
puking ; syncope ; and sometimes convulsions in 
every part of the body. 

* Dr. Hunter used to teach, in his lectures, that the 
final cause of the want of appetite, during the first months 
of pregnancy, was to obviate plethora, which disposed to 
abortion. This plethora should have been called an inflam- 
matory disease, in which abstinence is useful. 



DEFENCE OF BLOOD-LETTING. 351 

5. Sizy blood. This occurs almost uniformly 
in pregnancy. 

6. A membrane. Dr. Scarpa has proved the 
membrana decidua, which is formed during preg- 
nancy, to be in every respect the same in its pro- 
perties with the membrane which is formed upon 
other inflamed surfaces, particularly the trachea, 
the pleura, and the inside of the bowels. Thus we 
see all the common and most characteristic symp- 
toms and effects of inflammation, in other parts of 
the body, are exhibited by the uterus in pregnancy. 

These remarks being premised, I proceed to re- 
mark, that blood-letting is indicated, in certain 
states of pregnancy, by all the arguments that have 
been used in favour of it in any other inflammatory 
disease. The degree of inflammation in the womb, 
manifested by the pulse, pain, and other signs of 
disease, should determine the quantity of blood to 
be drawn. Low diet, gentle purges, and constant 
exercise, are excellent substitutes for it, but where 
they are not submitted to, blood-letting should be 
employed as a substitute for them. In that dispo- 
sition to abortion, which occurs about the third 
month of pregnancy, small and frequent bleedings 
should be preferred to all other modes of depletion. 
I can assert, from experience, that they prevent 



352 DEFENCE OF BLOOD-LETTING. 

abortion, nearly with as much certainty as they pre- 
vent a haemorrhage from the lungs : for what is an 
abortion but a haemoptysis (if I may be allowed the 
expression) from the uterus? During the last 
month of pregnancy, the loss of from twelve to 
twenty ounces of blood has the most beneficial ef- 
fects, in lessening the pains and danger of child- 
birth, and in preventing its subsequent diseases. 

The doctrine I have aimed to establish leads, not 
only to the use of blood-letting in the disease of 
pregnancy, when required, but to a more copious 
use of it, when combined with other diseases, than 
in those diseases in a simple state. This remark 
applies, in a particular manner, to those spasms and 
convulsions which sometimes occur in the latter 
months of pregnancy, Without bleeding, they 
are always fatal. By copious bleeding, amounting 
in some instances to 80 and 100 ounces, they are 
generally cured. 

Let it not be supposed that blood-letting is alike 
proper and useful in every state of pregnancy. 
There are what are called slow or chronic inflam- 
mations, in which the diseased action of the blood- 
vessels not only forbids it, but calls for cordial and 
stimulating: remedies. The same feeble state of 
inflammation sometimes takes place in the preg- 



DEFENCE OF BLOOD-LETTING. 353 

nant uterus. In these cases cordials and stimulants 
should be preferred to the lancet. 

Parturition is a higher grade of disease than that 
which takes place in pregnancy. It consists of 
convulsive or clonic spasms in the uterus, super- 
vening its inflammation, and is accompanied with 
chills, heat, thirst, a quick, full, tense, or a frequent 
and depressed pulse, and great pain. By some 
divines these symptoms, and particularly pain, 
have been considered as a standing and unchange- 
able punishment of the original disobedience of 
woman, and, by some physicians, as indispensa- 
bly necessary to enable the uterus to relieve itself 
of its burden. By contemplating the numerous 
instances in which it has pleased God to bless the 
labours and ingenuity of man, in lessening or des- 
troying the effects of the curse inflicting upon the 
earth, and by attending to the histories of the total 
exemption from pain in child-bearing that are re- 
corded of the women in the Brasils, Calabria, and 
some parts of Africa, and of the small degrees of it 
which are felt by the Turkish women, who reduce 
their systems by frequent purges of sweet oil dur- 
ing pregnancy, I was induced to believe pain does 
not accompany child-bearing by an immutable de- 
cree of Heaven. By recollecting further how 
effectually biqpd-letting relieves many other spas- 

vol. iv. 2- Y 



354 DEFENCE OF BLOOD-LETTINGS 

fnodic and painful diseases, and how suddenly it 
relaxes rigidity in the muscles, I was led, in the 
year 1795, to suppose it might be equally effectual 
in lessening the violence of the disease and pains 
of parturition. I was encouraged still more to ex- 
pect this advantage from it, by having repeated- 
ly observed the advantages of copious bleeding 
for inflammatory fevers, just before delivery, in 
mitigating its pains, and shortening its duration. 
Upon my mentioning these reflections and facts to 
Dr. Dewees, I was much gratified in being in- 
formed, that he had been in the practice, for seve- 
ral years before his removal from Abingdon to 
Philadelphia, of drawing large quantities of blood 
during parturition, and with all the happy effects 
I had expected from it. The practice has been 
strongly inculcated by the doctor in his lectures 
upon midwifery, and has been ably defended and 
supported by a number of recent facts, in an inge- 
nious inaugural dissertation, published by Dr. Pe- 
ter Miller, in the year 1804. It has been generally 
adopted by the practitidners of midwifery, of both 
sexes, in Philadelphia. 

I do not mean to insinuate that bleeding is a new 
remedy in parturition. It has long ago been ad- 
vised and used in France, and even by the mid- 
wives of Genoa, in Italy, but never, in any country, 



DEFENCE OP BLOOD-LETTING. 355 

in the large quantities that have been recommended 
by Dr. Dewees, that is, from 20 to 80 ounces, or 
until signs of fainting are induced, nor under the 
influence of the theory of parturition, being a vio- 
lent disease. 

But the advantages of this remedy are not con- 
fined to lessening the pains of delivery. It pre- 
vents after pains ; favours the easy and healthy se- 
cretion of milk ; prevents sore breasts, swelled legs, 
puerperile fever, and all the distressing train of 
anomalous complaints that often follow child-bear- 
ing. Dr. Hunter informed his pupils, in his lec- 
tures upon midwifery, in the year 1769, that he 
had often observed the most rapid recoveries to 
succeed the most severe labours. The severity 
of the pains in these cases created a disease, which 
prevented internal congestions in the womb. 
Bleeding, by depleting the uterus, obviates at once 
both disease and congestion. Its efficacy is much 
aided by means of glysters, which, by emptying 
the lower bowels, lessen the pressure upon the 
uterus. 

Let it not be inferred, from what has been said in 
favour of blood-letting in parturition, that it is pro- 
per in all cases. Where there has been great previ- 
ous inanition, and where there are marks of languor, 



' 1 



356 DEFENCE OF BLOOD-LETTING. 

and feeble morbid action in the system, the reme- 
dies should be of an opposite nature. Opium and 
other cordials are indicated in these cases. Their 
salutary effects in exciting the action of the uterus, 
and expediting delivery, are too well known to be 
mentioned. 

I have expressed a hope in another place*, that 
a medicine would be discovered that should sus- 
pend sensibility altogether, and leave irritability, or 
the powers of motion, unimpaired, and thereby 
destroy labour pains altogether. I was encouraged 
to cherish this hope, by having known delivery to 
take place, in one instance, during a paroxysm of 
epilepsy, and having heard of another, during a fit 
of drunkenness, in a woman attended by Dr. 
Church, in both of which there was neither consci- 
ousness, nor recollection of pain. 

2. During the period in which the menses are 
said to dodge, and for a year or two after they cease 
to flow, there is a morbid fulness and excitement 
in the blood-vessels, which are often followed by 
head-ach, cough, dropsy, haemorrhages, glandular 
obstructions, and cancers. They may all be pre- 
vented by frequent and moderate bleedings. 

9 Medical Repository, vol. vi. 



DEFENCE OF BLOOD-LETTING. 357 

3. It has been proved, by many facts, that opium, 
when taken in an excessive dose, acts by inducing 
a similar state of the system with that which is 
induced by the miasmata which bring on malignant 
and inflammatory fevers. The remedy for the dis- 
ease produced by it (where a vomiting cannot be 
excited to discharge the opium) has been found to 
be copious blood- letting. Of its efficacy, the reader 
will find an account in four cases, published in the 
fifth volume of the New- York Medical Repository. 

4. It is probable, from the uniformly stimulating 
manner in which poisons of all kinds act upon the 
human body, that bleeding would be useful in ob- 
viating their baneful effects. Dr. John Dorsey has 
lately proved its efficacy, in the case of a child that 
was affected with convulsions, in consequence of 
eating the leaves of the datura stramonium. 

5. It has been the misfortune of diabetes to be 
considered by physicians as exclusively a local dis- 
ease of weak morbid action, or as the effect of sim- 
ple debility in the kidneys ; and hence stimulating 
and tonic medicines have been exclusively pre- 
scribed for it. This opinion is not a correct one. 
It often affects the whole arterial system, more es- 
pecially in its first stage, with great morbid action. 
In two cases of it, where this state of the blood- 



358 DEFENCE OF BLOOD-LETTING. 

vessels took place, I have used blood-letting with 
success, joined with the common remedies for in- 
flammatory diseases. 

6. In dislocated bones which resist both skill 
and force, it has been suggested, that bleeding, 
till fainting is induced, would probably induce 
such a relaxation in the muscles as to favour 
their reduction. This principle was happily ap- 
plied, in the winter of 1795, by Dr. Physick, in 
the Pennsylvania hospital, in a case of dislocated 
humerus of two months continuance. The doc- 
tor bled his patient till he fainted, and then reduced 
his shoulder in less than a minute, and with very 
little exertion of force. The practice has since be- 
come general in Philadelphia, in luxations of large 
bones, where they resist the common degrees of 
strength employed to reduce them. 

In contemplating the prejudices against blood- 
letting, which formerly prevailed so generally in 
our countrv, I have been led to ascribe them to a 

ml ' 

cause wholly political. We are descended chiefly 
from Great- Britain, and have been for many years 
under the influence of English habits upon all sub- 
jects. Some of these habits, as far as they relate 
to government, have been partly changed; but in 
dress, arts, manufactures, manners, and science, 



DEFENCE OF BLOOD-LETTING. 359 

we are still governed by our early associations. 
Britain and France have been, for many centuries, 
hereditary enemies. The hostility of the former to 
the latter nation, extends to every thing that be- 
longs to their character. It discovers itself, in an 
eminent degree, in diet and medicine. Do the 
French love soups ? the English prefer solid flesh. 
Do the French love their meats well cooked ? the 
English prefer their meats but half roasted. Do 
the French sip coffee after dinner? the English 
spend their afternoons in drinking Port and Ma- 
deira wines. Do the French physicians prescribe 
purges and glysters to cleanse the bowels? the Eng- 
lish physicians prescribe vomits for the same pur- 
pose. Above all, do the French physicians advise 
bleeding in fevers ? the English physicians forbid 
it, in most fevers, and substitute sweating in the 
room of it. Here then we discover the source of 
the former prejudices and errors of our country- 
men, upon the subject of blood-letting. They are 
of British origin. They have been inculcated 
in British universities, and in British books; and 
they accord as ill with our climate and state of 
society, as the Dutch foot stoves did with the tem- 
perate climate of the Cape of Good Hope*. 

* I have frequently been surprised, in visiting English 
patients, to hear them say, when I have prescribed bleeding, 



360 DEFENCE OF BLOOD-LETTING. 

It is probable the bad consequences which have 
followed the indiscriminate use of the lancet in 
France, and some other countries, may have con- 
tributed in some degree to create the prejudices 
against it, which are entertained by the physicians 
in Great-Britain. Bleeding, like opium, has lost 
its character, in many cases, by being prescribed 
for the name of a disease. It is still used, Mr. 
Townsend tells us, in this empirical way in Spain, 
where a physician, when sent for to a patient, or- 
ders him to be bled before he visits him. The 
late just theory of the manner in which opium acts 
upon the body, has restrained its mischief, and add- 
ed greatly to its usefulness. In like manner, may 

that their physicians in England had charged them never to 
be bled. This advice excluded all regard to the changes 
which climate, diet, new employments, and age might in- 
duce upon the system. I am disposed to believe that many 
lives are lost, and numerous chronic diseases created in 
Great-Britain, by the neglect of bleeding in fevers. My for- 
mer pupil, Dr. Fisher, in a letter from the university of 
Edinburgh, dated in the winter of 1795, assured me, that he 
had cured several of his fellow-students of fevers (contrary 
to general prejudice) by early bleeding, in as easy and sum- 
mary a way as he had been accustomed to see them cured 
in Philadelphia, by the use of the same remedy. Dr. Gor- 
don, of Scotland, and several other physicians in Great-Bri- 
tain, have lately revived the lancet, and applied it with great 
judgment and success to the cure of fevers. 



DEFENCE OF BLOOD-LETTING. 361 

we not hope, that just theories of diseases, and 
proper ideas of the manner in which bleeding acts 
in curing them, will prevent a relapse into the evils 
which formerly accompanied this remedy, and ren- 
der it a great and universal blessing to mankind 2 



Vol. rv. 2 z 



AN INQUIRY 



INTO THE 



Comparative State of Medicine, 



IN PHILADELPHIA, 



BETWEEN THE YEARS 1760 AND 1766, 



AND THE YEAR 1805. 



AN INQUIRY, &c. 



IN estimating the progress and utility of 
medicine, important advantages may be derived 
from taking a view of its ancient, and comparing 
it with its present state. To do this upon an ex- 
tensive scale, would be difficult, and foreign to the 
design of this inquiry. I shall therefore limit it, to 
the history of the diseases and medical opinions 
which prevailed, and of the remedies which were 
in use, in the city of Philadelphia, between the 
years 1760 and 1766, and of the diseases, medi- 
cal opinions, and remedies of the year 1805. The 
result of a comparative view of each of them, will 
determine whether medicine has declined or im- 
proved, in that interval of time, in this part of the 
world. 

To derive all the benefits that are possible from 
such an inquiry, it will be proper to detail the 



366 STATE OF MEDrciNE, 

causes, which, by acting upon the human body, 
influence the subjects that have been mentioned, 
in those two remote periods of time. 

Those causes divide themselves into climate, 
diet, dress, and certain peculiar customs ; on each 
of which I shall make a few remarks. 

After what has been said, in the history of the 
Climate of Pennsylvania, in the first volume of these 
Inquiries, it will only be necessary in this place 
briefly to mention, that the winters in Philadelphia, 
between the years 1760 and 1766, were almost uni- 
formly cold. The ground was generally covered 
with snow, and the Delaware frozen, from the first 
or second week in December, to the last week in 
February, or the first week In March, Thaws 
were rare during the winter months, and seldom of 
longer duration than three or four days. The 
springs began in May. The summers were gene- 
rally warm, and the air seldom refreshed by cool 
north-west winds. Rains were frequent and heavy, 
and for the most part accompanied with thunder and 
lightning. The autumns began in October, and 
were gradually succeeded by cool and cold weather. 

The diet of the inhabitants of Philadelphia, dur- 
ing those years, consisted chiefly of animal food. 



BETWEEN 1760 AND 1766, AND 1805. 367 

It was eaten, in some families, three times, and in 
all, twice a day. A hot supper was a general meal. 
To two and three meals of animal food in a day, 
many persons added what was then called " a re- 
lish," about an hour before dinner. It consisted of 
a slice of ham, a piece of salted fish, and now and 
then a beef- steak, accompanied with large draughts 
of punch or toddy. Tea was taken in the interval 
between dinner and supper. 

In many companies, a glass of wine and bitters 
was taken a few minutes before dinner, in order to 
increase the appetite. 

The drinks, with dinner and supper, were punch 
and table beer. 

Besides feeding thus plentifully in their families, 
many of the most respectable citizens belonged to 
clubs, which met in the city in winter, and in its 
vicinity, under sheds, or the shade of trees, in 
summer, once and twice a week, and, in one in- 
stance, every night. They were drawn together 
by suppers in winter, and dinners in summer. 
Their food was simple, and taken chiefly in a solid 
form. The liquors used with it were punch, Lon- 
don porter, and sound old Madeira wine. 



368 STATE OF MEDICINE, 

Independently of these clubs, there were occa- 
sional meetings of citizens, particularly of young 
men, at taverns, for convivial purposes. A house 
in Water- street, known by the name of the Tun 
tavern, was devoted chiefly to this kind of acci- 
dental meetings. They were often followed by 
midnight sallies into the streets, and such acts of 
violence and indecency, as frequently consigned 
the perpetrators of them afterwards into the hands 
of the civil officers and physicians of the city. 

Many citizens, particularly tradesmen, met every 
evening for the purpose of drinking beer, at houses 
kept for that purpose. Instances of drunkenness 
were rare at such places. The company generally 
parted at ten o'clock, and retired in an orderly 
manner to their habitations. Morning drams, 
consisting of cordials of different kinds, were com- 
mon, both in taverns and private houses, but they 
were confined chiefly to the lower class of people. 

From this general use of distilled and fermented 
liquors, drunkenness was a common vice in all the 
different ranks of society. 

The dresses of the men, in the years alluded to, 
were composed of cloth in winter, and of thin 
woollen or silk stuffs in summer. Wigs composed 



BETWEEN 1760 AND 1766, AND 1805. 369 

the covering of the head, after middle life, and 
cocked hats were universally worn, except by the 
men who belonged to the society of friends. 

The dresses of the women, in the years before 
mentioned, consisted chiefly of silks and calicoes. 
Stays were universal, and hoops were generally 
worn by the ladies in genteel life. Long cloth or 
camblet cloaks were common, in cold weather, 
among all classes of women. 

The principal custom under this head, which in- 
fluenced health and life, was that which obliged 
women, after lying-in, " to sit up for company ;" 
that is, to dress themselves, every afternoon on the 
second week after their confinement, and to sit for 
four or five hours, exposed to the impure air of a 
crowded room, and sometimes to long and loud 
conversations. 

Porches were nearly universal appendages to 
houses, and it was common for ail the branches of 
a family to expose themselves upon them, to the 
evening air. Stoves were not in use, at that time, 
in any places of public worship. 

Funerals were attended by a large concourse of 
citizens, who were thereby often exposed to great 
vol. iv. 3 A. 



370 STATE OF MEDICINE, 

heat and cold, and sometimes to standing, while 
the funeral obsequies were performed, in a wet or 
damp church-yard. 

The human mind, in this period of the history 
of our city, was in a colonized state, and the pas- 
sions acted but feebly and partially upon literary 
and political subjects. 

We come now to mention the diseases which 
prevailed in our city between the years 1760 and 
1766. 

The cholera morbus was a frequent disease in 
the summer months. 

Sporadic cases of dysentery were at that time 
common. I have never seen that disease epidemic 
in Philadelphia. 

The intermitting fever prevailed in the month of 
August, and in the autumn, chiefly in the suburbs 
and neighbourhood of the city. In the year 1765, 
it was epidemic in South wark, and was so general, 
at the same time, as to affect two thirds of the in- 
habitants of the southern states. This fact is men- 
tioned by Dr. Bond, in a lecture preserved in the 



BETWEEN 1760 AND 1766, AND 1805. 371 

minutes of the managers of the Pennsylvania hos- 
pital. 

The slow chronic fever, called at that time the 
nervous fever, was very common, in the autumnal 
months, in the thickly settled parts of the city. 

The bilious fever prevailed, at the same time, in 
Southwark. The late Dr. Clarkson, who began 
to practise medicine in that part of the city, in the 
year 1761, upon hearing some of his medical 
brethren speak of the appearance of bilious remit- 
tents in its middle and northern parts, about the 
year 1778, said they had long been familiar to him, 
and that he had met with them every year since his 
settlement in Philadelphia*. 

* From the early knowledge this excellent physician and 
worthy man had thus acquired of the bilious remitting fever, 
he was very successful in the treatment of it. It was by in- 
struction conveyed by him to me with peculiar delicacy, that I 
was first taught the advantages of copious evacuations from 
the bowels in that disease. I had been called, when a young 
practitioner, to visit a gentleman with him in a bilious 
pleurisy. A third or fourth bleeding, which I advised, 
cured him. The doctor was much pleased with its effect, 
and said to me afterwards, " Doctor, you and I have each a 
great fault in our practice j I do not bleed enough, you do 
not purge enough." 



372 STATE OF MEDICINE, 

The yellow fever prevailed in the neighbourhood 
of Spruce- street wharf, and near a filthy stream of 
■water which flowed through what is now called 
Dock- street, in the year 1762. Some cases of it 
appeared likewise in Southwark. It was scarcely 
known in the north and west parts of the city. No 
desertion of the citizens took place at this time, 
nor did the fear of contagion drive the friends of 
the sick from their bed-sides, nor prevent the usual 
marks of respect being paid to them after death, by 
following their bodies to the grave. A few spora- 
dic cases of the same grade of fever appeared in 
the year 1763. 

Pneumonies, rheumatisms, inflammatory sore 
throats, and catarrhs were frequent during the win- 
ter and spring months. The last disease was in- 
duced, not only by sudden changes in the weather, 
but often by exposure to the evening air, on porches 
in summer, and by the damp and cold air of places 
of public worship in winter. 

The influenza was epidemic in the city in the 
spring of the year 1761. 

The malignant sore throat proved fatal to a num- 
ber of children in the winter of 1763. 



BETWEEN 1760 AND 1766, AND 1805. 373 

The scarlet fever prevailed generally in the year 
1764. It resembled the same disease, as described 
by Dr. Sydenham, in not being accompanied by a 
sore throat. 

Death from convulsions in pregnant women, al- 
so from parturition, and the puerperile fever, were 
common between the years 1760 and 1766. Death 
was likewise common between the 50th and 60th 
years of life from gout, apoplexy, palsy, obstructed 
livers, and dropsies. A club, consisting of about 
a dozen of the first gentlemen in the city, all paid, 
for their intemperance, the forfeit of their lives be- 
tween those ages, and most of them with some one, 
or more of the diseases that have been mentioned. 
I sat up with one of that club on the night of his 
death. Several of the members of it called at his 
house, the evening before he died, to inquire how 
he was. One of them, upon being informed of his 
extreme danger, spoke in high and pathetic terms 
of his convivial talents and virtues, and said, " he 
had spent 200 evenings a year with him, for the 
last twenty years of his life." These evenings 
w r ere all spent at public houses. 

The colica pictonum, or dry gripes, was for- 
merly a common disease in this city. It was 
sometimes followed by a palsy of the upper and 



374 STATE OF MEDICINE, 

lower extremities. Colics from crapulas were like- 
wise very frequent, and now and then terminated 
in death. 

Many children died of the cholera infantum, cy- 
nanche trachealis, and hydrocephalus internus. The 
last disease was generally ascribed to worms. 

Fifteen or twenty deaths occurred, every sum- 
mer, from drinking cold pump water, when the 
body was in a highly excitable state, from great 
heat and labour. 

The small-pox, within the period alluded to, was 
sometimes epidemic, and carried off many citizens. 
In the year 1759, Dr. Barnet was invited from Eli- 
zabeth-town, in New- Jersey, to Philadelphia, to ino- 
culate for the small-pox. The practice, though much 
opposed, soon became general. About that time, 
Dr. Redman published a short defence of it, and 
recommended the practice to his fellow-citizens in 
the most affectionate language. The success of 
inoculation was far from being universal. Subse- 
quent improvements in the mode of preparing the 
body, and treating the eruptive fever, have led us 
to ascribe this want of success to the deep wound 
made in the arm, to the excessive quantity of mer- 



BETWEEN 1760 AND 1766, AND 1805. 375 

cury given to prepare the body, and to the use of a 
warm regimen in the eruptive fever. 

The peculiar customs and the diseases which 
have been enumerated, by inducing general weak- 
ness, rendered the pulmonary consumption a fre- 
quent disease among both sexes. 

Pains and diseases from decayed teeth were very 
common, between the years 1760 and 1766. At 
that time, the profession of a dentist was unknown 
in the city. 

The practice of physic and surgery were united, 
during those years, in the same persons, and physi- 
cians were seldom employed as man-midwives, 
except in preternatural and tedious labours. 

The practice of surgery was regulated by Mr. 
Sharp's treatise upon that branch of medicine. 

Let us now take a view of the medical opinions 
which prevailed at the above period, and of the re- 
medies which were employed to cure the diseases 
that have been mentioned. 

The system of Dr. Boerhaave then governed the 
practice of every physician in Philadelphia. Of 



376 STATE OF MEDICINE, 

course diseases were ascribed to morbid acrimo- 
nies, and other matters in the blood, and the prac- 
tice of those years was influenced by a belief in 
them. Medicines were prescribed to thin, and to 
incrassate the blood, and diet drinks were adminis- 
tered in large quantities, in order to alter its quali- 
ties. Great reliance was placed upon the powers 
of nature, and critical days were expected with so- 
licitude, in order to observe the discharge of the 
morbid cause of fevers from the system. This 
matter was looked for chiefly in the urine, and 
glasses to retain it were a necessary part of the fur- 
niture of every sick room. To ensure the dis- 
charge of the supposed morbid matter of fevers 
through the pores, patients were confined to their 
beds, and fresh, with cool air, often excluded by 
close doors and curtains. The medicines to pro- 
mote sweats were generally of a feeble nature. 
The spiritus mindereri, and the spirit of sweet ni- 
tre were in daily use for that purpose. In danger- 
ous cases, saffron and Virginia snake-root were 
added to them. 

Blood-letting was used plentifully in pleurisies 
and rheumatisms, but sparingly in all other diseas- 
es. Blood was often drawn from the feet, in order 
to excite a revulsion of disease from the superior 
parts of the body. It was considered as unsafe, at 



BETWEEN 1760 AND 1766, AND 1805. 377 

that time, to bleed during the monthly disease of 
the female sex. 



Purges or vomits began the cure of all febrile 
diseases, but as the principal dependence was placed 
upon sweating medicines, those powerful remedies 
were seldom repeated in the subsequent stages of 
fevers. To this remark there was a general ex- 
ception in the yellow fever of 1762. Small doses 
of glauber's salts were given every day after bleed- 
ing, so as to promote a gentle, but constant dis= 
charge from the bowels. 

The bark was administered freely in intermit- 
tents. The prejudices against it at that time were 
so general among the common people, that it was 
often necessary to disguise it. An opinion pre- 
vailed among them, that it lay in their bones, and 
that it disposed them to take cold. It was seldom 
given in the low and gangrenous states of fever, 
when they were not attended with remissions. 

The use of opium was confined chiefly to ease 
pain, to compose a cough, and to restrain preterna- 
tural discharges from the body. Such were the 
prejudices against it, that it was often necessary to 
conceal it in other medicines. It was rarely taken 
without the advice of a physician. 

vol. iv. 3 B 



378 STATE OF MEDICINE, 

Mercury was in general use in the years that 
have been mentioned. I have said it was given to 
prepare the body for the small-pox. It was admi- 
nistered by my first preceptor in medicine, Dr. 
Redman, in the same disease, when it appeared in 
the natural way, with malignant or inflammatory 
symptoms, in order to keep the salivary glands 
open and flowing, during the turn of the pock. 
He gave it likewise liberally in the dry gripes. In 
one case of that disease, I well remember the plea- 
sure he expressed, in consequence of its having 
a fleeted his patient's mouth. 

But to Dr. Thomas Bond the city of Philadel- 
phia is indebted for the introduction of mercury 
into general use, in the practice of medicine. He 
called it emphatically " a revolutionary remedy," 
and prescribed it in all diseases which resisted the 
common modes of practice. He gave it liberally 
in the c}^nanche trachealis. He sometimes cured 
madness, by giving it in such quantities as to ex- 
cite a salivation. He attempted to cure pulmonary 
consumption by it, but without success ; for, at 
that time, the influence of the relative actions of 
different diseases and remedies, upon the human 
body, was not known, or, if known, no advantage 
was derived from it in the practice of medicine. 



BETWEEN 1760 AND 1766, AND 1805. 379 

The dry gripes were cured, at that time, by a 
new and peculiar mode of practice, by Dr. Thomas 
Cadwallader. He kept the patient easy by gentle 
anodynes, and gave lenient purges only in the be- 
ginning of the disease ; nor did he ever assist the 
latter by injections till the fourth and fifth days, 
at which time the bowels discharged their contents 
in an easy manner. It was said this mode of cure 
prevented the paralytic symptoms, which some- 
times follow that disease. It was afterwards adopted 
and highly commended by the late Dr. Warren, of 
London. 

Blisters were in general use, but seldom applied 
before the latter stage of fevers. They were pre- 
scribed, for the first time, in haemorrhages, and 
with great success, by Dr. George Glentworth. 

Wine was given sparingly, even in the lowest 
stage of what were then called putrid and nervous 
fevers. 

The warm and cold baths were but little used 
in private practice. The former was now and then 
employed in acute diseases. They were both used 
in the most liberal manner, together with the va- 
pour and warm air baths, in the Pennsylvania hos- 
pital, by Dr. Thomas Bond. An attempt was 



380 STATE OF MEDICINfe, 

made to erect warm and cold baths, in the neigh- 
bourhood of the city, and to connect them with a 
house of entertainment, by Dr. Lauchlin M'Clen, 
in the year 1761. The project was considered as 
unfriendly to morals, and petitions, from several 
religious societies, were addressed to the governor 
of the province, to prevent its execution. The 
enterprize was abandoned, and the doctor soon 
afterwards left the city. 

Riding on horseback, the fresh air of the sea- 
shore, and long journies, were often prescribed to 
invalids, by all the physicians of that day. 

I come now to mention the causes which influ- 
ence the diseases, also the medical opinions and re- 
medies of the present time. In this part of our 
discourse, I shall follow the order of the first part 
of our inquiry. 

I have already taken notice of the changes which 
the climate of Philadelphia has undergone since the 
year 1766. 

A change has of late years taken place in the 
dress of the inhabitants of Philadelphia. Wigs 
have generally been laid aside, and the hair worn 
cut and dressed in different ways. Round hats, 



BETWEEN 1760 AND 1766, AND 1805. 38^ 

with high crowns, have become fashionable. Um- 
brellas, which were formerly a part of female dress 
only, are now used in warm and wet weather, by 
men of all ranks in society ; and flannel is worn 
next to the skin in winter, and muslin in summer, 
by many persons of both sexes. Tight dresses are 
uncommon, and stays are unknown among our 
women. It is to be lamented that the benefits to 
health which might have been derived from the 
disuse of that part of female dress, have been pre- 
vented by the fashion of wearing such light cover- 
ings over the breasts and limbs. The evils from 
this cause, shall be mentioned hereafter. 

A revolution has taken place in the diet of our 
citizens. Relishes and suppers are generally abo- 
lished ; bitters, to provoke a preternatural appetite, 
also meridian bowls of punch, are now scarcely 
known. Animal food is eaten onlv at dinner, and 
excess in the use of it is prevented, by a profusion 
of excellent summer and winter vegetables. 

Malt liquors, or hydrant water, with a moderate 
quantity of wine, are usually taken with those sim- 
ple and wholesome meals. 

Clubs, for the exclusive purpose of feeding, are 
dissolved, and succeeded by family parties, col- 



• 



382 STATE OF MEDICINE, 

lected for the more rational entertainments of con- 
versation, dancing, music, and chess. Taverns 
and beer-houses are much less frequented than for- 
merly, and drunkenness is rarely seen in genteel 
life. The tea table, in an evening, has now become 
the place of resort of both sexes, and the midnight 
serenade has taken place of the midnight revels of 
the young gentlemen of former years. 

In doing justice to the temperance of the modern 
citizens of Philadelphia, I am sorry to admit, there 
is still a good deal of secret drinking among them. 
Physicians, who detect it by the diseases it pro- 
duces, often lament the inefficacy of their remedies 
to remove them. In addition to intemperance from 
spiritous liquors, a new species of intoxication from 
opium has found its way into our city. I have 
known death, in one instance, induced by it. 

The following circumstances have had a favour- 
able influence upon the health of the present inha- 
bitants of Philadelphia. 

The improvements in the construction of mo- 
dern houses, so as to render them cooler in sum- 
mer, and warmer in winter. 

The less frequent practice of sitting on porches, 
exposed to the dew, in summer evenings. 



BETWEEN 1760 AND 1766, AND 1805. 383 

The universal use of stoves in places of public 
worship. 

The abolition of the custom of obliging lying-in 
women to sit up for company. 

The partial use of Schuylkill or hydrant water, 
for culinary and other purposes. 

The enjoyment of pure air, in country seats, in 
the neighbourhood of the city. They not only 
preserve from sickness during the summer and au- 
tumn, but they render families less liable to dis- 
eases during the other seasons of the year. 

And, lastly, the frequent use of private, and pub- 
lic warm and cold baths. For the establishment of 
the latter, the citizens of Philadelphia are indebt- 
ed to Mr. Joseph Simons. 

The following circumstances have an unfavour- 
able influence upon the health of our citizens. 

Ice creams taken in excess, or upon an empty 
stomach. 

The continuance of the practice of attending 
funerals, under all the circumstances that were men- 



384 STATE OF MEDICINE, 

tioned in describing the customs which prevailed 
in Philadelphia, between the years 1760 and 1766. 

The combined influence of great heat and in- 
temperance in drinking, acting upon passions unu- 
sually excited by public objects, on the 4th of July, 
every year. 

The general and inordinate use of segars. 

The want of sufficient force in the water which 
falls into the common sewers to convey their con- 
tents into the Delaware, renders each of their aper- 
tures a source of sickly exhalations to the neigh- 
bouring streets and squares. 

The compact manner in which the gutters are 
now formed, by preventing the descent of water 
into the earth, has contributed very much to retain 
the filth of the city, in those seasons in which they 
are not washed by rain, nor by the waste water of 
the pumps and hydrants. 

The timbers of many of the wharves of the city 
have gone to decay. The docks have not been 
cleaned since the year 1774, and many of them ex- 
pose large surfaces to the action of the sun at low 
water. The buildings have increased in Water- 



BETWEEN 1760 AND 1766, AND 1805. 385 

street, and with them there has been a great increase 
of that kind of filth which is generated in all houses; 
the stores in this street often contain matters which 
putrify ; from all which there is, in warm weather, 
a constant emission of such a foetid odour, as to 
render a walk through that street, by a person who 
does not reside there, extremely disagreeable, and 
sometimes to produce sickness and vomiting. 

In many parts of the vicinity of the city are to 
be seen pools of stagnating water, from which there 
are exhaled large quantities of unhealthy vapours, 
during the summer and autumnal months. 

The privies have become so numerous, and are 
often so full, as to become offensive in most of the 
compact parts of the city, more especially in damp 
weather. 

The pump water is impregnated with many sa- 
line and aerial matters of an offensive nature. 

While these causes exert an unfriendly influence 
upon the bodies of the citizens of Philadelphia, 
the extreme elevation or depression of their pas- 
sions, by the different issues of their political con- 
tests (now far surpassing, in their magnitude, the 
contests of former years), together with their many 

vol. iv. 3 c 



386 STATE OF MEDICINE, 

new and fortuitous modes of suddenly acquiring 
and losing property, predispose them to many dis- 
eases of the mind. 

The present diseases of Philadelphia come next 
under our consideration. 

Fevers have assumed several new forms since 
the year 1766. The mild bilious fever has gradu- 
ally spread over every part of the city. It followed 
the filth which was left by the British army in the 
year 1778. In the year 1780, it prevailed, as an 
epidemic, in South wark, and in Water and Front- 
streets, below Market- street*. In the years 1791 
and 1792, it assumed an inflammatory appearance, 
and was accompanied, in many cases, with hepatic 
affections. The connection of our subject requires 
that I should barely repeat, that it appeared in 1793 
as an epidemic, in the form of what is called yel- 
low fever, in which form it has appeared, in spora- 
dic cases, or as an epidemic, every year since. 

* It appears, from the account given by Mr. White of 
the bilious fever of Bath, that it prevailed several years in 
its suburbs, before it became general in that city. It is re- 
markable, that South wark was nearly the exclusive seat, not 
only of the bilious or break-bone fever of 1780, but of the 
intermitting fever in 1765, taken notice of by Dr. Bond, and 
of the yellow fever of 1805. 



BEfWEEN 1760 AND 1766, AND 1805. 387 

During the reign of this high grade of bilious fever, 
mild intermittents and remittents, and the chronic 
or nervous forms of the summer and autumnal 
fever, have nearly disappeared. 

Inflammations and obstructions of the liver have 
been more frequent than in former years, and even 
the pneumonies, catarrhs, intercurrent, and other 
fevers of the winter and spring months, have all 
partaken more or less of the inflammatory and ma- 
lignant nature of the yellow fever. 

The pulmonary consumption continues to be a 
common disease among both sexes*. 

The cynanche trachealis, the scarlatina anginosa, 
the hydrocephalus internus, and cholera infantum, 
are likewise common diseases in Philadelphia. 

Madness, and several other diseases of the mind, 
have increased since the year 1766, from causes 
which have been mentioned. 

Several of the different forms of gout are still 
common among both sexes. 

Apoplexy and palsy have considerably dimi- 
nished in our city. It is true, the bills of morta- 



388 STATE OF MEDICINE, 

lity still record a number of deaths from the former, 
every year ; but this statement is incorrect, if it 
mean a disease of the brain only, for sudden deaths 
from all their causes are returned exclusively under 
the name of apoplexy. The less frequent occur- 
rence of this disease, also of palsy, is probably oc- 
casioned by the less consumption of animal food, 
and of distilled and fermented liquors, by that class 
of citizens who are most subject to them, than in 
former years. Perhaps the round hat, and the gene- 
ral use of umbrellas, may have contributed to lessen 
those diseases of the brain. 

The dropsy is now a rare disease, and seldom 
seen even in our hospital. 

The colica pictonum, or dry gripes, is scarcely 
known in Philadelphia. I have ascribed this to 
the use of flannel next to the skin as a part of 
dress, and to the general disuse of punch as a com- 
mon drink. 

The natural small-pox is nearly extirpated, and 
the puerperile fever is rarely met with in Philadel- 
phia. The scrophula is much less frequent than 
in former years. It is confined chiefly to persons 
in humble life. 



BETWEEN 1760 AND 1766, AND 1805. 389 

I proceed, in the order that was proposed, to 
take notice of the present medical opinions which 
prevail among the physicians of Philadelphia. The 
system of Dr. Boerhaave long ago ceased to regu- 
late the practice of physic. It was succeeded by 
the system of Dr. Cullen. In the year 1790, Dr. 
Brown's system of medicine was introduced and 
taught by Dr. Gibbon. It captivated a few young 
men for a while, but it soon fell into disrepute. 
Perhaps the high-toned diseases of our city expos- 
ed the fallacy and danger of the remedies inculcated 
by it, and afforded it a shorter life than it has had in 
many other countries. In the year 1790, the au- 
thor of this inquiry promulgated some new princi- 
ples in medicine, suggested by the peculiar phe- 
nomena of the diseases of the United States. 
These principles have been so much enlarged and 
improved by the successive observations and rea- 
sonings of many gentlemen in all the states, as to 
form an American system of medicine. This sys- 
tem rejects the nosological arrangement of diseases, 
and places all their numerous forms in morbid ex- 
citement, induced by irritants acting upon previous 
debility. It rejects, likewise, all prescriptions for 
the names of diseases, and, by directing their ap- 
plications wholly to the forming and fluctuating 
states of diseases, and the system, derives from a few 
active medicines all the advantages which have been 



390 STATE OF MEDICINE, 

in vain expected from the numerous articles which 
compose European treatises upon the materia me- 
dica. This system has been adopted by a part of 
the physicians of Philadelphia, but a respectable 
number of them are still attached to the system of 
Dr. Cullen. 

A great change has taken place in the remedies 
which are now in common use in Philadelphia. I 
shall briefly mention such of them as are new, and 
then take notice of the new and different modes of 
exhibiting such as were in use between the years 
1760 and 1766. 

Vaccination has been generally adopted in our 
city, in preference to inoculation with variolous 
matter. 

Digitalis, lead, zinc, and arsenic are now com- 
mon remedies in the hands of most of our practi- 
tioners. 

Cold air, cold water, and ice are among the new 
remedies of modern practice in Philadelphia. 

Blood-letting is now used in nearly all diseases 
of violent excitement, not only in the blood-ves- 
sels, but in other parts of the body. Its use is not, 



BETWEEN 1760 AND 1766, AND 1805. 391 

as in former times, limited to ounces in specific 
diseases, but regulated by their force, and the im- 
portance of the parts affected to health and life ; nor 
is it forbidden, as formerly, in infancy, in extreme 
old age, in the summer months, nor in the period 
of menstruation, where symptoms of a violent, or 
of a suffocated disease, manifested by an active or 
a feeble pulse, indicate it to be necessary. 

Leeches are now in general use in diseases 
which are removed, by their seat or local nature, 
beyond the influence of the lancet. For the intro- 
duction of this excellent remedy into our city we 
are indebted to Mr. John Cunitz. 

Opium and bark, which were formerly given in 
disguise, or with a trembling hand, are now, not 
only prescribed by physicians, but often purchased, 
and taken without their advice, by many of the citi- 
zens of Philadelphia. They even occupy a shelf 
in the closets of many families. 

The use of mercury has been revived, and a sa- 
livation has been extended, with great improve- 
ments and success, to nearly all violent and obsti- 
nate diseases. Nor has the influence of reason over 
ignorance and prejudice, with respect to that noble 
medicine, stopped here. Cold water, once sup- 



392 STATE OF MEDICINE, 

posed to be incompatible with its use, is now ap- 
plied to the body, in malignant fevers, in order to 
insure and accelerate its operation upon the salivary 
glands. 

Wine is given in large quantities, when indi- 
cated, without the least fear of producing intoxi- 
cation. 

The warm and cold baths, which were formerly 
confined chiefly to patients in the Pennsylvania 
hospital, are now common prescriptions in private 
practice. 

Exercise, country air, and the sea shore, are 
now universally recommended in chronic diseases, 
and in the debility which precedes and follows them. 

Great pains are now taken to regulate the quan- 
tity and quality of aliments and drinks, by the pe- 
culiar state of the system. 

Let us now inquire into the influence of the new 
opinions in medicine, and the new remedies which 
have been mentioned, upon human life. 

The small-pox, once the most fatal and univer- 
sal of all diseases, has nearly ceased to occupy a 



BETWEEN 1760 AND 1765, AND 1805. 393 

place in our bills of mortality, by the introduction 
of vaccination in our city. For the prompt adop- 
tion of this great discovery, the citizens of Phila- 
delphia owe a large debt of gratitude to Dr. Coxe, 
and Mr. John Vaughan. 

Fevers, from ail their causes, and in all their 
forms, with the exception of the bilious yellow fe- 
ver, now yield to medicine. Even that most ma- 
lignant form of febrile diseases is treated with more 
success in Philadelphia than in other countries. 
It would probably seldom prove mortal, did a be- 
lief in its being derived from an impure atmosphere, 
and of its exclusive influence upon the body, while 
it pre vailed as an epidemic, obtain universally among 
the physicians and citizens of Philadelphia. 

The pulmonary consumption has been prevented, 
in many hundred instances, by meeting its premo- 
nitory signs, in weakness and feeble morbid ex- 
citement in the whole system, by country air, gen- 
tle exercise, and gently stimulating remedies. 
Even when formed, and tending rapidly to its last 
stage, it has been cured by small and frequent 
bleedings, digitalis, and a mercurial salivation. 

The hydrocephalus internus, the cynanche tra- 
chealis, and cholera infantum, once so fatal to the 
vol. iv. 3 D 



394 STATE OF MEDICINE, 

children of our city, now yield to medicine in their 
early stages. The two former are cured by copi- 
ous bleeding, aided by remedies formerly employed 
in them without success. The last is cured by 
moderate bleeding, calomel, laudanum, and coun- 
try air. 

The gout has been torn from its ancient sanc- 
tuary in error and prejudice, and its acute parox- 
ysms now yield with as much certainty to the lan- 
cet, as the most simple inflammatory diseases. 

The dropsy is cured by renouncing the unfortu- 
nate association of specific remedies with its name, 
and accommodating them to the degrees of ex- 
citement in the blood-vessels. 

The tetanus from wounds is now prevented, in 
most cases, by inflaming the injured parts, and 
thereby compelling them to defend the whole sys- 
tem, by a local disease. Where this preventing 
remedy has been neglected, and where tetanus 
arises from other causes than wounds, it has often 
been cured by adding to the diffusible stimulus of 
opium, the durable stimuli of bark and wine. 

Death from drinking cold water, in the heated 
state of the body, is now obviated by previously 



BETWEEN 1760 AND 1766, AND 1805. 395 

wetting the hands or feet with the water ; and when 
this precaution is neglected, the disease induced by 
it is generally cured by large doses of liquid lau- 
danum. 

Madness, which formerly doomed its miserable 
subjects to cells or chains for life, has yielded to 
bleeding, low diet, mercury, the warm and cold 
baths, fresh air, gentle exercise, and mild treat- 
ment, since its seat has been discovered to be in 
the blood-vessels of the brain. 

The last achievement of our science in Philadel- 
phia, that I shall mention, consists in the discovery 
and observation of the premonitory signs of violent 
and mortal diseases, and in subduing them by sim- 
ple remedies, in their forming state. By this 
means, death has been despoiled of his prey, in 
many hundred instances. 

In this successful conflict of medicine with dis- 
ease and death, midwifery and surgery have borne 
a distinguished part. They derive their claims to 
the gratitude of the citizens of Philadelphia from 
the practice of each of them being more confined, 
than formerly, to a few members of our profession. 
It is in consequence of the former being exercised 
only by physicians of regular and extensive educa- 



396 STATE OF MEDfCINE, 

tions, that death from pregnancy and parturition 
is a rare occurrence in Philadelphia. 

I should greatly exceed the limits prescribed to 
this inquiry, should I mention how much pain and 
misery have been relieved, and how often death 
has been baffled in his attempts upon human life, 
by several late improvements in old, and the disco- 
covery of new remedies in surgery. I shall briefly 
name a few of them. 

In cases of blindness, from a partial opacity of 
the cornea, or from a closure of the natural pupil, 
a new pupil has been made ; and where the cornea 
has been partially opaque, the opening through the 
iris has been formed, opposite to any part of it, 
which retained its transparency. 

The cure of fractures has been accelerated by 
blood-letting, and, where the union of a broken 
bone has not taken place from a defect of bony 
matter, it has been produced by passing a seton be- 
tween the fractured ends of the bone, and effecting 
a union thereby between them. Luxations, which 
have long resisted both force and art, have been 
reduced in a few minutes, and without pain, by 
bleeding at deliquium animi. 



BETWEEN 1760 AND 1766, AND 1805. 397 

Old sores have been speedily healed, by des- 
troying their surfaces, and thereby placing them in 
the condition of recent accidents. 

The fruitless application of the trepan, in con- 
cussions of the brain, has been prevented by copi- 
ous bleeding, and a salivation. 

A suppression of urine has been cured, by the 
addition of a piece of a bougie to a flexible cathe- 
ter. 

Strictures in the urethra have been removed by 
means of a caustic, also, in a more expeditious way, 
by dividing them with a lancet. 

Hydrocele has been cured by a small puncture, 
and afterwards exciting inflammation and adhesion 
by an injection of wine into the tunica vaginalis 
testis. 

The popliteal aneurism and varicose veins have 
both been removed by operations that were un- 
known a few years ago. 

For the introduction of several of those new sur- 
gical remedies, and for the discovery and improve- 
ment of others, the citizens of Philadelphia are in- 



398 STATE OF MEDICINE, 

debted to Dr. Physick. They are likewise indebted 
to him and Dr. Griffitts for many of the new and 
successful modes of practice, in the diseases that 
have been mentioned. Even the few remedies that 
have been suggested by the author of these inqui- 
ries, owe their adoption and usefulness chiefly to 
the influence of those two respectable and popular 
physicians. 

Before I dismiss this part of our subject, I have 
only to add, that since the cure and extraction of 
the teeth have become a distinct branch of the pro- 
fession of medicine, several diseases which have 
arisen from them, when decayed, have been de- 
tected and cured*. 

We have thus taken a comparative view of the 
medical theories and remedies of former and mo- 
dern times, and of their different influence upon 
human life. To exhibit the advantages of the lat- 
ter over the former, I shall mention the difference 
in the number of deaths in three successive years, 
at a time when the population of the city and sub- 
urbs was supposed to amount to 30,000 souls, 



* The late Mr. Andrew Spence was the first regular bred 
dentist that settled in Philadelphia. There are now several 
well educated gentlemen in the city of that profession. 



BETWEEN 1760 AND 1766, AND 1805. 399 

and in three years, after the population exceeded 
double that number. 



Between the 25th of December, 1771, and the 
25th of December, 1772, there died 1291 persons. 

Between the same days of the same months, in 
1772 and 1773, there died 1344 persons. 

Within the same period of time, between 1773 
and 1774, the deaths amounted to 1021, making 
in all 3,656. I regret that I have not been able to 
procure the returns of deaths in years prior to those 
which have been mentioned. During the three 
years that have been selected, no unusually mor- 
tal diseases prevailed in the city. The measles 
were epidemic in 1771, but were not more fatal 
than in common years. 

Between the 25th of December, 1799, and the 
25th of December, 1800, there died 1525 persons. 

Between the same days of the same months, in 
the years 1801 and 1802, there died 1362 persons, 

Within the same period of time, between 1802 
and 1803, the deaths amounted to 1796, making 
in all 4,883. 



400 . STATE OF MEDICINE, 

Upon these returns it will be proper to remark, 
that several hundreds of the deaths, in 1802 and 
1803, were from the yellow fever, and that many 
of them were of strangers. Of 68 persons, who were 
interred in the Swedes' church-yard alone, one half 
were of that description of people. Deducting 500 
from both those causes of extra- mortality in the 
three years, between 1799 aud 1803, the increase of 
deaths above what they were in the years 1771 and 
1774 is but 727. Had diseases continued to be as 
mortal as they were thirty years ago, considering 
the present state of our population, the number 
of deaths would have been more than 7,312. 

To render the circumstances of the statement of 
deaths that has been given perfectly equal, it will 
be necessary to add, that the measles prevailed in 
the city, in the year 1802, as generally as they did 
in 1771. 

From the history that lias been given, of the 
effects of the late improvements and discoveries in 
medicine upon human life, in Philadelphia, we are 
led to appreciate its importance and usefulness. It 
has been said, by its enemies, to move ; but its 
motions have been asserted to be only in a circle. 
The facts that have been stated clearly prove, that 



BETWEEN 1760 AND 1766, AND 1805. 401 

it has moved, and rapidly too, within the last thirty 
years, in a straight line. 

To encourage and regulate application and enter- 
prize in medicine hereafter, let us inquire to what 
causes we are indebted for the late discoveries and 
improvements in our science, and for their happy 
effects in reducing the number of deaths so far be- 
low their former proportion to the inhabitants of 
Philadelphia. 

The first cause I shall mention is the great phy- 
sical changes which have taken place in the man- 
ners of our citizens in favour of health and life. 

A second cause, is the assistance which has been 
afforded to the practice of physic, by the numerous 
and important discoveries that have lately been 
made in anatomy, natural history, and chemistry, 
all of which have been conveyed, from time to time, 
to the physicians of the city, by means of the Phi- 
ladelphia and hospital libraries, and by the lectures 
upon those branches of science which are annually 
delivered in the university of Pennsylvania. 

3. The application of reasoning to our science 
has contributed greatly to extend its success in the 
cure of diseases. Simply to observe and to re- 
volt, iv. 3 E 



402 STATE OF MEDICINE, 

member, are the humblest operations of the human 
mind. Brutes do both. But to theorize, that is, 
to think, or, in other language, to compare facts, 
to reject counterfeits, to dissolve the seeming affi- 
nity of such as are not true, to combine those that 
are related, though found in remote situations from 
each other, and, finally, to deduce practical and 
useful inferences from them, are the high preroga- 
tives and interest of man, in all his intellectual pur- 
suits, and in none more, than in the profession of 
medicine. 

4. The accommodation of remedies to the changes 
which are induced in diseases by the late revolu- 
tions in our climate, seasons, and manners, has had 
a sensible influence in improving the practice of 
medicine in our city. The same diseases, like the 
descendants of the same families, lose their resem- 
blance to each other by the lapse of time ; and the 
almanacks of 1803 might as well be consulted to 
inform us of the monthly phases of the moon of 
the present year, as the experience of former years, 
or the books of foreign countries, be relied upon 
to regulate the practice of physic at the present 
time, in any of the cities of the United States. 

5. From the diffusion of medical knowledge 
among all classes of our citizens, by means of me- 



BETWEEN 1760 AND 1766, AND 1805. 403 

dical publications, and controversies, many people 
have been taught so much of the principles and 
practice of physic, as to be able to prescribe for 
themselves in the forming state of acute diseases, 
and thereby to prevent their fatal termination. It 
is to this self- acquired knowledge among the citi- 
zens of Philadelphia, that physicians are in part in- 
debted for not being called out of their beds so 
frequently as in former years. There are few peo- 
ple who do not venture to administer laudanum in 
bowel complaints, and there are some persons in 
the city, who have cured the cynanche trachealis 
when it has occurred in the night, by vomits and 
bleeding, without the advice of a physician. The 
disuse of suppers is another cause why physicians 
enjoy more rest at night than formerly, for many 
of their midnight calls, were to relieve diseases 
brought on by that superfluous meal. 

6. The dispensary instituted in our city, in the 
year 1786, for the medical relief of the poor, has 
assisted very much in promoting the empire of me- 
dicine over disease and death. Some lives have 
likewise been saved bv the exertions of the humane 
society, by means of their printed directions to pre- 
vent sudden death ; also, by the medical services 
which have lately been extended to out-patients, 



404 STATE OF MEDICINE, 

by order of the managers of the Pennsylvania hos- 
pital. 

7thly and lastly. A change, favourable to suc- 
cessful practice in Philadelphia, has taken place in 
the conduct of physicians to their patients. A sick 
room has ceased to be the theatre of imposture in 
dress and manners, and prescriptions are no longer 
delivered with the pomp and authority of edicts. 
On the contrary, sick people are now instructed in 
the nature of their diseases, and informed of the 
names and design of their medicines, by which 
means faith and reason are made to co-operate in 
adding efficacy to them. Nor are patients left, as 
formerly, by their physicians, under the usual ap- 
pearances of dissolution, without the aid of medi- 
cine. By thus disputing every inch of ground 
with death, many persons have been rescued from 
the grave, and lived, years afterwards, monuments 
of the power of the healing art. 

From a review of what has been effected within 
the last nine and thirty years, in lessening the mor- 
talitv of manv diseases, we are led to look forward 
with confidence and pleasure to the future achieve- 
ments of our science. 



BETWEEN 1760 AND 1766, AND 1805. 405 

Could we lift the curtain of time which separates 
the year 1843 from our view, we should see can- 
cers, pulmonary consumptions, apoplexies, palsies, 
epilepsy, and hydrophobia struck out of the list of 
mortal diseases, and many others which still retain 
an occasional power over life, rendered perfectly 
harmless, provided the same number of discoveries 
and improvements shall be made in medicine in the 
intermediate years, that have been made since the 
year 1766. 

But in vain will the avenues of death from those 
diseases be closed, while the more deadly yellow 
fever is permitted to supply their place, and to 
spread terror, distress, and poverty through the 
city, by destroying the lives of her citizens by 
hundreds or thousands every year. Dear cradle 
of liberty of conscience in the western world! nurse 
of industry and arts ! and patron of pious and be- 
nevolent institutions ! may this cease to be thy me- 
lancholy destiny ! May Heaven dispel the errors 
and prejudices of thy citizens upon the cause and 
means of preventing their pestilential calamities ! 
and may thy prosperity and happiness be revived, 
extended, and perpetuated for ages yet to come ! 



/■ 



INDEX. 



ANTHELMINTICS - i. 228 

Arsenic, a remedy for cancerous sores i. 240 

Army of the United States, diseases of i. 269 

, causes of - i. 272 

— , remedies for - i. ibid. 

Agriculture, the practice of, recommended to 

country physicians - i. 388 
Age, old, observations on the state of the body 

and mind in - " i. 427 

i , its diseases - i. 446 

, , their remedies - i. 449 

Association of ideas, its effects upon morals ii. 45 
Air, cool, its good effects in the yellow fever of 

1793 - - Hi. 279 



INDEX. 

B. 

Barometer, its mean elevation in Philadelphia i. 96 

Blisters, their efficacy in obstinate intermittents i. 179 

, in the bilious fever of 1780 i. 128 

, in the yellow fever of 1803, when 

applied in its early stage iv. 141 
Bed, lying in, useful in the bilious fever of 1780 i. 128 
Bleeding, its efficacy in the cure of obstinate in- 
termittents - - i. 179 

, in the yellow fever of 1 793 iii. 253 

, reasons for the practice iii. 254 

, circumstances which regulated it iii. 261 

, objections to it answered iii. 269 

, gradual manner of abstracting blood re- 
commended - - iii. 273 
Blood-letting, defence of it as a remedy for cer- 
tain diseases - iv. 275 

, indicated in fevers - iv. ibid. 

, its good effects in fevers iv. 277 

, objections to it answered iv. 284 

, its comparative advantages iv. 313 

, circumstances which should regulate its use iv. 316 

, appearances of the blood iv. 326 

, when forbidden, or to be used cautiously iv. 344 

, its advantages in pregnancy iv. 349 

, in parturition - iv. 353 

, during the cessation of the menses iv. 356 

, in curing the disease induced by a large 

dose of opium - - iv. 357 
— , in curing the disease induced by poison iv. ibid. 
*, in diabetes - - iv. ibid. 



INDEX. 

Blood-letting, in dislocated bones iv. 358 
Blood, quantity drawn from several persons in 

1797 - - iv. 37 
— , appearances of it in 1 793 iii. 256 
, in 1794 iii. 404 



32 
60 
71 
76 
78 



C. 

Civilization, diseases derived from it 

, ■ not necessarily connected with it 

Climate of Pennsylvania, account of 

, its changes 

— — , its temperature 

, its effects upon health and Hfe fc 108 

Calomel, useful joined with emetics in scarlatina 

anginosa i. 144 
, its effects as a purge, when combined with 

jalap, in the yellow fever 

, objections to it answered 

Contagious, the yellow fever not so 
Cholera infantum described 

, a form of bilious fever 

, its remedies 

, means of preventing it 

Cynanche trachealis, its different names 

appearances in the trachea after death 

, its different grades "\ - 

, its remedies in its forming state 

, its remedies after it is formed 

, favourable and unfavourable signs of its 

issue - 

Consumption, pulmonary, thoughts on 

vol. iv. 3 F 



• • • 

HI. 


241 


• • • 

111. 


243 


iv. 


223 


• 

i. 


157 


i. 


158 


• 

l. 


160 


i. 


164 


i. 


169 


i. 


170 


i. 


171 


• 

l. 


ibid. 


i. 


172 


i. 


174 


• 

i. 


199 



INDEX. 

Consumption, pulmonary, Indians, and persons 

who lead laborious lives, not subject to it i. 200 
, radical remedies for it in exercise, labour, 

and the hardships of a camp and naval life i. 204 

, its causes - - ii. 62 

not contagious - - ii. 79 

— , tracheal, described - ii. 84 

, its remedies - - ii. 87 

— , premonitory signs - ii. ibid. 

, of the remedies for its inflammatory state ii. 89 

• , of blood-letting - ii. ibid- 

, of a vegetable diet - ii. 104 

, of the remedies for its hectic state ii. 107 

— , for its typhus state - ii. 108 

, of its radical remedies - ii. 128 

— , of exercise - - ii. ibid. 

, of travelling - ii. 137 

, signs of its long or short duration, and of 

its issue in life and death - ii. 144 

, its different ways of terminating in death ii. 147 

College of physicians, their letter to the citizens 

of Philadelphia, declaring the existence of the 

yellow fever in the city, &c. in 1793 ii i- 82 
, their letter to the governor of the state, 

on the origin of the yellow fever in 1793 iii. 197 
, their opinion of the origin of the fever in 

1799 - - iv. 100 

D. 

Diseases of the Indians - i. 16 
from civilization - - i. 30 



INDEX. 

Diseases produced by ardent spirits i. 343 

— of the military hospitals, during the revo- 
lutionary war between Great-Britain and the 
United States 
'■■ of old age 

Drunkenness, a fit of it described 
, remedies for it 

Disease, summer and autumnal, its sources 

— , means of preventing it in its malignant 
forms t i * 

— — , in its mild forms 

, in its intestinal forms 

, of preserving cities and communities from 

them - - 

— , of exterminating them 

from drinking cold water 

— — , — , how prevented 

— — , — -, its cure 

Dropsies, their causes 

— , divided into inflammatory, and of weak 
morbid action in the blood-vessels 

, remedies for the inflammatory state of 

, , with weak morbid action in the 

blood-vessels 

Dropsy of the brain, internal 
, its history 

, its causes 

, its cure - 

Distress, familiarity with it, its moral effects 

Death, its proximate cause 



• 

1. 


269 


i. 


446 


• 

1. 


338 


• 

i. 


374 


iv. 


163 


c 
iv. 


173 


iv. 


198 


iv. 


200 


L 

iv. 


202 


iv. 


210 


• 

i. 


186 


• 

i. 


ibid. 


• 

i. 


185 


• • 

u. 


151 


• • 

u. 


157 


• • 

u. 


160 


• * 

n. 


176 


• • 

n. 


192 


• • 

li. 


195 


• » 

u. 


203 


• • 

n. 


210 


• ■ 

u. 


46 


• * 

n. 


447 



INDEX. 

E. 

Emetics, useful in the bilious fever of 1780* i. 186 

, in the scarlatina anginosaof 1783 and 1784 i. 144 

, in the yellow fever of 1 798 - iv. 79 

, in the yellow fever of 1799 iv. 97 

, hurtful in the yellow fever of 1 797 iv. 44 

Exhalations, putrid, their sources and effects in 

producing the summer and autumnal disease iv. 163 

R 

Faculty, moral, inquiry into the influence of phy- 
sical causes on - ii. 3 
Fruits, summer, useful in destroying worms i. 229 
Fever, bilious, history of it in 1780 i. 117 
outlines of a theory of - iii. 3 
its unity asserted - - iii. 17 
unity of its exciting causes iii. 16 
objections to a nosological arrangement of 
different forms - - m. 33 
effects of - - iii- 39 
different states of, enumerated iii. 41 
objections to putrefaction in iii. 43 
bilious yellow, history of, in 1793 iii. 69 
its exciting causes iii. 88 
its premonitory signs iii. 93 
its first symptoms iii. 95 
symptoms of it in the blood-vessels iii. 97 

, in the liver, lungs, and brain iii. 104 

, in the stomach and bowels iii. 108 

, in the secretions and excre- 



lts 



tions - - iii. HO 



INDEX. 

Fever, bilious yellow, symptoms of it, in the 

nervous system - iii. 116 

— — , , , in the senses and appetites iii. 122 

, , , in the lymphatic and glandu- 
lar system - - iii. 124 

, , , on the skin iii. 125 

, , , in the blood iii. 128 

— . — , ■ , nature of the black vomit iii. Ill 

j , types of the - iii. 135 

— , the empire of, over all other diseases iii. 1 39 

— , who most subject to it iii. 148 

— , negroes affected by it in common 



■> 



with white people - iii. 151 

— , , state of the atmosphere during the 



prevalence of - iii. 158 

— , , signs of the presence of miasmata in 

the body, universal - iii. 157 

— , , cases of re -infection iii. 164 

— , , external appearances of the body af- 
ter death in - iii. 165 
— , appearances of the body by dissec- 



tion iii. 167 

— , account of the distress of the city iii. 175 



-, its moral effects upon the inhabitants iii. 1 79 

-, number of deaths from it iii. 181 

-, is checked and destroyed by rain iii. 184 
-, inquiry into its origin by the gover- 



nor of the state - iii. 196 

— , i, said to be imported by the college 



of physicians - - iii. 19 

— , , objections to their opinion, and proofs 



of its domestic origin - iii. 198 



INDEX. 

Fever, bilious yellow, the sameness of its origin 

with the plague 
— — , state of the weather in 1793 
— , method of cure 

■ , dissentions of the physicians 

, of purging, 

, its salutary effects 

■ ■ , objections to it answered 
, blood-letting, its utility 



111. 


211 


• • • 

HI. 


215 


• • • 

111. 


223 


• • • 

111. 


235 


• • • 

111. 


239 


# • • 

111. 


241 


*• • 

111. 


243 


• • • 

111. 


253 


• • • 

HI. 


284 


• • • 

111. 


269 



— — , salivation, its utility 
— , convalescence 

■ ■ , remarks on the use of stimulating reme- 
dies in this fever - - iii. 292 

■ ■ , comparative view of the success of all the 



modes of practice employed in the fever 
Fever, yellow, of 1 794, history of 
— — , its exciting causes 



-, symptoms in the different systems of the 



body 

— , in the blood-vessels 

— , in the viscera 

, in the alimentary canal 

— , in the secretions and excretions 
— , in the nervous system 
— , in the senses and appetites 

, in the lymphatic system 

— — , in the blood 

— , different forms of the fever 

— -, its origin 

, method of cure 

— , bleeding 



111. 


298 


• • • 

111. 


357 


• • • 

HI. 


367 


• • • 

111. 


369 


• • • 

HI. 


ibid. 


• • • 

111. 


371 


• • • 

111. 


373 


• • • 

111. 


375 


* • • 

HI. 


379 


• • • 

111. 


383 


• • • 

111. 


ibid. 


• • ■ 

111. 


387 


• • • 

111. 


388 


• • • 

111. 


397 


• • • 

HI. 


401 


• • • 

111. 


402 



INDEX. 

Fever, yellow, of 1794, good effects of cool air 

and cold water in - iii. 40f 

of a salivation - iii. 411 

of blisters - - iii. 413 

of tonic remedies - iii. 41 5 

of the inefficacy of bark iii. ibid. 

of the effects of wine - iii. 418 

■■ of opium - iii. 419 

— — of nitre - - iii. 421 

■ of antimonials - iii. ibid. 

Fever, yellow, sporadic cases of, in the years 

1795 and 1796 - iii. 437 

Fever, yellow, of 1797 - iv. 3 

■ , symptoms of - - iv. 13 

, type of - iv. 20 

, different forms of - iv. 21 
— , influence of the moon upon it iv. 27 
-, number of deaths, particularly of physi- 
cians - - iv. 30 
— , origin of it - - iv. 33 
— -, its remedies - iv. ibid. 



— , of bleeding - - iv. ibid. 

— , of purging medicines - iv. 37 

— , of a salivation - - iv. 39 
— , different ways in which mercury acted 

upon the mouth and throat - iv. 40 

— , of emetics - - iv. 44 

— , of diet and drinks - - iv. 45 

— , of tonic remedies - iv. 49 

— , of blisters - - - iv. ibid. 

— — , of sweet oil - - iv. 51 



INDEX. 

Fever, yellow, of 1797, relative success of differ- 
ent modes of practice - iv. 53 

, signs of a favourable and unfavourable is- 
sue of the fever 

Fever, yellow, of 1798, account of 

, symptoms of 

, in the blood-vessels 

, alimentary canal 

, on the tongue 



-, in the nervous system 

-, in the eyes, lymphatics, and blood 

-, different modes in which it terminated in 



death 

— , state of the weather in 1798 
— , origin of the fever 
— , remedies for it 
— , bleeding 
emetics 



-, purges^ 

-, of a salivation 

-, of sweats 

- of bark 

-, of blisters 

-, symptoms which indicated a favourable 



IV. 


55 


iv. 


67 


iv. 


68 


iv. 


ibid. 


iv. 


ibid. 


iv. 


69 


iv. 


ibid. 


iv. 


71 


l 
iv. 


74 


iv. 


77 


iv. 


78 


iv. 


ibid. 


iv. 


ibid. 


iv. 


79 


iv. 


81 


iv. 


ibid. 


iv. 


82 


iv. 


83 


iv. 


ibid. 



and unfavourable issue of the disease iv. 84 

— , different modes of practice in this fever, 



and their different success - iv. 85 

Fever, bilious, of 1799 - - iv. 91 

, sickliness among certain animals iv. 94 

, its symptoms - - iv. 95 

■ , its remedies - - iv. 97 



INDEX. 



Fever, yellow, of 1799, signs of a favourable 

and unfavourable issue of it 
, its origin - - 



Fever, yellow, sporadic cases of, in 1800 

, , in 1801 

Fever, yellow, of 1 802, account of 

■ , its origin 
' ' , its types 

Fever, yellow, as it appeared in 1803 
— , symptoms of 

, remedies for 

Fever, yellow, sporadic cases in 1804 
Fever, yellow, as it appeared in 1805 

, its origin 

, its remedies 



-, not contagious 



G, 



Gout, peculiarities belonging to it 

, its remote causes 

, women most subject to it 

, its exciting causes 

, its symptoms 

, method of cure 

-, remedies in its forming state 



IV. 


99 


iv. 


100 


iv. 


103 


iv. 


111 


iv. 


123 


iv. 


123 


iv. 


127 


iv. 


133 


iv. 


136 


iv. 


139 


iv. 


147 


iv. 


153 


iv. 


155 


iv. 


156 


iv. 


223 


• • 
n. 


227 


• • 

u. 


230 


• • 

ii. 


232 


• * 

u. 


ibid. 


• » 

n. 


234 


• • 

n. 


251 


ii. 


253 



j in a paroxysm, when attended with great 

morbid or inflammatory action in the blood- 
vessels - - - ii. 252 

, when attended with weak morbid action 

in the blood-vessels - ii. 269 

, remedies for its symptoms ii. 275 

vol. iv. 3 G 



INDEX. 

Gout, means for preventing the return of inflam- 
matory - - ii. 285 
with weak morbid action ii. 293 

H. 

Hospitals, their origin 

-*- , military, their evils * 

m , constructed with ground floors, to be pre- 
ferred in fevers 

Heat, greatest in Philadelphia 

Habit, its effects upon morals 

Haemoptysis, observations on 

Hydrophobia, observations on 

, its causes 

, its symptoms in rabid animals 

? — j in the human species 

, supposed to be a malignant fever 

, remedies to prevent it 

-4 , — to cure it in its malignant or inflam- 
matory state - - ii. 317 

? — to cure it when attended with weak 

morbid action in the blood-vessels ii. 323 

, death from it, supposed to be from suffo- 
cation - - ii. 326 

-a — -, laryngotomy suggested to prevent it ii. 332 



1. 


55 


i. 


276 


• 

l. 


275 


• 

l. 


87 


• • 

n. 


43 


l. 


191 


• • 

ii. 


301 


• * 

u. 


302 


ii. 


306 


• • 

ii. 


308 


• • 

n. 


ibid. 


• • 

u. 


315 



I. 

Indians, oration on their diseases and remedies 

, peculiar customs of their women 

, — of their men - > 

-^ — -, — of both sexes 



3 

9 

11 

12 



INDEX. 

Indians, their diseases - - i. 16 

, their remedies - i. 20 

, comparative view of their diseases and 

remedies with those of civilized nations i. 39 
Iron, its preparations useful in destroying worms i. 232 
Jaw-fall, or trismus, in infants i. 254 
Imitation, its effects upon morals ii. , 42 
Influenza, account of it, as it appeared in Phi- 
ladelphia in 1789, 1790, and 1791 ii. 353 
— , history of its symptoms ii. 354 
, mode of treatment - ii. 360 



L. 

Laudanum, its efficacy in the disease brought 
on by drinking cold water in hot weather 

Legs, sore, observations on 

, classes of people most subject to them 

, their remedies 

Longevity, circumstances which favour it 

Life, animal, inquiry into its causes 

, a forced state, or the effects of impres- 
sions - 

, enumeration of those impressions 



_ ? how supported in sleep 

, in the foetus in utero 

, in infancy - ■ - - 

, in youth 

, in middle life 

, in old age - - ii. ibid. 

, in persons blind, or deaf and dumb from 

their birth - - - ii. 414 



1. 


185 


i. 


411 


i. 


412 


i. 


416 


i. 


428 


• • 

ii. 


371 


• • 

ii. 


377 


• • 

n. 


378 


* • 

ii. 


397 


ii. 


404 


• • 

u. 


405 


• ♦ 

n. 


409 


• • 

u. 


410 



INDEX. 



Life, in idiots 

j after long abstinence 

9 in asphyxia 

, in the Indians of North- America 
, in the Africans 

, in the Turkish empire 

, in China and the East- Indies 
— — , in the poor inhabitants of Europe 
— , stimuli which act alike in promoting it up- 
on all nations 
— -— , how supported in sundry animals 
, its extinction in death, how effected 



* » 

11. 


416 


ii. 


417 


• • 

n. 


419 


• • 

n. 


427 


u. 


428 


• • 

ii. 


429 


• • 

n. 


431 


• • 

ii. 


432 


• • 

u. 


434 


• • 


441 


11. 


447 



M. 

Midwifery, the practice of it more successful by 

men than by women - i. 53 

Manufactures, sedentary, unfriendly to the health 

of men - - i. 65 

Measles, history of, in 1789 ii. 338 

, their symptoms - ii. 339 

, a spurious, or external form of them de- 
scribed - - ii. 342 
-, remedies used in them ii. 346 

, history of them, as they appeared in 1801 iv. 117 

Medicine, an inquiry into its comparative state, 
in Philadelphia, between 1760 and 1766, and 
1805 - - iv. 365 

Diet of the inhabitants between 1 760 and 

1766 - iv. 366 

Dresses - - iv. 368 

Customs which had an influence on health iv. 369 
Diseases - iv. 370 



INDEX. 

N. 

Nature, meaning of the term - i. 35 

— , the extent of her powers in curing diseases i. 20 
Nosology, objections to it - iii. 33 
Negroes subject to the yellow fever in common 

with the white people - - iii. 366 

O. 

Opium, useful in the bilious fever of 1780 i. 130 
— , the disease induced by it cured by blood- 
letting - - iv. 357 
Onion juice, useful in destroying worms i. 231 

P. 

Philadelphia, its situation - i. 74 

— , population - i. 76 

, diseases between 1 760 and 1 766, and 1 805 iv. 365 

Purges, useful in the bilious fever of 1780. i. 127 

, — in the yellow fever of 1793 iii. 231 

— , objections to them answered iii. 243 

Pulse, state of, in old people i. 439 

, in the yellow fever of 1793, in persons not 

confined with it - iii. 157 
, in fevers, when it indicates blood-letting iv. 316 
Putrefaction, does not take place in the blood iii. 43 
Pregnancy, a morbid state of the system iv. 349 
, effects of blood-letting in relieving its dis- 
eases - - iv. ibid. 
Parturition, a disease - iv. 353 

, effects of blood-letting in lessening its 

pains iv. iblo- 



INDEX. 

Q. 

Quarantine laws, their inefficacy to prevent a yd* 

low fever - ' - iv. 218 
, their evils - - iv. ibid. 

R. 

Rain, usual quantity in Pennsylvania i. 72 

Revolution, American, its influence upon the hu- 
man body and mind - - i. 279 



S. 

Snow, common depth in Pennsylvania 

Sweating described among the Indians of North- 
America - 

Scarlatina anginosa of 1783 and 1784 described 

, additional observations on 

, prevented by gentle purges 

, cured by emetics in its forming state 

Salt, common, useful in the haemoptysis 

, in destroying worms 

Sugar, useful in destroying worms 

Spirits, ardent, their effects upon the human 
body and mind 

, diseases produced by them 

, their effects on property 

, substitutes for them 

, persons predisposed to their use 

, their influence upon the population of the 

United States 

Sweats, useful in the yellow fever of 1803 iv. 



91 

22 
138 
147 
151 
150 
192 
230 
ibid. 

337 
343 
347 
353 
360 

364 
140 



INDEX. 

Salivation, its usefulness in the yellow fever of 

1793 - - - iii. 284 

, , of 1794 - iii. 411 

y , of 1797 

, , of 1798 

Small-pox, new mode of inoculating for 

T. 

Tetanus, its causes 

— , its remedies when from wounds 

, , when from other causes 

W. 

Winters, cold, in Pennsylvania 

Winds, common, in Pennsylvania 

Water, cold, disease from drinking it when the 

body is preternaturally heated i. 184 

Worms, natural to young children, and to young 

animals - - i. 218 

, intended, probably, to prevent disease i. 21$ 

, destroyed by medicines that act mechani- 
cally and chemically upon them i. 128 

Wounds, gun-shot, in joints, followed by death i. 274 



IV. 


49 


iv. 


81 


i. 


311 


• 

i. 


248 


i. 


256 


• 

l. 


259 


i. 76, 1 


77, 7& 


i. 


90 



FINIS. 



LATELY PUBLISHED, 

And for sale by CONRAD 8c CO. at their stores in Philadelphia, Balti- 
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The Philadelphia Medical and Physical Journal, collected and arranged by 
Benjamin Smith Barton, professor of materia medica, natural history, and 
botany, in tho University of Pennsylvania. Volume I. Price, in boards, 
2 dollars. 

A System of Surgery. By Benjamin Bell, member of the Royal Colleges 
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dollars. 

A Treatise on the Fevers of Jamaica, with some Observations on the In- 
termitting Fever of America ; and an Appendix, containing some Hints on 
the Means of Preserving the Health of Soldiers in Hot Climates. By i?o- 
bert Jackson, M. D. 



IN THE PRESS, 



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