Chapter XXI: Section I: History of the Yellow Fever (2)

“The stomach contained a quantity of an atrabilious liquor, which, when poured on the ground, produced a sensible effervescence; but, when mixed with spirit of vitriol, a violent ebullition ensued. The dead bodies turned so quickly putrid, that at the end of six hours their stench was intolerable, and in some of them worms were already found lodged in the stomach. His Majesty’s ship the Tweed being at that time in Cadiz bay, several of her men were taken ill when on shore, but, by being carried on board, all of them recovered. Neither did the black vomit or any other deadly symptom of that fever make its appearance in any of the ships. The dread of this distemper forced many people of fashion to retire into the country, where they remained in perfect safety.”

Dr. Lind further remarks, that in the yellow fever it is a bad sign if the skin is very dry and rough; “and the longer it continues in this state, the greater is the danger, as such patients seldom recover, though the pulse may give hopes, and the other symptoms also be fluttering; for many have a good pulse in this fever a little before death.” He also quotes Dr. Bruce, an eminent physician of Barbadoes, whose account of the disease is to the same purpose. He says it may come on at any season of the year, but that the symptoms are most severe when there is great heat joined with moisture. The blood, even in the beginning of the disease, is of a florid red colour, and as it were rarefied; the crassamentum scarcely cohering; the serum of a clay-coloured yellow. It sometimes finishes its course in 24 hours.

The account given by Dr. Hillary corresponds also very much with that already given. The subjects of the disease are the same with those already mentioned. He has seen it at all seasons of the year, but it is worst in a hot season, especially if it was preceded by moist and warm weather. “Blood, taken even at the beginning of the disease, is often of an exceeding florid red colour, much rarefied and thin, and without the least appearance of fiziness; and the crassamentum, when it has stood till it is cold, will scarce cohere, but fluctuates; the serum is very yellow.... On the second or third day the blood is much more dissolved, the serum more yellow, and the crassamentum loose, scarcely cohering, but undulates like sizy water when shaken, and sometimes has dark, blackish spots on its surface, showing a strong gangrenescent diathesis.... In the latter stage of this fever the blood is so attenuated and dissolved, that we frequently see it flowing not only out of the nose and mouth, but from the eyes, and even through the very pores of the skin; also great quantities of black, half-baked, half-mortified blood is frequently voided, both by vomiting and stool, with great quantities of yellow and blackish putrid bile, by the same ways; and the urine, which was before of a high icteritious colour, is now almost black, and is frequently mixed with a quantity of half-dissolved blood.... Soon after death the body appears much fuller of livid, large, blackish, mortified spots, particularly about the præcordia and hypocondres, especially the right; which parts seem to be, even from the first seizure, the principal seat of this terrible disease. And upon opening the bodies of those who die of it, we generally find the gall-bladder and biliary ducts filled with a putrid blackish bile, and the liver and stomach, and adjoining parts, full of blackish and mortified spots, and sometimes gangrenes, in those, as also in several other parts of the body. And the whole corpse soon putrefies after death, and can be kept but a few hours above ground.”

Dr. Jackson, in describing the yellow fever of Jamaica, acknowledges the difficulty of characterising the disease, even though he is of opinion that it “possesses some characteristics of its own, different from those of any other.” In a note at the end of his work, he observes the impropriety of calling it the _yellow_ fever; because that yellowness sometimes does not appear at all; and in no one case does it ordinarily show itself till the latter stages. “I know also (says he) that most of the practitioners of Jamaica consider it only as an aggravated species of the remittent, the common endemic of hot climates. It appeared to me, I must confess, in a different light.... It may not, however, be improper here to take notice of the opinion of Dr. Moseley, who has endeavoured to persuade us that it is no other than the _kausos_, or ardent fever, of the ancients. But the yellow fever of the West Indies is, by Dr. Moseley’s own confession, in some measure peculiar to strangers newly arrived in tropical climates. The _kausos_, we are informed, made its appearance in the islands of the Archipelago, and on the coasts of the contiguous continents, indiscriminately among men and women, natives and foreigners: in fact it has not, as far as I can perceive, any claim to be considered as a distinct disease. If I rightly understand Hippocrates, or the description of the still more accurate Aretæus, _kausos_ in reality is only an accidental condition of the common endemic of the country, where the force of the fever is chiefly exerted upon the stomach and alimentary canal. In this manner it appears frequently in Jamaica, and in the southern provinces of America. In the hot months of summer, it appears occasionally in every climate; and is not necessarily accompanied with, nor does it depend upon, a general inflammatory diathesis of the system for its existence.”

The Doctor divides this disease into three species: 1. Where “signs of putrefaction are evident at a very early stage, which is generally rapid in its course, and which casually terminates in black vomiting. Yellowness seldom or never fails to make its appearance in the present instance; and perhaps it is the only one which, strictly speaking, can be called the yellow fever. 2. A form of fever which has either no remissions, or remissions which are scarcely perceptible; in which signs of nervous affection are more obvious than symptoms of putrescency; and in which yellowness and black vomiting are rare occurrences. 3. Another form, in which regular paroxysms and remissions cannot be traced, but in which there are marks of violent irritation, and appearances of inflammatory diathesis in the earlier stage, which give way, after a short continuance, to signs of debility and putrescency, to which yellowness frequently succeeds, or even sometimes the so much dreaded vomiting of matter of a dark colour. The disease in these three forms appears to be in reality one and the same. The difference of the symptoms probably arises from very trivial or very accidental causes. It is in some measure peculiar to strangers from colder regions soon after their arrival in the West Indies, and may generally be distinguished from the common endemic of the country, not only by a total want of paroxysms and remissions, but likewise by a certain expression of the eye and countenance, with something unusually disagreeable in the feelings, of which words convey only an imperfect idea.”

The symptoms enumerated by Dr. Jackson are in general the same with those already taken notice of. He mentions likewise a degree of confusion frequently joined with _grimness_, difficult to be described in words, but which a person acquainted with the appearances of the disease immediately recognises as one of its distinguishing marks. In the second stage he says, that no sweat or moisture was now observable on any part of the body: the state of the skin impressed the idea as if it were not pervious to any degree of perspiration, and heat gradually forsook the surface and extremities: the tongue became moist, and at the same time frequently clean about the edges: the gums became redder, more spongy, and showed a greater disposition to bleed: vomiting was troublesome: the matter thrown up was ropy, in large quantity, and abounding with villous or mucous flakes of a darker colour. The circulation in the extreme vessels became gradually more languid; the natural heat retired from the surface of the body, which was now dry and impervious; the pulse returned nearly to its ordinary state, or became slow, full and regular; the yellowness increased fast, so that the whole body was frequently yellow as an orange, or of as deep a colour as the skin of an American savage: anxiety was inexpressible; vomiting was irrestrainable, and the vomiting of a matter like the grounds of coffee at last made its appearance. This matter was often as black as soot, where the progress of the disease had been rapid; while it was not only less intensely black, but often tinged with green, where the disease had been more slow and gradual. The number of villous or mucous flakes, in the matter discharged by vomit, increased as the disease advanced, and with them were joined streaks of blood, which seemed principally to come from the throat and gums. As the disease advanced, the vomiting became more frequent, but was seldom accompanied with any violent retching. Quantities of liquor were discharged, so enormous that it was often difficult to imagine whence they came; after which the patient enjoyed some respite, till a similar collection was made. As soon as the matter discharged by vomit acquired this dark and sooty colour, the belly generally became loose, the stools being black, smooth, and not unlike tar or molasses; the tongue became clean, the gums putrid; hæmorrhages, or rather _oozings of blood_, were sometimes observed in different parts of the body, while livid blotches made their appearance on the belly and insides of the thighs. The pulse, which during the latter stages of the distemper could scarcely be distinguished from that of a person in health, became at last irregular, quick, or intermitting; soon after which coma or convulsions closed the scene. Sometimes the yellowness succeeded the black vomiting. In these the vomiting began unexpectedly, or without much previous affection of the stomach: the colour was commonly intensely black; the patient turned yellow almost in an instant, and died in a very short time. When any one recovered from this deplorable situation, of which there were some few instances, the termination was not by any regular crisis. The black vomiting ceased, sometimes apparently in consequence of treatment, sometimes evidently of its own accord: but a vomiting of a ropy, glutinous matter continued for a great length of time, together with an extreme irritability of the stomach, and a very peculiar state of the skin; which sometimes did not recover its natural smoothness and unctuosity for several weeks.

The disposition to faint, so common in the yellow fever, is supposed by Dr. Jackson to arise from a kind of torpor in the nervous system, rather than the usual causes of fainting. For this opinion he assigns as a reason, that “the patient was often able to stand upright for some time, and even to walk to a considerable distance; and, when at last overcome, was observed to fall down in a torpid, rather than a fainting, state.”

In dissections our author observed that the omentum and all its appendages were in a dry and parched state, and of an uncommon dark grey colour. But, along with this dark grey colour, and want of unctuosity and moisture, usually met with in the abdomen, the stomach and intestines had a dirty yellow appearance, were highly putrefied, and much distended with wind. The liver and spleen were generally enlarged in size; the former of a deeper yellow than any of the other abdominal viscera; while the texture of the spleen was often less firm than natural. The bile was usually black and thick, like tar or molasses; the blood-vessels of the liver bearing marks of uncommon distension. A quantity of black fluid, similar to that ejected by vomit, was found in the stomach, which fluid our author says positively derived its blackness from the bile, the flakes observed to float in it being parts of the villous coat of the stomach abraded. He denies that the black colour of the matter vomited is owing to blood, as many authors have supposed. He says that the passage of the bile might be easily traced from the gall-duct into the pylorus.

This being in the Doctor’s opinion the only true kind of yellow fever, we shall not follow him through the description of the other two species, but proceed to consider that remarkable and excessively fatal distemper which appeared in the year 1793, first in the West India islands, and then on the American continent. Dr. Chisholm, who has described the distemper very particularly, derives it from the coast of Africa, and gives the following account of its origin on the authority of a Mr. J. Paiba, “one of the adventurers in the Boullam scheme; and who, despairing of success, left the coast of Africa in a vessel called the _Hankey_. This vessel sailed from England in April 1792 with stores and adventurers for the intended colony at Boullam. The people were all in good health: that part of the coast of Africa on which they touched is remarkable for its healthiness; only it is destitute of water except what can be procured by digging temporary wells on the beach, and which is brackish, and consequently unwholesome. The ferocity of the negroes who inhabit that part of the continent prevented them from being accommodated on shore, so that they found themselves obliged to remain on board the Hankey for nine months. As the rainy season came on almost immediately after their arrival on the African coast, they attempted to shelter themselves by raising the sides of the vessel several feet, and covering it with a wooden roof.” Thus were upwards of two hundred persons, among whom were many women and children, confined in such a manner as must be supposed capable of producing fevers of a bad kind, if they could be produced by such causes. Accordingly a malignant fever did break out; the vessel was not ventilated, nor were the bed-clothes, &c. of the sick destroyed; from whence Dr. Chisholm concludes that the infection remained on board the vessel. The Doctor then proceeds to give the following account of the vessel after her departure from Boullam:[148] “Capt. Coxe, finding the water at Boullam unwholesome, proceeded with his ship to Bissao, where there is a Portuguese settlement, for a supply. The ship was navigated by about twelve seamen, most of whom had not experienced sickness, and had probably been procured from Sierra Leone: at any rate they were then taken on board for the first time. Of these, before the return of the Hankey to Boullam, nine died; and the remainder, with the captain, were reduced to a deplorable state. The time for which the Hankey was chartered being expired, Mr. Paiba, with his family, intended to return to England in her; but as no seamen could be procured they put to sea, having on board the captain, sick, and only the mate, Mr. Paiba and two seamen to navigate the ship. With much difficulty they arrived at St. Jago, where they fortunately found the Charon and Scorpion ships of war. Capt. Dodd of the former, humanely rendered them every service in his power, and on leaving them put two men of each ship on board the Hankey. With this aid they proceeded to the West Indies; a voyage to England being impracticable in their wretched state. On the third day after leaving St. Jago, the men they procured from the ships of war were seized with the fever, which had carried off three fourths of those on board the Hankey at Boullam; and, having no assistance, two of the four died: the remaining two were put on board here in the most wretched state possible. Capt. Dodd, on his arrival at Barbadoes from the coast of Africa, was ordered to convoy the homeward-bound fleet of merchantmen. In the execution of his orders he came to Grenada on the 27th of May, and, hearing of the mischief which the Hankey had been the cause of, mentioned that several of the Charon’s and Scorpion’s people were sent on board the Hankey at St. Jago, to repair her rigging, &c. that from this circumstance, and the communication which his barge’s crew had with that ship, the pestilence was brought on board both ships; and that of the Charon’s crew thirty died, and of the Scorpion’s, about fifteen. The Hankey arrived at the port of St. George’s (in Grenada) on the 19th of February, in the most distressed situation, and for a few days lay in the bay, but was afterwards brought into the careenage. From this period are we to date the commencement of a disease before, I believe, unknown in this country, and certainly unequalled in its destructive nature.”

[148] Chisholm’s Essay on the Malignant Pestilential Fever, p. 86.

This account of the introduction of the fever (which however is by Dr. Chisholm accounted very different from the yellow fever above described) is so clear and distinct, that, at first reading, it commands our belief. It hath not, however, met with universal approbation; and even the _facts_, for which both parties appeal to Mr. Paiba and capt. Dodd, vary from one another in a surprising manner. Dr. Trotter, in his Medicina Nautica, p. 328, gives the following account: “Dr. Chisholm tells us, that the ships of war on the African station, having sent men to assist the Hankey, after numbers had perished from the fever, received the infection by means of this communication, and that in the Charon thirty died, and fifteen in the Scorpion. Capt. Dodd, who at that time had his broad pendant in the Charon, now commands the Atlas of 98 guns in the fleet; Mr. Smithers, the surgeon, is at present in the Formidable, a second rate, also in the fleet; _from them_ I have copied the following narrative of their transactions with the Hankey:

“When the squadron under commodore Dodd came to St. Jago in 1793, the Hankey lay there in great distress for want of hands; having buried above one hundred persons, men, women and children, from the time she had been at Bulam. _The fever was now overcome_: Mr. Smithers saw two men that had lately recovered. He left a quantity of bark. The Charon and Scorpion sent two men each to assist in navigating her to the West Indies. The Hankey at this port was cleaned, washed with vinegar, and fumigated. _No fever appeared in either of the men of war_, in consequence of this communication; they arrived at Grenada in perfect health, but did not go into the same part of the island to which the Hankey went. The Charon, at this harbour received some seamen from the merchant ships then taking in cargoes for England; she had afterwards _fourteen_ cases of yellow fever, of which one died; but it is remarkable that the Scorpion did not bury a single man during the whole voyage.[149] It is probable from these facts, that the Hankey _did not_ import the infection that produced the Grenada fever; for, _after the disease was worn out_, she had a passage to make to the West indies of many hundred leagues. It is also doubtful how the effects left in the Hankey could produce the fever, for the _bedding was thrown away_, and what clothing remained had been aired, and probably had scarcely been in contact with the body after being sick.”

[149] To this is subjoined the attestation of Mr. Smithers with
respect to the Charon.

The discordance between this and the foregoing account is abundantly evident. Dr. Chisholm’s account of the bedding, &c. is also very different. “Our lieutenant governor, Ninian Home, esq. some time after the disease became epidemic, informed me, that, in consequence of the information he had received of the clothes, &c. of the victims of the fever at Boullam being still on board the Hankey, he ordered Capt. Coxe to be brought before him and some gentlemen of the council. He then acknowledged, that _all the effects_ of those who had died were then on board his ship, and said that he _would not_ destroy them, unless he was indemnified for the loss he might sustain, should the heirs of the deceased call on him for those effects. Every argument was used to induce him to destroy the articles, but the only one which influences a man of this description, _indemnification_; and he of course carried the seminium of the disease to England.” It was this consideration which induced the governor to write to the secretary of state, and in consequence of his representation the vessel was obliged to perform quarantine in England, a circumstance which Dr. Trotter mentions without approbation.

Thus far the matter of _fact_ seems to be very much obscured; and the more we investigate, the more we are involved in darkness. In the Medical Repository, vol. i, p. 484, we find the following severe censure passed upon Dr. Chisholm by the late Dr. Smith of New York: “It belongs to another part of this paper to assign the probable motives of Dr. Chisholm for maintaining that the fever was imported into Grenada: certain it is that he avowed a different opinion to Mr. Paiba, to whom he freely declared, that he could by no means trace the disease to the _Hankey_; and that he believed it to be of local origin, owing to the unhealthy condition of the careenage, and the particular prevailing winds: and, to confirm this notion, he informed Mr. Paiba that a similar disease, from the same cause, though in a less degree, had existed in St. George’s some years before.”

This was plainly giving Dr. Chisholm _the lie_; which, whatever might have been the consequence between the two parties, absolutely supersedes, to any impartial and unconcerned person, the evidence of _both_, at least as far as regards the origin of this disease. It is not, however, to be supposed that Dr. Chisholm would pass such a censure unnoticed. He did accordingly reply in a letter to Dr. Smith, who had sent him a copy of the Repository, with a letter inviting him to defend what he had said. Dr. Smith died before this letter reached him, but the principal part has appeared in the Medical Repository, vol. ii, p. 285. In this Dr. Chisholm retracts what he had said concerning the mortality on board the Charon and Scorpion ships of war. “I have lately received (says he) from a gentleman of the navy here, a log-book of the Charon, kept by one of her officers during the voyage in question. In this I find, that no sickness took place in either of these ships in consequence of this interview. A log-book is unquestionable evidence, and I therefore admit it.” As to the more serious part of the charge, viz. that Dr. Chisholm had wilfully misrepresented matters, the Doctor replies, that the narrative published by him was in general such as he had from Mr. Paiba; not indeed in manuscript, as Dr. Smith stated his to have been, but in conversation; and that this conversation took place expressly with a view to elucidate the cause of the fever, which he (Dr. Chisholm) could not account for by any reasoning from local causes, but heard it very generally ascribed to infection from the Hankey. Mr. Paiba was introduced to Dr. Chisholm at the request of the latter by the Hon. Samuel Mitchill _now_ (the letter is dated Sept. 6th 1768 probably 1798) the senior member of the council of Grenada. “Mr. Mitchill (says the Doctor) brought Mr. Paiba to my house, and was present during the greatest part of the time the conversation continued. I found Mr. Paiba very willing to give me every information in his power relative to the state of the Bulama or Boulam colony, and of the ship Hankey; but I found him strongly disinclined to fall in with the universally received opinion, that that ship introduced the disease. The particulars I have given, are those Mr. Paiba related to me in this conversation; and, in order to be correct, I immediately, after Mr. Paiba left me, committed them to paper. Mr. Paiba promised to favour me with a written account; and in order to direct that gentleman’s attention to the points I considered as of most importance, I drew up a set of queries, and Mr. Mitchill charged himself with the delivery of it. A copy of these I have now in my possession, and a slight attention will exhibit my view in framing them, and show the doubts respecting the nature of the epidemic which suggested them. Although I repeatedly, through Mr. Mitchill and Mr. Palmer, the gentlemen with whom Mr. Paiba resided in the country, renewed my request to have this promise fulfilled, Mr. Paiba left the Island without gratifying it. If no other strong proof existed of something peculiar in the fever which at that time prevailed, the circumstance of my formally applying to Mr. Paiba for information relative to the state of the Hankey, and of taking the trouble to obtain an interview with him, presents an evidence as conclusive as can well be required by reasonable men. But the belief of the infection of the Hankey was _universal_, nor was it by any means confined to those whose interest might have been affected by the prosperity of an infant colony on the coast of Africa.”

Another charge against Dr. Chisholm is, that he falsifies the date of the Hankey’s arrival at Grenada; and which in Dr. Smith’s paper is brought forward in the following words: “In p. 91 the Doctor remarks, that, ‘in the short space of time from the beginning of March to the end of May, 200 of about 500 sailors, who manned the ships in the regular trade, died of this fever.’ By this it appears that the fever in question broke out as early as the beginning of March. The disingenuousness of this author is particularly evident from this quotation, if the period of the commencement of the disease be correctly assigned: and that it is so is probable from the difficulty of concealing the fact; as there must have been thousands of witnesses to the progress of the fever. When therefore it was thought proper to fix the odium of introducing the disease upon the Hankey (a project of which Dr. Chisholm seems originally to have had no idea) it became necessary for him to fix an earlier date to her arrival. Now, that the Hankey did not arrive till towards the latter end of March, is verified by the concurring testimony of Mr. and Mrs. Paiba, and of Mr. Bell, of this city (New York) who happened to be in Grenada about that time, and was personally acquainted with Mr. and Mrs. Paiba in that island.”

In answer to this Dr. Chisholm repeats his declaration that the Hankey arrived at Grenada on the 18th of _February_, and not on the 19th of March, as Dr. Smith (supposed on the authority of Mr. Paiba) had stated. In proof of this he produces an incontestible evidence, viz. an extract from the St. George’s Gazette in Grenada, of date 19th of February, which begins thus: “By the ship Hankey of London, arrived here _yesterday_ from the island of Boulam on the coast of Africa, we are informed,” &c. The remainder of the extract contains an account of the excessive mortality on board the ships; which, as it may perhaps be exaggerated, it is needless to transcribe.

The next thing of consequence is the destruction of the bed-clothes and effects of the deceased; of which Dr. Smith says, “Before the Hankey put to sea, all the bedding of the sick was thrown overboard or destroyed; the ship was washed from stem to stern, both above and below, with salt water; and the purification was completed by fumigating her with tar, pitch and gun-powder. In this clean condition they bade farewel to Bulama on the 22d of November, 1792; but, in attempting to pass through the channel near to the entrance into the open sea, in a dark and foggy night, they got aground on a sand-bank, upon the north side of the island of Formosa or Warang, belonging to the Bijugas, who are represented as cannibals. The extreme terror excited by this accident was not calculated to improve the health of the people on board the Hankey; so that, when it became necessary to take measures for their security and deliverance, only four men were found in a condition to do duty, and all of these had intermittents. With them, however, and his lady, Mr. Paiba set off, in an open boat, for Bissao, to obtain assistance from the Portuguese settlement. Thither he arrived, rowing through rains and fogs, in a leaky boat, after being out two nights and a day; and having obtained such help as he could, returned to the Hankey, got her off, and carried her to Bissao. On the passage there _eight_ persons died who belonged to this ship. At Bissao they refitted, and the Hankey _was a second time purified as completely as she had been before leaving Bulama_.”

In answer to all this Dr. Chisholm _again declares_, “that the bedding and effects of the deceased _were preserved_ on board the Hankey, and constituted the seminium of the infection. Capt. William Liddle, of the ship General Mathew, saw them on board; and it was in consequence of that gentleman’s representation that the lieutenant governor, Mr. Home, entered into a strict investigation of the matter; the general result of which I have given; and the authenticity of it may be depended on. Capt. Liddle is now resident in London, and Mr. Byles, the governor’s secretary, is now resident commissary at Grenada; and these gentlemen will readily testify to the truth of my statement. The destructive articles I have mentioned _were not thrown overboard_ till the Hankey arrived in Grenville Bay, when they were destroyed at the request of Mr. Prendfoot, the gentleman who chartered the ship for England.”

Dr. Chisholm is likewise charged with having mis-stated the case of a Capt. Remington, said to be the first who suffered by the fever in Grenada. The words in Dr. Chisholm’s Essay are, “A Capt. Remington, an intimate acquaintance of Capt. Coxe’s, was the first person who visited the Hankey after her arrival in St. George’s bay. This person went on board of her in the evening after she anchored, and remained three days; at the end of which time he left St. George’s, and proceeded in a drogher (a coasting vessel) to Grenville bay, where his ship, the Adventure lay. He was seized with the malignant pestilential fever on the passage; and the violence of the symptoms increased so rapidly, as, on the third day, to put an end to his existence.” In opposition to this Dr. Smith gives the following statement from Mr. Paiba: “He (Capt. Remington) had been all day and all night coming from Grenville bay, and had been wet through. He slept on board in his clothes; and went in an open boat _the next day_ back to his ship: enough to kill any one in that climate.” Dr. Chisholm replies “that the above statement is not correct, nor founded on fact; Dr. Chisholm’s evidence for what he said was founded on the information of captains of vessels, who knew all the circumstances of his visit to the Hankey; and of Dr. Stewart, an eminent practitioner, who attended him at Grenville bay, when he landed there. Lastly, that the idea of his having returned to Grenville bay in an open boat, is absurd; nothing of the kind having been ever attempted.”

From this tedious account it is plain that the evidence relative to the importation of the fever into Grenada by the Hankey is quite contradictory, and subversive of itself, because we are unable to judge between the two disputants. A further consideration of it would lead us entirely from the subject of this treatise, into an endless dispute about which of the two parties had spoken the truth. Setting aside therefore _the whole_ of the evidence on both sides as insufficient, we shall now proceed to give an account of the symptoms of the distemper as described by Dr. Chisholm, and to which description there has never been any objection made.

In the most violent kind of this fever, according to our author, “the patient, without any previous complaint, suddenly becomes giddy; he loses his eye-sight; every thing seems to move round him with inconceivable velocity; he falls down almost insensible, and in that state remains near half an hour, or upwards. During this paroxysm the body feels cold, and is over-spread with cold sweat, which issues from every pore in astonishing abundance. On his recovery the cold goes off, and is instantly succeeded by intense heat, and quick, small, hard pulse; the head achs dreadfully, particularly the fore part; generally accompanied with pain in the right side and at the præcordia. The last, however, has never been acute, and may rather be called oppression than pain. The eyes are much inflamed, watery, protruded, and wildly rolling; the face much flushed; much heat is felt at the pit of the stomach, and that organ seems to be considerably affected by the frequent retching and vomiting which then come on. The patient soon after complains of intolerable pains in the small of his back and in the calves of his legs; but the latter appears to be most violent. During twelve, eighteen, twenty-four or thirty-six hours, these symptoms continue increasing, except the quickness and hardness of the pulse, which does not change materially during that time; and are then succeeded by general coldness, cold sweat, a greater or less degree of coma and delirium, or a state very much resembling intoxication. Life in this state is lengthened out to sixty or ninety hours from the first attack. A short interval of reason then takes place; the patient considers himself better, and is, for a moment, flattered with the prospect of recovery: but a fit as sudden and unexpected as the first comes on, during which he foams at the mouth, rolls his eyes dreadfully, and throws out and pulls back his extremities in quick succession. In general the patient expires in this fit; but some have recovered from it, and continued rational for a few hours longer, when a second fit has carried them off.”

This, without much deviation, was the general progress of the worst kind of the fever. In some, however, a comatose disposition showed itself from the very first; in others the disease began with short convulsive fits in frequent succession, followed by constant delirium and cold clammy sweat, without any intervening heat. In a few cases the first symptoms were coldness and shivering, as in other fevers.

The distinguishing symptoms were the uncommonly sudden attack, the remarkably acute pain in the loins and calves of the legs, the watery, inflamed and rolling eye, flushing of the face, tendency to coma, the pain generally confined to the forehead, and the peculiar cast of the delirium, during which the looks and actions of the patient very much resembled those of a person intoxicated. It was never furious in any other way than by making efforts to get out of bed; and these in a few instances rose so high that the patients got up, dressed themselves, and walked out a considerable way before they could be overpowered. “The strength during the delirium is to appearance surprisingly great, for it is frequently necessary to use the united efforts of two or three men to keep the patient in bed. This is, however, no more than a spasmodic affection of the muscles; for in reality the powers of the sick in this disease are reduced to the extreme of debility, as is seen in the convalescent state.”

The most unequivocal characteristic of this disease, however, according to our author, is the appearance of a kind of petechiæ, but which look rather like red or livid patches than what is commonly understood by that word. They were _always_ the forerunners of death. In a few very violent cases the body was almost of a livid or black colour, but they were generally seated on the neck, shoulders and breast. _Vibices_ also, like those in the plague, described p. 258, sometimes made their appearance, and were also a fatal presage.

Hæmorrhage occurred much more frequent and profuse in this than in any other acute distemper our author had met with. “In several instances, the immensity of blood discharged has evidently been the more immediate cause of death. The robust, plethoric and gross habits have been the most subject to it. It has taken place from the nostrils, mouth, anus, and urethra; sometimes from the canthi (corners) of the eyes; but never, I believe, from the ears or pores of the skin. The most profuse discharge has been from the nostrils and anus, and has frequently, amounted to three or four pounds at a time; the stools having been on those occasions entirely composed of pure blood. Towards the close of life, the blood thus discharged has appeared granulous, or like ichor, with a sediment of a black gritty substance, and has been so extremely offensive as to oblige all the attendants to keep at a considerable distance till the hæmorrhage ceased. Hæmorrhage, however, has never been critical, nor has it in any instance permanently relieved the head-ach or pain in the breast or side.... Nearly about the period that these profuse discharges came on, a rawness was felt on the whole of the interior surface of the nose, and on several parts of it little ulcers formed; on others, small eschars, which were remarkably itchy, but on being touched, or an attempt made to detach them from the membrane of the nose, were very painful, and bled. These disappeared in proportion to the patient’s recovery; and I have reason to suspect, that, when the issue of the disease was fatal, these little eschars became gangrenous.”

In this distemper there was always a tendency to coma after the first two days; and after the third, it certainly came on. On examining the heads of two who died convulsed after having been comatose for some time, a great quantity of serum was found in the brain; and, on narrowly inspecting the eyes of those who were afterwards seized with coma, the pupil was found manifestly dilated.

A remarkable symptom unnoticed in any other fever is taken notice of by our author; viz. an affection of the testicles. “About the end of the second day the patient began to complain of a violent pain in these parts, accompanied with a contraction of the spermatic cord, and a drawing up of the testicles towards the abdominal ring. On examination they appear very much lessened in size, are drawn up considerably towards the abdomen, and the scrotum appears at the same time remarkably flaccid and empty. The surface of the scrotum becomes soon after very painful, and an excoriation takes place, chiefly at the most descending part, from which a considerable quantity of very offensive purulent matter issues: at the same time a similar discharge from the urethra takes place, which ceases with the disease when the event is favourable, or becomes ichorous and bloody, and insufferably fœtid when death is the consequence. In cases which terminate favourably, the whole of the scrotum, in a few days, is covered with a crust of hardened pus, which in the convalescent state, comes away very easily by means of a warm bath. The thickness of this coat may be about the fourth of a line; and, when separated, it much resembles moistened parchment. In fatal cases, this affection of the scrotum always terminates in gangrene a few hours before death.”

Another remarkable symptom is the change of voice to a shrill, soft and low sound when compared with the natural tone, at the same time that the syllables are more distinguished, and the words are strangely lengthened out in a drawling and whining manner. This change of voice affords a pretty certain prognostic; every alteration towards the natural tone being an almost certain sign of a favourable change, and the contrary if the voice becomes farther removed from it.

The pains felt in this fever were in a great measure peculiar to it, and seem to have been of a spasmodic nature. In the head the pain shot from the forehead, to which it was confined, invariably towards the bottom of the orbits, where it was generally exquisite. Sometimes it extended to the temples, where there was always a throbbing; but in no case did it extend to the back part, or over the whole head. This pain extended also to the balls of the eyes, which were protruded, and seemed ready to start from their orbits, with an inflammation externally, and a sensation of pain internally, rendering the admission of light intolerable. In the legs the pain had its seat at the top of the great tendon, immediately below the calf, and in the point where it was seated a gnawing sensation was felt, occasioning exquisite torture, with an involuntary contraction of the limb; so that, on the whole, our author concludes that this pain much resembles the cramp, differing only in being more permanent.

With regard to the pulse, our author observes, that in this disease “it never intermits. Even at the approach of death it has not intermitted, but has generally been remarkably tremulous, and so slow as to beat no more than thirty times in a minute. On the whole, it has not been found quicker than 130, or slower than 30, in a minute.” In violent cases the pulse was hard, quick and small, but sometimes full; and when it was so it was a good sign. It was however subject to excessive variations; and it frequently happened, “especially in the robust, that, after the first stage, flushing and chillness have often alternated in less than a minute; and that, although the skin felt considerably warm, the pulse has been no more than 52; but that, even when the low state came on, in which there was always a disagreeable coldness of the surface, it has been as quick, and nearly as full, as during the preceding febrile stage, although unaccompanied with thirst, or any other evident symptom of the existence of fever.”

In the state of delirium, Dr. Chisholm observes, that, whatever was the subject of the patient’s raving thoughts, he was always strongly under the impression of fear; and a word from the physician always reduced him to implicit obedience, however restless he might have been before. During this state he complained of no pain, even from blisters, nor was he sensible of the operation of laxative medicines. On being asked about his situation, he always answered that he was very well, and sensible of no pain, as in the yellow fever already described. It is observable, however, that the yellow colour, so remarkable in the former, seldom took place in the Boulam fever; but indeed this symptom, as has formerly been noticed, is by no means a characteristic either of the one disease or the other; but Dr. Chisholm observes “that in some protracted cases on shore, and in some among the sailors, which might have been a combination of the pestilential and yellow fevers, this symptom appeared about the 5th, 7th or 9th day.”

Besides the petechiæ and vibices, already mentioned, Dr. Chisholm takes notice of two other sorts of eruptions, which appeared about the lips: the one was such as frequently appears at the termination of the common remittents, and was favourable; the other resembling spots made by the fine black pencil of a painter, all round the mouth, but especially the upper lip, and certainly affording a fatal prognostic.

This disease was attended with a suppression of urine, a violent pain above the os pubis, a scalding in the urethra, a sense of fulness, without any visible swelling, a contraction and distortion of the penis; the urine generally of a deep red, sometimes brownish, green, very often bloody, and in a few cases much inclining to black, and of an oily consistence. Its smell was generally very offensive. All the excretions were exceedingly offensive, but the fæces most remarkably so towards the latter end of the disease; for in the beginning they had no remarkable fœtor. The sick were almost universally costive, which our author supposes to have arisen from a suspension of tone in the intestinal canal; for by exciting action in the fibres a large evacuation generally ensued. The colour of the fæces varied from yellow, or a yellowish white, to black; and from a considerable degree of thickness, to the exact appearance of coffee-grounds. The matter discharged by vomit also varied from porraceous to black, and resembling coffee badly boiled.

In this disease, as in the plague described by Thucydides, most other diseases degenerated into it, or partook of its nature. Dysenteries suddenly stopped, and were immediately succeeded by the symptoms of pestilential fever. A remarkable instance of this is given in twenty-seven recruits, who had been seized with dysentery, in consequence of being exposed to rain, receiving the infection in the hospital to which they were carried. The medicines exhibited with a view to cure the dysentery seemed to be attended with surprising effect; but in a short time symptoms of pestilential fever came on, even in a few hours after those of dysentery had disappeared. In like manner catarrhal complaints soon changed their nature. Convalescents from other diseases, such as laboured under chronical complaints, particularly rheumatism and inflammation of the liver, were particularly subject to it. “The puerperal fever became malignant, and of course fatal; and even among pregnant negro women, who might otherwise have had it in the usual mild degree peculiar to that description of people, many were reduced to a very dangerous situation by it. In short, every disease in which the patient was liable to infection, sooner or later assumed the appearance, and acquired the danger, of the pestilential fever.”

This fever was said to be propagated from Grenada to others of the West India islands, and to the United States, where in the same year, 1793, it raged with great violence in Philadelphia. Without entering into any inquiry at present concerning the truth of this report, or the origin of the fever itself, let us see whether from the symptoms enumerated by Dr. Rush, who hath written a very lengthy dissertation upon the disease, it was the same with the Boulam fever already described. According to him the fever in 1793 was frequently preceded by “costiveness, a dull pain in the right side, defect of appetite, flatulence, perverted taste, heat in the stomach, giddiness or pain in the head, a dull, watery, brilliant, yellow or red eye, dim and imperfect vision, hoarseness, or slight sore throat, low spirits, or unusual vivacity, a moisture on the hands, a disposition to sweat at nights, or after moderate exercise, or a sudden suppression of night sweats.... On entering a sick room the physician was first struck by the _countenance_ of the patient. It was as much unlike that which is exhibited in the common bilious fever, as the face of a wild animal is unlike that of a domestic one. The eyes were sad, watery, and so inflamed in some cases as to resemble two balls of fire. Sometimes they had a most brilliant or ferocious appearance. The face was suffused with blood, or of a dusky colour, and the whole countenance was dusky and clouded. After the 10th of September, when the determination of blood to the brain became universal, there was a preternatural dilation of the pupil. Sighing attended in almost every case. The skin was dry, and frequently of its natural temperature.... The pulse at the beginning of the attack was sometimes full, tense and quick, but frequently weak; sometimes so low that it could not be perceived without pressing the wrists; and sometimes it had no preternatural quickness. In many it intermitted after the fourth or fifth, and sometimes after the fourteenth stroke. In some it was extremely slow; even as low as thirty strokes in a minute. The pulse was also _tense_ and _chorded_. The slow intermitting pulse was observed more frequently in children than adults, and supposed to proceed from a collection of water in the brain. Impressed with this idea, I requested Mr. Coxe, one of my pupils, to assist me in examining the state of the eye. For two days we discovered no change in it; but on the third day after we began to inspect the eyes, we both perceived a preternatural dilatation of the pupils in different patients; and we seldom afterwards saw an eye in which it was wanting. In Dr. Say it was attended with squinting, a symptom which marks a high degree of a morbid affection of the brain. Had this slowness or intermission of the pulse occurred only after signs of inflammation or congestion had appeared in the brain, I should have supposed that it had been derived wholly from that cause; but I well recollect having felt it several days before I could discover the least change in the pupil of the eye. I am forced therefore to call in the operation of another cause, to assist in accounting for this state of the pulse, and this I take to be a spasmodic affection, accompanied with preternatural dilatation or contraction of the heart. Lieutaud mentions this species of pulse in several places, as occurring with an undue enlargement of this muscle. Dr. Ferriar describes a case, in which a low, irregular, intermitting and hardly perceptible pulse attended a morbid dilatation of the heart.... After the 10th of September this undescribable or _sulky_ pulse became less observable, and, in proportion as the weather cooled, it disappeared. It was gradually succeeded by a pulse full, tense, quick, and as frequent as in pleurisy or rheumatism. It differed, however, from a pleuritic or rheumatic pulse, in imparting a very different sensation to the fingers. No two strokes seemed to be exactly alike. Its action was of a hobbling nature.... It was an alarming symptom.... The pulse most frequently lessened in its fulness, and became gradually weak, frequent and imperceptible before death; but I met with several cases in which it was full, active, and even tense, in the last hours of life.

“Hæmorrhages occurred in the beginning of the disorder, chiefly from the nose and uterus. Sometimes only a few drops of blood distilled from the nose. As the disease advanced, the discharges of blood became universal. They occurred from the gums, ears, stomach, bowels, and urinary passages. Drops of blood issued from the inner canthus of the left eye of Mr. Josiah Coates. Dr. Woodhouse attended a lady who bled from the holes of her ears which had been made for ear-rings. Many bled from the orifices which had been made in performing venesection, several days after they appeared to have been healed; and some from wounds in veins made in unsuccessful attempts to draw blood. These last were very troublesome, and in some cases precipitated death....