Chapter XXV: Section I: History of the Yellow Fever (6)

It appears from the experiments of Dr. Adair Crawford, that, when animals are immersed in hot water, the blood drawn from a vein is of a florid red colour. In summer it is likewise observed to be of a more florid colour than in winter. If heat thus gives a more bright red to the blood, it undoubtedly also makes it more fluid, and in proportion to its fluidity it will likewise become acrimonious; though this acrimony is not necessarily connected with a florid colour, as the blood of the arteries is not more so than that in the veins. In the yellow fever, however, the blood sometimes, towards the end of the disease, becomes endowed with extreme acrimony. Dr. Smith, in one of his letters to Dr. Buel, observes, that “blood drawn in the fever of 1795 was remarkably _wanting_ in floridity; especially what was evacuated towards the close of the disease, whether by art, or spontaneous effusion. In one instance it seemed endowed with a caustic quality, and affected a lancet so as to leave a permanent discolouration and inequality on its surface.” He observes also, nay, considers it as _demonstrated_, that the yellow fever _is not_ a disease of vascular debility, and he says that it is attended with an astonishing _fluidity_, or, as it is called, _dissolution_ of the blood. Every one therefore who comes from a cold to a warm climate must in some degree or other have his blood liquefied, and in a certain proportion rendered more acrimonious than before. This acrimony may be undoubtedly augmented by certain causes, and by none more probably than immoderate drinking of spiritous liquors. Every one therefore who comes from a cold country to a warm one, especially where the air is also moist, may consider himself as already diseased, at least in comparison with what he was when at home. For the blood is now exposed to a greater degree of heat, and consequently is about to absorb, or rather may be considered as in the act of absorbing, more, and consequently of changing from a thicker to a thinner or more fluid state; the latter being the natural situation of the blood in warm countries. Dr. Rush, in his inquiry into the proximate cause of fever, has accounted for the dissolved appearance of the blood in malignant fevers to a tendency in the blood-vessels to paralytic affection. He says that “it (the dissolution of the blood) begins in the veins, in which muscular action is more feeble than in the arteries. This has been proved by Dr. Mitchill in his account of the yellow fever in Virginia in 1741. He found the blood to be dissolved when drawn from the veins, which, when drawn from the arteries of the same persons, exhibited no marks of dissolution.” This, as the Doctor observes, “is a fact of great importance;” only we must remember, that, in every thing relative to the human body, when we find two phenomena constantly accompanying each other, it is extremely difficult for us to determine which is cause or effect. Instances of this often occur; and in the present case the dilemma is as great as any other. Though, from the testimony of Dr. Mitchill, we cannot doubt that in yellow fever the dissolution begins in the veins; and though it is likewise extremely probable that this dissolution is attended with a paralytic tendency, we cannot know whether the dissolution is the cause of the paralytic tendency, or the paralytic tendency the cause of the dissolution. The point, however, is of no importance. We see that in warm climates the blood of a person newly arrived has a natural tendency to dissolution, and of course the veins to the paralytic affection just mentioned. The liver therefore, which is supplied with blood by a large vein branched out like an artery, and terminating in other veins to carry back the blood from the former,[183] must be much more affected than any other part of the body; and this indeed seems a very probable reason why all those who come to warm countries become much more inclined to bilious complaints, which denote an affection of the liver, than they were before. This hepatic affection may very probably be greatly augmented, in new comers, by various causes. One of these is hard labour under a greater heat than they have been accustomed to; a second, that in the West India islands they have not access to that plentiful supply of fermented liquor, abounding in fixed air, which they had at home. This, though not generally taken notice of, is far from being a matter of little consequence; for, though emigrants from Britain and Ireland have been for the most part accustomed to drink spiritous liquors, yet fermented malt liquors certainly constitute the principal part of their drink. The total want of these, and the substitution of ardent spirit and water, must certainly be detrimental, even though they keep within the bounds of moderation, and much more if they do not. Dr. Moseley relates,[184] from Dr. Irving, that, in a bad kind of intermittent which broke out among the troops in service on the Spanish main in 1780, “nothing was so grateful as _London bottled porter_. Wine was neither so much desired by the sick, nor so serviceable in corroborating and keeping up the powers of the stomach; which, like the rest of the body, was soon reduced, from the slightest indisposition, to the lowest state of debility.” A third cause is no doubt their frequently drinking too freely of spiritous liquors, perhaps not of the best quality; and which, as they are neither conjoined with the fixed air nor with the mucilage which as it were inviscate and blunt their force in malt liquors, cannot fail of exerting their deleterious properties in a very remarkable manner.

[183] See p. 94.

[184] Treatise on Tropical Diseases, p. 173.

From these and other causes there must necessarily arise a predisposition to hepatic diseases; and this predisposition cannot be removed until the blood has assumed the state of fluidity proper to the climate in which they are, and the body has acquiesced in the change. They are then said to be _seasoned_ to the climate; and it is seldom that this seasoning takes place without a disease; indeed so seldom, that the first illness which happens to seize them after their arrival is called the _seasoning_. Dr. Trotter indeed gives a very different account of this seasoning. He considers those who come from a cold to a warm climate as having a redundancy both of excitement and excitability, and says that “to _wear out this accumulated excitability_ by slow and gentle gradations is the grand explanation of the word _seasoning_: it is the _secret_ which constitutes the only difference between the inhabitants of England and Jamaica. The yellow fever of the West Indies therefore, as it appears in the body of a raw European, is a disease of the _utmost excitement_, in a constitution of _accumulated excitability_; where a tense fibre and dense blood permit it to be carried to the highest pitch of inflammatory tendency; which, from the nature of the animal economy, speedily exhausts the powers of life, even in a day or two, inducing putrefaction and death.”

Explanations of this kind may edify those who understand them; but, though we should declaim ever so much about excitement and excitability, it is plain, that, in every one who comes from a cold country to a warm one, the liver is affected in a manner that the rest of the body is not. In some constitutions, or from exciting causes in any constitution, this affection of the liver may be augmented, and no doubt at last produce a bilious fever, which may be varied in a number of ways, according to the nature or the energy of these causes. The pure bilious fever, being of itself properly a local affection, may not be contagious; and we find it generally agreed among physicians that the common yellow fever of the West Indies is not infectious. Nevertheless, it seems by no means improbable that from certain circumstances contagion may be joined with it, and it may then spread and infect, even as the most deadly plague. Dr. Crawford relates, that, in the year 1770, a new kind of fever broke out in the Middlesex Indiaman, of which many died. It is not said that the disease was contagious; but, on opening the bodies of some who died, the liver was found enlarged, and of a more florid colour than it ought to be. It cannot be deemed impossible that contagion, even that of the true plague, might be mixed with this fever, which (as the affection of the liver was probably the original disease, might have been accounted little other than symptomatic) would then have assumed very malignant symptoms.

We might now say that we have got to the end of our subject. Having so amply discussed the question concerning contagion, and stated the principal part of the evidence against it, it seems proper to conclude the section with a short history of the disease in the malignant form it has assumed in the United States since the year 1792. Still, however, it is necessary to say something further of one or two of the causes which have been commonly assigned as necessarily inducing this disease. These are, 1. Extreme heat, and, 2. Marsh effluvia. The effect of the former has already been partly considered as a predisponent cause of yellow fever: but it doth not appear that merely from this cause the disease has ever been produced. It hath indeed been observed by very intelligent physicians, that in Virginia the remitting fever has often been brought on by mere exposure to the sun. Dr. Oliver of Salem hath obligingly informed me, that he has “in more than one instance been seized with that disease after riding in the sun;” and that an eminent practitioner in Virginia had informed him that he had also more than once suffered in the same way. Drs. Taylor and Hansforth observe, that, when the remitting fever proves mortal, it is generally attended by sickness and perpetual vomiting; which is the termination of the yellow fever. The above evidence is decisive with regard to heat being able to produce a remittent, but cannot exactly apply to the yellow fever, which has no remissions. Two sailors indeed, lately brought from a coasting vessel to the Salem hospital, were attacked with violent symptoms of yellow fever without having been, as is said, exposed to any infection. But evidence of this kind cannot be supposed to be incontrovertible. We have already seen the difficulty of ascertaining _facts_; and if it is difficult to prove that contagion _has_ been received, it must be still more so to prove that it _has not_. The persons in question had both worked during a very hot day in a vessel’s hold, they afterwards sat exposed in the damp air of the evening on the deck until 10 o’clock at night, and then slept in the vessel’s cabin with the windows open. One of them was seized in the night with a most violent pain, and the other on the morning succeeding. It is said that about 11 months since this vessel was at New York, and that a person on board had the yellow fever; it is also alleged that the vessel was not purified, and that the beds remained on board. It has therefore been by some conjectured that the disease might have been derived from this source.

Dr. Ramsay, in a letter to Dr. Currie of Philadelphia, censures Dr. Lining for saying that the yellow fever was imported into South Carolina. “The greater yellowness of the skin (says he) appears to be the only circumstance in which it differs from the bilious remittent fevers of hot climates, or very hot seasons of any climate.” Our author also censures Dr. Lind of Haslar,[185] who, he says, has been misled by the _misrepresentations_ of Dr. Warren and others. He also gives into the opinion that contagion acts only by contact, or at a very little distance; but this subject we cannot enter farther into at present. If we can believe Dr. Moseley, the sure criterion by which the yellow fever may be distinguished from any other is, that the former hath no remissions.[186] If solitary cases of it appear in Carolina and the southern States every year, this will not prove that the disease was generated in the country, any more than that the plague was generated in London, because it appeared there for many years successively.

[185] If physicians censure one another at this rate, how is it to be
determined who gives a true state of the matter?

[186] This position of Dr. Moseley is not universally received. The
meaning of the word _remission_ certainly is a temporary abatement,
and implies a recurrence, of the same symptoms which originally took
place. Dr. Moseley describes the yellow fever as beginning with one
kind of symptoms which suddenly cease and are succeeded after a
certain interval by others of a quite different kind; and he claims
the discovery as his own. If he be right in this description, the
yellow fever is certainly not a remittent; if otherwise, it must be
difficult to establish any true distinction between them.

But, if the heat of the sun cannot produce the true yellow fever, it can kill suddenly without any fever whatever. This is said by Dr. Moseley to be less frequent in the West India islands than on the eastern and western continents. He says that he has felt as great inconvenience from the sun’s heat at Venice, Naples, Rome, Montpelier, and in Virginia, as in the West Indies;[187] but he concludes that the _transitions_ from heat to cold are more pernicious to the human body than any continued heat, however violent.

[187] At Strasburg, in Germany, our author says that he saw a man
who had been an idiot for more than a year from a stroke of the sun.
The 8th of July 1707 was so hot in England that many people died at
their work, and many horses and oxen were killed by the sun’s rays.
In 1743, _eleven thousand_ people perished from the 14th to the
25th of July in the streets of Pekin in China. On the 30th of July,
1705, the heat at Montpelier was so great, that eggs were roasted by
it. Chalmers, in his account of the weather and diseases of South
Carolina, says, that he has seen a beef-steak, laid on a cannon for
twenty minutes, deprived of its juices, and overdone by the excessive
force of the sun’s rays.

With regard to the effluvia of marshes, it is not denied that they produce fevers, but those fevers are of the intermittent or remittent kind. Dr. Smith indeed, in the first volume of the Medical Repository, labours to prove that the plague described by Thucydides was not essentially different from the fevers which sometimes prevail in North America, and that it had its origin from marsh effluvia and the ravages of war. That this distemper was not the plague described by Russel we may gather from a single circumstance: for Russel tells us that _sneezing_ never occurred in the plague described by him,[188] while Thucydides says that it was one of the common symptoms of his. Neither does the description of it (Appendix No. 1) at all agree with any of the accounts of the yellow fever we have. The climate of Attica no doubt was variable, and may in this respect resemble that of North America; but so is the climate of China, yet no such diseases are there produced. The Doctor concludes that the distemper originated from _local_ causes; but the difficulty we find in proving such origin of diseases in our own days, and in the country where we reside, must certainly make us look upon the proofs which can be brought for the local origin of a disease which happened two thousand years ago, and in a distant country, as very equivocal. The following extract from the Paris Medical Memoirs may be adduced as a proof of the intrinsic power of marsh mud to produce fevers. It is contained in a paper written by Dr. Perkins of Boston. “A farmer was in the practice of spreading, upon about thirty acres of land, some new marsh mud, from October to April annually, to increase the fertility of the soil. In the summer of the third year, those inhabitants who lived to the northward and eastward of the place were attacked with a very malignant fever, which generally proved mortal. What is a proof that the marsh mud was the cause of the disease is, its extent, which was not more than a mile and an half from the farmer’s house, in the direction of the southerly and westerly winds. Perhaps had this marsh mud been washed by plentiful rains, the danger would have been less. Something like it happened to the inhabitants of the marshes _in East Sudbury_, (les marais situes a l’est dans le Sudberg) where the passage for the waters was too deep, and too confined. In regular seasons they were attacked with simple intermittent fevers; but, after wet seasons, there prevailed among them malignant fevers, and very obstinate remittents. Since the marshes have been drained, the inhabitants are no longer subject to fevers, and are as healthy as those of others places. We know that there are local epidemics, which are produced by a low, wet and rich soil; such are, probably, those which prevail in the lower part of New York, which, according to the informations obtained by Mr. Perkins, is more unhealthy towards the end of the summer than the other part of the city, and whose inhabitants are subject to diseases of a putrid _caractere_.

[188] See the Table.

“It appears, from several observations, that the most mortal epidemic fevers are not commonly produced by causes operating immediately; the cause often existing several months before the disease even appears.”

The other arguments used by Dr. Smith in his letters to Dr. Buel proceed upon the state of the city, the mode of living, &c. and the condition of most of the emigrants, their bad accommodations, and especially their abuse of spiritous liquors. The neglect of bathing is also much complained of, and a comparison made with the conduct of the French in this and other respects, greatly to the advantage of the latter.

Drs. Taylor and Hansforth consider the disease which took place in Norfolk in Virginia as only an higher degree of the common remittent fever which usually prevails, and ascribe it to the long-continued heat, putrescence, &c. Some French ships were said to have brought the disease, but these arrived “so long before the disease appeared, that (the Doctors think) it would be absurd to suppose even a possibility of its being derived from them.” Mr. Webster adds, in a note, that the French corvettes, three of which squadron were taken by the Thetis, capt. Cochran, “anchored in Hampton Roads, May 18th. The fever did not appear in Norfolk till August. Captain Cochran’s crew, however, _took the fever from the French prisoners_, and twelve of them died before the Thetis reached Halifax.” This is certainly a suspicious circumstance.

Dr. Ramsay, in his letter to Dr. Mitchill concerning the same distemper, observes that it was confined almost entirely to foreigners, of whom he gives a very unfavourable account. The situation of the town, putrescence, &c. are likewise brought in for a share, as well as the season, which had been uncommonly warm.

These are the principal evidences that have been brought for and against the origin of the disease which since 1792 has raged with such violence in the United States. Innumerable pieces have appeared in the Newspapers on both sides of the question, the most remarkable of which are the letters of Mr. Noah Webster to Dr. Currie. These, however, we cannot now consider, as we cannot expect indeed that they should contain any thing else than a fuller detail of what has already been set forth. Mr. Webster besides, in his letters, owns that he is not a medical man; nay, that he had not “read above three or four medical books.” I hope therefore the reader will excuse the preference given in this treatise to the writings and arguments of those who are acquainted with medicine both by reading and practice. The dispute between the College and Academy of medicine can be settled only by themselves; the only safe line of conduct seems to be to admit both doctrines, and to take every method of preventing the introduction of the disease, whether supposed to be generated or imported.

Whether the distemper which has so fatally prevailed since the year 1793 be naturally connected with the troubles in Europe and the West Indies or not, it is certain that it has been cotemporary with them. In New York the disease appeared in 1791, but we are not furnished with any particular accounts of it at that time; nor does it appear to have made any great ravages, either on the continent or the West India islands, till 1793. At this time the war raged in Europe with fury; the French royalists were every where driven out, and distressed in every possible way. Desolation and slaughter prevailed at St. Domingo, while an unbounded intercourse took place between the United States and all those nations who were involved in the calamities resulting from the unbridled passions of man excited to their utmost pitch of ferocity. In the midst of this general commotion the fever broke out in the West India islands, appearing first in the island of Grenada. We have seen, that, according to Dr. Chisholm, this disease was brought to Grenada in the Hankey, from the coast of Africa, on the 18th of February. About the middle of April it began to appear on land. In the beginning of May it reached a detachment of the royal artillery lying at a distance from the focus of infection, “but (says Dr. Chisholm) by the communication which the gunners in Fort George had with the 45th regiment, and the predisposition of the men to receive the infection as far as that could be induced by excesses in drinking, and other irregularities.” About the first of June the disease began to appear among the negroes of the estates in the neighbourhood of the town, but never attacked them with the same violence that it did the white people. During the months of May, June and July, it appeared in different parts of the country; being, as our author supposes, carried thither by infected persons. From Grenada, the Doctor says, the disease spread to the islands of Jamaica and St. Domingo, and from the latter to Philadelphia, “by vessels on which the infection was retained by the clothes, more especially the woollen jackets, of the deceased sailors.”

This account of the origin of the fever at Philadelphia, as we have already seen, is inadmissible by those who deny the contagious nature of the disease; but as the latter have never given any distinct account of its rise, or shown why it should first appear in one island and then in another, instead of beginning in them all at once, we must adhere to that of Dr. Chisholm, till we are furnished with a better.

In Philadelphia it has already been observed, that Dr. Rush was called to his first patient on the 5th of August; but Mr. Carey mentions a child of Dr. Hodges “as probably the first victim;” who was taken ill on the 26th or 27th of July. This same month the unfortunate fugitives had arrived from Cape Francois; and we have already seen, from Dr. Clarke, that the arrival of some of their fellow-sufferers in Dominica had the same dreadful attendant. Whether the disorder is to be ascribed to the arrival of these people in either place, the reader will judge. Other vessels are charged with having imported the same; but, facts being disputed, we cannot enter into the controversy.

The disease began in Water-street, to a particular part of which, near to that where the suspected ships lay, it was for some time confined, but did not excite public alarm till about the 19th of August. From this time to the 25th of the month the attention of the citizens was so much aroused, that they began to move into the country; and on the 22d, the city commissioners were peremptorily ordered by the mayor to keep the city clean. On the 26th the College met, and addressed the citizens on the subject; recommending such means of preventing the spreading of the sickness as to them seemed most proper. Among these were, to avoid any intercourse with the infected, to live temperate, keep their minds easy, and to avoid fatigue. Lighting of fires was particularly disapproved of; but the burning of gunpowder, and the steams of vinegar and camphor, were recommended for infected rooms, and for using on handkerchiefs, and in smelling-bottles.

In consequence of this address also the bells were stopped from tolling, the constant noise of which had greatly contributed to increase the public alarm. The people, who had been in use to light large fires in the corners of the streets, being forbid on the 29th by proclamation to do so, had recourse to firing of guns; which was at last carried to such excess, that it also was prohibited by proclamation on the 4th of September.

Notwithstanding all these precautions, the distemper continued to increase in such a manner as to produce the most dreadful terror and dismay. “Indeed (says Mr. Carey) it is not probable that London, at the last stage of the plague, exhibited stronger marks of terror than were to be seen in Philadelphia, from the 26th or 27th of August, till pretty late in September.” This produced scenes of distress unparalleled till this time in the city, and of which many instances are to be met with in Mr. Carey’s account. It cannot, however, be doubted that the violence of the distemper, its contagious nature, and the consequent danger of visiting the metropolis, were greatly exaggerated. Thus terror was struck throughout all the adjacent states. At Chester-town, in Maryland, a meeting was held, on the 10th of September, in consequence of which the Eastern shore line of stages was quickly stopped. On the 10th of the same month it was ordered by the mayor of New York that the names of all such persons as had arrived or should arrive from Philadelphia or other place, by land or water, that were or _should be sick_, should be reported to him, that those who were sick of infectious diseases might be removed out of the city. Next day the governor proclaimed that all vessels from Philadelphia should approach no nearer than Bedlow’s island, about two miles from the town, till license was given. But these precautions not being deemed sufficient, a night watch was established, and next day an address was published by delegates, purporting the insufficiency of all that had been done, and again calling upon their fellow-citizens to exert their utmost vigilance in detecting the fugitives from Philadelphia. Various other resolutions were passed in New York; and throughout the whole continent such measures were taken as seemed most likely to proscribe the unhappy Philadelphians, and to prevent their having any place of refuge from the sickness they so much dreaded. On the 1st of October, however, the inhabitants of Springfield, in New Jersey, passed a resolve, offering their town as an asylum for the people of Philadelphia, and directing an hospital to be provided for the reception of such as might fall sick. Similar resolutions were passed by the inhabitants of Elizabethtown, and Elkton in Maryland.

The distemper in the mean time arrived at the most dreadful height in Philadelphia, and almost all those who could take the charge and burthen of public affairs were absent. An hospital had been established at Bush Hill, but, for want of superintendence, had fallen into such disorder, that the poor chose rather to deny their illness than to be sent to it. On the 15th of September, however, Stephen Girard, a native of France, and a wealthy merchant, together with Peter Helm, a native of Pennsylvania, offered their services as superintendants. By their exertions the credit of the hospital was soon retrieved, and such numbers demanded admittance, that it became necessary for each candidate to procure a certificate from a physician, that the patient really laboured under a malignant fever. In a short time the affairs of the city went on, in every respect, with as much regularity as could be expected; but the mortality increased throughout the month of September, and the three first weeks of October. Great hopes were entertained from some cold and rainy weather in the end September; but they proved illusive, and the disease became even more fatal than before, till the 26th of October, when it suddenly ceased, as Mr. Carey says, with hardly any rain, and a very moderate degree of cold. “That day (adds he) was as warm as many of the most fatal ones in the early part of the month. To account for this is perhaps above our power. In fact, the whole of the disorder, from its first appearance to its final close, has set human wisdom and calculation at defiance.” During the time of this calamity Mr. Carey computes that _seventeen_ thousand left the city, and _four_ thousand and thirty-one perished.

This city suffered another attack in 1794 but far less severe than before. In 1795 and 1796 the disease seems scarcely to have made its appearance; but in 1797 it revived, and, in 1798, broke out with greater fury than even in 1793. No particular history hath been published of this last severe attack. We know only in general, that, though a much greater number of the inhabitants fled out of town in 1798 than in 1793, the number of deaths was almost as great; being estimated at three thousand eight hundred and forty-one. Great disputes, as has been observed, have taken place concerning the origin of these diseases; on which we shall only further remark, that if, after such repeated and dreadful experience of the bad effects of allowing putrid matters to accumulate, such quantities could be collected as to produce the very fatal sickness of last year, it argues a most unaccountable, and indeed incredible, insensibility on the part of the people, as well as remissness on that of the magistrates; and this perhaps may be accounted as strong an argument in favour of contagion as can be adduced.

That such a violent distemper should cease all at once, is indeed not to be expected; and we have already heard of its again appearing in the city. Fear has been very justly excited, there and in other places; but it is to be hoped that the remarkable coolness of the season will operate favourably in preventing any very violent attack for this year.

New York has also suffered very considerably from this disease. Here it appeared in 1791, in the autumn, and in a part of the town remarkable for its vicinity to a collection of filth. In 1792 it made no progress; and in 1793, though some died of it who fled from Philadelphia, it did not spread. In 1794 it returned with considerable violence, and with still greater in 1795. In the history of this disease by Dr. Seaman,[189] he takes notice that in July and August an unusual number of persons suffered from drinking cold water, and some fell down and died in the streets; but the Doctor supposes this to have happened rather through the excessive heat of the sun than the drinking of water. As the disease came on, all others gave way to it, even “_the common remitting bilious fever_;”[190] and in the month of July some cases occurred. We have already had occasion to take notice of the death of Dr. Treat, who was taken ill on the 22d of July; but before that time, on the 6th of the same month, Dr. Seaman says that, in conjunction with this gentleman, he had visited a patient “affected with all the full-marked and decided symptoms of an highly malignant yellow fever.”[191] The disease continued to gain ground in August, and became extremely violent in that and the following month; but, according to our author, the low ground in the southeast part of the city was the “grand centre of the calamity, diffusing its effects like diverging rays, aiding, by its most powerful influence, different secondary centres, already smoking hot, to flame out its pestiferous _operations_.” In this part of the town five hundred died in three months.

[189] Med. Repos. vol. i, p. 316.

[190] Webster’s Collection.

[191] This proves that Dr. Treat _was not_ the first person who
suffered by this disease but it will not prove that the disease was
not imported by capt. Bird’s vessel; for the fever spread in the
vicinity of the vessel, not of the almshouse, where the first patient
was carried.

The attack at this time did not arouse the people to a proper sense of their danger. As formerly, the origin of the disease in 1795 had been attributed to the filth of the city. Next year it was attributed to the same, and so in 1797 and 1798. This last year, particularly, it is said to have originated partly from great quantities of putrid beef and fish, collected for exportation, and which could not be exported. In Mr. Hardy’s account of this fever, it is calculated that there died in 1798 two thousand and eighty-six; but that, if it were taken into the account how many left the town and died in the country, the number would amount to between two thousand four hundred, and two thousand five hundred.

It is not in Philadelphia and New York alone that this distemper has prevailed. Boston, Newburyport, Portsmouth, Portland, and even detached spots in the country, to which it is not possible to trace any infection, have felt its ravages. At Salem also, where the disease was never known before, twenty-one cases, including some doubtful ones, appeared in 1798; and of these, eleven proved fatal. In 1796, when it prevailed in Newburyport, it was supposed to have been introduced by a vessel from the West Indies; and, according to Dr. Coffin, the opinion would have been incontrovertible, had not a large quantity of fish-garbage been collected at the place where the vessel landed; so that, though the disease spread from that place, it could not be known whether it proceeded from the vessel, or the fish, or both. It seems now unfortunately to be the case, that where this disease once gets footing it cannot easily be eradicated. If we suppose it always to be imported, the continual intercourse with the West India islands will account for this; but the extreme difficulty, or rather impossibility, of procuring an account of facts or even a single fact which cannot be controverted, renders every thing that can be said upon the subject uncertain and precarious. In the case of New London particularly, where 81 persons were destroyed by it last year, neither importation nor collections of filth could be assigned as the cause; nevertheless it began near a _wharf_; but Mr. Holt, in his account of the disease, thinks it was most probably owing to the mere heat and dryness of the season. On the other side of the question, however, we must still insert Dr. Brackett’s account of the origin of the disease at Portsmouth, in answer to a letter from Dr. Oliver of this place.

“The yellow or pestilential fever made its first appearance at Portsmouth, about the first of August last. Eight or ten days before that time a vessel arrived here from Martinico, and brought a French family (four or five in number.) This vessel, before she left the West Indies, had two sailors taken sick (as the captain informed me) one of whom died on the passage home; the other was on the recovery when the vessel came into this port.

“There was not, nor had not been for a long time before, any fever in this town. Two or three days after, I heard that one or two men, who were labourers (and probably had been on board, as they lived nigh where the vessel lay at the wharf) died suddenly with fever, but am uncertain whether with yellow fever, as I never saw them. The first of August, the owner, whose house was about four or five rods distant from the vessel, had a child of four or five years of age taken sick; the next day I visited it, and two days after he died. The symptoms appeared like a cholera morbus--sick stomach, and frequent puking of black bile. The day before he died a brother of his, fifteen years old, was taken ill, and had much the same symptoms, only greater inflammation and distress. He was blooded freely, took calomel, bark, &c. He died five days after sickened. Between the 8th and the 20th of August, four or five of the other children and servants were taken with the same symptoms, and recovered. On the sixteenth day, a daughter, seventeen years of age, was taken down with the same disease: she was treated in the same manner, with bleeding, mercury, warm bath, bark, &c. and died on the 9th day. This patient had a great discharge of blood from her mouth and gums for three days before she died. One or two more of the family had it afterwards, and recovered. All these patients took the infection, I believe, about the same time. Many others in that neighbourhood had the fever during this time, about one half of whom died: out of forty-six patients I lost fifteen. If I could procure a soreness of the fauces, by administering calomel in small doses, and rubbing it in the gums, or by frictions on the legs and arms with mercurial ointment, the third or fourth day, I was sure of their recovery.

“How many died of this disease in the whole, I have forgotten; as, through fatigue, and debility of body and mind, I kept no notes: I think rather more than half of those who had it. The fever agreed in every symptom, almost, with that described by Dr. Rush and others. The contagion did not appear to be propagated, as the largest number who had the disease were seized in the month of August, and lived in the streets only which communicated with the wharf where the vessel lay, and the beach where she was graved. These streets are in the highest part of the town, and always esteemed the most healthy, and as free of putrid substances as any in it. In the months of September and October the fever was followed by dysentery, and spread through almost every part of the town and its environs. There has been no case of fever or dysentery since last fall: this place, during the winter, and summer thus far, has been uncommonly healthy; and it appears likely to continue so, if the committee of health should not be remiss in their duty. Thus, without any comments, I have endeavoured to give you a short history of the pestilential fever, as it appeared here last summer. The ideas, you may communicate to the author of the book intended to be published.”

The following letter from Dr. Warren, which he obligingly sent to two physicians in Salem, gives an accurate account of the distemper which prevailed in Boston last year:

“I should immediately have answered your favour of last month, but for a wish to give you as complete an account of the causes and mortality of the late epidemic as could be collected.

“There were a number of suspected causes, which, though concealed during the prevalence of the disease, it was hoped would be developed after the agitation of the public mind had entirely subsided; and I was in expectation that some regular returns would have been made of the numbers who had passed through the disease, and of those who had died with it, so that some estimate might be formed of its malignity and mortality; but such returns have not yet been made, and it is therefore impossible to obtain any satisfactory evidence on those heads. I suppose the number of deaths to have been rather short of two hundred; but this is only a rude guess, and should not be relied on in forming any consequential deductions on the subject. I shall, however, now offer such an account of the disorder as my present materials have enabled me to prepare.

“The first unequivocal appearance of the malignant fever, in the town of Boston, was on the 20th of July 1798 (though one family had been attacked with a fever, attended with unusual symptoms, as early as the middle of June; but, as no other instances occurred for so long a time, of an alarming nature, some doubts may perhaps be justly entertained of the identity of the affection.) Three or four cases only, I believe, happened between this and the latter end of the month. The two first of these were young men employed in stores directly opposite to each other, on Green’s wharf, near the Town-dock. A few days after, three or four persons were seized with the same complaint, whilst following their respective occupation in Market square, on the east and south sides of Faneuil Hall, or the Market-house. In the beginning of the month of August several persons were taken sick in the same neighbourhood, chiefly young men between 16 and 24 years of age, whilst employed in stores and counting houses there situated. The stores in Merchant’s row, extending from the Market to State-street were more especially visited with the disease, and, in the course of the same month, a family at the bottom of State-street, and several persons at Oliver’s dock, were taken sick. At this place a kind of bason is formed between a point of the town projecting from Fort hill, and the Long wharf, which is constantly receiving the offals of fish, and other animal substances, which from its situation could not be washed off by the waters contained in it. This spot is remarkable for having been the residence of most of the persons first attacked with the bilious remittent fever of 1796. To the latter end of this month the number of sick continued to be increasing; but the attacks were principally confined to the above-mentioned quarters, till at length the disease appeared on the south side of Fort hill, at some distance to the southward of Oliver’s dock, leaping, as it were, over the summit of the hill, without lighting upon the inhabitants on the north of that eminence. The fatality of the disease was here probably greater than in any part of the town of equal population; and it was nearly the last place in which it disappeared. Very few families who remained in their own houses upon the hill escaped its attack; and the progress of the disease, in all the places above mentioned, seemed to have been arrested only by means of the evacuation of the buildings by the people who inhabited them. In the latter end of August, and through the month of September, many persons were taken sick in Fore-street, which runs northerly from Market of Dock square, along the heads of the wharves, on the eastern side of the town.

“Through the whole period of the sickness scarcely a person was taken ill who had not resided, or been in daily employment, in the vicinity of these places. The subjects of the disease were generally natives of the town, chiefly in the prime of life, and in the vigour of health. I recollect no instance of any French inhabitants being assailed by it, and have heard of only one or two instances of the blacks being affected with it.

“That the fever was in a degree contagious, I cannot entertain a doubt; but that it was not so in a very high degree, I am as fully persuaded, from the number of cases in which there was reason to believe it could not have been taken in that way. In most instances, where contagion might have been suspected, the subjects were so situated that they might have received it from the same source as those with whom they had communicated. I cannot learn that any evidence has been furnished of infection from the sick who had been removed into the country, though there were many instances of such removals, under the most malignant forms which it assumed.

“The fever was generally ushered in by a chill, but I think by no means equal to that which commonly precedes fevers of the ardent kind, nor in proportion to the violence of its subsequent periods. In a short time the rigors were succeeded by excessive heat; the pulse, which had been small and contracted, became hard and full; the respiration laborious from violent oppression at the scrobiculus cordis; the tongue assumed a whitish cast; the eyes became highly inflamed, while the pains in the head, back, and legs, were intolerably severe. To these symptoms succeeded nausea, and vomiting sometimes of a highly bilious matter, seldom attended with diarrhœa, but often with a burning at the stomach, tenderness of the abdomen, parcity of urine; and, in one instance, a dysuria, with a great proportion of blood at each evacuation of that fluid.

“These appearances usually continued about 48 hours, after which they often suddenly gave place to a very different train of symptoms. The pulse sunk astonishingly, and became intermittent; the heat and pains entirely subsided; and the patient supposed himself to be out of danger. From a perfect possession of all his intellectual faculties, with a serenity of mind, which in no other disease, I believe, is so generally observed to accompany its last stages, on or about the 5th day from the accession of the fever, he fell into a state of insensibility, and thence sunk gently into the arms of death. In others this change was less rapid; the pulse became gradually smaller, the distressing symptoms slowly abated, a coldness of the extremities took place, and continued for several days before death, accompanied with clammy sweats, often without any perceptible pulse in the wrists, for several hours before the fatal termination. The tongue seldom became much coated, to the last. Delirium was by no means generally attendant; and a yellowness of the skin was far from being universal; sometimes, however, this appearance was observed within the three first days; often on the fourth and fifth; and I was induced to consider it as an accident, rather than a constituent character of the disease.

“The black vomit, as it has been usually called, though in my opinion by no means to be considered as a pathognomic sign of the disease (as I have frequently seen it take place in other acute fevers, especially the puerperal) was very frequently attendant on the last stages of the disorder; very few recovered after this circumstance had taken place; in one person, however, who had it in the most alarming form, together with an intermittent pulse, coldness of the extremities, singultus, and every usual mark of immediate dissolution, a most unexpected recovery happily disappointed the positive prognostics of his physicians. As the cure advanced, the skin in this instance became extremely yellow, and continued so for many weeks after the fever had subsided; the biliary ducts having been completely obstructed, and consequently the alvine evacuations of a clayey colour, and with much difficulty procured. Frequent repetitions of rhubarb and calomel in large doses, the continuance of the mercurial medicine in small doses, so as to keep up a continual ptyalism, and a laxative diet, restored him to perfect health.

“For the discoveries which were made on dissecting the bodies of some of those who died with the disease, I beg leave to refer you to a publication in the Boston Centinel, made during the prevalence of the disorder in this place, and subscribed by Dr. Isaac Rand, sen. President of the M. Medical Society, and myself.” (For these discoveries see the table, facing p. 434.)

“We had heretofore treated our patients agreeably to the method practised at Philadelphia in 1793, with bleeding in most instances, and active purges of jalap and calomel, or Rochelle salts. The diseased state of the liver, the known effects of mercury in hepatitis, and the recollection of the suggestions contained in Dr. Rush’s publication on the yellow fever, together with those of several other celebrated writers on the same subject, induced us to enter immediately on the use of calomel in small doses, as recommended in our paper above referred to.

“In my own practice I _now_ usually commenced the treatment by bleeding from ten to sixteen ounces, and followed it by a dose of between ten and fifteen grains of calomel with between twenty and twenty-five grains of jalap, or an ounce of Rochelle salts, or more, according to the constitution. Immediately after the operation of these medicines I began with the use of calomel in small doses, in pills of a grain, every hour, and sometimes of 3 grains every two hours. Within the first twenty-four hours, but scarcely ever after, I found occasion frequently to repeat the bleeding, and it is worthy of remark, that in scarcely a single instance was this operation performed without almost instantaneous relief; although in most cases, a few hours after, there was a recurrence of the symptoms. The blood for the most part was dark. In three cases there was no separation of serum from the coagulated mass at the end of forty-eight hours. In two of these (and they were the only cases in which I observed it) a firm buff was formed on its surface; and all three died of the disease.

“The calomel was often continued through the whole course of the fever; and ptyalism was usually brought on within three or four days: though sometimes upwards of 200 grains were given, at the rate of a grain every hour, without any specific effect on the salivary glands. In proportion as the soreness of the mouth advanced, the symptoms universally gave way; and in every patient, two only excepted, this effect of the remedy was a sure pledge of recovery. In this exception were comprehended two persons of the same family, a father and daughter, both of whom had survived the 14th day of the disease, had copious hæmorrhages from the mouth (a circumstance which also attended on many who recovered) and died in a state of apparent putrefaction.

“The purgative medicines were generally repeated every second day; or an enema of water gruel was administered occasionally, if the bowels were constipated; but if otherwise, and the calomel passed off by those emunctories, opium was combined with it in sufficient quantities to restrain the discharge. The evacuations which took place from the intestines, during the use of the mercury, were almost universally of a remarkably dark colour, generally approaching to a deep green, but by no means remarkably fœtid. When spontaneous, they were often observed to be of the colour and consistence of water gruel.

“In cases of very laborious respiration, which was frequently in an extreme degree distressing, especially after the first 36 or 48 hours had elapsed, blisters, applied either to the chest or extremities, had a favourable effect; on the latter, they were most useful in the advanced stages of the disease, by exciting to action the debilitated vessels, and by restoring circulation and warmth to the parts. In the same intention, wine, snake-root, and the bark, were sometimes used with advantage.

“The diet was generally of the lightest and most cooling nature; barley-water, apple-water, and spruce-beer, were generally both grateful and salutary. The warm bath was often exhibited with apparent success, especially in the beginning of the disease, and when a copious sweat had been induced by it. The cold bath was also resorted to by some respectable practitioners, and perhaps, under some circumstances, with good effects; but I have no reason to think it was generally advantageous.

“Upon the whole, I believe that the most efficacious remedy, and the only one to be relied on, is mercury. It is certain that, as far as my observation has extended, under no other method of treatment did so many recover; and there were but few instances of a fatal termination, when it had been administered from the commencement of the fever.