Chapter V: Part 5

The science of medicine is related to every thing, and the philosopher as well as the christian will be gratified by knowing the effects of a great and mortal epidemic upon the morals of a people. It was some alleviation of the distress produced by it, to observe its influence upon the obligations of morality and religion. It was remarked during this time, by many people, that the name of the Supreme Being was seldom profaned, either in the streets, or in the intercourse of the citizens with each other. But two robberies, and those of a trifling nature, occurred in nearly two months, although many hundred houses were exposed to plunder, every hour of the day and night. Many of the religious societies met two or three times a week, and some of them every evening, to implore the interposition of Heaven to save the city from desolation. Humanity and charity kept pace with devotion. The public have already seen accounts of their benevolent exercises in other publications. It was my lot to witness the uncommon activity of those virtues upon a smaller scale. I saw little to blame, but much to admire and praise in persons of different professions, both sexes, and of all colours. It would be foreign to the design of this work to draw from the obscurity which they sought, the many acts of humanity and charity, of fortitude, patience, and perseverance, which came under my notice. They will be made public and applauded elsewhere.

But the virtues which were excited by our calamity were not confined to the city of Philadelphia. The United States wept for the distresses of their capital. In several of the states, and in many cities and villages, days of humiliation and prayer were set apart to supplicate the Father of Mercies in behalf of our afflicted city. Nor was this all. From nearly every state in the union the most liberal contributions of money, provisions, and fuel were poured in for the relief and support of such as had been reduced to want by the suspension of business, as well as by sickness and the death of friends.

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

died. |
August 1 9 |
2 8 |
3 9 |
4 10 |
5 10 |
6 3 |
7 12 |
8 5 |
9 11 |
10 6 |
11 7 |
12 5 |
13 11 |
14 4 |
15 9 |
16 7 |
17 6 |
18 5 |
19 9 |
20 7 |
21 8 |
22 13 |
23 10 |
24 17 |
25 12 |
26 17 |
27 12 |
28 22 |
29 24 |
30 20 |
31 17 |
September 1 17 |
2 18 |
3 11 |
4 23 |
5 20 |
6 24 |
7 18 |
8 42 |
9 32 |
10 29 |
11 23 |
12 33 |
13 37 |
14 48 |
15 56 |
16 67 |
17 81 |
18 68 |
19 61 |
20 67 |
21 57 |
22 76 |
23 68 |
24 96 |
25 87 |
26 52 |
27 60 |
28 51 |
29 57 |
30 63 |
October 1 74 |
2 66 |
3 78 |
4 58 |
5 71 |
6 76 |
7 82 |
8 90 |
9 102 |
10 93 |
11 119 |
12 111 |
13 104 |
14 81 |
15 80 |
16 70 |
17 80 |
18 59 |
19 65 |
20 55 |
21 59 |
22 82 |
23 54 |
24 38 |
25 35 |
26 23 |
27 13 |
28 24 |
29 17 |
30 16 |
31 21 |
November 1 13 |
2 21 |
3 15 |
4 15 |
5 14 |
6 11 |
7 15 |
8 8 |
9 6 |
---- |
Total[56] 3881 |

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

From this table it appears that the principal mortality was in the second week of October. A general expectation had obtained, that cold weather was as fatal to this fever as heavy rains. The usual time for its arrival had come, but the weather was still not only moderate, but warm. In this awful situation, the stoutest hearts began to fail. Hope sickened, and despair succeeded distress in almost every countenance. On the _fifteenth_ of October, it pleased God to alter the state of the air. The clouds at last dropped health in showers of rain, which continued during the whole day, and which were succeeded for several nights afterwards by cold and frost. The effects of this change in the weather appeared first in the sudden diminution of the sick, for the deaths continued for a week afterwards to be numerous, but they were of persons who had been confined before, or on the day in which the change had taken place in the weather.

The appearance of this rain was like a dove with an olive branch in its mouth to the whole city. Public notice was given of its beneficial effects, in a letter subscribed by the mayor of Philadelphia, who acted as president of the committee, to the mayor of New-York. I shall insert the whole of this letter. It contains, besides the above information, a record of the liberality of that city to the distressed inhabitants of Philadelphia.

"SIR,

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

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

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

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

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

"The refreshing rain which fell the day before yesterday, though light, and the cool weather which hath succeeded, appear to have given a check to the prevalence of the disorder: of this we have satisfactory proofs, as well in the decrease of the funerals, as in the applications for removal to the hospital.

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

"With sentiments of the greatest esteem and regard,

"I am, sir,
"Your most obedient humble servant,

"MATTH. CLARKSON.

_"Philadelphia, Oct. 17, 1793._
_"Richard Varick, mayor of the city of New-York."_

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

The yellow fever which raged in Philadelphia in 1699, and which is taken notice of by Thomas Story in his journal, ceased about the latter end of October, or the beginning of November. Of this there are satisfactory proofs, in the register of the interments in the friends' burying-ground, and in a letter, dated November 9th, old style, 1699, from Isaac Norris to one of his correspondents, which his grandson, Mr. Joseph P. Norris, politely put into my hands, with several others, which mention the disease, and all written in that memorable year in Philadelphia. The letter says, "It has pleased God to put a stop to our sore visitation, and town and country are now generally healthy." The same disease was checked by wet and cold weather in the year 1741. Of this there is a proof in a letter from Dr. Franklin to one of his brothers, who stopped at Burlington, on his way from Boston to Philadelphia, on account of the fever, until he was assured by the doctor, that a thunder gust, which had cooled the air, had rendered it safe for him to come into the city[57]. Mr. Lynford Lardner, in a letter to one of his English friends, dated September 24, 1747, old style, after mentioning the prevalence of the fever in the city, says, "the weather is now much cooler, and those under the disorder revive. The symptoms are less violent, and the fever gradually abates."

[57] From a short note in the register of the interments in the
friends' burying-ground, it appears that the fever this year made
its first appearance in the month of June. The following is a copy
of that note: "12th of the 6th month (O. S.), 1741, a malignant
yellow fever now spreads much." Besides that note, there is the
following: "25th of the 7th month (O. S.), 1741, many who died of
the above distemper were persons lively, and strong, and in the
prime of their time."

I have in vain attempted to procure an account of the time of the commencement of cold weather in the autumn of 1762. In the short history of the fever of that year, which I have inserted from my note book, I have said that it continued to prevail in the months of November and December. The register of the interments in the friends' burying-ground in those months confirms that account. They were nearly as numerous in November and December as in September and October, viz. in September 22, in October 27, in November 19, and in December 26.

The bilious remitting fever of 1780 yielded to cool weather, accompanied by rain and an easterly wind[58].

[58] Vol. i.

Sir John Pringle will furnish ample satisfaction to such of my readers as wish for more proofs of the efficacy of heavy rains, and cold weather, in checking the progress and violence of autumnal remitting fevers[59].

[59] P. 5, 56, 180, and 323.

From the 15th of October the disease not only declined, but assumed more obvious inflammatory symptoms. It was, as in the beginning, more necessarily fatal where left to itself, but it yielded more certainly to art than it did a few weeks before. The duration of it was now more tedious than in the warmer weather.

There were a few cases of yellow fever in November and December, after the citizens who had retired to the country returned to the city.

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

In consequence of a proclamation by the governor, and a recommendation by the clergy of Philadelphia, the 12th of December was observed as a day of thanksgiving throughout the state, for the extinction of the disease in the city.

It was easy to distinguish, in walking the streets, the persons who had returned from the country to the city, from those who had remained in it during the prevalence of the fever. The former appeared ruddy and healthy, while the latter appeared of a pale or sallow colour.

It afforded a subject of equal surprise and joy to behold the suddenness with which the city recovered its former habits of business. In the course of six weeks after the disease had ceased, nothing but fresh graves, and the black dresses of many of the citizens, afforded a public trace of the distress which had so lately prevailed in the city.

The month of November, and all the winter months which followed the autumnal epidemic, were in general healthy. A catarrh affected a number of people in November. I suspected it to be the influenza which had revived from a dormant state, and which had not spent itself, when it yielded to the predominance of the yellow fever. This opinion derives some support from a curious fact related by the late Mr. Hunter of the revival of the small-pox in a patient, in whom it had been suspended for some time by the measles[60]. The few fevers which prevailed in the winter were highly inflammatory. The small-pox in the natural way was in several instances confluent; and in one or two fatal. I was prepared to expect this inflammatory diathesis in the fevers of the winter; for I had been taught by Dr. Sydenham, that the diseases which follow a great and mortal epidemic partake more or less of its general character. But the diseases of the winter had a peculiarity still more extraordinary; and that was, many of them had several of the symptoms of the yellow fever, particularly a puking of bile, dark-coloured stools, and a yellow eye. Mr. Samuel D. Alexander, a student of medicine from South-Carolina, who was seized with a pneumony about Christmas, had, with a yellow eye, a dilated pupil and a hard pulse, which beat only fifty strokes in a minute. His blood was such as I had frequently observed in the yellow fever. Dr. Griffitts informed me that he attended a patient on the 9th of January, in a pneumony, who had a universal yellowness on his skin. I met with a case of pneumony on the 20th of the same month, in which I observed the same degrees of redness in the eyes that were common in the yellow fever. My pupil, Mr. Coxe, lost blood in an inflammatory fever, on the 18th of February, which was dissolved. Mr. Innes, the brewer, had a deep yellow colour in his eyes, on the fourth day of a pneumony, on the 27th of the same month; and Mr. Magnus Miller had the same symptom of a similar disease on the 16th of March. None of these bilious and anomalous symptoms of the inflammatory fevers of the winter and spring surprised me. I had been early taught, by Dr. Sydenham, that the epidemics of autumn often insinuate some of their symptoms into the winter diseases which follow them. Dr. Cleghorn informs us, that "the pleurisies which succeeded the autumnal tertians in Minorca, were accompanied by a vomiting and purging of green or yellow bilious matters[61]."

[60] Introduction to a Treatise on the Venereal Disease, p. 3. of the
American edition.

[61] Page 273.

It belongs to powerful epidemics to be followed by similar diseases after they disappear, as well as to run into others at their first appearance. In the former case it is occasioned by a peculiar state of the body, created by the epidemic constitution of the air, not having been changed by the weather which succeeded it.

The weather in March resembled that of May; while the weather in April resembled that of March in common years. A rash prevailed in many families, in April, accompanied in a few cases by a sore throat. It was attended with an itching, a redness of the eyes, and a slight fever in a few instances. The small-pox by inoculation in this month was more mortal than in former years. However unimportant these facts may appear at this time, future observations may perhaps connect them with a similar constitution of the air which produced the previous autumnal epidemic.

The appearance of bilious symptoms in the diseases of the winter, excited apprehensions in several instances of the revival of the yellow fever. The alarms, though false, served to produce vigilance and industry in the corporation, in airing and purifying such houses and articles of furniture as belonged to the poor; and which had been neglected in the autumn, after the ceasing of the disease.

The modes of purifying houses, beds, and clothes were various. Fumigations of nitre and aromatic substances were used by some people. Burying infected articles of furniture under ground, and baking them in ovens, were used by others. Some destroyed all their beds and clothing that had been infected, or threw them into the Delaware. Many white-washed their walls, and painted the wood-work of their house. I did not conceive the seeds of the disease required all, or any of those means to destroy it. I believed _cold_ and _water_ to be sufficient for that purpose. I therefore advised keeping the windows of infected rooms open night and day, for a few days; to have the floors and walls of houses well washed; and to expose beds and such articles of household furniture as might be injured by washing, upon the bare earth for a week or two, taking care to turn them every day. I used no other methods of destroying the accumulated miasmata in my house and furniture, and experience showed that they were sufficient.

It is possible a portion of the excretions of the sick may be retained in clothes or beds, so as to afford an exhalation that may in the course of a succeeding summer and autumn, or from accidental warmth at any time, create a solitary case of fever, but it cannot render it epidemic. A trunk full of clothes, the property of Mr. James Bingham, who died of the yellow fever in one of the West-India islands about 50 years ago, was opened, some months after they were received by his friends, by a young man who lived in his brother's family. This young man took the disease, and died; but without infecting any of the family; nor did the disease spread afterwards in the city. The father of Mr. Joseph Paschall was infected with the yellow fever of 1741, by the smell of a foul bed in passing through Norris's Alley, in the latter end of December, after the disease had left the city. He died on the 25th of the month, but without reviving the fever in the city, or even infecting his family.

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

In a letter from Dr. Senter of Newport, dated January 7th, 1794, I find the following fact, which I shall communicate in his own words. It is introduced to support the principle, that the yellow fever does not spread by contagion. "This place (says the doctor) has traded formerly very much to the West-India islands, and more or less of our people have died there every season, when the disease prevails in those parts. Clothes of these unfortunate people have been repeatedly brought home to their friends, without any accident happening to them."

I feel with my reader the fatigue of this long detail of facts, and equal impatience with him to proceed to the history of the treatment of the fever; but I must beg leave to detain him a little longer from that part of the work, while I resume the subject of the origin of the fever. It is an interesting question, as it involves in it the means of preventing the return of the disease, and thereby of saving the lives of thousands of our citizens.

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

"SIR,

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

"No instance has ever occurred of the disease called the _yellow fever_ having been generated in this city, or in any other parts of the United States, as far as we know; but there have been frequent instances of its having been imported, not only into this, but into other parts of North-America, and prevailing there for a certain period of time; and from the rise, progress, and nature of the malignant fever, which began to prevail here about the beginning of last August, and extended itself gradually over a great part of the city, we are of opinion that this disease was imported into Philadelphia, by some of the vessels which arrived in the port after the middle of July. This opinion we are further confirmed in by various accounts we have received from unquestionable authorities.

"Signed, by order of the college of physicians,

"JOHN REDMAN, _President_.

"_November 26th, 1793._
"_To the governor of Pennsylvania._"

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

I have asserted, in the introduction to the history of this fever, that I believed it to have been generated in our city; I shall now deliver my reasons for that belief.

1. The yellow fever in the West-Indies, and in all other countries where it is endemic, is the offspring of vegetable putrefaction. Heat, exercise, and intemperance in drinking (says Dr. Lind) _dispose_ to this fever in hot climates, but they do not produce it without the concurrence of a remote cause. This remote cause exists at all times, in some spots of the islands, but in other parts even of the same islands, where there are no marsh exhalations, the disease is unknown. I shall not waste a moment in inquiring into the truth of Dr. Warren's account of the origin of this fever. It is fully refuted by Dr. Hillary, and it is treated as chimerical by Dr. Lind. They have very limited ideas of the history of this fever who suppose it to be peculiar to the East or West-Indies. It was admitted to have been generated in Cadiz after a hot and dry summer in 1764, and in Pensacola in 1765[62]. The tertian fever of Minorca, when it attacked Englishmen, put on the usual symptoms of the yellow fever[63]. In short, this disease appears, according to Dr. Lind, in all the southern parts of Europe, after hot and dry weather[64].

[62] Lind on the Diseases of Hot Climates, p. 36 and 124.

[63] Cleghorn, p. 176.

[64] Diseases of Hot Climates, p. 123.

2. The same causes (under like circumstances) must always produce the same effects. There is nothing in the air of the West-Indies, above other hot countries, which disposes it to produce a yellow fever. Similar degrees of heat, acting upon dead and moist vegetable matters, are capable of producing it, together with all its various modifications, in every part of the world. In support of this opinion, I shall transcribe part of a letter from Dr. Miller, formerly of the Delaware state, and now of New-York.

"_Dover, Nov. 5, 1793._

"DEAR SIR,

"Since the middle of last July we have had a bilious colic epidemic in this neighbourhood, which exhibits phænomena very singular in this climate; and, so far as I am informed, unprecedented in the medical records, or popular traditions of this country. To avoid unnecessary details it will suffice at present to observe, that the disease, on this occasion, has assumed, not only all the essential characters, but likewise all the violence, obstinacy, and malignity described by the East and West-Indian practitioners. If any difference can be observed it seems here to manifest higher degrees of stubbornness and malignity than we usually meet in the histories of tropical writers. In the course of the disease, not only extreme constipation, frequent vomiting, and the most excruciating pains of the bowels and limbs, harass the unhappy patient; but to these succeed paralysis, convulsions, &c. and almost always uncommon muscular debility, oppression of the præcordia, &c. are the consequence of a severe attack. Bile discharged in enormous quantities constantly assumes the most corrupted and acrimonious appearances, commonly æruginous in a very high degree, and sometimes quite atrabilious.

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

To the above information it may be added, that the dysentery which prevailed during the autumn of 1793, in several of the villages of Pennsylvania, was attended with a malignity and mortality unknown before in any part of the state. I need not pause to remark that this dysentery arose from putrid exhalation, and that it is, like the bilious colic, only a modification of bilious fever.

But further, a malignant fever, resembling that which was epidemic in our city, prevailed during the autumn in many parts of the United States, viz. at Lynn in Massachusetts, at Weatherfield and Coventry in Connecticut, at New-Galloway in the state of New-York, on Walkill and on Pensocken creeks in New-Jersey, at Harrisburgh and Hummelstown in Pennsylvania, in Caroline county in Maryland, on the south branch of the Potowmac in Hardie county, also in Lynchburgh and in Alexandria in Virginia, and in several counties in North-Carolina. In none of these places was there a suspicion of the disease being imported from abroad, or conveyed by an intercourse with the city of Philadelphia.

It is no objection to the inference which follows from these facts, that the common remitting fever was not known during the above period in the neighbourhood of this city, and in many other parts of the state, where it had usually appeared in the autumnal months. There is a certain combination of moisture with heat, which is essential to the production of the remote cause of a bilious fever. Where the heat is so intense, or of such long duration, as wholly to dissipate moisture, or when the rains are so great as totally to overflow the marshy ground, or to wash away putrid masses of matter, no fever can be produced.

Dr. Dazilles, in his treatise upon the diseases of the negroes in the West-Indies, informs us, that the _rainy_ season is the most healthy at Cayenne, owing to the neighbouring morasses being _deeply_ overflowed; whereas, at St. Domingo, a _dry_ season is most productive of diseases, owing to its favouring those degrees of moisture which produce morbid exhalations. These facts will explain the reason why, in certain seasons, places which are naturally healthy in our country become sickly, while those places which are naturally sickly escape the prevailing epidemic. Previously to the dissipation of the moisture from the putrid masses of vegetable matters in our streets, and in the neighbourhood of the city, there were (as several practitioners can testify) many cases of mild remittents, but they all disappeared about the first week in September.

It is worthy of notice, that the yellow fever prevailed in Virginia in the year 1741, and in Charleston, in South-Carolina, in the year 1699, in both which years it prevailed in Philadelphia. Its prevalence in Charleston is taken notice of in a letter, dated November 18th, O. S. 1699, from Isaac Norris to one of his correspondents. The letter says, that "150 persons had died in Charleston in a few days," that "the survivors fled into the country," and that "the town was thinned to a very few people." Is it not probable, from the prevalence of this fever twice in two places in the same years, that it was produced (as in 1793) by a general constitution of air, co-operating with miasmata, which favoured its generation in different parts of the continent? But again, such was the state of the air in the summer of 1793, that it predisposed other animals to diseases, besides the human species. In some parts of New-Jersey, a disease prevailed with great mortality among the horses, and in Virginia among the cows, during the autumn. The urine in both was yellow.--Large abscesses appeared in different parts of the body in the latter animals, which, when opened, discharged a yellow serous fluid. From the colour of these discharges, and of the urine, the disease got the name of the _yellow water_.

3. I have before remarked, that a quantity of damaged coffee was exposed at a time (July the 24th) and in a situation (on a wharf and in a dock) which favoured its putrefaction and exhalation. Its smell was highly putrid and offensive, insomuch that the inhabitants of the houses in Water and Front-streets, who were near it, were obliged, in the hottest weather, to exclude it by shutting their doors and windows. Even persons, who only walked along those streets, complained of an intolerable f[oe]tor, which, upon inquiring, was constantly traced to the putrid coffee. It should not surprise us, that this seed, so inoffensive in its natural state, should produce, after its putrefaction, a violent fever. The records of medicine (to be mentioned hereafter) furnish instances of similar fevers being produced, by the putrefaction of many other vegetable substances.

4. The rapid progress of the fever from Water-street, and the courses through which it travelled into other parts of the city, afford a strong evidence that it was at first propagated by exhalation from the putrid coffee. It was observed that it passed first through those alleys and streets which were in the course of the winds that blew across the dock and wharf, where the coffee had been thrown in a state of putrefaction.

5. Many persons who had worked, or even visited, in the neighbourhood of the exhalation from the coffee, early in the month of August, were indisposed afterwards with sickness, puking, and yellow sweats, long before the air of Water-street was so much impregnated with the exhalation, as to produce such effects; and several patients, whom I attended in the yellow fever, declared to me, or to their friends, that their indispositions began exactly at the time they inhaled the offensive effluvia of the coffee.

6. The first cases of the yellow fever have been clearly traced to the sailors of the vessel who were first exposed to the effluvia of the coffee. Their sickness commenced with the day on which the coffee began to emit its putrid smell. The disease spread with the increase of the poisonous exhalation. A journeyman of Mr. Peter Brown's, who worked near the corner of Race and Water-streets, caught the disease on the 27th of July. Elizabeth Hill, the wife of a fisherman, was infected by only sailing near the pestilential wharf, about the 1st of August, and died at Kensington on the 14th of the same month. Many other names might be mentioned of persons who sickened during the last week in July or the first week in August, who ascribed their illnesses to the smell of the coffee.

7. It has been remarked that this fever did not spread in the country, when carried there by persons who were infected, and who afterwards died with it. During four times in which it prevailed in Charleston, in no one instance, according to Dr. Lining, was it propagated in any other part of the state.

8. In the histories of the disease which have been preserved in this country, it has _six_ times appeared about the first or middle of August, and declined or ceased about the middle of October: viz. in 1732, 1739, 1745, and 1748 in Charleston, in 1791 in New-York, and in 1793 in Philadelphia. This frequent occurrence of the yellow fever at the usual period of our common bilious remittents, cannot be ascribed to accidental coincidence, but must be resolved, in most cases, into the combination of more active miasmata with the predisposition of a tropical season. In speaking of a tropical season, I include that kind of weather in which rains and heats are alternated with each other, as well as that which is uniformly warm.

9. Several circumstances attended this epidemic, which do not occur in the West-India yellow fever. It affected children as well as adults, in common with our annual bilious fevers. In the West-Indies, Dr. Hume tells us, it never attacked any person under puberty. It had, moreover, many peculiar symptoms (as I have already shown) which are not to be met with in any of the histories of the West India yellow fever.

10. Why should it surprise us to see a yellow fever generated amongst us? It is only a higher grade of a fever which prevails every year in our city, from vegetable putrefaction. It conforms, in the difference of its degrees of violence and danger, to season as well as climate, and in this respect it is upon a footing with the small-pox, the measles, the sore-throat, and several other diseases. There are few years pass, in which a plethoric habit, and more active but limited miasmata, do not produce sporadic cases of true yellow fever in Philadelphia. It is very common in South and North-Carolina and in Virginia, and there are facts which prove, that not only strangers, but native individuals, and, in one instance, a whole family, have been carried off by it in the state of Maryland. It proved fatal to one hundred persons in the city of New-York in the year of 1791, where it was evidently generated by putrid exhalation. The yellow colour of the skin has unfortunately too often been considered as the characteristic mark of this fever, otherwise many other instances of its prevalence might be discovered, I have no doubt, in every part of the United States. I wish, with Dr. Mosely, the term _yellow_ could be abolished from the titles of this fever, for this colour is not only frequently absent, but sometimes occurs in the mildest bilious remittents. Dr. Haller, in his pathology, describes an epidemic of this kind in Switzerland, in which this colour generally attended, and I have once seen it almost universal in a common bilious fever, which prevailed in the American army, in the year 1776.

I cannot help taking notice, in this place, of an omission in the answer to the governor's letter, by the college of physicians. The governor requested to know whether it was imported; if it were, from _what place_, at _what time_, and in _what manner_. In the answer of the college of physicians to the governor's letter no notice was taken of any of those questions. In vain did Dr. Foulke call upon the college to be more definite in their answer to them. They had faithfully sought for the information required, but to no purpose. The character of their departed brother, Dr. Hutchinson, for capacity and vigilance in his office, as inspector of sickly vessels, was urged without effect as an argument against the probability of the disease being imported. Public report had derived it from several different islands; had chased it from ship to ship, and from shore to shore; and finally conveyed it at different times into the city, alternately by dead and living bodies; and from these tales, all of which, when investigated, were proved to be without foundation, the college of physicians composed their letter. It would seem, from this conduct of the college, as if medical superstition had changed its names, and that, in accounting for the origin of pestilential fevers, celestial, planetary, and demoniacal influence had only yielded to the term _importation_.

Let not the reader reject the opinion I have delivered because it is opposed by so great a majority of the physicians of Philadelphia. A single physician supported an opinion of the existence of the plague at Messina, in the year 1743, in opposition to all the physicians (33 in number) of that city. They denied the disease in question to exist, because it was not accompanied by glandular swellings. Time showed that they were all mistaken, and the plague, which might probably have been checked, at its first appearance, by their united efforts, was, by means of their ignorance, introduced with great mortality into every part of the city. This disposition of physicians to limit the symptoms of several other diseases, cannot be sufficiently lamented. The frequent absence of a yellow colour, in this epidemic, led to mistakes which cost the city of Philadelphia several hundred lives.

The letter of the college of physicians has served to confirm me in an opinion, that the plagues which occasionally desolated most of the countries of Europe, in former centuries, and which were always said to be of foreign extraction, were of domestic origin. Between the years 1006 and 1680, the plague was epidemic fifty-two times all over Europe. It prevailed fourteen times in the 14th century. The state of Europe, in this long period, is well known. Idleness, a deficiency of vegetable aliment, a camp life, from the frequency of wars, famine, an uncultivated and marshy soil, small cabins, and the want of cleanliness in dress, diet, and furniture, all concurred to generate pestilential diseases. The plagues which prevailed in London, every year from 1593 to 1611, and from 1636 to 1649, I believe were generated in that city. The diminution of plagues in Europe, more especially in London, appears to have been produced by the great change in the diet and manners of the people; also by the more commodious and airy forms of the houses of the poor, among whom the plague _always_ makes its first appearance. It is true, these plagues were said by authors to have been imported, either directly or indirectly, from the Levant; but the proofs of such importation were as vague and deficient as they were of the West-India origin of our epidemic. The pestilential fevers which have been mentioned, have been described by authors by the generic name of the plague, but they appear to have originated from putrid vegetable exhalations, and to have resembled, in most of their symptoms, the West-India and _North-American_ yellow fever.

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

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

[Hand] The following page begins an account of the states of the thermometer and weather, from the 1st of January to the 1st of August, and of the states of the barometer, thermometer, winds, and weather, from the 1st of August to the 9th of November, 1793. The times of observation, for the first three months are at 7 in the morning, and 2 in the afternoon; for the next five months they are at 6 in the morning, and 3 in the afternoon. From the 1st of October to the 9th of November, they are as in the first three months.

_January, 1793._ _February, 1793._
+----+---------+----------------------+---------+---------------------+
| | Therm. | Weather. | Therm. | Weather. |
| D. | 7h | 2h | | 7h | 2h | |
+----+----+----+----------------------+----+----+---------------------+
| 1 | 27 | 30 | Cloudy. | 9 | 26 | Fair, hazy. |
| 2 | 30 | 41 | Fair, cloudy. | 25 | 34 | Rain, ditto. |
| 3 | 30 | 33 | Cloudy, rain. | 33 | 37 | Cloudy, fair. |
| 4 | 38 | 41 | Rain, cloudy. | 25 | 46 | Cloudy, fair. |
| 5 | 35 | 42 | Fair, cloudy. | 36 | 44 | Cloudy, ditto. |
| 6 | 33 | 47 | Cloudy, fair. | 35 | 46 | Cloudy, rain. |
| 7 | 38 | 51 | Fair, fair. | 36 | 40 | Cloudy, fair. |
| 8 | 32 | 49 | Fair, ditto. | 28 | 44 | Cloudy, ditto. |
| 9 | 33 | 48 | Hazy, fair. | 42 | 50 | Rain, fair. |
| 10 | 38 | 51 | Fair, ditto. | 38 | 40 | Cloudy, fair. |
| 11 | 35 | 48 | Fair, clouds. | 19 | 27 | Fair, cloudy. |
| 12 | 31 | 42 | Fair, ditto. | 20 | 28 | Snow, cloudy. |
| 13 | 28 | 42 | Fair, ditto. | 22 | 31 | Cloudy, snow. |
| 14 | 25 | 27 | Hail, snow, sleet. | 27 | 39 | Cloudy, fair. |
| 15 | 32 | 37 | Clouds, mist. | 18 | 40 | Fair, ditto. |
| 16 | 37 | 39 | Rain, ditto. | 29 | 42 | Cloudy, ditto. |
| 17 | 37 | 45 | Rain, snow, fair. | 44 | 48 | Rain, ditto. |
| 18 | 32 | 52 | Fair, ditto. | 39 | 49 | Cloudy, fair. |
| 19 | 37 | 48 | Fair, ditto. | 31 | 41 | Cloudy, rain. |
| 20 | 33 | 47 | Hazy, cloudy. | 52 | 53 | Rain, fair. |
| 21 | 36 | 47 | Cloudy, fair. | 37 | 49 | Fair, ditto. |
| 22 | 27 | 32 | Fair, ditto. | 29 | 34 | Fair, ditto. |
| 23 | 22 | 37 | Fair, ditto. | 22 | 34 | Snow, cloudy. |
| 24 | 30 | 39 | Cloudy, ditto. | 54 | 59 | Rain, cloudy. |
| 25 | 30 | 41 | Fair, hazy. | 34 | 35 | Cloudy, ditto. |
| 26 | 31 | -- | Fair. | 35 | 43 | Rain, mist. |
| 27 | 23 | 38 | Fair, cloudy, snow. | 43 | 43 | Rain, cloudy. |
| 28 | 35 | 45 | Cloudy, fair. | 14 | 26 | Fair, ditto. |
| 29 | 29 | 37 | Fair, ditto. | | | |
| 30 | 22 | 23 | Snow, hail. | | | |
| 31 | 25 | 32 | Cloudy, fair. | | | |
+----+----+----+----------------------+----+----+---------------------+
_March, 1793._ _April, 1793._
+----+---------+----------------------+---------+---------------------+
| | Therm. | Weather. | Therm. | Weather. |
| D. | 7h | 2h | | 7h | 2h | |
+----+----+----+----------------------+----+----+---------------------+
| 1 | 20 | 38 | Fair, ditto. | 45 | 70 | Cloudy, fair. |
| 2 | 31 | 51 | Hazy, cloudy. | 47 | 71 | Fair, ditto. |
| 3 | 48 | 63 | Rain, fair. | 56 | 80 | Fair, ditto. |
| 4 | 43 | 61 | Hazy, ditto. | 51 | 72 | Cloudy, fair. |
| 5 | 51 | 52 | Rain, fair. | 53 | 61 | Cloudy, rain. |
| 6 | 32 | 50 | Fair, ditto. | 60 | 76 | Misty, fair. |
| 7 | 36 | 62 | Fair, ditto, clouds. | 51 | 65 | Fair, ditto. |
| 8 | 54 | 60 | Cloudy, rain. | 46 | 74 | Fair, ditto. |
| 9 | 26 | 41 | Fair, ditto. | 55 | 71 | Fair, cloudy. |
| 10 | 29 | 51 | Fair, ditto. | 50 | 56 | Fair, ditto. |
| 11 | 43 | 55 | Rain, ditto. | 37 | 63 | Fair, ditto. |
| 12 | 40 | 43 | Cloudy, ditto. | 54 | 62 | Cloudy, rain, fair. |
| 13 | 38 | 39 | Cloudy, fair. | 49 | 62 | Fair, ditto. |
| 14 | 26 | 44 | Fair, ditto. | 50 | 70 | Fair, ditto. |
| 15 | 32 | 59 | Fair, ditto. | 45 | 55 | Rain, cloudy. |
| 16 | 52 | 62 | Cloudy, fair. | 46 | 62 | Cloudy, fair. |
| 17 | 51 | 72 | Cloudy, fair. | 48 | 67 | Fair, clouds, fair. |
| 18 | 58 | 69 | Hazy, cloudy. | 52 | 66 | Cloudy, fair. |
| 19 | 53 | 59 | Fair, ditto. | 52 | 75 | Fair, ditto. |
| 20 | 42 | 61 | Fair, ditto. | 52 | 49 | Rain, cloudy. |
| 21 | 41 | 43 | Rain, cloudy. | 44 | 47 | Cloudy, ditto. |
| 22 | 31 | 47 | Fair, ditto. | 43 | 46 | Rain, cloudy. |
| 23 | 35 | 57 | Fair, ditto. | 42 | 63 | Fair, ditto. |
| 24 | 37 | 50 | Fair, ditto. | 44 | 68 | Fair, ditto. |
| 25 | 35 | 59 | Fair, ditto. | 45 | 65 | Cloudy, ditto. |
| 26 | 47 | 54 | Cloudy, rain. | 53 | 57 | Cloudy, rain. |
| 27 | 43 | 51 | Fair, cloudy. | 47 | 46 | Rain, ditto. |
| 28 | 33 | 45 | Fair, clouds, fair. | 44 | 54 | Rain, cloudy. |
| 29 | 34 | 57 | Fair, ditto. | 40 | 59 | Fair, ditto. |
| 30 | 41 | 58 | Cloudy, fair. | 40 | 65 | Fair, ditto. |
| 31 | 42 | 61 | Cloudy, fair. | | | |
+----+----+----+----------------------+----+----+---------------------|
_May, 1793._ _June, 1793._
+----+---------+----------------------+---------+---------------------+
| | Therm. | Weather. | Therm. | Weather. |
| D. | 7h | 2h | | 7h | 2h | |
+----+----+----+----------------------+----+----+---------------------+
| 1 | 45 | 69 | Foggy, cloudy. | 53 | 61 | Rain, showery. |
| 2 | 52 | 73 | Fog, clouds, fair. | 54 | 64 | Clouds, showers. |
| 3 | 60 | 63 | Rain, ditto. | 55 | 62 | Cloudy, rain, fair. |
| 4 | 60 | 80 | Fair, ditto. | 54 | 60 | Rain, do. cloudy. |
| 5 | 55 | 56 | Cloudy, ditto. | 58 | 72 | Cloudy, fair, rain. |
| 6 | 47 | 58 | Cloudy, fair. | -- | 71 | Cloudy, rain. |
| 7 | 50 | 68 | Cloudy, fair. | 68 | 78 | Fair, ditto. |
| 8 | 59 | 78 | Cloudy, fair. | 65 | -- | Fair, ditto. |
| 9 | 61 | 79 | Foggy, fair. | 70 | 88 | Fog, fair. |
| 10 | 65 | 71 | Rain, hazy. | 74 | 90 | Fair, ditto. |
| 11 | 55 | 75 | Cloudy, fair. | 76 | 90 | Fair, ditto. |
| 12 | 61 | 76 | Cloudy, rain. | 75 | 88 | Fair, showers. |
| 13 | 57 | 78 | Fair, ditto. | 74 | 81 | Cloudy, rain. |
| 14 | 59 | 83 | Fair, cloudy. | 63 | 77 | Fair, ditto. |
| 15 | 60 | 71 | Fair, ditto. | 63 | 82 | Fair, hazy. |
| 16 | 50 | 69 | Fair, ditto. | 67 | 85 | Fair, ditto. |
| 17 | 48 | 74 | Fair, ditto. | 74 | 89 | Fair, showers. |
| 18 | 61 | 81 | Cloudy, fair. | 73 | 88 | Fair, ditto. |
| 19 | 65 | 85 | Fair, rain. | 77 | 91 | Fair, ditto. |
| 20 | 65 | 87 | Fair, ditto. | 79 | 88 | Fair, rain, fair. |
| 21 | 68 | 86 | Fair, ditto, clouds. | 75 | 85 | Cloudy, rain. |
| 22 | 72 | 80 | Clouds, gusts. | 58 | 78 | Cloudy, fair. |
| 23 | 94 | 79 | Cloudy, fair. | 58 | 78 | Fair, ditto. |
| 24 | 58 | 75 | Fair, ditto. | 60 | 79 | Fair, ditto. |
| 25 | 52 | 70 | Fair, cloudy. | 67 | 74 | Cloudy, rain. |
| 26 | 61 | 66 | Rain, ditto. | 66 | 69 | Cloudy, rain. |
| 27 | 68 | 84 | Cloudy, fair. | 68 | 80 | Cloudy, fair. |
| 28 | 70 | 68 | Fair, clouds, rain. | 71 | 85 | Cloudy, fair. |
| 29 | 57 | 62 | Cloudy, rain, clouds.| 77 | 88 | Cloudy, ditto. |
| 30 | 54 | 57 | Cloudy, rain. | 74 | 90 | Fair, ditto. |
| 31 | 54 | 60 | Clouds, ditto. | | | |
+----+----+----+----------------------+----+----+---------------------+