MANY Physicians have published in the newspa­pers of this country, their methods of preventing and curing this disease, which may be ranked as one of the most destructive and fatal;—but none of them have yet thought of favoring the public with an accurate ac­count of the nature and particular symptoms of the fever, that makes such cruel havoc.

Never agreeing among themselves, they have mu­tually opposed the opinions of each other, and have often bestowed reciprocal offence. The result of this difference of ideas, always dangerous for suffer­ing humanity, has been, that each prescribed accord­ing to his own manner, as well for preserving persons against the contagion, as for treating the disease, by bleeding, drastic purges, by stimulants, by diluents, by demulcents, by antiseptics, and by tonics, without pointing out, in the smallest degree, the circumstances or particular cases, wherein such medicines might be employed or rejected.

[Page 6]The most credulous amongst the people, alarmed by the public papers, and by the numerous precau­tions advised to be taken against the pretended pestilence, began to administer medicines to them­selves, and in order to avoid imaginary evils, pro­duced real ones; some by having recourse to the heat­ing regimen, gave additional fire to their disease, and thus created their own graves—others applied to physicians, who, smitten with fear, thought that they perceived pestilential appearances in a common disorder, and or­dered medicines, which could only add to the evil. Of consequence, those who did not fall a sacrifice, reco­vered with difficulty. Hence the number of the sick and dead have amazingly encreased; and the sentiment of fear operating upon every mind, has made the great­est part of the inhabitants to leave the city, and for­sake in it, without attendance or assistance, the sick, who were not able to quit it. ^*

Would to God, that instead of that fear carried to excess, the citizens of Philadelphia had imitated the Turks! thus behaving like them towards those, would not have abandoned their children, nor the children [Page 7]their parents, the servants their masters, nor friends each other; but every one would have contributed to comfort and solace one another. The physicians were frequently compelled, by motives of humanity, to be­come nurses to the sick, who were unable of them­selves to take the medicines. ^*

These remarks may sound harshly, but they are founded upon my own experience as well as that of several other physicians, who, whilst others were argu­ing on the means of preserving the city from the conta­gion, were courageously treading in the path of prac­tice, solicitous to fulfil the sacred and religious duties of their profession.

In order to make up as much as in my power lies, for the void left by those who have spoken of that dis­ease in the public papers, I shall endeavour to express my ideas as clearly and precisely as I can.

I may have mistaken the inductions with which the diagnostic signs of the disease have furnished me. I may also have mistaken the proximate and distant cau­ses of the present epidemic. But what I am to ad­vance, shall be less sounded on theory, which often de­ceives, than on practice, and my clinical observations. [Page 8]Thus, I will only say what I have seen or believe my­self to have seen, in my patients. I shall neither ex­aggerate nor disguise any thing. I only seek for truth, and I write but for the good of humanity, without intending to give my observations for incontestable de­cisions. Hippocrates has said of medicine, Ars longa, oc­casio celeris, experimentum periculosum, et judicium diffi­cile. I have, then, no other aim but to stimulate my col­leagues, more learned than me, to enlighten the pub­lic. It is our duty likewise to undeceive the physicians in other parts of this continent, and of Europe, con­cerning the specifics recommended in the newspapers of North America, which may be very fatal to man­kind.

All epidemics are more or less contagious. They can be but the effect of a common and universal cause: the vitiated nature of aliments, or a derangement of the temperature of the atmosphere, cause them. If the air is not infected, diseases cannot be epidemic, and this is so, indeed, though it only attacks the natives.^*

What can be the cause of that corruption of the air? For what reason are the natives and those inured to the climate of Philadelphia alone infected, with the [Page 9]prevailing disease, whilst foreigners escape it? they are the first subjects of our enquiry.

The summer of 1792 was very warm. We were tormented by an amazing number of flies and other insects, till the middle of November. The following winter was very moderate as to cold, but subject to surprising variations. By various meteorological obser­vations, it appears that the thermometer^* ascended and descended from eight to ten degrees in a single day. There was almost a constant rain, till the end of the Spring, which was very cold, and very damp. There was no hard frost, and the snow had scarcely fallen, when it was succeeded by a thaw. ^§ The waters, which, without being frozen, had been stagnant; the quantity of insects, which winter had killed, the en­trails of the fish made use of in the city, cast by the side of the Delaware, the rotten skins of the dead animals, and reptiles left near the wharves, or at a short dis­tance from the city, have all certainly contributed to fill the air with putrid and hurtful miasma. These added to the quantity of vapours, and of corpuscles of [Page 10]all kinds with which the atmosphere is always loaded, cannot but rarify or thicken the liquids, affect the so­lids, and derange the animal economy, in the most sen­sible manner.^*

Besides the burning heat of this Summer, we have had a small share of wind, rain, or thunder since Spring; and those three agents are necessary to purge the air from the putrid miasma, and the infectious par­ticles with which it was impregnated. The exhalati­ons continually produced by the rays of the sun, from the prodigious number of burying places in Philadel­phia, must be subjoined to the other causes of infection. To these we likewise must add the great consumption of meat, salt provisions, and green fruits; the strong drink, an ill fermented beer, and cyder made of green fruit; we will perceive, I think, in this manner of li­ving of the inhabitants of this country, (notwithstand­ing the conformity of their constitutions to the atmos­phere, of which I shall speak hereafter) that their stomachs were much more disposed to receive the pu­trid miasmas of the air, than the stomachs of those who have observed a good regimen, and have been regular in their eating, and sober in their drinking. Let one ob­serve [Page 11]the most part of those who have been attacked by this disease. He will find that seven-eighths have been strong persons, mechanics who had not observed any re­gimen, and children, whom green fruits, and an immense quantity of water melons, and sweet potatoes, have caused to be attacked by worms, which killed them, without the most part of the latter being attacked by any particular fever, either bilious, putrid, or malig­nant. Besides, we are not ignorant, that every country has its periodical diseases; that the spring, e­quinox, and summer, produce a great deal of disorder in the animal oeconomy, and that as soon as the air is infected, the character of endemical diseases is chang­ed, and they become more serious, and mortal. That being once admitted, we shall proceed, to investigate the nature of the fever, which the air and so many o­ther causes have produced, and we shall afterwards examine which are the surest means of cur­ing it. I do not flatter myself that I shall analyse these objects with certainty: physic being a science con­jectural, notwithstanding its own principles, and the mass of knowledge requisite for practising it.—I will then only relate the observations which I have made upon a considerable number of patients, and the infer­ences with which they have supplied me.

Fevers, in general, may be ranked in two classes: essential fevers, and symptomatic fevers. These take [Page 12]their origin from a local vice, or from another disease caused by some accident, or by some putrid miasma re­siding in the air; and whose characters vary infinitely, owing as well to the complexion, to the solids and liquids, as to the stomach, to the liver, and final­ly, to the whole hypogastric region, and abdominals, &c. We shall say nothing of the essential fevers pro­ceeding from the fault of the blood and humours alone: which appear to us to have no affinity with the epide­mical diseases, since they are the effects of a complica­tion of causes belonging to the individual.

The reigning fever as far as I have been able to ob­serve it, begins by pains in the loins, and in the head, at first light, and afterwards acute, accompanied with chills more or less considerable. The face then becomes very red, as well as the eyes, which are filled with tears. Some are delirious from the first day of the fever, some only towards the third day, after which they sink into a state of weakness, or into a profound lethargy, from which they never recover. The belly, and hypocon­dres, excepting a few pains, are almost in their natural state; but the stomach is generally tense or painful. The tongue, in all cases, from the beginning to the end, is loaded with a whitish crust, and the edges are of a ve­ry high red.

Some have vomitings from the first days, others only towards the third or fourth day. The matter which [Page 13]they then bring up, is whitish, green or black. Some vomit pure blood. They have a bloody flux, always preceded by bleeding of the nose more or less consi­derable. Some are thirsty, and others, though their tongue is dry, are not so. The skin is sometimes dry, and shrivelled, and sometimes much covered with sweat. But I have not perceived on the skin of any of my patients, any buboes or carbuncles or any other pestilential eruption. I have observed on three per­sons only, some few red spots, like the bite of a fly, on the stomach or breast.^* Many are fatigued and low spirited.

Some have kept their spirits, and have exhibited all the good symptoms, during four days, till the be­ginning of the fifth, when all is changed, and the pa­tient is despaired of. The urine, as to quantity, is the same as in a state of health; as to quality, it is highly coloured, with a great deal of a whitish sediment. But some have, towards the beginning of the seventh day, considerable evacuations of blood.^† The pulse, that compass of physicians, is here very equivocal. It ne­ver [Page 14]corresponds with the alarming symptoms which ac­company the disease, excepting the starting of the ten­dons; and that in a few patients, I have neither found the pulse intermittent, nor altogether obliterated.— More or less motion, strength or weakness was all that I could observe; so that, during the time of my attend­ance I regarded, with more attention, the other signs, than the state of the pulse. In that variety of symp­toms, the patients die on the second, third, fifth, se­venth, or ninth day, of the disease; and notwithstand­ing the observation of those critical days, several have elapsed without having any sensible crisis, whereby nature could drive away the disease. They recovered in proportion as the alarming symptoms ceased, which happens very seldom in acute diseases. Some women, attacked with that fever during their menses, had them suddenly suppressed, and children sometimes passed up and down a great quantity of worms, for the most part very red. In the critical days, the hiccup torments the patients in a most cruel manner, and then the eyes and skin of some become yellowish. Several patients who spate or vomited blood, bled at the nose, evacuated a brown matter, and were tor­mented with the hiccup, did however recover, not­withstanding those alarming signs, which together with the other symptoms, announced the approach of death. But those who vomited a black matter, who pissed blood, who were heavy and sleepy, who became [Page 15]yellow before the seventh day, or whose stomach was much swelled, especially those who in the beginning of the disease, made any use of cathartics, died be­tween the fifth and eighth day.^*

Those are the observations, I have made on my pa­tients, whose different situations I have studied with the most steady application.

What is then this fever? Is it the sweating sickness, the putrid bilious fever, the inflammatory fever, or the disease of Siam, or the malignant fever?—I do not know; but I am convinced, that it unites in itself almost e­very characteristic sign of these diverse fevers. Besides, it disguises itself, varies and assumes so many different aspects, according to the complexion and constitution of the patient, the state of the mass of blood and humours, the diseases, which he was subject to, when he was attacked with that fever, and still much more than it is supposed, to the tranquility and agitation of his mind, that all judgment, and even inductions, upon its particular character, are liable to error.

Nevertheless it appears that it is produced by one [Page 16]and the same cause: that it shews the cause of its own principle, and is only derived from an inflamma­tion, which the miasmas of the air, combined with the dispositions of the body, produce an inflammation in the episgrastic region, which affects the liver and the hypocondria in such a manner, that the blood, the bile, and other humours acquire more fluidity, owing to the heat increasing the dilatation of the vessels, causing a dissolution of the blood and of the humours, which are the principal characters with which the fever in ques­tion is accompanied. Pains in the stomach and reins, the first signs of this disease, are succeeded by the pathagnomic signs, as well as by vomitings and pissing of blood; and it is certain, that all which can pro­duce the gastritis, of which the several species have been described by Sauvage and Hoffman, and especially drastic cathartics, strong emeticks, and all that in­crease the fluidity of the humours, such as mercury, &c. are not only contrary to the treatment of the dis­ease, but may occasion certain death. And how many since it prevails have been victims of the violent treat­ment, and pretended specifics?^*

[Page 17]The result of all that I have said is that in the cure of this disease, no regular system can be followed.— Therefore, I followed none, nor have I adopted any one medicine in preference to another. My prescrip­tions were only regulated by the conjectures which I have drawn from the examination of my patients, and the informations they could give me concerning their constitutions, and the state of their health before they were taken ill.

After that, here is a summary of the method I have followed, and still constantly follow, with such successes, that compared, with the number of patients, whom I fear to have been the unfortunate victims of [Page 18]the means used in vain to cure them, confirms me more and more in the resolution I have taken to fol­low that practice.^*

[Page 19]As soon as I was called to visit a patient, and as soon as I perceived the least sign of inflammation, I, first of all, ordered him to be bled once or twice, and regula­ted the quantity of blood to be let, according to his age, and the strength of his constitution. If it was the first day of the sickness, and the inflammation was not likely to be of consequence, and if the patient in­clined much to vomiting, I administered to him either a vomit in a large quantity of water, or some purgative of senna, manna, cream of tartar, and salt of seignette to cleanse the first passages. If he complained of a head ach, which did not lessen, or if the inflammation be­gan, I prescribed bleeding after the purgatives^*, and during that time until the third day, I only prescribed plentiful and cooling drinks, and in proportion as the strength failed, or I suspected a beginning of dissolu­tion in the humours, I did not spare cordials, or the most softening astringents, mixed with mucilages and antiphlogistics; not forgetting, when occasion requi­red, antiseptics, for which I used the alexipharmic essence of stahl, and the camphoric tincture of besoard; I also prescribed blisters, when I perceived the least [Page 20]sign of sleepiness. I have never purged any patient, excepting those who took physic on the first day; but about the sixth day of his illness, or when I perceived, by his urine, that the coction was made, I never used bark, which I look upon rather as a good strengthen­er than as an antiputrid, before the disease is abating. As to children, all I prescribed for them was bermifu­ges and glysters made of milk and honey, and every one evacuated a considerable quantity of reddish worms.

Amongst all the melancholy symptoms of this cruel disease, I found none so difficult to calm as vomitings, and hiccup. Acids composed of dulcified marine, and vitriolic salt, had but little success. I succeeded much better, as well against continual vomitings as against bloody evacuations, with a strong mucilage made of flax-seed, gum-arabic, honey, and cinnamon water, of which I directed my patients to take a spoonful every ten minutes.

Topics of emollient herbs boiled in strong wine, vinegar applied warm on the stomach, the lower part of the belly, and the reins, have also been of great service with me against the pains of those parts. I used no narcotics. If the patient, when the disease abated, was tormented with a want of sleep, I only administered to him almond-juice very thick, mixed [Page 21]with diacodium. In fine, my whole treatment was at first only established upon the inflammation, which I always believed to be the origin of that disease, and afterwards on the dissolution of humors which follow­ed; and therefore I made the application according to circumstances, and the different shapes in which the disease presented itself, and of the best advices given us by the most eminent authors who have written on physic.

But is, or is not this disease contagious? A question which I think I am only able to answer by a distinc­tion, which experience seems to justify. It is contagi­ous for those, whose organical constitution has great homogenity with the air of this country. The affinity and relation existing between their constitution, and the impression of this atmosphere, gives them a near­er disposition to receive the impressions of the putrid miasmas, with which the air is impregnated, and which alter and trouble, more, or less that equilibrium of the solids and liquids, so necessary to maintain good health. The disease is not contagious for foreigners, whose constitutions have little homogenity with that dry air. We are convinced of it by the prodigious num­bers abounding in this city, none of whom were at­tacked with that disease, whilst the most part of the natives, and those used to the climate, were taken ill with it.

[Page 22]The relations of man with all that surrounds him, and the influence of the air on the constitutions, can­not be described. We see the effects of them without often being able to penetrate the causes. We can give but conjectures on that head; and I only ground this, upon this certain fact, that men accustomed to a climate, are much more subject to the hurtful variati­ons and influences of its atmosphere, than those, whose complexion, through a physical propensity, is still subject to the nature of the climate that they have just quit­ted. From thence arise endemic diseases, which do not affect foreigners, and from thence also the peculiar diseases which attack new-comers, without affecting the natives, as experience has often shewed to us in our colonies.

Such are, in a few words, what I have observed in this disease, and the methods I have followed to cure it. This is what the little leisure, left me by my patients, could allow me to commit hastily to writing. The public will not, certainly, find, in my style, any thing to make amends for the dryness of the subject I am wri­ting upon. If what I say, has nothing new nor learn­ed, what I have shewn, without order and method, is at least said with candor and sincerity. My aim is to obtain light, in order the better to serve my patients; and should this short publication prove agreeable to the public, I will give a longer dissertation on the ac­tual [Page 23]epidemic. If, after what I have just said, any phy­sicians, having followed a method different from mine, may have met with greater success, I beg that they would publish their observations. I assure them, before hand, of my sincere gratitude, and of the thanks of the public; non est in medico semper relevetur ut aeger.