THE yellow fever, or tropical endemic causus, and the small pox, are inflammatory in the attack; and are communicated by specific contagion. The poison of the former, as it seems, is conveyed di­rectly to the stomach with the saliva, or any thing swallowed, and acts upon it, and upon the pylorus and duodenum, by corrosion; which first raising an inflammation on the parts, these afterwards become gangrenous. This poison acts as other acrid poisons taken into the stomach. The disease is a corrosion of the stomach, the pylorus, and the duodenum; all else of the complaints, are they more than symptoms consequent of that corrosion▪ ^*

The contagious poison of the small pox acts more like that infused into the blood by the bite of poison­ous animals, which contaminates the mass.

The constituent parts of these poisons, or by what process of nature they are generated, few pretend to know; and though some may fancy they know them, yet it is beyond the conjecture of most.

[Page 2]Whilst we are ignorant of the cause of the yellow fever and small pox, we may however admit that they are infectious, though not alike in all circumstances.^* The small pox may be communicated in all states of the air, but the yellow fever can exist only in a hot air, as histories of it show: and there are also strong reasons for believing from those histories that frost kills the infectious matter of it, as surely as it kills certain other exotics. Many people, in the time of the late epidemic in Philadelphia, looked for rain, [Page 3] which they believed would be fatal to the infection.^* Others regarded not the coming of rain, otherwise than as it might be attended with or followed by cold; and they looked only for mere cold, whether attended with rain or not, because histories of this fever assured them that cold had always been fatal to the infection. It is admitted that floods of rain, by diluting and washing off the stagnant putrid water of a low country, relieve from the remitting, the bilious, and the putrid fevers common to such countries.

Although the yellow fever originates in countries of perpetual heat, yet it may be brought from thence into this country of both cold and heat, as it hereto­fore has been: there are, however, two particulars especially necessary to that end; that it be in the peculiar air of a large town, and that the season be hot. It may well be presumed it cannot act, in this country at least, but under this combination; because it ne­ver yet has appeared on the continent, unattended [Page 4] with those circumstances. If the matter of this con­tagion suffers cold, it suffers death; as may be col­lected from facts uniformly heretofore happening in this country. When it was in Charleston, S. C. in 1748, it received its death stroke from cold air on the fourteenth of October; and about the same time of October it lately experienced the like, on the change of air from an uncommon heat, for that season, to the proper degree of autumnal cold. The cool air, especially at night, in the last week of September, 1793, produced such a change in the degree of infection and complaints of the sick in Philadelphia, that the physicians expressed an agree­able surprize, on the great abatement of both: but the return of warm close weather, with a shift of wind from the northern quarters to the southern, in the beginning of October, gave so fatal a malignancy to the disease, as occasioned more frequent deaths, for some days, even after the return of cooler wea­ther: but, it seems it had generally effected too much to admit of recovery, of the then sick, in any state of the air afterwards.

For supporting the aforegoing principles, we need only be assured that the yellow fever has never been communicated in country places or small towns on this continent; and that as often as it has been amongst us, it always appeared to be imported, always vanished in the cool season of autumn, and never recurred with the ensuing summer, nor until again ushered in from the West Indies. Re­ports say indeed, that it has been taken in country places, in some few instances. But on inquiry, it appears there has been a want of knowledge to distinguish the yellow fever from diseases of the [Page 5] country, the symptoms being partly alike. In other instances, people have received the infection in Philadelphia, but have pretended they had not been in the city: others alarmed, have imagined they had it, when they have only had a little cold or common complaint, or mere apprehension may have induced the supposition.^*

People and merchandise have been continually arriving from the West India islands, the source of the yellow fever for ages past; yet the disease was never communicated to the people of this city, but in the heat of summer, and that only thrice in above sixty years; probably the seldomer, from the con­tagious matter having generally spent itself, or eva­porated in the time of performing the voyages.

[Page 6]To satisfy the mind that the late epidemic, in Philadelphia, was introduced from a tropical climate, sober reason requires but to know, that it is a disease natural to the West India islands; that it never was known to originate in this country; but has been admitted, without a doubt of any one till now, to have been always brought from thence; that it has been, this year, raging in those islands more than usual; that there never was before such a plenty of means for bringing it from thence, and that it first broke out in a part of the city near which ships from those islands, that had unusual numbers of sick peo­ple on board, discharged their cargoes. From all which circumstances there arises an irresistible pre­sumption, that the late contagious fever, called the yellow fever, was imported from the West India islands.^*

[Page 7]It has been inconsiderately imputed to Philadel­phia, that it is more liable to receive the yellow fever than other large towns of America. It is made by people who had collected from recent hasty pub­lications, that it had been three or four times in this city, without their being informed how often it had been in other towns. This fever, it seems, has been at least as often in Charleston, S. C. and New York. The accurate doctor Lining speaks of four times that it was in Charleston; in the years 1732, ′39, ′45, and ′48. Charleston being nearer the ocean, the tropic, the Havanna, and the West India islands, seems more liable to receive the infection than a town further from them, and near a hundred miles inland, that in general is remarkably healthful, and which would [Page 8] probably scarcely ever receive it, were it not that it is more populous, and therefore has more of the air peculiar to large towns, which is so necessary, toge­ther with the heat of a summer, to give action to the contagious matter, on its speedy arrival fresh from its tropical source.

It is also said that the yellow fever has been intro­duced into this country in ships from Rotterdam and Ireland, crouded with passengers: but this a great mistake. The hospital fever has often been intro­duced by them into America, but never once the yellow fever, which is not a disease of northern climates. The hospital or gaol fever is thought to arise from animal effluvia. Prisons, hospitals and ships are crouded with men, and abound with excre­mentitious animal effluvia pent up from fresh air. The gaol fever is peculiar to such places, and is very infectious.

It is wished those persons who are apprehensive that contagious matter of the yellow fever is wrapped up in furniture, and they know not what, and that it will break out next summer, would be at the pains to inform themselves from the histories of the disease heretofore published, of the manner and the time when it usually arrived or broke out, and when it died away on this continent. It will pacify them. They will especially be assured that some number of years passed away between the times of its recurring in our country.

[Page 9]THE public is obliged to doctors Physick and Cathrall for an account, early given, of their dis­sections of persons who died of the yellow fever which raged in Philadelphia in the year 1793; the purport whereof follows, together with remarks thereon by the editor.

1. The brain in all its parts, has been found in a natural condition.

Remark. The disease is local to the stomach and parts near it. The brain is distant from the seat of it. The first, se­cond, third and ninth of the following instances of dissection were of such persons as died early in the disease. Note well the ninth observation of the doctors.

2. The viscera of the thorax are perfectly sound. The blood however, in the heart and veins, is fluid; similar in its consistence to the blood of persons who have been hanged or destroyed by electricity.

Remark. The early death from spasm of the stomach— a stroke local that effects not general disease, may account for this: and moreover, in hot weather coagulation occurs not very soon.

3. The stomach and beginning of the duodenum are the parts that appear the most diseased. In two persons who died of the disease on the fifth day, the villous membrane of the stomach, especially about its smaller end, was found highly inflamed, and this inflammation extended through the pylorus into the duodenum, some way. The inflammation here was exactly similar to that induced in the stomach by acrid poi­sons; as by arsenic, which we have once had an opportunity of seeing in a person destroyed by it.

Remark. This illustrates the reality of the matter of a specific contagion acting immediately on the stomach. A part whereof may tend downward, and here and there attach to the intestines. If some of it is, in certain cases, enveloped in the passing excrement, so as to be carried off at the common outlet, [Page 10] yet enough of it may adhere, and act on the bowels to the worst purposes.

4. The bile in the gall bladder was quite of its natural colour, though very viscid.

Remark. The fluids are not the immediate subjects of this disease.—☞ The preceding are in instances of early deaths, in the state of a contraction or inflammation of the stomach. The following are of later deaths, where gangrene has oc­curred, after the inflammatory state.

5. In a person who died on the eighth day of the disease, several spots of extravasations were discovered between the membranes, particularly about the smaller end of the sto­mach, the inflammation of which had considerably abated. Pus was seen in the beginning of the duodenum, and the villous membrane of this part was thickened.

Remark. The inflammation abates as gangrene approaches. Was not the production of pus owing to an effort of health? The thickening was an indication of putrefaction.

6. In two other persons who died at a more advanced period of the disease, the stomach appeared spotted in many places with extravasations, and the inflammation disappeared. It contained, as did also the intestines, a black liquor, such as had been vomited and purged before death.—This black liquor appears clearly to be an altered secretion from the liver: for, a fluid in all respects of the same qualities was found in the gall bladder. This liquor was so acrid that it induced considerable inflammation and swelling on the ope­rator's hands, which remained some days. The villous membrane of the intestines, in these last two bodies, was found inflamed in several places.

Remark. The effects of the poison, though mostly local to the stomach and duodenum, sometimes appear in other parts of the bowels; and they act destructively where there is the rea­diest susceptibility. The poison first is in contact with the stomach: and after having effected a corrosion and inflammation there, which is followed by a gangrene of that bowel, it or some part of it may descend, as it seems, and raise an inflam­mation on the inferior bowels, where it chances to adhere, even [Page 11] after the stomach is destroyed. The general mass is not imme­diately contaminated by the attack on the stomach, so as to be­come gangrenous or putrid: otherwise, could a subsequent in­flammation be produced [...] the other bowels?

7. The liver was of its natural appearance, excepting in one of the last persons, on the surface of which a very few distended veins were seen, although other abdominal viscera were of healthy appearance.

Remark. The spasms and corrosions of the stomach are con­siderable. Such as must soon induce general disorder of the body, and extensive [...] effects both in the solids and the fluids, though not always alike or in the same parts.

8. The external surface of the stomach, as well as of the intestines, was quite free from the inflammation; the veins being distended with blood, which appeared through the transparent peritoneum, gave them a dark colour.

Remark. This is further in favour of the locality of this disease. How confined!—All is effected first by contact with the fibres and nerves of the stomach. The symptoms were dif­fuse; and in the end the fluids with the solids become exten­sively morbid.

9. The stomach of those who died early in the disease, was always contracted: but in those who died in a more advanced period of it, where extravasations appeared, it was distended with air.

Remark. The corrosive poison early injures the fibres of the stomach, and occasions spasm; first of the minuter parts with which it comes into contact; and this presently extends so con­siderably and so forcibly as to contract the whole or a great part of that bowel, during the inflammatory state, and until gangrene dissolves the contraction of the fibres. The consequent putrefaction is then attended with a distension of the parts. Such sudden, strong, and extensive contraction must arrest the natural and necessary functions; and death comes with speed, before time is given for gangrene to effect it.