THE circumstances on which Dr. Rush founds his opini­on, that the Contagious Yellow Fever which prevailed in Philadelphia from the beginning of August to November, in the year 1793, he tells us, are these, viz.

1st. "A quantity of damaged coffee was exposed on the 24th of July, in a situation, on a wharf and in a dock, which favoured its putrefaction and exhalation, in consequence of which its smell was highly putrid and offensive to the inhabi­tants who resided in the neighbourhood of that wharf." And

2dly. "The Yellow Fever in the West Indies, and in all other counties where it is endemic, is the offspring of vegeta­ble putrefaction. And as the same causes under like circum­stances must always produce the same effects, 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 he has employed some authorities, and a multitude of very ingenious and highly laboured argu­ments.

Instead of entering into a formal refutation of these, I shall content myself with opposing a few authorities to those which he has quoted respecting the opinion of the Yellow Fever being the offspring of vegetable putrefaction, and instead of replying methodically to all his arguments, shall shew "how a plain tale will set him down."

The observations of the generality of the West India writers have been so imperfect and inaccurate, that they did not even suspect the disease of being contagious, and instead of ascribing it to the exhalations from putrid vegetable substances they say, [Page 4] it is occasioned by some irregularity in some of the non natu­rals in conjunction with the heat of the climate.—Even Lind, who is quoted by Dr. Rush in support of his opinion, makes no mention of its being derived from vegetable putrefaction; all he says is, that "in general it proceeds from intense heat and a peculiar unhealthfulness of the air: But what gives rise to that unhealthfulness of the air, he has not said ^*.

It cannot be inferred that the Fever is the offspring of vege­table putrefaction from what is said by Dr. Lind at page 179, respecting the greater mortality of patients with the Yellow Fever at Greenwich Hospital in Jamaica, which was situated in a low, damp, unwholesome place, but only implies that un­wholesome air aggravated the symptoms of the disease, which we know to be the case in all other fevers.

The support, Dr Rush supposed his opinion had received from Dr. Miller's account of the bilious colic which prevailed at Dover from vegetable putrefaction, must fall to the ground, when the reader is assured, that the cases of colic which were supposed to have arisen from that cause, have since been proved by Dr. Sykes to have arisen from the use of bark adulterated with litharge, as I can make appear from a letter now in my possession from Dr. Sykes, dated at Dover the 29th of May last.

That Dr. Lind, as well as Sir John Pringle, should have mistaken the nature and causes of this fever, is by no means surprising; since neither of them ever had an opportunity of seeing a case of it, and as they did not know or even suspect the disease to be contagious, and believed that every other kind of contagious fever was derived from dead and putrid animal mat­ter, and had very vague and imperfect ideas of the nature of contagion and its causes, their authority on the present question ought not to be admitted.

Even Dr. Cullen, forming his opinion upon the report of others, has mistaken the nature of the disease, and classed it im­properly, amongst putrid diseases; whereas not only the symp­toms, but every dissection which has been made, demonstrate the disease to be specifically different from both the bilious, and the putrid fever^†. Instead of a redundancy of bile excreted at the beginning, which is one of the pathognomonic signs of a bilious fever, there was a deficiency of that fluid, as is well [Page 5] known to every practitioner in this city, and that the principal affection was an inflammation of the stomach and parts adja­cent, requiring a treatment similar to other inflammatory local affections, connected with idiopathic fever, not only the success of the treatment but every dissection sufficiently proves. If the disease was neither a bilious nor a putrid fever, but a synochus or an inflammatory fever at the beginning, and putrid before its termination, when it proved mortal, instead of ascribing it to the exhalations from putrid vegetables, common sense would dictate, as well as analogy direct us to ascribe it to spe­cific contagion, as Dr. Mitchel did when it occurred in Virgi­nia.

The effects of putrefaction upon coffee as well as upon most other vegetables, is the extrication of a quantity of fixed, and inflammable air, besides earth, coal, alkaline salt and water.— And it is well known, that none of these are capable of pro­ducing a contagious disease, though by inducing weakness they may dispose the body to be more easily affected by contagion or other causes of fever.

Dr. Blane who had frequent opportunities of seeing the Yellow Fever at Jamaica, in the year 1781 and 82, remarks that, "with regard to the cause of this fever, it differs from the Bilious Remittent in this, that the air of woods and marshes is not necessary to produce it, for it was most commonly brought on by intemperance or by too much exercise in the heat of the sun. It was observable however that it was more apt to arise when, besides these causes, men were exposed to un­wholesome land air, or to the foul air of ships, either from in­fectious effluvia or from the putrefaction that takes place in ne­glected holds."—It is also remarkable, adds Dr. Blane, that this fever is confined almost entirely to new comers from a cold or a temperate climate.

Dr. Mosely who published his observations on tropical disea­ses since Dr. Blane, and who practised 12 years in Jamaica, says the Yellow Fever is totally different from the Remitting Bilious Fever; for all habits, natives as well as foreigners are subject to the latter, particularly after the periodical rains and in the fall of the year; whereas the Yellow Fever, is confined almost entirely to foreigners or new comers." But as he was ignorant of its contagious nature he has ascribed it to the sensible quali­ties of the atmosphere operating on plethoric habits not acco­modated to the climate. Hence he has named it the endemial Causus, or inflammatory fever of hot climates, Dr. Jackson also who resided some time in Jamaica, and has lately published an [Page 6] excellent treatise on fevers, says "the Yellow Fever seldom at­tacks any but new comers in that island, whereas the remitting fever attacks persons of all descriptions, whether natives or foreigners, a fact which irrefragably proves that there actually exists some essential difference between the two diseases."

To these I might add the opinions of many more all tending to prove that the Yellow Fever is no way connected with the genus of Bilious Fever.

Dr. Mitchel in his letter on the Yellow Fever which appear­ed in Virginia in 1741, considered the disease as arising from specific contagion, and says it was imported twice into that state by ships of war from the West Indies".^*

That Bilious Remittents are not contagious, is not "a new doctrine held and propagated in no part of the world but in this city," as Dr. Rush asserts, is evident from the writings of Prin­gle, Vanswieten, Monro, Lind, and Cullen, and many other au­thors of the most respectable character. Some of the authors quoted by Dr. Rush, in support of the opposite side of the question, were not qualified to discern the connection between cause and effect, and others have published such incongruous, and absurd things that it would be a waste of time to attempt a formal refutation of their opinions.

I shall therefore only observe, that if those authors were not deceived, why have we not more frequent instances of the contagious nature of such diseases, and why do not Physicians discover such cases in this country as well as in others. The efficient cause of an effect must necessarily always produce the same effect under similar circumstances; the same Circumstan­ces often occur here in which these diseases are said to have been contagious in other countries, but no such effect is obser­ved to follow; The Bilious Fever, therefore, is not conta­gious.

Again, If the Bilious Fever were contagious it should pro­pagate a fever of the same kind, which would always be distin­guished by the same leading or characteristic symptoms, but this is never the case, therefore the Bilious Fever is not con­tagious. But the Yellow Fever is contagious of consequence it is not a higher gra [...]e of the Bilious Remitting Fever, and the title which Dr. Rush has given it is wrong. Surely if Dr. Lind had thought the Bilious Fever was contagious, he would not have said the Yellow Fever in Jamaica was not con­tagious, and have quoted Dr Naysmith in support of that opi­nion, [Page 7] when he entertained an opinion that it was only a higher degree of the Bilious Fever of hot climates^*; It is true if he was mistaken in the one circumstance, he might have been de­ceived in the other; but it can hardly be supposed, that all the other authors that I have mentioned, would have been totally silent if they had ever met with cases of such fevers, propagated by contagion.

Dr. Gardner, who is an advocate for the contagious power of Intermittent and Remittent fevers, acknowledges that "they must be changed in their nature before they can become con­tagious, in consequence of the impure air of crowded wards or other unfavourable situations." Dr. Black also, on the human species, says "these fevers not only differ from continued fevers in their not being contagious, but also in their exacerbations occurring only once in 24 hours, whereas those of the continued genus have two exacerbations in the course of every 24 hours." A similar observation is made by Dr. Cullen in his first lines. This is certainly giving up the point; for a disease changed in its nature is no longer the same, and when fevers occcur with characters different from those from whence they are supposed to originate in particular situations, it only implies that a contagion has been generated in consequence of such situation, different from the original disease; this takes place where num­bers are crowded together, and fresh air is excluded, though every person was perfectly healthy before they were so crowded and deprived of fresh air^†. As this part of my subject is intended [Page 8] for medical people, I need only appeal to medical records for the truth of what I have advanced. I shall only add that the contagion so generated is always of a specific nature, and occa­sions a fever of a continued and not of an Intermitting or Re­mitting form.

According to the principles laid down by Dr. Rush, where and whenever vegetable putrefaction abounds in a hot season, the contagion of the Yellow Fever must necessarily be gene­rated; if this were the case it would appear every year in Madrid, which is situated almost in the middle of an extensive plain, where the climate is exceedingly sultry during the sum­mer season, and where, according to the observations of Lord Kaim in his sketches of the history of man, heaps of unmolested dirt and putrefaction, raise in every part of that populous, and crowded city the most intolerable stench, and fill the air with putrid exhalations, so gross as almost to suffocate a stranger upon his first arrival. These however have never yet produced the Yellow Fever. Nor is there any records of its having ever appeared at Carthagena, where we are told by Mr. Townsend, the weather is still hotter than at Madrid, the streets more filthy, and the air more replete with putrid exhalations; though "a bilious fever prevails there every autumn, in consequence of its proximity to an extensive marsh on its east side called the Al­major." But these differ in no respect from remittents of other Countries, except that putrid symptoms sooner come on than in colder climates with a purer air.

But we need not explore foreign Countries for evidence to prove that the Yellow Fever is not the product of vegetable putrefaction conjoined with great heat, but is a disease essenti­ally different from every other hitherto known; for we have many situations in our own Country, which abound with a greater quantity of putrid vegetables than Philadelphia, nor are evidence wanting to prove that Philadelphia has had more putrid matter in it, and in its vicinity, in former years when the summers were both dryer and hotter than the last. The year 1782, when almost every blade of grass was consumed by heat and drought, and some of the marshy ground set on fire by the heat of the sun, or by the action of the electric fluid on the inflammable air generated in such places, must be recollected by numbers, but if it is not, may be found on record; yet there was no Yellow Fever here then, nor in any part of United Ame­rica; nor at any other time, but what has or might have been traced to importation, as I shall make appear in the se­quel.

[Page 9]But what shews in the most forcible manner, that the disease did not depend upon situation or the influence of putrid vege­table exhalation, is the manner in which it began and spread through the city, and also in New York in the year 1791, from the middle of August to the middle of October. Epidemics, such as bilious remittents ^* which arise from season and soil, attack numbers at the same time, and always the debilitated first, and the more robust afterwards as they also become debilitated. But this was not the case with the Yellow Fever, Synochus Icteroides or Gastritis Contagiosa, which prevailed last year in Philadelphia. On the contrary this disease began at a lodging house, and ordinary kept by Richard Dennie in water street, where two French men from the West Indies were then at lodgings, and where the first case was observed on the first or second of August by Dr. Physick; and on the 3d of the same month in the same house, another patient with the disease was visitted by Dr. Cathrall; from whence it spread gradually as people in the neighbourhood had intercourse with the infected and with one another. To that neighbourhood it was con­fined for more than two weeks, before it occasioned much a alarm, or even any suspicion of its being contagious. Dr. Rush acknowledges that he had no suspicion of the nature or origin of the disease, before the 19th, when he was in consultation on the case of Mrs. Lemaigre, and was informed by Dr. Hodge, that several had died very suddenly in that neighbourhood, with symptoms of a very malignant fever; and was the same day told by Dr. Foulke that a quantity of damaged coffee which was intolerably offensive, had been discharged on Mr Ball's Wharf."

From these circumstances, Dr. Rush, before he had an oppor­tunity of informing himself sufficiently of the facts, conceived [Page 10] the idea that the disease was the offspring of the exhalation from the damaged coffee; in consequence of which, he immediately published that opinion. Need I tell the reader that Dr. San­grado published a book, in which he advised copious bleeding and immeasurable quantities of warm water for the cure of the Dropsy, and when he discovered his mistake, he observed to Gil Blas with a solemn air, "though I know I am wrong yet it is better that all Valadolid should die than for me to change my opinion." If Dr. Rush's opinion "had not been founded on the baseless fabric of a vision" the disease would have attack­ed numbers at the same time as has been already observed, but instead of that it affected none but those who came within a certain distance of the sick or into the air of the sick room, for it is well known that all who shut themselves up in their houses, retired into the country, and shunned every substance which had been in contact with or near to those actually infected; and that every one who observed these precautions, though daily abroad in the open streets and markets, escaped the disease, as was also the case with the prisoners in the jail, the pensioners in the alms-house, and the patients in the Hospital, where strict attention was paid to avoid all intercourse with the infected.

Can any man of common sense suppose this could possibly have been the case if the disease had been occasioned by the exhalations from putrid coffee or other putrid vegetable sub­stances, diffused abroad through the atmosphere of the whole city, as has been so positively asserted. Oracles may utter any thing at Delphos, and credulity will swallow it.

Having thus proved the opinion of the gentleman to whom I am opposed in sentiment, to be erroneous, I now proceed to state the evidence in favour of the opinion that the disease was imported: and though I should not be able to establish it, by direct or positive proofs, I expect the circumstantial evidence, which I shall say before the reader, will be sufficient to convince him beyond the power of resistance, that the disease was intro­duced into Philadelphia by importation, and was not generated in it.

The reader need not be informed, that much difficulty arises, and many obstacles are generally opposed to investigations of this kind, from the parties most immediately concerned. I need only refer to Russell's account of the difficulty that attended the detection of the vessel and goods, by which the plague was introduced into Marseilles in 1720, its introduction into Aleppo in 1761, and into Moscow in Russia in 17 [...]1, as recorded by M [...], &c. Ve [...]s [...] had been continually arriving all sum­mer [Page 11] from the West India islands, in some of which the Yellow Fever had prevailed with unusual mortality, ever since the year 1791, as appears from Dr. Chisholm's account published in the Edinburgh Medical Commentaries for 1793, and from a letter now in possession of Dr. Cumming of this city from Dr. George Davidson ^* of St. Vincents to Dr. Brown of Balti­more, dated November 12 1793, for which I am indebted to the politeness of Dr. Cumming. Similar accounts are contained [Page 12] in several of the London Newspapers, particularly ^* in the Courier of August 13th and 24th 1793, in the Observer of Au­gust 25th, and in a Kingston paper of October 12th 1793, the Kingston paper contains the following paragraph. "The islands of Barbadoes and Dominica continue to be afflicted with the Malignant Fever, (some of the other papers say the Yellow Fever) about 300 white inhabitants have perished in the for­mer, and near 500 in the latter."

It was also epidemic and extremely mortal among the Eu­ropean troops at the same time at St Domingo, from whence a multitude of the inhabitants fled at different times in the summer of 1793, on account of a desolating war, in conse­quence of the insurrections of the slaves in that island, and took shelter in Philadelphia. Several sick persons as well as others were brought away.

[Page 13]Two vessels in particular from that island consigned to the house of Vanuxem and Lombart, arrived in this port after the middle of July, and came-to at their wharf, which is very near to the house where the disease made its first appearance. One of these named the sloop Amelia, William Williams Master, arrived in the port from Borgne, a small port of St Domingo, laden with coffee with five hands besides the Master, and came-to at Mr. Vanuxem's wharf on the 24th of July, where she immedi­ately began to discharge her cargo, part of which, from a leak she had get in her passage was very wet and damaged; several hundred weight were thrown into the dock which at low water is covered with water, and on the 30th, 98 bags of that which was least damaged was sold on the wharf, as appears by a letter from Mr Vanuxem, and the bill of sales of Mr Footman auc­tioneer. This vessel left the wharf on the first of August to heave down.

"When this Vessel unloaded the coffee, Mr. Vanuxem at­tests that no smell whatever was observed, but after she was unloaded, a most intolerable stench was occasioned for two or three days, while the sailors were clearing the hold of the bilge water, which in all vessels when suffered to stagnate, becomes putrid and is very offensive, but has never been observed to pro­duce a yellow or any other contagious fever.

It is true the captain and hands were sick while employed in clearing the water out of the hold, but as "they all recovered within three days without the aid of medicine," it cannot be suspected [...] had the Yellow Fever. Nothing is more co [...]m [...] than for people's stomachs to be unsettled by fetid bilge water, and to be rendered weak from exposure to the noxious air generated in neglected holds, as we learn from the observations of Lind and Blane, but they tell us nothing of Yellow fever from this source.

The other Vessel which arrived at the same wharf, about the same time, together with the Sans Culottes privateer, and her prize, the ship Flora of Glasgow had stopped at Chester, where the Master, Hamilton Sage, died with unequivocal symptom [...] of the Yellow Fever at Mr William Kerlins, as appears from a letter to me from Dr. William Martin of that place.

Mr Kirlin, who received compensation for the trouble and expences he had been at on account of the captain, from Mr. Vanuxem, declares that there were several passengers sick on board the Vessel when she left Chester.

Several sick persons were also seen coming on shore at Mr. Vanuxems, and Mr Lemaigre's wharfs, between the 25th of [Page 14] July and the first of August, by Major Hodgson, Mr Lemaigre, his Clerk, Mr Ashbridge, his wife, and several other respec­table people, who resided in Water-street near to the suspected wharfs, and some were buried at different times with evident symptoms of the Yellow Fever from on board those Vessels.

The disease not being at first suspected to be contagious pre­vented these from being particularly noticed, till it was too late to make effectual enquiry.

A respectable citizen of Philadelphia, supercargo of one of our vessels, informed Mr. M. Carey, that he saw in July six or seven people sick of this fever, on board a brig at Cape Francois bound to Philadelphia.

Several upon coming on shore went into Mr Lemaigre's, and Mr Vanuxem's kitchens, to rest themselves.

But if it could not be proved that any one came sick on shore, it is no argument against the contagion having been brought in goods close packed from the islands; medical records are full of such instances.

There are also numerous instances of people in close and con­fined places, generating a contagion which is communicable to others, though they are insensible to it themselves, see Stow's Chronicle, Meads paper on infection, Blane's observations, &c.

From all the foregoing circumstances singly and collectively, I think I may fairly conclude without hesitation, that the dis­ease was introduced by importation, and was not generated in this city, and that a different opinion is a reflection upon the credit of its salubrity which was never before called in question, and which all former bills of mortality demonstrate, it does not deserve. By these bills it appears that there has never more died in a year than in the proportion of one in 50 since the introduc­tion of inoculation, except when the Yellow Fever was intro­duced into it from the West Indies: whereas in most of the cities of Europe, there dies every year in the proportion of 1 in 20 or 30 at most.

To satisfy every impartial person that the disease was import­ [...] into this city from the West Indies last summer, he has only to recollect that every time it appeared before in this country, whether in Carolina, Virginia or Pennsylvania, it was always traced to importation. For proofs of this I appeal to Gough's history of the Society of Friends, vol. iii. p. 516, Lind on infec­tion; Lining's account of its several occurrences in Charlestown. Dr. Mitchels letter to Dr. Franklin respecting its appearance in Virginia in 1741. Dr. Redman's notes read in the College of Physicians last fall, giving an account of it in 1762. When it [Page 15] appeared in New York in 1791, its origin was never enquired into. It has been ascribed by Dr. Addoms of that place in his dissertation on it, to specific contagion, but how generated or from whence brought, he does not say. Let the reader also recollect that the disease is peculiar to, and is always existing more or less among those who emigrate to tropical climates, and that when exported from thence it has never become epide­mic except in very hot weather, and in the atmosphere peculiar to a town, or confined place; that it has never existed or been active in this country under any other circumstances, and that like most other pestilential fevers, it is destroyed entirely by cold and frost; and let him subscribe to the opinion that it was gene­rated here, if he can.